Frequently Asked Questions
As part of our technological improvement initiatives,
we have re-designed our website. We have improved our website functions
and understand that you may have questions about the new website and processes.
On this page you will find the most commonly asked questions.
If you cannot find what you are looking for, please
contact us through our online form.
General Questions
Q. Why did my employer choose AultCare to handle my health
care plan?
With our long-standing relationship with the
Aultman Health Foundation and Stark Quality Care Physicians,
we are the largest hospital-based PPO in northeast Ohio offering
the best doctors and hospitals in the area.
When you call or stop into AultCare, you are always greeted
by friendly customer service representatives. You are never
caught in an automated telephone system that only gives you menu
choices. AultCare is highly committed to providing you with
exceptional customer service and high quality care.
Q. How do I find out what benefits are provided by my
health care plan?
AultCare handles over 1,200 self-funded and fully insured
plans. For this reason, we provide you with knowledgeable and
friendly customer service representatives Monday through Friday
between the hours of 7:30 a.m. and 5:00 p.m. EST
Many of your questions can be answered by looking at your
employee health plan booklet. You should have received this when
you enrolled in the plan, however, if you don’t have one or have
a question,
Contact Us.
Q. How can I find out if my medical claim has been paid?
AultCare is very proud of our claims turnaround time. We process your medical claims within 10 days from the time we receive your completed claim information from your health care provider.
We have also worked with many of our health care providers to allow them to send us information electronically. This allows us to process your medical claims in even less time.
Your electronic Explanation of Benefits (EOB) statements are available on AultCare.com for you to view once you have logged on with your member ID and Password. This document explains which claims were processed for each covered member of your family, along with how the claims were paid, and what balance, if any, is owed to the provider.
If you would prefer to receive your EOB statements by mail, rather than electronically, you may change the delivery format from our website or you may contact us with your request.
Q. How do I read my explanation of benefits that I receive
in the mail?
AultCare knows how challenging medical paperwork can be to
understand and we work at making our explanation of benefits
easier for you to read. For your convenience, we have provided a
sample explanation of benefits page with a detailed
explanation of how to read it.
AultCare provides you with knowledgeable customer service
representatives Monday through Friday between the hours of 7:30
a.m. and 5:00 p.m. EST. They are always willing to answer any
questions you might have.
Contact us.
Q. How do I change my mailing address?
If you have coverage with your employer, please contact your employer to change your address and/or contact information. If you have individual coverage, please contact customer service at 330-363-6360 or use the online form to contact us.
Q. What are COBRA benefits and how do I know if I am
eligible for them?
COBRA is a continuation of employer-sponsored health care
benefits when coverage is lost. Federal law requires employers
who employ 20 or more employees (a special formula is used to
calculate this) to offer COBRA coverage to employees (or former
employees) and/or their dependents when employer-sponsored
health care coverage is lost. If you and/or your dependents have
lost employer-sponsored health care coverage, check with that
employer to see if they offer COBRA.
Q. What if I want/need to use a provider that is not
listed in the Provider Directory?
If you see a provider (doctor or hospital) not in the
AultCare network, your claim will be paid as out-of-network per
your plan design. This usually means a higher deductible and a
higher percentage of co-insurance for you to pay after the
deductible is satisfied. You are also responsible for paying
amounts billed that are over Usual, Reasonable and Customary
(UCR).Click on the link below to see an example of claims
payment both in- and out-of-network.
UCR SAMPLE
Q. What is HIPAA and how does it affect me?
HIPAA stands for the Health Insurance Portability and
Accountability Act of 1996 which prohibits healthcare providers
from sharing your personal and medical information without your
express permission. AultCare prides itself on strict adherence
to the regulations and will only share the information necessary
for completing your claim and taking care of your medical needs.
For more information,
click here.
Questions about the website
Q. What is AultCAS.com?
AultCAS is our Central Application Service System. This helps
us route all of our transactions through single secure channel. You can think of
AultCAS as a parent site to AultCare.com.
