Frequently Asked Questions

Learn more about Bright HealthCare and help us find the right plan for you.

We know health insurance can be confusing, but our mission is to make it easier for you. Check out our FAQs (frequently asked questions) and learn all about Bright HealthCare, our Individual & Family health insurance plans, the Affordable Care Act (ACA) Marketplace, Open Enrollment, Special Enrollment and much more.

 

Medicare Advantage member FAQs


How can I enroll in an Individual & Family plan?

The Open Enrollment Period for Individual & Family health insurance typically runs from November 1 to December 15. However, some states extend the period if they have their own exchange, like Colorado did last year. Plans sold during Open Enrollment start January 1.

We try to make the process as simple and painless as possible. You can learn about the ACA, see if you qualify for subsidies, view plans, get a quote and enroll right on our website. Call Bright HealthCare at 833-356-1182. Or visit with a broker or a Health Insurance Marketplace navigator.

We provide a helpful tool to help you choose the right plan based on things like your epected usuage, subsidies you can get based on income, number of family members, and more.

Explore plans

If you or anyone in your household has had a “major life event” like the ones below within the last 60 days, you may qualify for a Special Enrollment Period which is offered throughout the year:

  • Got married
  • Had a baby, adopted a child, or placed a child for adoptive or foster care
  • Got divorced or legally separated and lost health insurance
  • Lost a job and your health insurance
  • Death of someone on your plan
  • Changes in residence that moves you out of your current network
  • Loss of health insurance

Please know this is not a complete list of events that trigger Special Enrollment qualification. For more qualifying event information, visit .

A broker or agent can help you better understand your health insurance options and can help you save money. They are an excellent resource to use while shopping for healthcare, which we all know is a pain, to help you find the right care for the right price. Learn more about brokers here.

Tell me about Bright HealthCare.

At Bright HealthCare, we’re on a mission to make healthcare right together. We approach healthcare plans, services and benefits with the goal of making them easy-to-use and easy-to-understand. We collaborate with curated network of providers that we call Care Partners – to make health care simpler, personal and more affordable. Learn more about Bright HealthCare.

Our Care Partners are curated healthcare networks of doctors, clinics and hospitals in your community – hand-selected by Bright HealthCare to help deliver simpler, more personal and affordable healthcare at the best possible price. They do this by bringing you:

  • Better coordinated care
  • Seamless healthcare experience from enrollment to doctor’s visits and billing
  • Meaningful, useful benefits
  • Lower cost of exceptional care

All things work better with great relationships, and having a local Care Partner in each community we serve allows us to make things run as smooth as possible. These partnerships mean we work together for one singular purpose—quality care for you, that’s easy to manage and the best possible value.

Consumer satisfaction statistics are available upon request.

Tell me about the Affordable Care Act and subsidies.

Plan costs will vary. You can view plans and get a quote online or call Bright HealthCare at 833-356-1182 and we can help you estimate your costs. You can save by checking to see if you qualify for Affordable Care Act (ACA), or Obamacare, government subsidies. Learn more about how subsidies work and how to get them.

The Affordable Care Act (ACA) is the comprehensive health care reform law enacted in March 2010, sometimes known as ACA, PPACA, or Obamacare. The law provides consumers with subsidies, or premium tax credits, that lower costs for many households who qualify based on income.

A navigator or certified assister is someone trained and paid by the federal government to help you navigate your Health Insurance Marketplace. They are unbiased and will try to get you government subsidies and help you find the best plan for the best price. Learn more about navigators.

The Health Insurance Marketplace, also known as the “Marketplace” or “exchange,” provides health plan shopping and enrollment services through websites, call centers, and in-person help. Some states, such as Colorado, run their own Marketplaces. They are kind of like Amazon, basically, a website that offers and sells all the plans, but doesn't make products itself. This is also the place where you get subsidies, or Advanced Premium Tax Credits (APTC).

The Advanced Premium Tax Credit (APTC) is a federal subsidy available to individuals and families who earn less than 400% of the Federal Poverty Level (FPL). This subsidy helps to pay part of your health insurance premiums in order to make your insurance more affordable as part of the Affordable Care Act (ACA).

Member Hub

3-5 business days after you've made your initial payment.

As a first-time user, you’ll need to register, then you can just log in after that. Register or log in at Member Hub.

Note:

  • You'll need to have your Member ID.
  • Names must be entered EXACTLY as it was entered on enrollment application
  • Spouses and dependents can create their own Member Hub account by checking the "Are you a dependent?" box and entering their First Name and Date of Birth. They will also be required to enter the Member ID number, Policy Holder's Name and Date of Birth to complete account registration.

 

Finding Your Member ID

If your payment has cleared but you haven't received your ID card yet, you can use the Member Lookup Tool to find your Member ID.

Check out our helpful Member Hub resource page for more information about what you can do in the Member Hub.

Your Member Hub has a “Questions & Messages” area that allows you to ask general questions to our Member Services team. So if you don’t want to call, you can use this to reach out online.

