Give our customer service department a holler. There are a few ways to reach out:

Our customer service team is available Monday-Friday 8AM - 5PM (MST)

Looking for a doctor? We make it easy with our Find a Doctor directory.

Members are not required to select a primary care physician (PCP) or notify St. Luke’s Health Plan of a change in PCP. However, we do recommend members have a PCP to help coordinate care and ensure they are receiving the proper guidance and preventive services.

Hey, it happens! Request a new card through MyChart, your member portal, and we’ll send you a new one in the mail. If you're an iPhone user, you can also download your ID card to your Apple digital wallet.

Log into MyChart, your member portal—you’ll find all of your current claims there.

Your St. Luke's Health Plan member portal is MyChart. To find your benefit information, open the menu in the upper left corner, scroll to the Insurance section, select "Insurance Summary" and then select "View Coverage Details".

You can log in to MyChart on your computer or use the MyChart mobile app (available in the Apple or Android store).

Sure thing. Specific life events, like losing a job or a loved one, may qualify you for Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits. Contact [email protected] for more information.

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.

St. Luke’s Health Plan does not require a referral for members to see a specialist. This applies to both in-network and out-of-network specialists. However, it’s important to note that members receive reduced benefits when going out-of-network, meaning it will cost more out-of-pocket. If a member believes that necessary services are not available within the network, the provider can submit a Higher Level of Benefits Waiver request on behalf of the member.

You bet! St. Luke’s On-Demand Virtual Care visits have a $0 copay for St. Luke’s Health Plan members. Virtual Care brings local health care professionals to you, making it quick and easy to get care for common concerns like sore throat, sinus issues, back pain and the flu. It’s available to members in Idaho, Oregon, Washington, Utah, Nevada, Arizona and California, every day with extended hours.

Of course! Those fall under our $0 preventive care coverage.

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.

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.

• Prior authorization: Sometimes known as “pre-authorization,” prior 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.”

This varies depending on your plan. Please refer to your plan documents or contact Customer Service if you have any questions about what services require authorization. Find your plan documents.

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.

Members can utilize the Prior Authorization Request Form.

Our pharmacy network is broad, and you can find a pharmacy near you with our pharmacy directory. Specialty medications must 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 208-205-7779. For your maintenance medication needs, please call St. Luke’s Pharmacy – Home Delivery at 208-706-6245 or visit our website to enroll.

Probably! We partner with nearly all chains and independent pharmacies to supply the medication you rely on. We recommend you double-check that your pharmacy is listed in our pharmacy directory or call us at 1-833-975-1281.

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.

St. Luke’s Health Plan will periodically add medications to the formulary. However, St. Luke's Health Plan will not remove medications in the middle of the plan year.

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.

Many of our plans offer $0 co-pays on commonly prescribed generic medications. These medications are on tier 1 of the Prescription Drug List. In addition, we offer some preventive medications at $0 on all plans. These medications are identified with ACA on the Prescription Drug List. Some exceptions may apply, please refer to plan documents for specifics.

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.

St. Luke's Pharmacy - Home Delivery serves the St. Luke's Health Plan. No more waiting in lines at the pharmacy for your maintenance medications.

It can save you money on your brand and generic medications. You can get up to a 100-day supply of your generic maintenance medications for the price of a 60-day supply filled with St. Luke's Home Delivery. Please call 1-208-706-6245 or visit our Home Delivery website for more information about how to enroll.

Specialty medications are high-cost medications used to treat complex 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.

Specialty medications must be filled through St. Luke’s Specialty Pharmacy. The St. Luke’s Specialty Pharmacy offers best-in-class care and support. To learn more, call 1-208-205-7779.

St. Luke's Health Plan does not require High Deductible Health Plan (HDHP) participants to meet their deductible prior to covering medications in some 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. These medications are designated as "PREV" in the Prescription Drug List. Medications in the following categories are included:

• Anticonvulsants
• Asthma and COPD
• Brand Contraceptives
• Cardiovascular (including cholesterol, blood pressure and blood thinners)
• Diabetes (Insulin, Non-Insulin, and Test Strips)
• Mental Health (antipsychotics and antidepressants)
• Osteoporosis

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.

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.

At St. Luke’s Health Plan, we are dedicated to providing top-notch customer service. At any point, if you are unhappy with the service you receive, you have the right to file a grievance. A grievance is an expression of dissatisfaction with the service you receive from St. Luke’s Health Plan, except for a coverage determination. If you disagree or are unhappy with a decision about your coverage, you should file an appeal rather than a grievance. A grievance may also be called a complaint.

Grievances can be submitted by telephone at 1-833-840-3600 or in writing. We encourage you to use the Grievance Form, but use of this form is not required.

An appeal is a request that St. Luke’s Health Plan reconsider a decision that was made about your coverage. For example, if we denied a prior authorization request or claim, and you disagree with that denial, you have the right to file an appeal.

If you have more questions about the grievance or appeal process, call Customer Service at 1-833-840-3600. Our team is available Monday through Friday from 8 a.m. to 5 p.m.