As a valuable PrimeTime Health Plan member, you have access to information regarding your health plan. Listed below, you will find information available to you on website.
• Extensive Health Library, Interactive Self-Management Tools, Silver&Fit.
Find health and wellness information on our website by clicking here.
• Explanation of Benefits.
Find out how we paid your claims including your out-of-pocket cost, and if claims have been received and are waiting to be processed. This information is only available by logging into your online account. Click here to login to your account.
• Summary of Benefits.
An overview of your benefits is available on our website. Click here to learn more.
• Evidence of Coverage.*
To access your Evidence of Coverage forms, click here
and select your plan.
o The Evidence of Coverage includes information on:
• How to obtain language/interpreter services
• Pharmacy Management Program information
• Obtaining a Primary Care Physician (PCP),specialist, behavioral healthcare services and hospital services
• Obtaining emergency/urgent care services in or out of the network and during or after normal business hours, including an inpatient admittance
• How and when to submit an appeal or complaint,including the independent appeals process
• How to submit a claim for covered services
• Benefit restrictions outside of the network
• Services included and excluded from your coverage, including copayments and other charges for which members are responsible
• Enrollee rights & responsibilities
• Referral, Prior-Authorization, and Pre-Certification Guidelines.
This includes information on how to submit a request for coverage and what services require pre-certification or prior-authorization. Click here
and select “Grievances, Coverage Determinations & Appeals.”·
• Web-Based Searchable Provider Directory.
Our searchable provider directories include information about our network healthcare professionals. You can search by network, specialty, name, hospital affiliation, languages spoken, gender, zip code, county, and whether or not they are accepting new patients. Click here to visit our provider directory.
• Pharmacy Information.
You have access to the pharmacy directory, formularies, recall information, and prior-authorization/step therapy/quantity limit information. Click here to find this information.
Enrollment forms, HIPAA release of information form, forms for submitting coverage determinations, and prescription mail order forms are available by clicking here.
• Quality Program Outcomes.
You can see health plan performance outcomes on clinical and consumer satisfaction metrics, information on the health plan’s accreditation and a year-end quality evaluation summary. Click here to find this information.
• Notice of Privacy Policies. Click here
to find this information.
• National Coverage Determinations.
Throughout the year, the Centers for Medicare & Medicaid Services (CMS) may issue notifications of additional services covered by the Medicare program or clarifications of existing covered services.These notifications are called National Coverage Determinations (NCDs). Click here to find this information.
• Contact Information.
Information on how to email or contact PrimeTime Health Plan is available by clicking here.
Hearing impaired and language assistance contact information can also be found online.
*If you are enrolled in an employer sponsored plan, you will need to log into your online account to access your Summary of Benefits/Evidence of Coverage.