Whether youre young or old, healthy or sickly everyone can benefit from regularly scheduled preventative checkups with their healthcare provider. For example, if the providers charge is $200, and the allowed amount is $110, the provider may bill for the remaining $90. AultCare 2600 6th St SW. Canton, OH 44710. Prescription Drugs:Drugs and medications that by law require a prescription. Moreover, the insurance provider offers an online Health Risk Assessment tool that helps individuals determine their risk factors for certain conditions like diabetes and heart disease.Aultcares commitment to covering vital preventative care measures ensures that its members have access to essential healthcare resources necessary in maintaining good health status at all times. You can also call us at 330-363-6360 or 800-344-8858 with any questions. HealthReimbursement Arrangements are sometimes called Health Reimbursement Accounts.HSA Health Savings Account (HSA)- A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. If you paid an amount exceeding your typical co-pay and the medication is covered under your benefit, you can expect a check to be sent to you automatically for the difference. Hospital Outpatient Care:Care in a hospital that usually does not require an overnight stay. Applies to most types of health plans and insurance. Canton, OH 44710. Health plans will often pay less to non-network providers because of the inability to control costs. For more information, visit www.ncqa.org. Instant Savings Quickly see what kind of savings you qualify for under the Affordable Care Act without ever having to sign up. No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. If we decide that your medical condition does not meet the requirements for an expedited decision, we will verbally communicate with you. Applicable to primary plans only, the estimate is based on the current status of the members copay, deductible, and out-of-pocket expenses. AultCare/Aultra provides free language services to people whose primary language is not English, such as: Qualified interpreters and information written in other languages.If you need these services, or if you believe that AultCare/Aultra has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can contact or file a grievance with the: AultCare/Aultra Civil Rights Coordinator, 2600 6th St. S.W. AultCare does things differently than ordinary health insurers, even the biggest ones. Some examples of cost-sharing are copayments, deductibles, and coinsurance. You can take the pricing information to the pharmacy that you normally utilize and see if they can offer the same pricing through GoodRx or other means. The actual coverage may vary. We take your healthcare personally. Also included are services to prevent or discover illness, disease or other health problems. Health Plans Available from AultCare AultCare - A guide Types of insurance - Citizens Advice To receive your 2022 IRS Form 1095-B, submit the request via our CONTACT US on our website or send the request to:AultCare Insurance Company2600 Sixth ST SWCanton, OH 44710. The formulary listings are intended for the use and application of plans subject to the AultCare formulary. AultCare/Aultra does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. AultCare/Aultra complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sexual orientation, gender identity, or sex. Studies have shown that health plans earning NCQA Accreditation outperform nonaccredited health plans on every single measure of clinical quality and member satisfaction. Urgent Care:Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care. Some examples of a provider include a doctor, nurse, chiropractor, physician assistant, hospital, surgical center, skilled nursing facility, and rehabilitation center. If you receive coverage through your employer, you can change your plan during your companys open enrollment period. If you need help filing a grievance, our Civil Rights staff is available to help you.You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD). Health Insurance 101 AultCare AultCare offers health plans for young adults, students, self-employed individuals, early retirees, individuals, and families. AultCare/Aultra complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sexual orientation, gender identity, or sex. Preventive care is crucial for maintaining a healthy lifestyle and preventing serious illnesses. What is Usual, Customary, and Reasonable (UCR)? View the results of the survey using this link. What is travel health insurance? The Region's Leading Health Insurance AultCare *Advanced Premium Tax Credit (APTC)- A tax credit based on income estimates and household size. AultCare developed a pharmacy transparency tool allowing you to make the most cost-effective decisions with your prescriptions. At AultCare, we are committed to providing you with affordable prescription coverage. Most insurance companies will consider the average cost for a medical service within the local area to determine how much it will pay for the service. 