FAQ & MEMBER SUPPORT
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Frequently Asked Questions.
Have questions? We're here to help.
Ask us anything.
How can I talk to a person?
Give our customer service department a holler. There are a few ways to reach out:
Give us a ring at 1-833-478-5853
Our customer service team is available Monday-Friday 8AM - 5PM (MST)
Send us an email at [email protected]
If you're reaching us after hours (or just don't feel like talking), send us an email and we'll get back to you within 24 hours.
How do I find out if my doctor is in your plan?
Looking for a doctor? We make it easy with our Find a Doctor directory.
I lost my ID card. Can I get a new one?
Hey, it happens! In our member portal, you can print a temporary card to have on hand while you wait for a new one to arrive. Request a new card through the Member Portal and we’ll send you a new one in the mail.
How can I check a claim?
Log into the Member Portal—you’ll find all of your current claims there.
Where can I see my benefits online?
Log in to the Member Portal and navigate over to the Covered Benefits section.
How do I find out about the benefits that are specific to my plan?
Refer to the coverage documents in your Member Portal for information specific to your coverage plan.
I need to sign up for COBRA. Does St. Luke’s Health Plan offer that?
Sure thing. Specific life events, like losing a job or a loved one, may qualify you for Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits. Check your Member Portal documents for more details about COBRA for your plan.
How long does it take for coverage to kick in?
If you enroll during the annual open enrollment period, your coverage kicks in on January 1. Outside of open enrollment, coverage starts the first day of the month after you complete the enrollment process.
Which benefits are 100% covered?
$0 in-network primary care physician visits
$0 in-network preventive care
$0 in-network maternity care
$0 preventive prescription drugs
$0 preferred generic drugs on most plans
Check your complete list of benefits in your Member Portal.
Is virtual care covered?
You bet! St. Luke’s Health Plan offers virtual appointments for both regular checkups and urgent care visits. Our patients like our virtual care services so much that they’ve given them a 96 percent satisfaction rate.
Will my flu shot and COVID-19 vaccine be covered?
Of course! Those fall under our $0 preventive care coverage.
Do I have to get pre-authorization for procedures?
St. Luke’s Health Plan is committed to ensuring members receive health care that is high-quality, medically necessary and cost-effective. That’s why we require authorization for certain services before, during or after the services are rendered. See below for more information about authorization and how it could impact you as a member.
What is an authorization request?
An authorization request is when a member or health care provider asks St. Luke’s Health Plan to cover a specific health care service, item or medication. During the authorization process, we evaluate the request to decide if it is a covered benefit and if it is medically necessary. An approved authorization means we agree the service is medically necessary and should be covered according to the benefits.
What are the different types of authorizations?
- Pre-authorization: Sometimes known as “prior authorization,” pre-authorization is a request for coverage before services are rendered. This process is most often used for non-emergent situations, like elective surgeries.
- Concurrent Review: A concurrent review is performed while a member is actively receiving care. St. Luke’s Health Plan performs periodic concurrent reviews on all inpatient stays, including admission to a hospital or skilled nursing facility.
- Postservice Authorization: A postservice authorization is a request for coverage after services are rendered. This type of authorization is most often used for emergency situations, where it would be dangerous to wait for an authorization approval before proceeding with treatment. Postservice authorizations are also sometimes called “retrospective authorizations.”
What services require authorization?
This varies depending on your plan. Please refer to your plan documents or contact Customer Care if you have any questions about what services require authorization.
Who is responsible for obtaining authorization?
In general, your health care provider will take the necessary steps to request authorization from St. Luke’s Health Plan. Sometimes members have to submit their own authorization requests, particularly when utilizing providers that are out-of-network on their plan. It is important to obtain an authorization when required, because failure to do so can result in denied or reduced benefits.
How can a member or provider submit an authorization request?
Providers can submit authorization requests electronically through the St. Luke’s Health Plan Provider Portal. Members can utilize the Pre-authorization Request Form.
Do I have to go to certain pharmacies to fill my medications?
