Plan Central Member Portal Learning Guide

Transcription

1 Plan Central Member Portal Learning Guide Plan Central Member Guide, April 2015

2 Table of Contents Introduction... 2 Accessing Plan Central... 3 Plan Central Welcome Page... 3 New to Plan Central... 4 Member Registration... 4 Returning Plan Central Users... 8 Log In... 8 Forgotten Password... 8 Automatic Sign Out... 9 Navigation...10 Main Menu...10 Home Page...10 My Benefits...11 Member Details...12 Eligibility History...12 Claim History...13 Deductible Information...15 Plan Benefits...16 Request ID Card...17 Auth History...18 Change PCP...20 Manage COB Details...21 EOB History...21 My Inquiries...24 My Authorizations...24 My Claims...25 My Resources...25 Frequently Asked Questions (FAQ)...26 My Resources...27 My Settings...33 Manage My Access...33 My Profile...35 Contacting SummaCare...36 Logging Out

3 Introduction SummaCare is proud to introduce the all-new Plan Central web portal for members. Our team of account managers, information technology professionals, and eligibility specialists worked together to provide you with an attractive, intuitive, and convenient way to manage your healthcare benefits. The new Plan Central was completely developed in-house at SummaCare and all changes and enhancements will be handled by our internal Plan Central development specialists. The Plan Central Member portal provides convenient, secure access to your personal plan information, including benefit descriptions, claims history and authorization requests. In addition, you can view the same information for your eligible spouse and/or dependents. You can also choose to allow your spouse access to your information.* As with any online application, you will need to familiarize yourself with how the system has been designed, what features it includes, and how the features should be used. This guide will help you accomplish these tasks. * At SummaCare, we are committed to protecting our members privacy. To that end, you have options for accessing and sharing you and your family s health information stored in Plan Central. Although you will be able to access the information for dependents under the age of 18, your spouse and dependents over the age of 18 must grant your access to his or her information. Likewise, you can choose to grant your spouse access to your information or keep it private. Refer to page 31 for more information on managing your access. 2

4 Accessing Plan Central Plan Central is accessible via summacare.com. Click the MEMBERS tab and then select My Benefits. The Plan Central log in will automatically launch. Plan Central Welcome Page The Plan Central Welcome page is shown below. First time users, including those who used the previous Plan Central application, will need to register. 3

5 New to Plan Central Member Registration 1. Click the Member Registration link to proceed. 2. Complete the requested information and then click Next. 4

6 Member Registration, Cont d. 3. Review and then click the check box to accept the Terms and Conditions; click Continue. 5

7 Member Registration, Cont d. 4. Complete the requested information and then click Submit. (Note: If the Security Question and Answer are not completed, you will be unable to use the Forgot Password function.) 5. A user can select to view underage dependents information on their Plan Central Account by selecting Yes. 6

8 6. The confirmation page will be displayed. Click the Enter Plan Central link to log in to the newly created account. 7

9 Returning Plan Central Users Log In To log into your Plan Central account, enter your User Name and Password. The password is case sensitive. Then, click Log In. Forgotten Password 1. To retrieve a forgotten password, click the Forgot Password link. 2. Enter your User Name and click Get Password. 8

10 Forgotten Password, Cont d. 3. Next, provide the answer to your secret question. Then, click Get Password. 4. An will be automatically sent to the address you provided in your personal Plan Central profile. Automatic Sign Out As a security measure, Plan Central automatically signs out any user who has not actively used the system for 30 minutes. Plan Central will prompt the user to log back in to the system. Printer Friendly The printer icon indicates that the displayed page is available in printable format. 9

11 Navigation Main Menu Plan Central is designed with a main menu that is always displayed near the top of the screen. Click a menu option for specific functions. Home Page The Home page displays active members under the plan and the plan name. To view inactive members, select Show Inactive Members. Additional Resources allows a user to perform a provider search without leaving the Plan Central website. There is also an option for those members who qualify, to elect to receive Paperless EOBs. Coming Attractions: My Documents The documents field will display the specific member group and benefit information, as well as the plan document. 10

12 My Benefits A user can quickly access an Explanation of Benefits by selecting this option under the My Benefits tab. Clicking on the My Benefits Menu Option, takes the User to the My Benefits home page. To view details for an individual family member, including claims history, deductible requirements and balance, and benefit descriptions, click on the member name under Family History. 11

