» VIDEO: How to Manage Your Benefits Online
Need to see a doctor? The first step is to find one in your network. PEHP has three provider networks, Summit, Advantage, and Preferred. Not sure which is yours? Log in to your online personal account and click, "See What I'm Enrolled In."
Visit in-network doctors and medical providers to be sure to get the best benefit. Use our provider search to find doctors, hospitals, and clinics near you. You'll also see reviews from actual PEHP patients, as well as costs estimates and cautionary notes.
Some plans may pay limited benefits for providers not on your network (learn more), but you often end up paying more out-of-pocket. However, PEHP doesn’t pay for any services from certain providers, regardless if you have an out-of-network benefit.
Will my plan pay for the service I need? Will I be required to cover part of the bill?
Find the answers in your Benefits Summary and Master Policy. Benefits summaries provide an overview of how PEHP covers specific services. Master policies contain detailed benefit information, terms, and conditions. Access these books when you log in to your online personal account (see your Benefit Information Library).
» VIDEO: Understanding Your Benefits Summary
Your Benefits Summary will tell you which services require preauthorization. To get preauthorization, call PEHP at 801-366-7755 or 800-753-7754. It’s important not to forget this step. Failure to preauthorize may result in a reduction in benefits, or your claim may be denied entirely. This list shows some common services that require preauthorization. Learn More.
Present your PEHP card at the time of service. New members will get a card shortly after enrollment. You won't be issued a new card unless the information on it changes. If you lose your card or need additional copies, call PEHP at 801-366-7555 or 800-765-7347.
Disagree with PEHP’s action on a claim? Request a review by writing to the PEHP Appeals and Policy Management Department within 180 days.
The coordination of benefits (COB) provision applies when you or your dependents have coverage with more than one health benefit plan. The purpose of coordinating benefits is to avoid duplication of insurance payments. It involves determining which insurer is required to pay benefits as the primary payer, which insurer must pay as the secondary payer, and so on, until all insurers are considered in the correct payment order.
You must inform PEHP of other medical and/or dental coverage in force by completing a duplicate coverage form. If applicable, you may be required to submit court orders or decrees. You must also keep PEHP informed of any changes in the status of the other coverage.
When PEHP is the primary plan, eligible benefits are paid before those of the other health benefit plan and without considering the other health plan’s benefits.
When PEHP is the secondary plan, PEHP calculates the amount of eligible benefits it would normally pay in the absence of other coverage, including the application of credits to any policy maximums, and applies the payable amount to unpaid covered charges after eligible benefits have been paid by the primary plan. This amount includes deductibles and co-payments you may owe. PEHP will use its own deductible and co-payments to calculate the amount it would have paid in the absence of other coverage. In no event will PEHP pay more than the member is responsible to pay after the primary carrier has paid the claim. COB will be administered in accordance with Utah Insurance Code, R590-131-5.
For complete information about your PEHP plan, see your applicable benefits summary and master policy.