Have new health insurance? Here’s how to get started.

Adult Health - April 16th, 2024

Reading Time: 7 Minute/s

Have new health insurance? Here’s how to get started.

Adult Health

Have new health insurance? Here’s how to get started.

Posted on April 16th, 2024 - Reading Time: 7 Minute/s

Whew – you’re insured! Now what? Follow this step-by-step guide to get the most out of your health insurance plan.

Whether your plan starts with the changing calendar year or after a big change in your life, a new health plan is a great way to set yourself up for a healthy year to come.

Confirm you are covered

Have you received your member welcome kit yet? If you haven’t received this packet explaining your coverage and benefits, and it has been more than a month since you signed up, call your health plan to confirm your enrollment.

On the call, you may also want to confirm:

  • Your coverage start date
  • Your contact information
  • How to pay your bills (If you’re on Apple Health (Medicaid) you won’t have a premium)

If you’re a Community Health Plan of Washington (CHPW) member, you should get a welcome call from our team within the first month of your plan’s effective date. Our friendly team will make sure you have everything you need to get started.

Look at the plan papers you got in the mail

It can look like a lot, but here’s what’s important and how it can help you.

For every health plan you’ll get a Member ID card or health insurance card. This is your proof that you have a health plan. If you’re renewing your same health plan and nothing has changed, you may not get a new card.

Depending on your health insurance, the names of your plan documents might be slightly different. Here are the top plan documents to make sure you have if you’re a CHPW member:

CHPW Apple Health (Medicaid) Plans

Member Handbook – You’ll find a lot in here. Go here for information about the benefits and services your coverage includes such as regular doctor visits, tests and screenings, and dental care as well as how to get care, your rights, and more.

The most important piece of mail is your ID card! This is what you show all your providers to get services. For Apple Health and Medicare Advantage Dual (HMO D-SNP) members there are two of them, and for all others there is just one card.

  • Your white CHPW card (all members get this!)
  • Your blue/green ProviderOne card (Apple Health and D-SNP members only)
  • Some Medicare Advantage members may also get a third card for over-the-counter (OTC) benefits, depending on your plan.
“If you have two cards, you should show both to your providers to get all the services offered to you!”
Bridget Hume, Supervisor Member Engagement

CHPW Cascade Select Individual & Family Plans

Evidence of Coverage – This is your Health Care Coverage Agreement and a binding contract. It describes the health care benefits available to you and your rights and responsibilities under your plan.

Schedule of Benefits – Here you’ll find details about how much you pay for each type of health care service covered by your plan, including your deductibles, copays, coinsurance, and out-of-pocket maximum amounts.

CHPW Medicare Advantage (HMO) Plans

Evidence of Coverage (EOC) – This is your Health Care Coverage Agreement or contract. Here, you will find out how things work. This also includes payments you’ll be responsible for (if any), like deductibles, copays, and coinsurance.

Also, it details what’s covered by your plan, how to access health care services like a social worker to help coordinate your care, and prescription drugs.

Seeing words that don’t make sense? Deductible, copayment, premium—to get familiar with it all, take a look at this CHPW Connections article.

Set up your online account

Most health plans have a website where you can manage your plan. Set up yours to:

  • Pay monthly bills (premium)
  • Print your member ID card
  • Calculate service costs
  • See your provider network (provider directory)
  • See covered medications (drug formulary)
  • Submit claims
  • Get telehealth and virtual care

CHPW offers the Member Services Center and myCHPW Member Portal. Have you set up your accounts yet?

To get started, head to your member center at CHPW Individual & Family, Medicare Advantage, or Apple Health.

Pay your first monthly bill, if you have one

Be sure to pay your first monthly bill (premium) if you have one, so you have coverage when you need it. Your coverage will stop if you miss your first premium payment.

If your financial situation has changed and you can’t pay, let your health plan know right away, you may qualify for a different plan.

CHPW Individual & Family Cascade Select members, your due date is the 23rd of the month that your coverage starts. See how to pay your bill.

Also keep in mind, things change each year. If you happen to get a notice about a monthly premium that you were not expecting, be sure to call your health plan and ask about it!

If you are a CHPW Medicare Advantage member, and you recently received a bill for a premium in the mail, don’t ignore it.

Call us at 1-800-942-0247 (TTY:711) and ask about setting up automatic payments so you don’t risk missing a payment and losing coverage.

Get to know your plan

Check your deductible

Check your deductible

Each year, what you paid toward your plan’s deductible goes back to $0. Look in your plan documents for this number and track your deductible in your online account.

Learn more about your plan’s rules for deductibles in your Evidence of Coverage. Apple Health and Dual plans have no deductible.

Get your freebies

Get your freebies

Health plans cover some health services before you pay anything towards your deductible. You pay nothing for things like in-network preventive services including:

  • Your annual checkup or physical
  • Recommended immunizations and screenings
  • Contraceptive drugs and devices

Learn more about preventive care

Know what’s covered and not covered

Know what’s covered and not covered

Check your plan documents for coverage information about:

  • Types of services and providers
  • Medication and prescriptions
  • Medical equipment
  • Emergency and urgent care
  • Specialist care

To double-check if something is covered, call the number on your member ID card before any service or procedure.

If you’re a CHPW member and have any questions about your coverage, providers, or network, our friendly Customer Service team is ready to help at 1-866-907-1906 (TTY Relay: 711).

Find out where to get care

Many health plans offer different types of care for different situations. Review the options that are covered by your plan now, so you’ll know where to go when you need care.

Types of care

  • Primary care is the ongoing care you get from your primary care provider.
  • Telehealth or virtual care lets you see a doctor from home. Providers can diagnose, recommend treatment, and prescribe medication virtually for minor illness.
  • 24-hour nurse line is a registered nurse just a call away to answer questions about immediate health concerns.
  • Urgent care clinics offer same-day appointments for non-life-threatening health conditions that need immediate medical attention.
  • Emergency rooms are open 24 hours a day, seven days a week, for severe or life-threatening conditions.

When you have a health problem that can’t wait, it may seem like the emergency room is the best place to go.

Sometimes, urgent care, or the nurse advice line may be a faster or lower cost option for non-life threatening medical situations. Learn more about what to do when you need care or advice immediately.

Your network

Pay the least amount, or nothing at all, by getting care from providers in your health plan’s network.

Browse CHPW’s in-network providers online for Medicare Advantage, Apple Health, or Individual & Family.

Choose your doctor or primary care provider (PCP)

This is the doctor you see at least once a year for checkups. When you have a primary care provider, getting care can be simpler.

Here’s why:

  • Lower costs than the emergency room or urgent care
  • Often shorter wait times when you go
  • You can schedule appointments

With CHPW health plans, your primary care provider is at the center of your care. You can choose your own, or we will automatically choose one for you. You can change your primary care provider at any time, but you will need to have a PCP to get care.

Learn more about primary care providers and how to find yours ->

Schedule appointments in advance

The best way to get the most out of your health plan is to schedule your appointments at the start of the year, especially if you need to see a specialist.

CHPW Apple Health members, have you seen the CHPW Health Calendar? Use this to see which appointments are covered in your plan and what you might still need to schedule.

Remember, taking care of your health is an ongoing process. By staying informed and making healthy choices, you will have many healthy years ahead of you!

If you’re new to CHPW, we welcome you and we look forward to supporting your health along the way.

Learn more

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