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Medical Plan Overview

The following medical plan options are available through the Tuality Healthcare Benefits Program and are administered by Tuality Health Alliance.

My Health Plan

The My Health Plan has a network of doctors and hospitals through THA and HRNW (Adventist) that 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 at any time, as long as they are in your network.

This plan also provides coverage for eligible dependents that live outside the plan’s service area when registered with Tuality Healthcare Human Resources.  If an out of area dependent is seeking services in Oregon, Washington, Montana, Wyoming, North Dakota, South Dakota, or parts of Colorado they must use a First Choice Health Network Provider (except emergencies).   If an out of area dependent does not reside in a covered First Choice Health Network State, they may seek care from any provider willing to bill Tuality Health Alliance.

It is important that members seek care within the appropriate network of providers because there are no out of network benefits, except emergencies, out of area dependents, or when prior authorized.

For more detail about the benefits, see the Tuality Healthcare Plan booklet.

My Extended Network

My Extended Network has a network of doctors and hospitals through THA, HRNW (Adventist), and the First Choice Health Network that you must use when need care when you need care (except for emergencies).  You do not need to choose a primary care provider and have the freedom to change at any time, as long as they are in your network.

This plan also provides coverage for eligible dependents that live outside the plan’s service area when registered with Tuality Healthcare Human Resources.  If an out of area dependent is seeking services in Oregon, Washington, Montana, Wyoming, North Dakota, South Dakota, or parts of Colorado they must use a First Choice Health Network Provider (except emergencies).   If an out of area dependent does not reside in a covered First Choice Health Network State, they may seek care from any provider willing to bill Tuality Health Alliance.

It is important that members seek care within the appropriate network of providers because there are no out of network benefits, except emergencies, out of area dependents, or when prior authorized.

For more detail about the benefits, see the Tuality Healthcare Plan booklet.

Preauthorization

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
Website:  www.innovativecare.com

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.

Provider Directory

First Choice Health Network

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.