Plan Resources

“In-network” means the healthcare professionals and healthcare facilities participate with CoOportunity Health. In-network providers are individuals and places that work directly with us to accept your insurance coverage

It’s simple. Go to Provider Search and click on your plan name to get started with your search for an in-network provider.

You may or may not have insurance coverage when you use an out-of-network provider, depending on your plan. If you do have coverage, the amount (how much your insurance plan pays) may be significantly less. This means you pay more of the costs for care.

Yes, our national provider networks — the PHCS Network and the MultiPlan network — allow you to receive care from an in-network provider and receive network savings even when you’re not home. Go to Provider Search and click on your plan name to get started with your search for an in-network provider.

PHCS Network

• Largest independent primary PPO network in the country with providers in all 50 states
• Includes more than 4,200 hospitals, 68,000 ancillary-care facilities and 590,000 healthcare professionals

MultiPlan Network

• Nationwide network that complements the PHCS Network by giving access to an additional choice of providers at discounted rates
• Includes more than 4,600 hospitals, 93,000 ancillary-care facilities and 620,000 providers

Simply search the CoOportunity Health Drug List . You may either type in the name of drug you want to look up or click on a condition category to see a list of drugs for that particular health issue.

The cost depends on the drug and into which tier it falls. Depending on your particular plan, you may also be responsible for the deductible before you pay the tier amount. To determine the cost for a specific drug, check its status on the EnhancedRx Drug List . The status column will either include “F,” meaning the drug is on the formulary; or “NF,” meaning the drug is a non-formulary drug. Read the symbol descriptions on the bottom of the drug list page for more specifics.

*The copay amounts are what you pay for each 31-day retail supply of your covered prescription drug. Some plans, including HSA-qualified plans, require that you meet your plan deductible before you pay the copay amounts listed. Be sure to check your specific plan.

Yes, if you take certain prescribed medications (for conditions such as cholesterol or high blood pressure) on an ongoing basis, you can save time and money using the myMail Rx mail-order program. This program allows you to buy and receive a three-month supply of your prescription, often for the cost to you of a two-month supply.

Using myMail Rx allows you to receive a 93-day supply of medication and pay

• $20 for Tier 1 generic drugs
• $80 for Tier 2 brand-name formulary drugs
• $240 for Tier 3 non-formulary drugs

To get started using myMailRx, call myMailRx Customer Service toll-free at 1.800.591.0011.

A: Check your Individual Policy/Benefits Certificate and Benefits Chart. You may view your Individual Policy/Benefits Certificate and Benefits Chart when you logon to the secure Member website. You may also contact Member Services at 1.888.324.2064.

ERs are designed when life-or-limb-saving care is needed immediately. If you aren’t sure how severe a condition is, always contact emergency medical professionals.

Many areas have urgent-care clinics to treat health issues when the doctor’s office is closed or doesn’t have any available appointments. Urgent-care clinics are walk-in clinics that can handle conditions that need to be treated right away but aren’t emergencies.

Preventive care includes vaccinations to prevent medical problems from occurring and screenings and examinations to find and stop medical issues before they become major problems.

Under the Affordable Care Act (ACA), all health plans must cover:

• Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
• Alcohol Misuse screening and counseling
• Aspirin use to prevent cardiovascular disease for men and women of certain ages
• Blood Pressure screening for all adults
• Cholesterol screening for adults of certain ages or at higher risk
• Colorectal Cancer screening for adults over 50
• Depression screening for adults
• Diabetes (Type 2) screening for adults with high blood pressure
• Diet counseling for adults at higher risk for chronic disease
• HIV screening for everyone ages 15 to 65, and other ages at increased risk
• Immunization vaccines for adults – doses, recommended ages, and recommended populations vary:
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus
  • Influenza (Flu Shot)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella

• Obesity screening and counseling for all adults

• Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
• Syphilis screening for all adults at higher risk
• Tobacco Use screening for all adults and cessation interventions for tobacco users

You can search the Preventive Guidelines to find out what preventive care services may be appropriate based on your age and gender. You should also check with your healthcare provider who may have other recommendations for preventive care services based on your personal and family health histories.

Health support programs are additional free health and condition-specific resources you can access when you need them.

• CareLine^SM 24/7 services are available any time of the day, 365 days a year, at 1.888.324.2064. Our registered nurses can answer questions about treatments, medicines, urgent healthcare, pregnancy and new babies, or any question you may have after business hours.

• Healthy Pregnancy – Personal Nurse Support – At-risk moms can work with a personal nurse trained to help pregnant women and their families.

• Disease Support – Personal Nurse Support – If you’re living with a condition such as asthma, diabetes, heart disease or depression, our nurses can help you to follow your treatment plan, find balance in your life, build skills and knowledge about your condition, and work with your clinical-care team.

• Treatment & Decision Support – Clinical Navigators are ready to help you with decision support and coordination-of-care questions for medical and pharmacy issues.

• Personalized Assistance Line (PAL) Service offers support with finding a mental health or chemical dependency healthcare professional and can answer questions about coverage.

To get started with any of our health support programs, learn more by visiting the Healthy Living section of our website or call Member Services toll-free at 1.888.324.2064 to find out more about whether these programs might be appropriate for you.

No, health support programs are available to you at no additional cost. We want to make sure you get the support you need to live the healthiest life possible.