...is restricted in some way. Doing this gives you time to talk with your provider about the change in coverage and figure out what to do. Eligibility To be eligible...

...have access to increased premium tax credits that can lower their monthly premium or increase their coverage. These are available for selection starting April 1. During the current Special Enrollment...

...at any time. It will not affect your benefits or coverage. Go to www.express-scripts.com/mppp and choose the opt-out option. You can also call 1-866-845-1803. After you leave the program, you...

...is restricted in some way. Doing this gives you time to talk with your provider about the change in coverage and figure out what to do. Eligibility To be eligible...

Learn what the terms mean that your provider uses. There are even more word meanings in your member handbook. Term Definition Inpatient Services Inpatient Services are when you spend at...

...have made adversely affects your coverage or benefits, you have a right to file an appeal. You need to ask for an appeal within 60 calendar days from the date...

...necessity, investigational and experimental services. The following policies have moved to the Pharmacy Policy page: Medicaid Drug Rebate Program (MDRP) Coverage Rules – AC Reject Medical Necessity – Off Label...

Our Provider Manual is a resource for working with our health plan. This manual communicates policies and programs and outlines key information, such as claim submission, and reimbursement processes, authorizations,...

...year, we will not discontinue or reduce coverage of the drug during the coverage year. There are times when this may change like when a new, less expensive generic drug...

...Coverage Redetermination Request Form – If you are unhappy with the result of a coverage determination request, you can file an appeal. Use this redetermination form: online or hard copy....