24-Hour Nurse Line: 866-422-9603 330-363-7620, Customer Service Hours: Monday - Friday 7:30 am - 5:00 pm EST, Mailing Address:2600 Sixth St S.W. Find an AultCare Provider AultCare The plan may require the provider to be licensed, certified, or accredited as required by state law.Reconstructive Surgery: Surgery and follow-up treatment are needed to correct or improve a part of the body because of birth defects, accidents, injuries, or medical conditions. Ohio has become the cradle of a drug overdose for the American Midwest, a problem driven primarily by the uptick in American opioid addiction, part of the epidemic affecting the rest of the country as well.Data from the state's Department of Health indicated that there were 4,854 overdose fatalities in 2017, while alcohol addiction continued to threaten . What is covered under Aultcare insurance? You and/or your employer usually pay it monthly, quarterly, or yearly.Premium Tax Credits: Financial help that lowers your taxes to help you and your family pay for private health insurance. Aultcare Insurance provides ample coverage for many types of preventive care services that can help you stay on top of your health. However, its always best practice to double-check before scheduling any appointments just in case there are any out-of-pocket expenses associated with a specific service.Utilizing preventive care benefits through your Aultcare insurance is straightforward and can help keep you healthy while saving money on healthcare costs down the line. Network Provider (Preferred Provider):A provider who has a contract with your health insurer or plan which has agreed to provide services to members of a plan. Describe to your pharmacy/pharmacist that you want to make sure you are attaining the best price for your medication. Read what we're saying about a range of issues. Billing & Insurance | Cleveland Clinic Mercy Hospital Allowed expenses include insurance co-payments and deductibles, qualified prescription drugs, insulin, and medical devices.Grievance: A complaint communicated to your health insurer or plan. The providers office staff will take care of billing Aultcare directly so you dont have to worry about submitting claims yourself.Its also worth noting that many preventive care services are offered at no cost under most insurance plans thanks to provisions in the Affordable Care Act. AultCare is 1 of only 4 commercial plans in Ohio to receive a 4 out of 5 overall star rating. All plans cover essential health benefits, including both Medical and Pharmacy benefits. You may need to provide the details of your illness/injury to AultCare to assure your claim processes at the network level of benefits. You can file a grievance in person or by mail, fax, or email. In-Network Co-payment:A fixed amount (for example, $15) you pay for covered healthcare services to providers who contract with your health insurance or plan. AultCare developed a pharmacy transparency tool allowing you to make the most cost-effective decisions with your prescriptions. Registered charity number 279057 VAT number 726 0202 76 Company limited by guarantee. Through the AultSaveRx platform, you can search for your prescribed medication and see a detailed comparison of different pricing options. To get an expedited decision, you must meet the following requirement: Our plan can approve or deny your request: If we approve your request we will provide the coverage we have agreed to within the appropriate time frame. If you are an AultCare member, you can find your Summary of Benefits on your online account. UCR will apply. What household contents insurance normally covers, how to choose a policy and how to make a claim. Our HMO and PPO Accreditation status was awarded after rigorous evaluation by NCQA of all aspects of our plan including preventive health services, member satisfaction, physician credentialing, and quality improvement. Please review this resource to understand your rights regarding. Use the AultSaveRx platform to submit your receipt. You can also find this information by contacting your health plan. I have read and agree to the Terms & Conditions.. By registering for access to this website I acknowledge and agree to the following. Participation is voluntary. A medication or treatment for chronic illnesses that require special handling techniques, careful administration, and a unique ordering process. If you need help filing a grievance, our Civil Rights staff is available to help you.You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD). The company is headquartered in Canton, Ohio. The goal is to help you save money on your generic prescription medication. Cholesterol screening for adults of certain ages or at higher risk. Learn more >>, 24-Hour Nurse Line: 866-422-9603 330-363-7620, Customer Service Hours: Monday - Friday 7:30 am - 5:00 pm EST, Mailing Address:2600 Sixth St S.W. Additionally, our commitment to teamwork helps us provide excellent customer service, quality, and cost-effective healthcare planning the standard core of our philosophy. We are extremely proud of our achievement, in terms of not only what it means to us but also what it means to you - that you can be confident in the quality of healthcare you receive from us. The formulary designs provide adequate options in each therapeutic category and include most generics and selected brands. If you ask for an expedited decision on your own (without your doctor's or other prescriber's support), our plan will decide whether your health requires that we give you an expedited decision. Your request will be furnished within 30 days of receipt. Login to your account *The phone number and email you have registered to your account will be used for multi-factor authentication. Founded in 1985, AultCare operates as an insurance company that provides health, dental, wellness, workers compensation, accidental, and disability insurance services. First, its important to understand what services are considered preventive care and covered by your plan. Other events could be considered and you should contact your health plan to see if your event qualifies. Please note that comparing prices can be beneficial for members taking medications because AultSaveRx makes it easy to submit your payment for the generic drugs found using the tool and they are applied to your deductible. It can be used to help lower your monthly premium payments. Follow the steps to enter your drug information to reveal the costs and saving opportunities. You can file a grievance in person or by mail, fax, or