SummaCare Pricing Transparency

As part of the Transparency in Coverage Act, health plans are required to post Machine-Readable Files (MRFs) containing the following costs for items and services when accessing care:

• In-Network Rate File: Rates for all covered items and services between the plan or issuer and in-network providers.
• Allowed Amount File: Allowed amounts for, and billed charges from, out-of-network providers.

This information is intended to help you better understand the cost of seeking care for specific services under your SummaCare plan.

View Machine-Readable Files containing pricing information from SummaCare.

If you have any questions, please contact edisupport@summacare.com.

Learn more about pricing transparency by visiting the Centers for Medicare and Medicaid Services website.

Transparency In Coverage

SummaCare is dedicated to providing you with easy-to-understand materials and information so you are more informed about your coverage and how it works.

Individual

Qualified Health Plan Issuer Application Instructions

Coordination of Benefits 

Drug Exceptions Timeframes and Enrollee Responsibilities

Enrollee Claim Submission

Enrollee Recoupment of Overpayments

Grace Period

Information on Explanations of Benefits (EOBs)

Medical Necessity and Prior Authorization

Out-of-Network Liability and Balance Billing

Retroactive Denials

Group

Coordination of Benefits

Drug Exceptions Timeframes and Enrollee Responsibilities

Enrollee Claim Submission

Grace Period

Information on Explanations of Benefits (EOBs)

Medical Necessity and Prior Authorization 

Out-of-Network Liability and Balance Billing

Retroactive Denials