FREQUENTLY ASKED QUESTIONS

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  • What is Open Enrollment?

    The yearly period anyone can enroll in a health insurance plan.

  • What is Special Enrollment?

    The time outside of Open Enrollment, you may be eligible to apply for coverage due to a Qualifying Life Event.

  • What is an ACO?

    ACO stands for accountable care organization. It’s a community of doctors, clinics and hospitals specifically focused on keeping you at your best health. You get the same coverage and benefits as you would from a traditional health plan, plus extra education and recommendations based on your condition, treatment plan and medications.

  • What's the difference between PreferredHealth and PreferredOne?

    PreferredOne is the company that pays your claims and makes sure your plan runs smoothly. PreferredHealth is the network of health care providers dedicated to your health.

  • What happens after I enroll?

    First, you’ll receive a welcome kit, which includes your ID cards and explains how to use your new health plan. Then, we’ll give you a call to introduce ourselves and answer any questions you may have about PreferredHealth.

  • Where can I view my claims, EOBs and plan information?

    My Account is your personal and secure web page with your claim history, deductible balances and links to all your plan features. Once you receive your ID card, go to PreferredOne.com and activate your My Account page.

  • Can I see my current doctor?

    If your doctor is in the PreferredHealth network, you may continue that relationship. If not, to receive the greatest benefit, you’ll need to choose a doctor who participates in the PreferredHealth network. We’re here to help you with that and we’ll make sure all of your records transfer to your new provider.

  • What doctors, clinics and hospitals are in the PreferredHealth network?

    M Health Fairview and North Memorial Health are in your network, along with several other clinics such as Apple Valley Medical Center, Entira Clinics, Voyage Healthcare (formerly called North Clinics) and Northwest Family Physicians. For a complete listing, go to Find a Doctor.

  • How many doctors, clinics and hospitals are in the PreferredHealth network?

    You can choose from over 5,000 doctors, 666 clinics, 11 hospitals, online care, urgent care and a number of convenience care locations.

  • Do I need a referral to see a specialist in the PreferredHealth network?

    You may see any PreferredHealth network provider without a referral. Search the network at PreferredOne.com/PH or, if you need help finding a specialist, call 763-847-4444 or 1-844-346-4414.

  • What if I see a provider outside the PreferredHealth network?

    You can get care outside of the network, however you won’t receive the highest level of coverage and some services may not be covered.

  • Can I get care online?

    Absolutely! Log into your member site. Our clinicians are available 24 hours a day to provide a diagnosis and treatment plan. If you need a prescription, they’ll send it right to your pharmacy.

  • What about urgent care?

    The PreferredHealth network includes retail convenience clinics such as CVS, Target and many urgent care centers.

  • Where can I view my benefits (deductible, coinsurance and copayments)?

    A Summary of Benefits and Coverage (SBC) provides benefit details and can be found at PreferredOne.com. After you receive your ID card and activate your personal My Account page on PreferredOne.com, you can view all of your plan documents.

  • Is preventative care covered?

    Yes, preventive care is covered at 100 percent, for certain preventive care services that members receive from participating providers. The ACA defines preventive services to include, for covered adults and children, as applicable, certain annual or periodic exam, screening, counseling and immunization services, and, for women with reproductive capacity, certain contraceptive methods and related counseling.

  • Do you cover pre-existing conditions?

    Pre-existing conditions are covered. We’ll help you find network providers to continue treating your condition and transfer your records or prescriptions if necessary.

  • What happens if I need care when I am on vacation?

    In cases of an emergencyies, you should seek care immediately. True emergency care will be covered as if you were in-network.

  • What is a formulary?

    Formulary is a list of medications that are covered on your insurance plan.

  • Can I see the formulary?

    Yes, your formulary is posted on PreferredOne.com in the pharmacy section. The formulary will be posted on your My Account member portal once you are enrolled.

  • What pharmacies can I use?

    More than 70,000 pharmacies participate nationwide including major chains and independent pharmacies. You can search for network pharmacies at PreferredOne.com in the pharmacy section.