Health Care 101
We know that health insurance can be a difficult topic to understand. So we've gathered the information needed to answer your questions and provide you with a one-stop shop for your FirstCare-related and general health care questions.
You've got questions, and we've got answers. We're here to help.
Click on any of the topics below for more details:
How Does Health Insurance Work?
This quick video, courtesy of Kaiser Permanente, explains health insurance using easy-to-understand terminology. It breaks down important insurance concepts, such as premiums, deductibles, provider networks, and how to pay for coverage and obtain medical care and prescription drugs when enrolled in various types of health insurance, including HMOs and PPOs.
“Health Insurance Explained – The YouToons Have It Covered,” The Henry J. Kaiser Family Foundation, accessed 02/25/2015, http://kff.org/health-reform/video/health-insurance-explained-youtoons/
How Does Your Plan Work?
||You pay until you reach the deductible.
The deductible is the amount you are responsible for paying for covered health care services. You will pay for all covered medical and pharmacy services until you reach your plan’s deductible amount. Once you've reached your plan's deductible, FirstCare will begin paying for covered heatlh services. Note: Unless stated in your plan documents, your plan's deductible typically does not include costs such as office visit copays.
||You and FirstCare share the cost for covered services.
After paying the deductible, your plan also includes coinsurance. Coinsurance is when you and FirstCare share the cost for covered services. For example, if FirstCare pays 80% of the cost for covered medical services, you will pay the remaining 20% for those services. Depending on your coverage, and the service(s) rendered, this coinsurance may also be subject to your plan’s deductible.
|Your Out-of-Pocket Maximum
||You are done paying.
If your deductible and coinsurance payments reach the plan’s out-of-pocket maximum, you are done paying. FirstCare will pay 100% of covered services for the remainder of your plan year. This limit is there to protect you and your covered dependents in case of a major medical event.
Need Help Choosing a Plan?
There are many factors to consider when selecting the health care coverage that is right for you.
We get it. That’s why we offer a broad range of affordable health plans designed to meet the needs of our friends, neighbors and fellow Texans. Our plans are simple to understand and use. We make it easy for our members to access the doctors, hospitals and health services in our communities. And, we provide exceptional service for our members. Because at FirstCare, we put you first.
You'll find more details and resource links to our plan information below. If you have questions, feel free to call our Customer Service team at 1.800.214.0502 and we'll be glad to get you the answers you need.
Individual & Family Plans
Are you looking for an individual or family plan? Here's a quick chart to show you the different types of health plans available and help you determine what type of plan best fits your needs:
Employer & Group Plans
If you are a business owner, FirstCare offers employee benefit solutions for companies of all sizes. We have group plan options to fit your needs, depending on your number of employees, the type of coverage you're looking for, and what funding options you prefer. Click on the links below for more information:
Already a FirstCare Member?
After selecting a plan, learn more about how you can use your FirstCare health care coverage to access the services you need, when you need them.
FirstCare Member Handbook
As a FirstCare member, your Member Handbook provides you with details about your plan, how to utilize the FirstCare network of physicians, and more. Click on the links below to access the Member Handbook for your plan:
Quick Reference Guides
Our priority is to provide you—the FirstCare member—with an exceptional health care coverage experience. These quick rerference guides are designed to provide information about your coverage and help you get the most out of your plan. Click on the links below to access the Quick Reference Guide for your plan:
Your FirstCare Member ID Card
Remember to carry your FirstCare member ID card with you at all times. You will need to show it to your provider(s) when you receive covered services. You card contains important informaiton, including your plan name, member ID number, copay/coinsurnace amounts, and customer service phone number(s) to call if you have questions. Below is a sample ID card. Information shown on your ID card may vary based on your plan benefits.
A sample of the FirstCare ID card is below...
To print a temporary copy of your ID card, please log on to our Member Self-Service Portal. You can also contact our Customer Service team and request your new card be mailed to you.
|Front of card
||Back of card
FirstCare members can access our self-service portal to access claims, print temporary ID cards, see current plan deductible/out-of-pocket maximum balances, select a PCP (where applicable), and more. Click on the links below to find out more:
Find a Provider/Pharmacy
Looking for a doctor in your area? FirstCare's online provider directory helps you locate a doctor or hospital in your area. You can also find links to view your plan's pharmacy directory. To get started click here.
For pharmacy information, FirstCare's pharmacy benefits manager (PBM) Navitus, makes it easy to get started using your prescription drug benefits.
for tips on accessing the Navitus portal, setting up mail-order prescription drugs, contact information for your prescription benefit questions, and a helpful FAQ.
Click on the following links to access details on your plan's prescription drug network:
What Does It Mean?—A Health Insurance Glossary
Health insurance terms and phrases can be confusing, so we've compiled a list to help you.
Click here for a list of commonly used terms that can help you understand your plan and ask the right questions about your coverage.
Health and Wellness—FirstCare Plus
Helping you stay healthy. That’s what FirstCare Plus is all about.
By combining personal health support with online tools and resources, you’ll have the tools to enhance your wellness experience:
- Take a customized health assessment.
- Check out any symptoms that are worrying you.
- Discover programs to help you take charge of your health and wellness.
- Expecting a child? Access our new Expecting the Best™ Maternity Program for information and educational tools.
FirstCare members can access FirstCare Plus (including our new Expecting the Best™
Maternity Program) here
for a link to guidelines for health screenings and immunizations, provided by
the Centers for Disease Control and Prevention (CDC).
Questions? Contact Us!
If you have any questions about your plan, your benefits, or FirstCare—our Customer Service team is standing by, ready to assist you.