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 coinsurance, and how does it work?

Accepted Answer

Coinsurance is the amount a patient pays for a covered service after their deductible has been met. If you complete a Baseline Visit within the first 120 days of activation with Curative, you don’t have to worry about coinsurance because you’ll have no deductibles for in-network services.

Question 5

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 health care 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 6

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 7

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 8

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 9

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 10

What are preferred and non-preferred drugs with Curative?

Accepted Answer

The Curative formulary (list of drugs covered by the health plan), available for download on our Drug Search Tool, 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 11

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 12

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 13

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 at a lower level of benefit coverage and you will be subject to out-of-pocket costs. Please visit curative.com/get-care to determine if a Provider is In-Network.

Question 14

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. or 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 health care 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 15

What is considered Medically Necessary?

Accepted Answer

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

Question 16

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 17

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 18

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 19

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 20

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 21

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 22

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 health care 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 23

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 24

What health care 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 health care 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 25

What health care 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 26

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 to Curative, understand your health goals, and how we can best work with you to meet your current and future health care 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.

Question 27

I am a member but I do not see where I can log in on this website. Where do I find access to my member benefits, coverage, etc?

Accepted Answer

All members can log in through the member portal.

Question 28

How and when can I get in touch with customer service?

Accepted Answer

We’re here to help! Customer service can be reached at curative.com/support or through our help line at 855-428-7284 or health@curative.com.

Question 29

How can I get a new ID card?

Accepted Answer

For a new ID card, please visit curative.com/for-members/contact. Feel free to call out help line at 855-428-7284 or email us at health@curative.com

Question 30

How do I change or update my name, address, or other contact information?

Accepted Answer

Members should notify both Curative and their employer to change any important account information. To let us know, please call customer support at 855-428-7284 or health@curative.com.

Question 31

If I am discontinuing employment with my employer, will my health insurance coverage continue?

Accepted Answer

Employees often use the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) or similar state laws to continue existing health insurance coverage after termination of employment. Your employer can help you determine eligibility and navigate the process. If you are changing jobs, inquire about Curative insurance with your new employer.

Question 32

How can I cover my newborn from birth?

Accepted Answer

Congratulations on your newborn! When a child is born, they are covered automatically for 30 days. To cover afterwards, they need to be enrolled through your employer within 31 days of birth.

Question 33

Are adopted children eligible for coverage? If so, how do I add an adopted child?

Accepted Answer

Congratulations on the new addition to your family! Yes, adopted children need to be enrolled within 31 days of adoption. Please contact your employer’s HR and benefits department for adding an adopted child.

Question 34

How do I add or remove family members from my plan?

Accepted Answer

To add or remove family members, please visit your employer’s enrollment system. All enrollment changes must go through your employer’s HR and benefits department as they will determine whether a family member can be added or removed and any cost share changes as well as how to add or remove family members. Typically changes may be made outside of open enrollment only following special enrollment or other qualifying events determined by the employer. In that case, typically, the change to enrollment must take place within 31 days of the qualifying event and will take effect upon enrollment, but may be backdated to the first of the month or date of the event. Please first contact your employer to make changes to your plan.

Question 35

What is a Baseline Visit?

Accepted Answer

To get the most out of your membership, every member is encouraged to participate in a Baseline Visit that can be used to tailor an individualized plan for finding services from Curative and network providers. By doing so, you are eligible for the full benefit of $0 co-pays and deductibles as long as you stay in-network. The Baseline Visit is a meeting with a Curative Clinician to onboard you to the Curative Health Plan, understand your health goals and how we can best work with you to meet your current and future health care 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.

Question 36

Why should I get a Baseline Visit?

Accepted Answer

The individualized attention from the Baseline Visit focuses on your complete wellbeing and how to get help from your health plan’s benefits and resources. The Baseline Visit can provide you with information to help you understand your current health and potential risks, and may also be used to offer you services or resources through the health plan. By collaborating with your provider to focus on your physical, mental, social, emotional, and environmental health, you are in greater control of your health care outcomes.

Question 37

What happens if covered members do not receive a Baseline Visit?