Q. I need help registering on AultCAS.com - Is there a guide available?
We have a guide available:
Q. When I visit AultCare.com, I see a security certificate
warning?
Due to our recent website upgrade, the security certificate
error may appear if you try to visit AultCare through "https". Please make sure
the URL you are using to access our website is
http://www.AultCare.com (notice there is no "s" after "http")
Q. How do I retrieve or upload files on the new site?
We have a guide available for online file transfers:
Q. I am having problems finding what I am looking for?
We understand that it will take some time to get familiar
with the new website. If there is anything particular you are looking for and
are unable to find it, please contact us through our online form. It is
very important to us that you have pleasant experience migrating to our new
website.
Q. I need help - who should I contact?
If you need help with the new website, please contact us through our online form. This is
a direct way to contact the technical team of the new website.
Q. I used to have an account on your old website. Do I have
to re-register?
Due to the security reasons, we were unable to move old accounts
to the new website. You must re-register at AultCare.com. Please visit this page to create a new login.
Q. I tried to log into new site (at www.AultCAS.com) but the system would not let me log in?
Please make sure you have successfully registered and received an email notifying of your approval on the new website.
The new website will not accept the username and password from the old website. You must re-register on the new website.
Q. I would like to have an account on your new site
- how do I do this?
If you are a vendor, broker, or an employer working with either AultCare or Aultra, you may register at the following locations:
At this page, select the membership type, Employers or Vendors and click the “Sign up Now” button.
You can also read How to register guide here.
Q. I received an email notifying of my billing invoice being available on the web, where do I go to get it?
If you have an account registered and approved on the new site (www.AultCAS.com), you will log on to the new site at:
If you do not have an account registered and approved on the new site (www.AultCAS.com) and you have an active account on the old site (www.AultCare.com or www.AultraGroup.com), you must log in to the old site at:
Q. I cannot find some of the forms on the new website - Where are these forms?
Try the following steps to locate the forms you need. If you
still cannot find what you are looking for, please contact us immediately through our online form.
-
Visit the new website:
-
Login to your account
-
Once you are successfully logged in - click on
"Forms"
Q. My group is through Aultra but the
AultCAS site logo reads AultCare?
If you have an account registered and approved on the new site (www.AultCAS.com), you should log in at the appropriate login portal:
Q. The email notification about my monthly invoice contained the words “if your account has been migrated..”. Does this mean that I automatically have an account on the new site?
No. Due to the security reasons, we are unable to migrate accounts automatically.
Q. If I register on the new site, will my files be available there? I have logged in and can only see my latest invoice but need earlier ones?
If you are a group that receives files online (monthly billing, etc.), your files from July 1st on will already be there waiting for you. If you need earlier files on the new site, we will move them for you upon your request through our online form.
Open Enrollment
Information on AultCare Insurance Company's Open
Enrollment Program
Ohio's state budget (HB 1) passed in 2009. It includes new requirements that
help uninsured adults to get coverage. The requirements include changes to open
enrollment, which insurance companies offer each year to people who would not
otherwise be able to get coverage.
Q. What is open enrollment, and what changes have been made to this program?
Open enrollment is the time when people who don't have health coverage can apply for it. People who cannot get health insurance coverage because of pre-existing medical conditions, and those who have not been previously covered through an employer's plan, may apply for individual coverage through
"open enrollment".
Beginning in January 2010, every Ohio insurance company must hold open enrollment until the company has taken its required percentage of newly insured individuals. There are a few changes to the program.
First, insurers will be limited in how much they can charge people with pre-existing or chronic conditions who buy individual health policies through open enrollment.
Second, there is a rate cap. The cap on premium charges is one and a half times the lowest rate being charged for similar benefits for a person of similar age and gender who does not have these conditions. The cap on charges applies only to open enrollment individual coverage, not employer groups.
Q: How do I enroll in coverage during the open enrollment period?