email. https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, http://www.hhs.gov/ocr/office/file/index.html, Experience of Care Utilization and Risk-Adjusted Utilization, Measures Collected Using Electronic Clinical Data System . Because you matter, are believe you deserve access to the best on healthcare with AultCare human insurance plans. (Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law and the terms of the plan, which provides coordinates, or helps you access a range of healthcare services. AultCare/Aultra provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Services may be provided in a licensed hospitals emergency room or other places that provide care for emergency medical conditions.Excluded Services: Healthcare services that your plan does not pay for or cover.Formulary: A list of drugs your plan covers. AultCare developed a pharmacy transparency tool allowing you to make the most cost-effective decisions with your prescriptions. A plan with an overall deductible may also have separate deductibles that apply to specific services or groups of services. Less expensive than the Select Network and Traditional Network, Access to 7 area hospitals within Stark, Summit, Tuscarawas, Carroll and Wayne counties and physicians associated with these facilities. PPO Directory Deductible and out-of-pocket accumulators. Plan: Health coverage issued to you directly (individual plan) or through an employer, union, or other group sponsors (employer group plan) that provides coverage for certain healthcare costs. Please contact AultCare customer service to assist with your questions. PDF Summary of Benefits and Coverage: What this Plan Covers - AultCare Also called preferred provider or participating provider.Orthotics andProsthetics:Leg, arm, back, and neck braces, artificial legs, arms, and eyes, and external breast prostheses after a mastectomy. The AultCare managed formularies are designed to provide value. This set of surveys asks patients to report on their healthcare experiences with both their health plan and their providers. This section provides information on the different types of insurance available, how to choose a policy, and how to make a claim. You can get this help if you receive health insurance through the Marketplace and your income is below a certain level. Prescription Drug Plan AultCare critical illness - this can provide you with a lump sum payment if you can't work for medical reasons, such as a heart attack, cancer or a stroke. A formulary may include how much your share of the cost is for each drug. It is the only Medicare Advantage Plan in Ohio to receive this rating. AultCare/Aultra does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Making a claim if your car or its contents are stolen. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html, or you are not sure which formulary your plan has, 2023 Commercial Formulary (Abridged) 7/1/2023, 2023 Premium Managed Formulary 7/1/2023, Magnesium Citrate Saline Laxative Oral Solution, Drug Recall Insulin Glargine Injection Pens, Federal Employee Health Benefit Program (FEHB), 2023 Commercial Formulary (Comprehensive) 7/1/2023, 5th Tier Medications (not all plans are subject to 5th Tier), Breast Cancer Preventive Medications Enrollment Form, 2023 OptumRx Variable Copay Solution (VCS) Drug List, Healthcare Reform Copay Waiver Request Enrollment Form, Statin Preventive Medications Enrollment Form, Preventive Care, Benefits, and Services- Birth Control, Optum Getting Started Member Mail-Order Guide, Gentry Health Services Specialty Pharmacy - Member Guide for Specialty Medications, 2023 OptumRx Variable Copy Solution (VCS) Drug List, 2023 Vigilant Drug Program Clinical duplicate medications, 2023 Vigilant Drug Program High-cost brands with generic medications, 2023 Vigilant Drug Program High-cost generic medications, 2023 Vigilant Drug Program Non-essential medications, 2023 Vigilant Drug Program Non-essential patches and creams, Akorn declares bankruptcy - recalls all drug products, BD Insulin Syringes with the BD Micro-Fine IV Needle, https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, http://www.hhs.gov/ocr/office/file/index.html, If using the standard deadlines could cause serious harm to your health or hurt your ability to function. Canton, OH 44710, 330-363-7456, CivilRightsCoordinator@aultcare.com. Travel Medical Insurance: Emergency Coverage While You Travel The Marketplace is a service operated by the federal government for those searching for an individual plan. Most health plans must cover preventive services at no cost to you. The takeaway. Examples of qualifying life events are marriage, divorce, death, a permanent move, or a job loss. The comparison tool allows you to toggle between drug type, quantity, dosage, as well as your zip code to get a more transparent view of all your available options. The health insurance or plan pays the rest of the allowed amount.Complications of Pregnancy: Conditions due to pregnancy, labor, and delivery that require medical care to prevent serious harm to the health of the mother or the fetus. NCQA is committed to providing health care quality information in order to help consumers, employers and others make more informed health care choices. View your account statements, benefits and Claims online anywhere anytime. Citizens Advice is an operating name of the National Association of Citizens Advice Bureaux. For instance, if the health insurance or plans allowed amount for an office visit is $100 and youve met your deductible, your coinsurance payment of 20% would be $20. Are There Insurance Points Charged For An Unsafe Driving Ticket In Nj? If you need help filing a grievance, our Civil Rights staff is available to help you.You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD).