Member FAQs

There are a few ways you can enroll in a plan:

• Through a local agent. Call 844-708-3837 to find a local agent. See the section below titled “Working with an Agent” for more information.
• By enrolling directly online
• Contacting the Individual and Family Plans CCHP Sales Team at 844-708-3837
• Visiting healthcare.gov
  
  

Agents, also known as brokers, are licensed experts in the field who can help explain the differences between the health insurance plans/carriers in a way that is easy for the member to understand. They are better prepared to help the customer choose a plan that is going to be the best fit for themselves and their family.

Agents are advocates for the customer; helping them to navigate a complex explanation of benefits (EOB), premium bill, service issue, complaint, etc.

To find a local agent, please call us at 844-708-3837.

During Open Enrollment, which runs from November 1, 2023 through January 15, 2024, individuals and families can officially enroll in a plan. However,  CCHP offers support through brokers who can answer questions and guide you to the right plan for you or your family. For help enrolling, contact Sales at 844-708-3837.

However, if you do not enroll during this period, there are Special Enrollment Periods where specific qualifying events allow you to enroll in a health insurance plan:

• You had a baby or adopted a child
• You got married
• You moved
• You lost coverage under a previous plan

For a full list of qualifying life events, visit healthcare.gov.

On-exchange: If you purchased your health insurance coverage and received a subsidy or tax credit (on-exchange), you will need to contact the Health Insurance Marketplace to make any changes to your application. This can be done online at healthcare.gov or by calling 800-318-2596.

Off-exchange: If you purchased your coverage without a subsidy or tax credit (off-exchange), and it is before your policy has begun, contact the sales team at 844-708-3837. After your policy has begun, you can log into your member portal to make changes or call the sales team for assistance.

A Special Enrollment Period (SEP) is a time outside the yearly open enrollment period (November 1, 2023 - January 15, 2024) when you can sign up for health insurance. You qualify for a SEP if you’ve experienced a qualifying event like losing health coverage, moving, getting married, having a baby, or adopting a child. If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next open enrollment period to apply. You will have to provide documentation showing you are eligible for a SEP.

To learn more about if you qualify for a special enrollment period, please visit healthcare.gov.

To find a provider in network, please browse our provider directory or contact Customer Service at 844-201-4672.

Members have many payment options to keep their coverage. Members are able to pay their premium monthly with the following options:

• Log into CCHP Connect
• Pay by credit or debit card
  • Pay from your checking or savings account
  • Mail a check or money order to:
    Chorus Community Health Plans
    PO Box 360190
    Pittsburgh, PA 15251-6190

You can also Call Customer Service at 844-201-4672 to pay by checking or savings account, credit card, or debit card.

Agents are licensed experts in the field who can help explain the differences between the health insurance plans/carriers in a way that is easy for the member to understand. They are better prepared to help the customer choose a plan that is going to be the best fit for themselves and their family.

Agents are advocates for the customer; helping them to navigate a complex explanation of benefits (EOB), premium bill, service issue, complaint, exc.

To find a local agent, please call us at 844-708-3837.

If you have a question or concern, please reach out to Customer Service at 844-201-4672.

On-exchange: If you purchased your health insurance coverage and received a subsidy or tax credit (on-exchange), you will need to contact the Health Insurance Marketplace to make any changes to your application. This can be done online at healthcare.gov or by calling 800-318-2596.

Off-exchange: If you purchased your coverage without a subsidy or tax credit (off-exchange), and it is before your policy has begun, contact the sales team at 844-708-3837. After your policy has begun, you can log into your member portal to make changes or call the sales team for assistance.

By signing up for CCHP Connect, you will be able to print a new ID card and have access to all your plan documents. If you don't already have access to CCHP Connect, call Customer Service at 844-201-4672 to request member materials.

Except for your first premium, any premium not paid to us by the due date is in default. However, there is a grace period beginning with the first day of the payment period during which you fail to pay the premium. Your grace period is 30 days from the due date, unless you are receiving an advanced premium tax credit from the federal government, in which case you will have a 3-month grace period. If you are receiving an advanced premium tax credit from the federal government, we reserve the right to pend (or hold) payment of all applicable claims that occur in the second and third month of the grace period.

If you do not pay your past due premiums before the end of the grace period, your coverage will be terminated retroactively to the end of your first grace period month. If this happens, any pended (or held) claims will not be paid and it will become your responsibility to pay providers directly for the services that you received during months two and three of the grace period. If claims were paid during the grace period, and coverage is terminated, CCHP will recoup payments from the provider and the provider will bill you for any outstanding balances on your account. It will be your financial responsibility to pay for these services.

Important: Partial premium payments will not extend the duration of your grace period. You must pay all past due amounts in order to bring your account into good standing.

Please see the Prior Authorization Guide or contact Customer Service at 844-201-4672.

For a list of exclusions and limitations within your plan, please reference the Evidence of Coverage (EOC) or contact our Customer Service team at 844-201-4672.

You can speak with a Customer Service team member at 844-201-4672 or refer to the Pharmacy Benefit Guide.

Contact Customer Service 844-201-4672. Customer Service representatives are available: Monday - Friday, 8 a.m. - 6 p.m. Saturday, 8 a.m. - 2 p.m.

After we receive your complaint, we will notify you of the resolution within 30 days.

If you are unhappy with any service offered through Chorus Community Health Plan, the practitioners or providers in our network, you have the right to file an appeal. At any time during the course of the complaint and appeal process, you may choose to designate an authorized representative to participate in the process on your behalf.

To learn more about filing an appeal, visit your Evidence of Coverage (EOC).

The Appeals process is as follows:

• You have the right to file an appeal with us within three years of the date of the decision regarding a complaint or any adverse benefit determination. To file a formal appeal, you or your authorized representative should write down your concerns and mail your written appeal (in any form) along with copies of any supporting documents to us.
  
  Submit your written appeal to:
  Chorus Community Health Plans
  P.O. Box 1997, MS 6280
  Milwaukee, WI 53201-1997

• You may also file an appeal by emailing CCHP-Appeals@chorushealthplans.org or by fax. Chorus Community Health Plan's appeal fax number is 414-266-4195.
• If you have questions about the appeal process, or if you feel that the denial of benefits is life threatening, call our appeals line at 1-877-900-2247.
• We will send you a letter within five business days notifying you that the appeal was received. Depending on the type of appeal, either our appeals committee or specialist will review the appeal, investigate and provide you with a decision within 30 calendar days of receiving the appeal.

Health Care Reform, also called the Affordable Care Act (ACA), was signed into law in March 2010. It aimed to make both health insurance and health care affordable and accessible to the population.

The ACA states that health insurance must have three key parts:

• Essential health benefit coverage
• Preventive services at no cost
• Expanded access to coverage

Those who do not purchase health coverage may be subject to a penalty. However, there are certain groups that are exempt from coverage and paying penalties. To find out if you may be exempt, please visit healthcare.gov.

A subsidy is financial support that helps you pay for something. The federal government offers two kinds of subsidies for individuals and families on the Marketplace:

• The Advanced Premium Tax Credit – Helps by lowering your monthly health insurance payment, or premium.
• Cost Sharing Reduction – Helps reduce out-of-pocket costs
  

Only consumers within certain income ranges are eligible for the advanced premium tax credits and cost sharing reductions listed above.

While you are applying for insurance on the Marketplace, you will find out if you are eligible for a subsidy that can lower your monthly premium. The amount of the subsidy is dependent on the household income you stated on your application along with household size and the cost of health insurance in your state.

To see if you are eligible, visit healthcare.gov.

The Marketplace (or the Health Insurance Marketplace) was created through Health Care Reform and is the platform that allows those without insurance to purchase health care coverage either as an individual or family. Individuals and families can purchase plans in four metallic levels with each having their own cost, benefit levels and plan details.

Preventive care consists of various services (as recommended by the Affordable Care Act) that covered at 100% (meaning no copayment or coinsurance) when you visit an in-network provider. A full list of these services can be found on the Preventive Services Guide.