coverage Archives - Live360 Health Plan

Welcome! Live360 Health Plan is underwritten by Medical Associates Health Plans, a regional insurer headquartered in Iowa that celebrated 40 years of service in 2022. As a Live360 member, you are now covered by a company that has built a reputation of providing award winning healthcare coverage and excellent customer service. You may have questions as you get started and we are here to help. Below are our top five tips to help you and your family utilize your benefits in the best way.

1. Utilize our convenient member web portal, My eLink.

My eLink is a convenient, confidential web portal that offers online access to your personal health plan information 24/7. It’s free and even mobile friendly! Some actions you can accomplish through your My eLink account are:

View and check on claims
View and print EOB (Explanation of Benefits)
Search for a network provider
Submit basic questions to our staff
Print and request I.D. cards
View benefit information
Renew and refill prescriptions
Compare medication pricing
Check the deductible amount that you’ve paid
View your archived claims information
Change your address and other personal information
View authorizations
Grant an authorization to release information

Click here to create a My eLink account today. First-time users need to click on the Proceed to our sign up process link under the login boxes.

2. Stay in your network.

Live360 Health Plan has robust relationships with physicians in multiple communities in Illinois. Our provider networks include hundreds of primary care providers, specialty care providers, independent providers, and many hospitals. Staying in your network will mean paying less than using an out-of-network provider. The same is true for mental health professionals, chiropractors, hospitals, and labs.

You can search your provider directory through your My eLink account or by visiting the member page of our website. Click on the appropriate plan type under the heading, Find a Provider. Having a primary care provider (PCP) is a great place to start. When your doctor becomes familiar with your medical history, your habits and lifestyle, they’ll be able to better notice signs of a more serious health issue and take care of you in the long run.

3. Schedule your first appointment and take advantage of preventive care.

Live360 Health Plan believes in the importance of yearly wellness exams. These exams help find potential problems early so they can be treated early. Preventive services and immunizations are covered at no cost to you when using in-network providers. Some covered preventive services include:

Adult preventive exams which include lab tests, pap smears, breast and pelvic examinations
Child and adolescent preventive exams for members ages 7-17 years, including preventive laboratory tests
Well baby and child preventive examinations for members through age 6, including preventive laboratory tests, audiometry, visual acuity and lead screening
Coverage for colorectal cancer screening
Mammography examinations

Some limits apply. Refer to your subscriber agreement for specific benefit information.

4. Explore your pharmacy benefits.

Whether you take prescription drugs regularly or use medications for specific treatments, it’s helpful to understand pharmacy benefits. It could mean getting prescriptions filled more easily and at a lower cost.

We cover both brand name drugs and generic drugs. If a drug is listed on our formulary, we will generally cover it if it is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. If you are unsure if a drug will be covered, you can use the Pharmacy Drug Lookup tool found on our member website page.

5. Keep your member I.D. cards handy.

You will receive your membership card in 10-14 days after we receive your enrollment information. Live360 Health Plan members are issued a membership identification card to be presented each time care is sought at a participating provider’s office or hospital. Take your current I.D. card with you whenever you receive care. It’s proof that you have insurance with Live360 Health Plan. Healthcare providers will use the information on the card to confirm they are a part of your network and to bill us for your care.

On the back of your card you’ll find the Live360 Health Plan website address and phone numbers you can call for help. The Member Services number is handy if you have a question on coverage, prescription drugs, authorizations, or finding a provider.

We appreciate the opportunity to assist you in getting the most out of your healthcare benefits. This information and more can be found in the Live360 Member Handbook. In addition to our online resources, you can contact us 24 hours a day, 7 days a week at 217-206-5050 or toll free at 833-728-0538.

Understanding your health insurance can be intimidating. Between unfamiliar terms, puzzling acronyms, and optional coverage items, there’s a lot to unpack. By better understanding how health insurance works and key aspects of your employer sponsored plan, you can better utilize your coverage to save both time and money. Take a few minutes to review these basic insurance terms:

Premium: The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly, or yearly.
Deductible: An amount you could owe during a coverage period (usually one year) for covered healthcare services before your plan begins to pay. An overall deductible applies to all or almost all covered items and services. A plan with an overall deductible may also have separate deductibles that apply to specific services or groups of services. A plan may also have only separate deductibles. (For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered healthcare services subject to the deductible.)
Copayment: A fixed amount (for example, $15) you pay for a covered healthcare service, usually when you receive the service. The amount can vary by the type of covered healthcare service.
Coinsurance: Your share of the costs of a covered healthcare service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You generally pay coinsurance plus any deductibles you owe. (For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.)
Out-of-Pocket Limit or Maximum: The most you could pay during a coverage period (usually one year) for your share of the costs of covered services. After you meet this limit, the plan will usually pay 100% of the allowed amount. This limit helps you plan for healthcare costs. It never includes your premium, balance-billed charges or healthcare your plan doesn’t cover. Some plans don’t count all of your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit.

Now that you better understand these key aspects of a health plans potential costs. Review these key terms and phrases to better understand your medical bills and how you can use your coverage in the most cost-effective way:

Allowed Amount: This is the maximum payment the plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
Balance Billing: When a provider bills you for the balance remaining on the bill that your plan doesn’t cover. This amount is the difference between the actual billed amount and the allowed amount. For example, if the provider’s charge is $200 and the allowed amount is $110, the provider may bill you for the remaining $90. This happens most often when you see an out-of-network provider (non-preferred provider). A network provider (preferred provider) may not bill you for covered services.
Prior Authorization: A decision by your health insurer or plan that a healthcare service, treatment plan, prescription drug or durable medical equipment (DME) is medically necessary. It’s sometimes called preauthorization, prior approval, or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.
Network Provider (Preferred Provider): A provider who has a contract with your health insurer or plan who has agreed to provide services to members of a plan. You will pay less if you see a provider in the network. Also called “preferred provider” or “participating provider.”
Explanation of Benefits (EOB): A list that you get after you’ve received a medical service, drug, or item. This list that tells you the full price of the service, drug, or item that you received. This is not a bill.

As a member, another great way to better utilize your health insurance benefits is to utilize our secure web portal, My eLink. This convenient online tool is free and gives you access to your personal health plan information 24/7. It’s even mobile friendly! You can check on claims, search for network providers, view EOBs, benefit information, and authorizations. You can compare medication pricing, print and request I.D. cards, and submit basic questions to your Member Services team. Log in to your My eLink account here. Don’t have an account yet? No problem, use the link and click on Proceed to our sign-up process to register.