Frequently Asked Questions

Forms 1095 A & B


Monthly Premium Payments

How can I make my individual monthly premium payment?

  • If you would like to make your premium payment by phone, please use our automated payment system by calling 877-254-3508. For debit card payments, please have your member identification number and debit card account number, security code and expiration date ready. For payments by check, please have your member identification number, bank routing number and account number ready


Making a Premium Payment just got a little easier.

  • Did you know that you are able to make a payment using Health Options’ automated phone payment system?  Our Members are able to make a premium payment by debit card or check using the automated phone payment option by calling 1-877-254-3508.
    • For debit card payments, please have your member identification number and debit card account number, security code and expiration date ready.
      • *Important note - Do not include yoru three digit person code at the end of your member identification number. The person code is the three digit number starting with a "0" following the space after your identification number (example - 001, 002, etc.)
    • For payments by check, please have your member identification number, bank routing number and account number ready.
      • *Important note - Do not​ include yoru three digit person code at the end of your member identification number. The person code is the three digit number starting with a "0" following the space after your identification number (example - 001, 002, etc.)

Monthly Invoices for Individuals


I have received an invoice for the plan I cancelled though the Marketplace. How can I stop these? And will this impact my credit score?
  • Community Health Options receives notification from the Marketplace when someone cancels their plan. Sometimes there can be a delay in this notification. Until we receive this notification and process it, we must continue to send invoices.

  • If you receive an invoice, and you have called the Marketplace to confirm that your plan is cancelled, you can dis-regard it. We do not report late payments to credit agencies. If we do not receive premium payments, plans purchased through the Marketplace will cancel after a three-month grace period and plans purchased directly through Community Health Options will cancel after a one-month grace period.

  • If you are not sure whether you have cancelled your plan through the Marketplace, you should call 1-800-318-2596 to verify.


When will I get my invoice?
  • Once enrolled, Community Health Options will mail you an invoice around the 10th business day of every month for the following month. The payment is due by the first of the month. 

Managing Your Auto Pay Plan


How do I set up, edit, or delete my auto pay plan?

ID Cards


When will I get my welcome packet and Member ID card?
  • Due to the high volume of new and re-enrollment of individual and group membership, both on and off the exchange, there has been a delay in sending Member Welcome Packets and Membership ID cards. 

  • We apologize for the delay and are working very quickly to correct the situation. Unfortunately, we are experiencing some technical difficulties with the “Print a Temporary ID Card” function in the Member Portal, we hope to have this corrected shortly.

  • New ID cards are currently in the process of mailing, however some Members might not receive them until early February.  In the meantime, Members who have re-enrolled in the same plan can continue to use their old cards.  If you are newly enrolled and have made your monthly payments and are seeking pharmacy or health care services, please ask your Pharmacist or Provider to call 1-855-624-6463 to verify eligibility at the time of service.

  • We apologize for any inconvenience this may have caused you.  Thank you for your patience and continued support


PCP Information


What is a Primary Care Provider (PCP)?
  • A provider in internal medicine, family practice, general practice, pediatrics, or obstetrics and gynecology, or a certified nurse practitioner or certified nurse midwife licensed by the Maine Board of Nursing, who is under contract with Community Health Options to provide and authorize Members’ care.

Why do I need a PCP?
  • Having a strong relationship with a Primary Care Provider (PCP) whom you trust is important to maintaining and improving your health.

How do I select a PCP?
  1. Log in to the secure Member portal
  2. Click on the blue button that says ASSIGN MY PCP
  3. Assign a PCP for you and/or your family members by completing the fields on the screen
  4. Click Submit to confirm your selection

Prior Approval


What is prior approval? 
  • Some Covered Services require Community Health Options’ Prior Approval before we will pay Benefits. The Prior Approval program helps us ensure that: 
    • The services you receive are Medically Necessary; 
    • You receive the appropriate level of care in the appropriate setting; 
    • Information is shared with your Providers so that your care can be coordinated; and  
    • We pay the correct amount of Benefits
 
What services require prior approval? 
  • A complete listing of services that require prior approval is available in your Member Benefit Agreement (MBA).  You will receive a copy of your MBA with your welcome package. 

Provider Network


Will Community Health Options cover services provided out-of-state? 

  • Yes, Community Health Options Members will be able take advantage of an out-of-state Network of Providers throughout the United States through our relationship with First Health network.


How can I find out if my behavioral health provider is in network? 

  • All providers including behavioral health providers in our network are listed in our find a provider tool.

Referrals


Will I need a referral to see a specialist? 

  • Community Health Options does not require referrals to see Specialists or for specialty care.  We encourage our Members to consult their Primary Care Providers (PCP), however, since coordinating care with a PCP typically results in better health outcomes.

Reimbursement


How do I submit a claim that I paid for out of pocket?

  • Medical and prescription reimbursement forms are available on our website: Find a Form.

The Preferred Regional Pharmacy Pilot Program ended on December 31, 2015.


If I currently get reduced prescription medications under the Chronic Illness Support Program (CISP) will that program continue? 
  • Yes, the Chronic Illness Support Program (CISP), offered on many of our plans, offers reduced (and in some cases $0 cost-sharing) for some prescription medications for Members with the following conditions at all in-network pharmacies:  diabetes, hypertension, asthma, Chronic Obstructive Pulmonary Disease (COPD), and Coronary Artery Disease (CAD). CISP is not available on HSA plans, Community Assist and Safe Harbor (catastrophic plan).

Does this mean I have to switch medications? 
  • No, as a Member, you can continue with your current prescription medications.

What does the end of the Pharmacy Pilot Program mean for my prescription drug costs?  
  • Prescription medications will be subject to copays and deductibles as outlined in the Member Benefit Agreement.  

Can I submit an appeal to reverse Community Health Options’ decision?
  • A Member always has a right to file an appeal.  However the Preferred Regional Pharmacy Pilot Program was not guaranteed in the applicable Member Materials, therefore Community Health Options will not make exceptions to continue the program. Prescription medications will be subject to the cost-sharing as outlined in the applicable Member Benefit Agreement and Schedule of Benefits.