Our pharmacy network is broad, and you can find a pharmacy near you with our pharmacy directory. Most specialty medications are required to be filled through St. Luke’s Specialty Pharmacy. The St. Luke’s Specialty Pharmacy offers best-in-class care and support. To learn more about the preferred specialty pharmacy, call 1-208-205-7779. For your maintenance medication needs, please call St. Luke’s Mail Order Pharmacy at 1-208-706-6245 for more information about how to enroll for mail order services.
Can I use my existing pharmacy on the St. Luke’s Health Plan?
Probably! We partner with nearly all chains and independent pharmacies to supply the medication you rely on. To be sure, we recommend you double-check that your pharmacy is listed in our pharmacy directory or call us at 1-833-975-1281.
What medications does my plan cover?
The list of covered drugs is commonly referred to as a drug formulary or Prescription Drug List (PDL). The medications covered by St. Luke’s Health Plan are described in our Prescription Drug List. You may also search Your Health Idaho to find covered medications.
How much are my medications?
The cost of your medications depends on your plan and the tier your medication is placed on. Please see your plan documents for the pricing of your medications. Our plans have five tiers: Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, and Specialty. The lowest tier (tier 1) will have the least expensive copay. The highest tier (tier 5) will have the most expensive copay. If you have questions about the cost of your medications, please call 1-833-975-1281.
Are any of my medications free?
Most commonly prescribed generic medications are $0 on many of our plans. These medications are on tier 1 of the Prescription Drug List. Some exceptions may apply, please refer to plan documents for specifics.
What if my medication requires prior authorization?
If your medication requires prior authorization, your doctor will need to send additional information to St. Luke’s Health Plan prior to the plan covering the medication. This is to help save you money and ensure we are safely using medications. Refer to the Prescription Drug List for a list of medications that require prior authorization. Please ask your doctor to call 1-833-975-1281 to obtain the required forms to start the prior authorization process.
Can I have my medications mailed to me?
The St. Luke’s Mail Order pharmacy serves as the mail order service for the St. Luke’s Health Plan. No more waiting in long lines at the pharmacy for your maintenance medications.
St. Luke’s Mail Order pharmacy can save you money on your maintenance medications. You can get up to a 100-day supply of your maintenance medications for the price of a 60-day supply filled at St. Luke’s Mail Order pharmacy. For your maintenance medication needs, please call the St. Luke’s Mail Order Pharmacy at 1-208-706-6245 for more information about how to enroll for mail order services.
What is a specialty medication and how do I get access to specialty medications?
Specialty medications are high-cost medications used to treat rare or complicated conditions such as cancer, rheumatoid arthritis, and multiple sclerosis, to name a few. Specialty medications are listed as tier 5 on the Prescription Drug List.
Most specialty medications are required to be filled through St. Luke’s Specialty Pharmacy. The St. Luke’s Specialty Pharmacy offers best-in-class care and support. To learn more about the preferred specialty pharmacy, call 1-208-205-7779.
I have a high deductible health plan, how do I afford my medications?
St. Luke's Health Plan does not require High Deductible Health Plan (HDHP) participants to meet their deductible prior to covering drugs in some drug categories. If you are enrolled in an HDHP, you will not have to meet your deductible before the Plan contributes to the cost of your prescription for medications listed in the categories below. Refer to the Prescription Drug List for a list of medications in the following categories:
- Asthma and COPD
- Blood Thinners
- Brand Contraceptives
- Diabetes (Insulin, Non-Insulin, and Test Strips)
What is step therapy?
Certain medications require you to have already tried an alternative medication preferred by St. Luke’s Health Plan. This process is called “step therapy.” The alternative medication is generally a more cost-effective therapy that does not compromise clinical quality. If your doctor feels that the alternative medication does not meet your needs, St. Luke’s Health Plan may cover the medication without step therapy if St. Luke’s Health Plan determines it is medically necessary. Please ask your doctor to call 1-833-975-1281 to obtain the required forms to start the step therapy process.
What is a quantity limit?
Sometimes the Plan may cover only a certain amount of medication. If your doctor prescribes more than this limit, they may submit a prior authorization to request an exception. Please ask your doctor to call 1-833-975-1281 to obtain the required forms to start the prior authorization process.
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