It all happens in the Hub. This is the place you can really connect with your plan. Here are some of the things you can do:

  • Set up recurring payments—make sure you never miss a payment
  • Search the Drug Formulary—find out if your prescriptions are included
  • Use the Provider Finder—choose a Primary Care Provider, find a specialist, and more
  • Earn rewards—$$ for taking healthy actions—Amazing, right?
  • Explore telehealth options—get the care you need without leaving home
  • Access your Virtual ID Card—forgot your card? No problem!
  • How do I make an account? - Create your Member Hub account here. - All you need to get started is an email address and your ID card or SSN.
  • What if I already have an account? - Simply sign in with your existing username/email address and password. If you have forgotten your password, click on Forgot Password

For members in Alabama, Arizona, Colorado, Florida, Illinois, Oklahoma, North Carolina, Nebraska, South Carolina, and Tennessee:

English - 855-827-4448 (TTY: 711)

Español - 800-882-2520 (TTY: 711)

For members in California, Georga, Texas, Virginia, and Utah:

English - 844-926-4524 (TTY: 711)

Español - 844-926-4523 (TTY: 711)

中文, 한국인, Tiếng Việt - 844-926-4524 (TTY: 711)

California residents contact guide

If your payment has cleared but you haven't received your ID card yet, you can use the Member Lookup Tool to find your Member ID.

Earn up to $500 in rewards

Start earning on 1/1 by taking simple health actions such as:

  1. Sign up for Rewards with your Member Hub account = Earn $25
  2. Complete a short health survey = Earn $50
  3. Select your primary care provider (PCP) = Earn $50
  4. Plus more! Log in to the member hub to see all rewards opportunities available

Throughout the year you will receive opportunities to earn up to $500 total on your reloadable prepaid Visa card. Sign up in the member hub and start earning on 1/1/2022.

*Enrolled members can earn up to $500 for completing actions. Actions to obtain rewards are optional and aren’t a requirement to retain enrollment. Members who reside in California can earn up to $200 in rewards per year.

You can now get text alerts!

Here are 3 great reasons to sign up:

  1. Get important alerts about your plan, benefits, and coverage
  2. Find out first about new Rewards opportunities
  3. Stay connected with us about timely health topics

You can sign up via the Member Hub

  1. Log into the Member Hub
  2. If you haven’t already signed up, there will be a place to do so on the very first page you are brought to.
  3. Provide your phone info, agree to the terms, and submit
  4. Youll receive a text requesting confirmation of your opt-in
  5. Once you reply Yes, you are all set!

ID Cards

10-14 business days after enrollment

If your payment has cleared but you haven't received your ID card yet, you can use the Member Lookup Tool to find your Member ID.

You can view and print out a new ID card in your Member Hub.

  1. Log in to your Member Hub (or register if you haven't already)
  2. From the Member Hub dashboard, click "View ID card" under My Account
  3. View or print the ID card
  1. Log in to your Member Hub
  2. Scroll down to the "My Account" section
  3. Click the "Request New Member ID Card" link
  4. Fill out the form with your member information

We know ID cards can look a little intimidating. Here’s a short list of some of the lines you may see on yours and what they mean.

  1. ID # - Here’s your unique Member ID – you’ll need it to get started in the Member Hub.
  2. Effective Date – This is when you can start using your health plan.
  3. PCP/SPEC/URG/ER –Some basic information about what you’ll pay for care:
  • PCP: Primary Care Physician
  • SPEC: Specialist
  • URG: Urgent care
  • ER: Emergency room
  1. DED: Deductible
  2. Pharmacy benefits –basic information about what you’ll pay for prescriptions.
  3. RXBIN - Banking identification number: indicates which company will reimburse the pharmacy for the cost of the prescription
  4. RXPCN - Processor control number: an identifier used to route pharmacy reimbursements
  5. RXGRP – Prescription group
  6. Member Services – we’re here to help. Call us any time you have questions about your coverage.

Payments

You can make an initial payment online in the Member Hub by clicking Pay My Bill.

  • If you don’t yet have an account, to see instructions on how to do so

If you prefer, you can also pay by phone or mail.

  • NOTE: You can also make future payments by these means OR set up autopay via the Member Hub

After you’ve submitted your first payment, you’ll need to wait 3-5 business days before following these steps.

If you have not registered your Member Hub account:

  1. Register your Member Hub account
  2. Click “Pay My Bill” at the top right
  3. Follow the “Billing” link in the upper right corner of the next screen
  4. Select “Setup recurring payments” to provide your banking information

If you have already registered a Member Hub account:

  1. Log in to the Member Hub
  2. You should arrive directly in your billing portal if you use the link above
  3. Click "Schedule Payment" to enroll in autopay

Please wait 2-3 business days for our systems to update your autopay status.

Get to know my plan

A primary care provider (PCP) is the main healthcare provider you see for routine care or common medical problems. Most often your doctor, the PCP, may also be a nurse practitioner or physician assistant.