Accepted Answer

We encourage all members to complete their Baseline Visit! If members do not complete a Baseline Visit within 120 days after enrollment, they will be responsible for the deductible and coinsurance listed in the Benefits Booklet for both medical services and pharmacy.

Question 38

What is Curative’s Care Cost Estimator?

Accepted Answer

As part of an effort to reduce health care costs, the federal government has rolled out a series of regulations related to providing more transparency around how much insurers and members pay for specific procedures. One of the requirements under Transparency in Coverage (TiC) regulations is to provide an internet-based tool to allow members to look up prices for procedures in their area. Curative’s Care Cost Estimator tool enables members to compare prices of 500 medical procedures among providers in the Austin area. The TiC tool can be found on the member portal.

Question 39

I am a new Curative health plan member. Before receiving my ID card, I needed to go to the doctor, and my physician required me to pay for the appointment out of pocket. How do I submit a claim?

Accepted Answer

Most claims will be processed through your provider. If you need to file a claim individually, claim forms will be available through our customer service line: 855-428-7284. Upon receipt of your member ID, ask your provider to resubmit your claim to Curative and once paid, your provider can refund any additional out of pocket costs. Your member information will also be available on the Curative portal upon enrollment, and can be used if you need a prescription prior to receiving your physical card.

Question 40

Where do I file a claim for medical care received outside the United States?

Accepted Answer

At this time, no services outside of the United States are eligible for coverage. If a member is traveling outside of the United States, it is in their best interest to buy a travel plan for that region. For more information, please contact member services at 855-428-7284.

Question 41

How do I receive medical care and prescriptions outside of the Austin area?

Accepted Answer

If you need to receive medical care or prescriptions when outside the Austin area, you can reach out to member services for further clarification on your coverage options at 855-428-7284.

Question 42

Who do I contact when I have billing questions, need to get claim forms or talk to if a claim has been rejected?

Accepted Answer

Members can reach out to member services at 855-428-7284.

Question 43

I was denied coverage, a claim, or received an erroneous charge on my Explanation of Benefits (EOB), whom do I contact?

Accepted Answer

Members can reach out to member services at 855-428-7284.

Question 44

Are there any health services that require prior authorization (PA)?

Accepted Answer

Prior authorization (PA) is a utilization management process used by some health insurance companies in the United States to determine if they will cover a prescribed procedure, service, or drug. For Curative, there is a list of services that require PA in the Benefits Booklet. drugs that require prior authorization are listed here. This list will also be available to providers through their provider manual. Network Providers are responsible for contacting Curative for PA when required.

Question 45

What are the steps required to obtain prior authorization (PA)?

Accepted Answer

Typically, providers request PA. Network Providers are responsible for contacting Curative. For out-of-network providers, the provider must submit the request for PA. A standard state form can be submitted via fax or they can use the Curative form. This information is available in the provider manual that will be available on our website. For Pharmacy PAs, providers will submit a form to the Pharmacy Benefits Managers for review. A list of drugs requiring PA are available here.

Question 46

Does Curative’s health plan cover the cost of blood work?

Accepted Answer

We are happy to cover the cost of blood work, as long as it is medically necessary as stated in the Benefits Booklet.

Question 47

I’m working with an out-of-network lab. Do I have out-of-network lab coverage?

Accepted Answer

Curative’s Benefits Booklet will explain coverage for out-of-network labs, including deductibles and co-insurance.

Question 48

What percentage of in-network diagnostic laboratory services are covered by my plan?

Accepted Answer

If deemed medically necessary and the Baseline Visit is completed, these services will be covered with $0 out-of-pocket costs.

Question 49

What are the costs associated with advanced specialty testing?

Accepted Answer

If deemed medically necessary, any required prior authorizations are approved, and the Baseline Visit is completed, advanced specialty testing from Network Providers will be covered with $0 out-of-pocket costs. Out-of-network services will have deductible and coinsurance requirements listed in the Benefits Booklet.

Question 50

What does Curative’s health plan cover?

Accepted Answer

Please visit curative.com for coverage details.

Question 51

What would be deemed a preventive service?

