Access the tools and information you need to manage your health insurance benefits with confidence. From ordering a new Member ID card and updating your information to viewing services that require prior authorization, these resources are designed to help you stay organized and make the most of your coverage.
Please note that not all resources may be applicable based on your specific plan.
Submit a request to update your address so your account information stays accurate and you continue receiving important plan communications without interruption.
Submit a request to change your primary care provider so you can choose a provider that best fits your healthcare needs and preferences.
Submit a request to receive benefit materials and important plan documents so you can better understand your coverage and make informed healthcare decisions.
Log in to your member account to request a new ID card or print a temporary ID card so you always have access to your coverage when you need it.
Simply log in to your member account to view claim and health insurance benefits information, including information about our appeals and grievances process.
Whether looking for a pharmacy or prescription copay information, members with SummaCare prescription drug coverage can find what they’re looking for.
Download and complete the deductible credit transfer form to request a transfer of eligible deductible amounts and ensure your benefits are applied correctly.
Learn about your rights under federal law and how you’re protected from certain unexpected medical bills, including when and how these protections apply to your care.
1095 Tax Statements are now available to SummaCare Commercial Group members and SummaCare Individual & Family members who bought their plan off exchange.
Each Tax Form 1095-B is issued by SummaCare for our commercial group population (Non-MEWA) and individual and family plan members who purchased off exchange policies. This tax form is used to report certain information to the IRS and to taxpayers about individuals who are covered by minimum essential coverage and therefore are not liable for the individual shared responsibility payment.
For these members, statements are available on Plan Central. If you do not already have a Plan Central account, you can create one using your SummaCare Member ID number found on your member ID card.
If you would like to request a hard copy of your statement, please call Member Services using the phone number on the back of your member ID card.
Each Tax Form 1095-A is issued by the Health Insurance Marketplaces. This form will show any premium tax credit that was taken in advance and the months of coverage for each individual covered under that policy. This form allows the member to reconcile their policy and to file an accurate tax return.
Each Tax Form 1095-C is issued and furnished to any employee of an Applicable Large Employers (ALE) member who is a full-time employee for one or more months of the calendar year. ALE members must report that information for all twelve months of the calendar year for each employee. (These are normally for Self-Insured groups.)
Learn about advance directives and how to document your healthcare preferences so your care decisions are understood and respected if you are unable to communicate them.
Search the formulary to find your prescription and see what your drug coverage includes so you can better understand your medication options and costs.
Learn how to identify and report suspected fraud, waste, or abuse related to your healthcare coverage. Access resources and reporting options so concerns can be reviewed and investigated to help protect your benefits and ensure proper use of healthcare services.
Learn about the vendors and partners who support your healthcare services, including programs and resources that help deliver your benefits and enhance your member experience.
The Women's Health and Cancer Rights Act was signed into law on October 21, 1998. This law provides mandatory coverage for women with respect to medical and surgical benefits after having a mastectomy, providing that the health plan covers mastectomies. Group health plans, as well as health insurance issuers that offer coverage for mastectomies, are required to provide the coverage to participants of group health plans, as well as to those participants enrolled in an individual plan. Benefits under the Act include:
Copays, coinsurance and deductibles apply as long as they are consistent with other benefits under the plan. Additionally, persons moving from one plan to another may be required to comply with the new plan's pre-existing condition limitations, subject to HIPAA (Health Insurance Portability and Accountability Act) restrictions.
| Season | Days | Times |
|---|---|---|
| Oct 1 – Mar 31 | 7 days a week | 8:00 a.m. – 8:00 p.m. |
| Apr 1 – Sep 30 | Mon – Fri | 8:00 a.m. – 8:00 p.m. |
Outside these hours, you may leave us a message and a representative will return your call the next business day.