February 2018 HealthVoice

HealthVoice masthead

Member Newsletter

February 2018


HealthSCOPE Benefits is New Claims and Benefits Administrator

HealthSCOPE Benefits, HealthChoice’s new claims and benefits administrator, took over handling claims and benefits, and also certification requests, Jan. 1. New ID cards were issued and mailed to you in December.

The previous administrator will continue to process and pay claims for services prior to 2018.

If you have questions on current plan year claims or benefits, call customer care toll-free at 800-323-4314 or TTY 711.

NEW – Your HealthChoice Connect Member Portal

HealthChoice Connect is the new web portal where you can access and manage your HealthChoice information and tasks online. Through HealthChoice Connect, you can:

  • View/print explanations of benefits or register to receive EOBs by email.
  • View eligibility and claim status.
  • Request ID cards.
  • Update coordination of benefits information.*
  • Designate a personal representative.

You can also access quick links to the HealthChoice website from the portal to easily search for network providers, download forms and applications, and complete the tobacco-free attestation during the annual Option Period.

*Update COB Information

If you have urgent pharmacy needs delayed for COB information, please call member services at 405-717-8780 or toll-free 800-752-9475 to expedite since COB information takes about one week to update with the pharmacy benefit manager. TDD users call 405-949-2281 or toll-free 866-447-0436.

Register and get connected today! Visit www.healthchoiceconnect.com.

Back to Top

Pharmacy Deductible Reminder

As a reminder, your pharmacy deductible restarted Jan. 1, the beginning of the new plan year.

Current and Pre-Medicare Members

The HealthChoice High and High Alternative plans, and as of Jan. 1 the HealthChoice Basic and Basic Alternative plans, have a $100 per person pharmacy deductible with a $300 maximum per family. This deductible applies to the pharmacy benefit only and you must meet this deductible before the normal HealthChoice copay structure applies.

The HealthChoice Preventive Medication List is an expanded list of generic medications that are not subject to the pharmacy deductible and pay at the normal generic copay level of up to $10 for a 30-day supply and up to $25 for a 90-day supply. The list can be accessed at https://www.ok.gov/sib/documents/HCPreventiveMedicationList.pdf.

Medicare High Option Members

The HealthChoice SilverScript High Option Medicare Supplement Plan has a $100 per person pharmacy deductible. This deductible is for the pharmacy benefit only and you must meet this deductible before the copay structure applies.

Back to Top

How to Recognize and Report Health Care Fraud

HealthChoice is always on the alert for any suspected fraud as it is detrimental to the plan and its members. Unidentified health care fraud can increase premium costs, which is a concern to all plan members.

Remain aware of your health care information and indicators of fraud, such as:

  • False claims filed on your account.
  • Billed services not performed.
  • Use of HealthChoice ID card or member number by another person to obtain health care services or prescription drugs.
  • False information on an application for insurance coverage.
  • Unusually high charges for regular health care items or services.

Your EOB is one of the best ways to identify health care fraud. EOBs are available through the member portal, HealthChoice Connect. If you notice any suspicious activity, take the initiative to report it to HealthChoice.

Not all suspicious activity is fraud. Providers file a large number of claims and mistakes are possible. Call the provider’s office to question billing statements you feel contain errors. If you still feel there is suspicious activity, you can contact the EGID Fraud Hotline toll-free at 866-381-3815 or EGID.antifraud@omes.ok.gov, and the EGID compliance team will investigate to determine if the suspicious activity is actually fraud and report their findings to you.

Back to Top