13 Member Details The Member Details tab contains the Member, Eligibility and Address Information. Eligibility History The Eligibility History tab contains a list of all the Benefit Plans and Networks the Member has been covered under as well as the Primary Care Physician information if the Member was required to designate one. 12

14 Claim History Claim History will display all claims on file for the member. If there are multiple pages, click the drop down on the bottom, Select a page to navigate to another page. Select the Claim you wish to view. 13

15 Claim History, Cont d. Detailed information appears concerning the claim selected. 14

16 Deductible Information The Deductible Information tab contains the most up to date information about the Member s Deductible and Out of Pocket Maximums to date. To view a different calendar year, click the drop down next to Select Plan Year. 15

17 Deductible Information Cont d. To view claims that have been applied to the dedcutible or out-of-pocket maximum, click on the deductible or OOP line. Clicking the specific claim line will display the details of the claim. 16

18 Plan Benefits Clicking on the Plan Benefits tab will bring up a brief description of the member s benefits. For more detailed plan information, click on the Schedule of Benefits hyperlink. This will launch a PDF of plan information. Request ID Card Request ID Card allows a user to request a new ID card and/or print a Temporary ID Card. You will also be able to see when an ID card was issued. To view a future ID card, select the date using the drop down calendar. Next, select Change. 17

19 Auth History If you are receiving care that requires prior authorization, you can view the status of the request by clicking the Auth History tab. To access a list of services that require prior authorization, refer to your plan documents. 18

20 Auth History, Cont d. Select the authorization to view. Additional information about the authorization appears below. 19

21 Change PCP If your Plan requires a Primary Care Physician (PCP) be designated, the Change PCP tab will be visible. To select a PCP or change your current PCP, click on Select PCP. Fill in your search criteria then click on search to view the results. When the results return, click on Save PCP Changes. You will receive an new ID card in 7-10 business days. 20

22 Manage COB Details The Manage COB tab allows the Contract holder to update the Coordination of Benefits Information. (Note: This option may not be available to all Members. Some Group Plans do not use this feature.) If you have any questions on how to complete this form, please contact Customer Service at the phone number on your Member ID card. EOB History Members receive an Explanation of Benefits, or EOB, after a claim has been received by SummaCare, indicating the benefits and charges covered or not covered by the Plan. A paper copy of the EOB is mailed to the member; however, members can view the EOB via Plan Central. Please note: In order to view and/or download an EOB, Adobe Reader software must be installed on your computer. You can download this software for free via the link found on the Explanation of Benefits page. 21

23 EOB History, Cont d. An EOB can be viewed and printed by clicking on the EOB History tab. 1. Select a particular claim run date. Doing this will launch a PDF of that EOB. 2. The following prompt will be displayed. 22

24 EOB History, Cont d. 3. Click Open to view the EOB in PDF format. The EOB will display in a separate window. (As an alternative, you may click Save to save the file to your computer.) Coming Attractions: Billing/Payment Information This field will display the billing and payment history information for a contract. The ability to make an online payment will be accessed through this tab. This will only be displayed for member s who make premium payments directly to SummaCare. 23

25 My Inquiries My Inquiries menu also allows a user to search for pending Authorizations or Claims. My Authorizations If you are receiving care that requires prior authorization, you can view the status of the request by clicking the My Authorizations menu. To search for an Authorization, enter your Member ID number or First and Last Name into the search box and click on Search. To access a list of services that require prior authorization, refer to your plan documents. Members may also have the option of accessing the information online as shown below. 24

26 My Claims Another way to search for Claims is by entering in the Claim Number or Claim Status (Finalized/Paid, Finalized/Denied, or In Process) and service date range. My Resources The My Resources tab will take you to the My Resources home page or FAQs. 25

27 Frequently Asked Questions (FAQ) Clicking on FAQ launches the Frequently Asked Questions page. To obtain the answer to a particular FAQ, click on the Question Mark. 26

28 My Resources On the My Resources homepage, you have links to the Provider and Drug Search tools and then any other tools that you may be eligible to use. These tools may vary. Paperless EOB If you are interested in signing up for Paperless EOBs, click on the icon on the My Resources screen. It is a quick process and if you change your mind, you can cancel and continue to receive paper EOBs. Click on the Paperless EOB box as shown below. You must agree to the Terms of the Paperless Process in the lower left corner. 27

