Business transparency
Understanding our procedures
To understand how we do business, see any of these topics for more details about a few of our procedures.
- Drug exception time frames and enrollee responsibilities
- Enrollee claims submission
- Enrollee recoupment of overpayments
- Transparency in coverage machine readable information
About benefits
- Individual and Family - Coordination of Benefits (COB) (PDF)
If you have coverage from more than one health plan, coordination of benefits helps determine which plan is primary and pays first and which plan is secondary. - How to Read Your EOB
We send you an an EOB statement with details about what medical treatments/services we've paid for you and what you will have to pay, according to your policy.
Additional resources
- Grace period and claims pending
- Out of network liability and balance billing
- Medical necessity and prior authorization time frames and enrollee responsibilities
- Retroactive denials
This information pertains only to our QHP (Qualified Health Plan) plans.