As a SummaCare Individual & Family member, your plan includes comprehensive benefits that will cover you when you do not have employer group insurance and are not yet eligible for Medicare.
You may qualify for financial assistance in the form of an advanced premium tax credit and/or cost-sharing subsidy if applicable to your household. To be eligible for savings on your monthly premium, you must be under age 65 and not eligible for coverage through your employer, Medicare or Medicaid. Savings are based upon income, household size and plan options available in your area. Get an estimate of potential cost savings available.
If we make a medical coverage decision that you are not satisfied with, you can appeal this decision. An appeal is a formal way of asking us to review and change a coverage decision we have made. Learn more about our appeals and grievances process in your Evidence of Coverage document, as well as how to appeal a decision.
All SummaCare Individual & Family Plans include medical and pharmacy coverage, health and wellness services and programs and essential health services including pediatric vision and maternity benefits. Learn more about what’s included.
Learn more about Marketplace prior authorization metrics for medical items and services, including approval rates, processing timelines and additional transparency information related to prior authorization decisions. This resource helps members better understand how prior authorization requests are reviewed and managed for covered care and services.
Learn more about SummaCare’s Utilization Management program and how medical services are reviewed to help ensure members receive safe, effective and medically appropriate care. Explore information about prior authorization, medical necessity criteria and the processes used to support quality care and coverage decisions for members.
| Days | Times |
|---|---|
| Mon – Fri | 8:30 a.m. – 5:30 p.m. |
Outside these hours, you may leave us a message and a representative will return your call the next business day.