Medical Plan Overview
The following Medical Plan options are available through the Tuality Healthcare Benefits Program and are administered by the Tuality Health Alliance.
The Select-Plus Plan
The Select-Plus plan has a network of doctors and hospitals you must use when you need care (except for emergencies). You do not need to choose a Primary care provider and have the freedom to change your Primary care provider at any time. The Select-Plus plan features the THA/OHSU Network as well as the First Choice Health Network. However, you may choose from either network for your care. THA/OHSU-Option 1 Network has an annual deductible of $400 Individual ($800 family) and FCHN-Option 2 Network has an annual deductible of $600 individual ($1200 family). The plan pays most covered services in full after you pay your co-payment or coinsurance and meet your annual deductible. This plan also provides coverage for eligible dependents that live outside the plan's service area.
Coverage for dependents (eligible spouse/children who reside out of the Select-Plus plan service area): Services rendered outside of Oregon, Washington, Idaho, Montana, Wyoming, North Dakota, South Dakota, Alaska or parts of Colorado, will pay at the FCHN-Option 2 benefit level. Refer to the Schedule of Benefits for details on Covered Services.
There is no coverage for members seeking care from non-THA/OHSU or non-FCHN network providers unless the member lives outside the service areas for both THA/OHSU and FCHN Networks.
For more detail about the benefits, see the Tuality Healthcare Plan booklet.
Prior to a planned hospital admission or surgery, you or your doctor must call Innovative Care Management to request "pre-admission certification". Pre-admission certification is required to make sure you'll receive the maximum amount of benefits under your plan. Failure to call could result in a penalty or reduced benefit for your hospital admission and/or surgery.
Your physician should contact Innovative Care Management to obtain preauthorization before you are admitted or before services are provided.
Toll Free: 800-862-3338
In a medical emergency, you may be admitted to an inpatient facility without preauthorization, but your physician should contact Innovative Care Management as soon as reasonably possible after your admission. Additional days of inpatient care, beyond those initially authorized, must also be preauthorized by Innovative Care Management.
- Tuality Preferred
- Provider Directory Select Plan – Specialty
- Provider Directory Select Plan – Alpha
- Primary Care Physician (PCP), Hospital & Urgent Care Locations
This is your extended network of providers covered under your Out of Network benefit level. Please review your benefit booklet or call THA customer service for more information.