29 Paperless EOB, Cont d. You can view the Terms by clicking on the blue hyperlink. Once you agree to the Paperless Terms, click on the Update button. You will then be asked to confirm your address. If it is already on file, this box will be populated with the address we have in Plan Central. Click on the Submit button. Your request will be processed. You will receive an from Plan Central within 48 hours asking you to verify that you made the request to receive your EOBs in a Paperless format. You are required to click on the hyperlink in the in order to complete the process. If your dependents have granted you access to their information, you can set up Paperless EOB for them as well. For more information on Shared Access, see page

30 Find a Doctor or Hospital The Find a Doctor of Hospital tool allows you to search for doctors, hospitals or other medical facilities via SummaCare s Provider Directory search engine. From either the Plan Central Home Page or the My Resources tab, click Find a Doctor or Hospital. The search will be facilitated via summacare.com and will be launched in a separate window. 29

31 Find a Doctor or Hospital, Cont d. Select and/or enter criteria for your search and then click Continue. 30

32 Find a Doctor or Hospital, Cont d. Select or enter the required network information and then click Search. 31

33 Find a Doctor or Hospital, Cont d. The search results will be displayed. Drug Search If SummaCare manages your Prescription Drug coverage, you can search for information about a particular medication using the Drug Search tool located in My Resources. (Note: If you are not sure if SummaCare manages your Prescription Drug coverage, check your SummaCare ID card. You can also contact SummaCare s Customer Service Department at the phone number listed on the back of your ID card.) The search will be facilitated via medimpact.com and will be launched in a separate window. 32

34 My Settings On the My Settings page, you can manage your access, opt for Paperless EOBs, or update your user details and change your password. Manage My Access Plan Central users can chose to share data regarding claims, authorizations, and deductibles with family members. Because we are committed to protecting our members privacy, contract holders must grant access to their spouse and dependents. Although you will be able to access Plan Central health information for dependents under the age of 18, your spouse and dependents over the age of 18 must grant your access to his or her information. Likewise, you can choose to grant your spouse and/or dependents access to your information, or keep it private. To share your Plan Central access, click the My Settings menu and choose Manage My Access. 33

35 Manage My Access, Cont d. From the Share My Access tab, select the type of information which is (claims, authorizations, deductibles) you would like to share with your spouse and/or dependents. In the example below, the contract holder has chosen to share his claims, authorization, and deductible information with his spouse, as indicated by the checkboxes and the spouse s name in the drop-down field. The contract holder can also choose to share dependent information with the spouse, provided the dependent is under 18. Click Update when finished; a confirmation message will be displayed. The spouse will be able to access the contract holder s selected information the next time she logs in to Plan Central. Contract holders may view Plan Central data for their spouse and/or dependents over the age of 18, but only after the spouse and/or dependents grant access to the contract holder. Therefore, the spouse and/or dependent is required register for a Plan Central member account and then proceed to the Share My Access screen. Once there, the spouse and/or dependent should refer to the instructions on p. 25. After access has been granted, the contract holder can log back in to Plan Central to view the selected spouse/dependent information. Viewing Information for Dependents under Age 18 To view claims for your dependent under the age of 18: 1. From the My Settings menu, select Manage My Access. 2. The My Access tab will appear and list the current spouse/dependents on your plan. Select the items you wish to view. 34

36 Viewing Information for Dependents Under Age 18, Cont d. 3. Click the Update button. You will receive a message "Update Successful" on the bottom left of the screen notifying you the update has been made. 4. Log out of Plan Central and then log back in using your own login ID and password to view dependent information. 5. You will now be able to view the claims for your dependent. My Profile Access the My Profile page to change your name, phone number, address, or password. Hover over My Settings then click My Profile to view the profile. 35

37 My Profile, Cont d. Once you have updated your User Details, click on the Update Profile button. If you update your password, please note passwords must be alphanumeric and between 8 12 characters in length. Contacting SummaCare Click the Contact Us link, which is always available at the bottom of the page. The Customer Service phone number will be displayed. Logging Out To exit Plan Central, click the Log Out link. The session will be terminated and the Welcome page will be displayed. 36