Accepted Answer

We believe preventive care is a crucial part of overall health and offer preventive services as detailed in our benefits booklet and aligned with the United States Preventative Health Services Task Force. Preventive care helps detect or prevent serious diseases and medical problems before they can become major. Annual check-ups, immunizations, as well as certain tests and screenings, are a few examples of preventive care. This may also be called routine care.

Question 52

What copays and deductibles are included with Curative’s health plan?

Accepted Answer

Please see the benefit summary in the benefit booklet.

Question 53

Does Curative’s health plan cover dental and vision?

Accepted Answer

Curative’s health plan currently does not cover dental and vision, but we are working to offer these services in the future.

Question 54

Does Curative’s health plan cover orthodontic care?

Accepted Answer

Curative’s health plan currently does not cover orthodontic care, but we are working to offer these services in the future.

Question 55

Does Curative’s health plan cover acupuncture and massage?

Accepted Answer

Acupuncture is covered for musculoskeletal diagnoses. While Curative’s insurance does not cover massages, massage services are planned to be available at the Curative Commons.

Question 56

Does Curative’s health plan cover mental health services?

Accepted Answer

Curative believes that mental health and physical health are deeply intertwined. Mental health services are covered for office visits, and inpatient and outpatient services, just as they would any other medical services. All inpatient and certain outpatient treatment for behavioral health should be Prior Authorized by calling Curative Member Services at 855-428-7284. For more information, please visit the Benefits Booklet.

Question 57

How do I know if I need a referral to see a specialist?

Accepted Answer

At Curative, we don’t require referrals for specialist visits.

Question 58

How is the formulary or preferred drug list (PDL) created?

Accepted Answer

The formulary is developed based on the recommendation of a committee made up of physicians and pharmacists. The committee meets quarterly to evaluate the current formulary and to make recommendations on new drugs that are approved by the Food and Drug Administration (FDA) or on existing drugs that have new generics, new strengths, or new dosage forms available. The drugs selected for the formulary are based on a variety of factors, including safety, efficacy, and cost. Therefore, updates to the formulary may take place quarterly; if your drug is not available on the formulary today, it may be available in the future. Continue to check our website for any formulary updates.

Question 59

Can I use any pharmacy to fill or refill my prescription?

Accepted Answer

While you are able to fill your prescription at any licensed pharmacy, you can maximize your coverage by staying in-network. If you use an in-network pharmacy, you will pay $0 for preferred drugs and covered services and a fixed copay of either $50 for Tier 2 or $250 for Tier 3 drugs. If you use a pharmacy that is not in-network, you will be subject to paying out-of-pocket until you reach your deductible, and then a coinsurance of 50% will apply. To transfer prescriptions to an in-network pharmacy contact the in-network pharmacy you want to transfer your prescriptions to. You can contact Curative Pharmacy at 1-833-4-Curative.

Question 60

How do I transfer my prescription(s) to Curative Pharmacy?

Accepted Answer

You can also call Curative Pharmacy at 1-833-4-Curative.

Question 61

What is Curative’s drug formulary and how do I access it?

Accepted Answer

Curative’s drug formulary is a list of drugs that Curative covers. Curative’s Pharmacy and Therapeutics Committee consists of a group of physicians and pharmacists who determine the list. Here’s a link to the formulary: curative.com/drugs.

Question 62

What is the cost of prescription drugs with Curative’s plan?

Accepted Answer

If you use an in-network pharmacy, you can receive drugs on our preferred drug list for a $0 copay, and fixed copays for non-preferred drugs. Here’s a more detailed link to our formulary which is a list of covered drugs: curative.com/drugs.

Question 63

What is a preferred drug? What is a non-preferred drug?

Accepted Answer

Preferred drugs are selected by the P&T committee that are deemed safe, effective, and low cost. Our formulary offers preferred drugs to treat most diseases.

Non-preferred drugs may also be effective, but the P&T committee has found other options to be more beneficial.

Question 64

What is a brand name drug? What is a generic drug?

Accepted Answer

A generic drug is a drug created to be the same as an already marketed brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use.

A brand name is a drug sold by a drug company under a specific name or trademark and that is protected by a patent. Brand name drugs may be available by prescription or over the counter.

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Baseline Visit

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Employer Portal

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