A healthcare network is a system of facilities (hospitals and clinics), providers (doctors), and suppliers (pharmacies) that your health insurance company has contracted with to provide healthcare services. Bright HealthCare works diligently to hand-select quality healthcare networks as our Care Partners.

You can easily find your doctor or healthcare provider, including clinics, hospitals and pharmacies – or choose a new one – with our Provider Finder tool. Learn more about the possible financial impact of going out of network.

In-network refers to providers or healthcare facilities that are part of Bright HealthCare’s network of providers with which we have negotiated service. When you see an in-network provider, your bills will likely be lower. An out-of-network provider is one that has not contracted with Bright HealthCare. If you see an out-of-network provider, your bills will likely be much higher except in cases of emergency or if we authorize you to receive care out-of-network. Learn how to better understand the possible financial impact of going out of network.

A copayment (or “copay”) is a monetary charge that your health insurance plan may require you to pay in order to receive a specific medical service or supply. For example, your health insurance plan may require a $15 copayment for an office visit or brand-name prescription drug.

The amount you pay for covered healthcare services (other than your included, no-cost benefits) before your plan starts to pay.

The percentage of costs of a covered healthcare service you pay (20%, for example) after you've paid your deductible. Let's say your health insurance plan's allowed amount for an office visit is $100 and your coinsurance is 20%. If you've paid your deductible: You pay 20% of $100, or $20 – until you’ve reached your maximum out-of-pocket amount.

  • Preventive visits
  • $0 drug list
  • COVID-19 vaccination
  • Flu Shot
  • Telehealth
    • COVID-19 changed life as we know it, and telehealth emerged as a major way of getting and giving care. These virtual visits allow greater flexibility and safety, and are a smart choice for:
      • Times you need to stay home
      • Times when your PCP isn’t available
      • Minor illness
      • Mental health

To help explain the difference between these next two terms, let’s take a look at an example of an in-network visit for a covered service:

  • Let’s say your doctor charged $340 for a recent visit, and you have already met your deductible for the plan year. (Remember—until you meet your deductible, you pay the full $340).
  • If your plan has a $25 copay for this service, which is a flat rate, once the copay is paid, Bright HealthCare covers the rest.
  • If your plan has 20% coinsurance, which is a percentage of the total, Bright HealthCare covers the remaining cost for the service after you pay your percentage.

In this scenario, we assume that you have not hit your Maximum out-of-pocket limit. You will never pay more than that amount. The plan will pay 100% of costs after that point for your covered benefits. Infographics are illustrative and dollar amounts are for reference only.

The most you have to pay for covered services in a plan year—after you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.

This is also known as a walk-in clinic, found at a CVS or The Little Clinic near you. These clinics often have longer hours and are available in places you are visiting for other needs, making them extra convenient. This is where you can go to get treatment for common, non-life-threatening medical conditions.

  • Ear infections
  • Sore throats
  • Pinkeye
  • Minor burns and rashes

Your Bright HealthCare plan contains these essential benefits, and more:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care
  • Mental Health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services, including oral and vision care

An EPO is a care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).

Formulary is the formal name for the list of medications covered by your Bright HealthCare plan. It is sometimes called a “Drug List.” Check out the FAQ section to learn how to navigate the formulary.

Where you can find your detailed coverage information such as co-pays or co-insurance by medication tier. Summary of benefits

We send letters in the fall that explain the status of your specific plan, but in case the information is not handy, or you have additional questions, contact our customer service team at 855-827-4448, or your health insurance agent or broker. *Note: some members may need to provide additional information to their state or federal marketplace in order to renew their plan.

Getting care you need

The key to making the most of your Bright HealthCare plan is by knowing and staying within your network. We’ve carefully selected our local provider network in order to get you the personalized, quality care you deserve. Choosing to visit an in-network provider and/or facility will ensure you always get the most for your money. Get started by visiting the Provider Finder in the Member Hub.

Urgent Care

Visits to urgent care facilities can be a helpful alternative to PCP and telehealth visits at the right time. Urgent care is great for:

  • Needs that occur outside your PCP’s office hours
  • Minor fractures
  • Fever
  • Severe headache
  • Cuts that may require stitches

Telehealth

COVID-19 changed life as we know it, and telehealth emerged as a major way of getting and giving care. These virtual visits allow greater flexibility and safety, and are a smart choice for:

  • Times you need to stay home
  • Times when your PCP isn’t available
  • Minor illness
  • Mental health

Emergency Care

Save visits to the emergency room for true emergencies. You will save money, and help ensure the ER staff is available to treat patients with things like:

  • Chest pain
  • Trouble breathing
  • Head trauma
  • Severe injury
  • Loss of vision

Mental Health

The pandemic has taken an extra toll on our emotions and stress levels. Learning to cope will make us, and the people in our lives, more resilient. We are aware of the importance of mental health and want to help you find the best care.

  • $0 mental health office visits on most of our plans
  • Three ways to access our mental health services: Doctor on Demand, in-person visits, and telehealth from your provider

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