Health Care Facilitator FAQs

Home / Campus / ( Published on 2014-05-01 )

The following are answers to frequently asked questions (FAQs) regarding UC sponsored health plans.

  • What is my membership I.D. number? Your membership I.D. is alpha-numeric and listed on the front of your medical insurance card.
  • What if the I.D. cards for myself and my family do not list the PCP/Medical group I selected? Contact your medical Plan Member Services immediatelyand request the desired PCP/medical group assignments for each family member. Each family member may be assigned to a different PCP/medical group.
  • My primary care provider (PCP) is affiliated with Brown and Toland (B&T) Medical Group.  However, B&T does not have a record of my enrollment. What should I do? Call B&T customer service, 1-800-225-5637, let the representative know that you have a PCP affiliated with B&T.  Request that your eligibility be updated in their database.
  • I just received an explanation of benefits (EOB) statement from Blue Cross that states paid amount is zero and a detail message asking, “Are group health insurance benefits for these expenses available from an other source?” What should I do? Do not be alarmed!  Blue Cross sends an EOB of this type once a year to each member.  Complete the form as requested and mail back to Blue Cross. Once processed you will receive an updated EOB.
  • Will the formulary (the health plan’s list of covered medications) change during the year? Yes, the plan’s formulary is subject to change at any time. Each plan has a three-tiered system allowing you to obtain generic, brand and non-formulary medications by paying a different copay. Keep in mind that some medications require Prior Authorization even though they are on the formulary.
  • Can I change my primary care provider (PCP) outside of Open Enrollment? (Applies to HealthNet, and Blue Cross Plus enrollees.) Yes, you may change your PCP and provider group outside of open enrollment. Most plans allow you to make a change once a month. Typically if you request the change before the 15th of the month, the change is effective the first of the following month. Contact your health plan regarding the administrative processes required to make the change. Please note that if you are under care for an escalated healthcare issue, your movement between medical groups may be restricted.
  • How do I find out if a specialist is covered under my insurance plan? Search the medical plan website under ‘specialist type’. Your may also call the medical plan member services department and ask if the specialist is in their plan.  Generally an HMO member must be referred by his/her primary care physician (PCP) to a specialist in the medical group network in order for the services to be covered.  (A referral to an out-of-network specialist requires special authorization by the medical group.)