Your plan documents contain important information to help you better understand and use your benefits. Take a few minutes to familiarize yourself with these documents and access them whenever you need to know more about plan coverage, policies, and practices.
Member ID Card
Explanation of Benefits (EOB)
Individual Policy/Benefits Certificate and Benefits Chart
Summary of Benefits and Coverage (SBC)
Medical Policies/Coverage Criteria
Think of your member ID card as your driver’s license for your health plan. It contains the information your healthcare providers need to work with CoOportunity Health to make sure you get the coverage you need. You should always carry your ID card with you and present it whenever you obtain healthcare services from a provider or fill a prescription.
Your ID card also is a handy wallet-size reference card for you.
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Front: Contains your ID and Group Numbers and Plan Name, along with your cost-share information for Office Visits, Urgent Care and ERs. Your drug plan code is also included.
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Back: Contains important phone numbers and Website addresses for both you and your provider.
If you want to view your ID card or order a replacement card, simply log on to the secure Member website. Click on “Get ID Card” at the top of the home page next to your name and membership number. Or, click on the “My Plan Information” tab and click on “My Plan: Claims and Benefits.”
You can also receive a replacement ID card by calling Member Services toll-free at 1.888.324.2064
, Mon-Fri, 8 a.m. to 6 p.m. central time.
CoOportunity Health typically provides you with an Explanation of Benefits (EOB) for healthcare services so that you can understand how we plan to process your claims. They are generated when you receive healthcare services. EOBs are not bills; they show what service was performed, the provider charge for the service, the health plan coverage for that service, and any member responsibility (copays, deductibles, or coinsurance). If you owe anything, your healthcare provider will send you a bill.
The EOB also shows your cost-share totals to date so you can see how much you’ve paid toward your deductible and out-of-pocket maximum for the plan year so far. Learn more about how to read your EOB.
Think of this document as the owner’s manual for your health plan. It provides the coverage details of your specific plan – including what’s covered, what’s not, how much you’re responsible for paying, your rights and responsibilities as a member, and more.
To view your Individual Policy/Benefits Certificate and Benefits Chart, simply log on to the secure Member website. Click on the “My Plan Information” tab and then click on “View Plan Benefits.” If you are not a registered user, it only takes a few minutes to sign up for instant access to important plan documents. Follow these steps to register.
You can also receive a copy of your Individual Policy/Benefits Certificate and Benefits Chart by calling Member Services toll-free at 1.888.324.2064.
An SBC is a booklet that helps to explain your health insurance benefits in plain language that is simple and consistent. The SBC makes it easy for you to compare plans and understand your benefits. You receive an SBC when you shop for coverage on your own or through your job, renew or change coverage, or request a copy from your health insurance company. All individual and group health plans must use the same standard form to help you compare plans.
View and download the SBCs for all CoOportunity Health plans.
Or, log on to the secure Member website to view the Summary of Benefits and Coverage for the plan you are enrolled in.
Medical Policies contain coverage criteria that describe how CoOportunity Health makes coverage decisions for certain healthcare services and items.
Want to find out the coverage criteria for a certain service or item? Search Medical Policies now.