Question 1

What is a premium, and how does it work?

Accepted Answer

A health insurance premium is an amount that policyholders pay monthly out of pocket for health coverage. A portion or all is often paid by the employer depending on the organization. After completing a Baseline Visit within 120 of activation with Curative, that’s the only price you and/or your employer will pay for comprehensive in-network services and preferred prescriptions.

Question 2

What is a deductible, and how does it work?

Accepted Answer

A deductible is an amount you pay for out-of-pocket costs for your covered health care before your plan begins to pay. If you complete a Baseline Visit within 120 days of activation with Curative, you’ll have a $0 deductible for all in-network services.

Question 3

What is an allowable amount?

Accepted Answer

The allowable amount is how much your health insurer will pay for a covered health care service. For in-network services and prescriptions, this is the cost that Curative and in-network providers have agreed upon for the procedure or service. If you complete your Baseline Visit within 120 days and are receiving an in-network service, you won’t have to worry about this cost. The maximum allowable amount for out-of-network services is a percentage of Medicare pricing that Curative has determined as our reimbursement policy for the procedure or service. If your provider charges more than Curative’s allowed amount and you have not completed a Baseline Visit or you’re receiving out-of-network care, you may have to pay the difference.

Question 4

What is a copay, and how does it work?

Accepted Answer

A copay is a fixed flat fee a patient pays their provider before receiving a healthcare service. If you complete a Baseline Visit with Curative, there are no copays for all in-network services and preferred prescriptions. Goodbye surprise bills.

Question 5

Will I always have a copay, deductible and/or coinsurance?

Accepted Answer

During your first 120 days with Curative, all copays, deductibles, and coinsurance will be waived for in-network services. Then, if you complete your Baseline Visit within those first 120 days, all medical in-network copays, deductibles, and coinsurances will continue to  be $0. Maximum visits, limitations, and tiered Pharmacy benefits will continue to apply. Please refer to the Benefits Summary for your Plan for any applicable deductible, copay, or coinsurance information.

Question 6

What does estimated cost mean?

Accepted Answer

Estimated cost is your cost is based on a) how much “out-of-pocket” you are responsible for, based on whether you’ve met your deductible and/or out-of-pocket maximum, and b) the copays and coinsurance percentage the plan has specified for the given procedure or service.  If you complete your Baseline Visit within 120 days of plan and are receiving in-network care, your estimated cost will be $0.  Curative’s estimated cost for out-of-network care is the difference between the maximum allowable amount and your estimated cost for the procedure or service. You can see estimated costs for 500 medical procedures using Curative’s Care Cost Estimator.

Question 7

What does out-of-pocket mean?

Accepted Answer

Out-of-pocket refers to your expenses for medical care that aren't reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered. If you complete your Baseline Visit with 120 days and are receiving in-network care or preferred prescriptions, you’ll have $0 out-of-pocket costs.

Question 8

What does cost-sharing mean?

Accepted Answer

Cost-sharing is a term that refers to the amount of money you will pay for health care services under your health plan. Cost-sharing factors in deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered.

Question 9

What are preferred and non-preferred drugs with Curative?

Accepted Answer

The Curative formulary (list of drugs covered by the health plan) includes preferred and non-preferred drugs. Preferred drugs treat almost all clinical conditions and were selected by our Pharmacy team as the most clinically- and cost-effective, including generic, brand name, and specialty drugs, Non-preferred drugs are available with either a $50 or $250 copay.

Question 10

What is an Explanation of Benefits (EOB), and how do they work?

Accepted Answer

An Explanation of Benefits (EOB) is our the health plan’s  written explanation regarding a claim. An EOB shows what Curative paid, what the member owes, and other helpful information, such as how to seek support. An EOB is not a bill. Get your Baseline Visit within 120 days and access in-network care, and your EOB will show your $0 benefit.

Question 11

Is my EOB a bill?

Accepted Answer

No, an EOB is not a bill.  The Explanation of Benefits (EOD) is our company’s written explanation regarding a claim. With Curative, your EOB will show  $0 copays, deductibles, and co-insurance if you complete your Baseline Visit within 120 days.

Question 12

What's the difference between in-network and out-of-network? How can I tell what’s In-Network?

Accepted Answer

In-network means a health care provider contracted with Curative, which allows them to be at a higher level of benefit coverage than it provides for out-of-network services. In-network services are $0 if you complete a Baseline Visit within the first 120 days.  Out-of-network means a provider has not contracted with your Curative, which means they are s a lower level of benefit coverage and you will be subject to out-of-pocket costs l. Please visit the curative.com/get-care to determine if a Provider is In-Network.

Question 13

What is the difference between walk-in clinics, urgent care (including virtual), and the emergency room (ER)?

Accepted Answer

With Curative, you’ll have the option to utilize walk-in clinics, urgent care (in-person and virtual), and visit the emergency room. Walk-in clinics are places where people can seek basic medical care for minor illnesses and injuries, such as cold and flu-like symptoms or minor skin conditions. Some walk-in clinics also offer select immunizations and testing.

Urgent care centers cater to medical conditions that are not considered emergencies but still would lead a person to believe timely care is necessary to avoid serious deterioration of the condition or a person’s health. They’re similar to walk-in clinics, but with additional capabilities! Virtual urgent care means you’ll have access to an interactive virtual office visit with an on-demand urgent care doctor.

Emergency care means healthcare services provided in a hospital emergency facility (for example, an emergency room), freestanding emergency medical care facility, or comparable emergency facility to evaluate and treat emergency medical conditions.

If you are experiencing a medical emergency, please call 911 or visit your nearest emergency room. For anything less severe than an emergency, use clinics urgent care centers.

Question 14

What is considered Medically Necessary?

Accepted Answer

Medically Necessary/Medical Necessity means the healthcare services needed to diagnose or treat an illness, injury, condition, disease, or its symptoms that meet medically acceptable screening criteria used by Curative.

Question 15

What is prior authorization?

Accepted Answer

Sometimes, before receiving a service or prescription, a provider will want to ensure that it’s covered by your insurance. Prior authorization means that your health plan will review the services or prescriptions requested from a provider for medical necessity and coverage.

Question 16

What types of medical treatments and medications may need prior authorization?

Accepted Answer

Please refer to the Benefit Booklet or call Curative Members Services at (855) 428-7284 to determine the types of services that require prior authorization.
Some prescriptions require prior authorization, as well. Prior authorizations are required to ensure a drug's appropriate use, including safety and efficacy.  A list of the prescriptions that require prior authorization is available at curative.com/pharmacy, or you can contact Curative Member Services at (855) 428-7284.

Question 17

Why does Curative require prior authorization?

Accepted Answer

Only certain services require advanced approval (prior authorizations) by Curative. Prior authorization ensures that services are  medically necessary and appropriate.

Question 18

How do I get prior authorization?

Accepted Answer

To satisfy prior authorization requirements, you and your providers must call Curative Member Services at (855) 482-7284.  A Clinical Care Coordinator from our team will follow up with your provider’s office.

Question 19

Is prior authorization required in emergency situations?

Accepted Answer

No. However, providers can submit any urgent prior authorization requests by calling Curative Member Services at 855-428-7284 or by providing a written request when the Member needs emergency care. Curative will respond to the request within one (1) working day by telephone or electronic transmission notifying the provider, followed by a letter within (3) working days notifying the patient and the provider.

Question 20

What is an Adverse Determination?

Accepted Answer

Adverse determination is when a treatment or service is deemed not medically necessary or appropriate, or is experimental or investigational.

Question 21

What is a medical claim? When, how, and why should I submit one?

Accepted Answer

A medical claim is a request for payment that your healthcare provider sends to Curative. Your provider should submit, and Curative should receive all claims for benefits within 180 days of the date on which you received the service unless the network contract dictates differently or the date a primary payer finalizes their claim submission. Out-of-network providers may not submit a claim and you will need to submit the claims directly with a detailed receipt. Please refer to the Benefit Booklet to learn more about the submission process or reach out to Member Services.

Question 22

What is a Qualifying Life Event?

Accepted Answer

A Qualifying Life Event is a change in your circumstances  — for example, you got married or welcomed a new child — that would make you eligible for special enrollment outside of the year’s open enrollment period. You have 31 days from the date of a Qualifying Life Event to notify your employer and change your plan elections.  If you do not make the changes during the 31-day status change period, your changes cannot be made until the Annual Enrollment period for your plan to be effective on the next plan year’s effective date. Please refer to the Benefit Booklet for more information about qualifying life events.

Question 23

What healthcare decisions do I need to make when I get pregnant?

Accepted Answer

Curative covers maternity related expenses for Participants.  Maternity care includes diagnosis of pregnancy, pre- and post-natal care, and delivery.  Curative covers inpatient care for the mother and newborn child in a healthcare facility for a minimum of 48 hours following an uncomplicated vaginal delivery and for a minimum of 96 hours following an uncomplicated delivery by Cesarean section.  Concurrent reviews will be required for prolonged stays exceeding the standard coverage period.

Question 24

What healthcare decisions do I need to make for newly adopted children?

Accepted Answer

If you are eligible for coverage, you may include your dependents.  If you and your spouse or domestic partner are both eligible employees for your Employer’s plan, then your children may be covered as dependents of either parent, but not both.  In addition, a spouse or domestic partner that is an eligible employee for your Employer’s plan may not be covered as a dependent. Adopted children are considered eligible dependents under the plan.

To enroll your newly adopted child in your health care plan, please see the Benefit Booklet for steps on enrolling due to a qualifying life event, which must be done within 31 days of the event.

Question 25

What is a Baseline Visit with Curative and why does Curative require it for full benefits?

Accepted Answer

The Baseline Visit is an in-person meeting with a Care Navigator and Curative Clinician to onboard you toCurative, understand your health goals, and how we can best work with you to meet your current and future healthcare needs. The Baseline Visit will also include an Evaluation of Preventive recommendations indicated by the United States Preventive Services Task Force (USPSTF) and evaluate whether your immunizations are up to date, all designed to keep you healthy.

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Health Insurance 101

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