Beginning January 1, 2010, you may ask for an application to be mailed to your home address or complete the application below and mail to us for review. You do not need to apply in person.
Click here for an Open Enrollment Application.
Complete the application and mail to the following address:
AultCare Open Enrollment
ATTN: Sales Department
2600 Sixth Street SW
Canton, Ohio 44710
Q: Is there an enrollment quota that insurers must accept under the new Open Enrollment program?
Yes. Open Enrollment plans are required to take a percentage of Federally Eligible Individuals and Non Federally Eligible Individuals during their open enrollment period. That percentage is based on the total enrollment in their other individual products.
Q: What does it mean to be a Federally Eligible Individual under the Open Enrollment Program?
Ohio law requires us to accept a certain number of individuals for open enrollment coverage without regard to health status. If you qualify as a Federally Eligible Individual (FEI), your coverage will be effective immediately without any pre-existing condition exclusion period. If you do not qualify as a FEI, you may apply for non-FEI open enrollment coverage.
You are a Federally Eligible Individual if you meet all of the following conditions -
1. You had health coverage for at least 18 months without a break in coverage greater than 63 days.
2. Your most recent health coverage was under a group health plan, governmental plan or church plan.
3. You are not eligible for coverage under any of the following plans:
a. A group health plan
b. Medicare
c. Medicaid
4. You do not have any other health coverage.
5. Your most recent health coverage was not terminated because of nonpayment of premiums or fraud.
6. If you had been offered the option to continue coverage under COBRA or a state continuation plan, you both elected and exhausted the continuation coverage.
If we have not yet met our enrollment quota, we will offer you the Ohio health care Basic or Standard benefit plans for purchase. You may need to submit proof of previous creditable coverage.
You are a Non-Federally Eligible Individual if you meet the following conditions -
1. You are not applying for coverage as an employee of an employer, member of an association or member of any other group.
2. You do not have any other health coverage and are not eligible to be covered under any private or public health benefit plans including the following:
a. Medicare or Medicare supplement policy
b. Medicaid
c. Any COBRA or state continuation coverage plan
d. Other health benefits arrangement
If we have not yet met our enrollment quota, we will offer you the Ohio health care Basic and Standard benefit plans for purchase. We are not required to accept applicants who at the time of enrollment, are confined to a health care facility due to chronic illness or permanent injury. As a Non-Federally Eligible Individual coverage may be limited for pre-existing conditions for the first 12 months, however, we will credit time you were covered under a recent previous health plan.
Q: What options are there if your plan meets the enrollment quota? Is there a waiting list?
If our plan has met the enrollment quota, you can access information on other carriers by going to
www.insurance.ohio.gov. Otherwise, we do have a waiting list. If we have met our enrollment quota when you apply for coverage, we can add you to our waiting list. This list is monitored daily. When we have an opening in the open enrollment program we will contact you. If you are still interested in applying for the open enrollment program at that time, we will review your application for enrollment.
Q: What are the factors that may be considered when you set open enrollment rates?
Ohio law allow insurers to take into account the age, gender and place of residence of those we insure when determining rates. We must set open enrollment rates based on an average of the costs associated with each of these categories. A pre-existing condition can be used to exclude an individual from coverage for a particular condition for a period of time, but cannot be used to determine a rate.
Note: Open Enrollment coverage is available to individuals throughout the state, if you have a provider that is outside Stark, Tuscarawas, Wayne, Holmes, or Carroll counties, the benefits may be at an out of network reimbursement.
Q: Once enrolled, when will my first payment be due?
Your first payment is due at the time you choose to buy a plan. Your check should be mailed with the acceptance letter. Premiums are then due the first of each month. Payments can be made either by Electronic Funds Transfer or by check.
Q: When will my coverage be effective?
Coverage begins the beginning of each month. Upon your acceptance of the plan your coverage will begin the first of the following month.
Q: Where can I get more information about open enrollment?
Call us at 330-363-6360 locally or 1-800-344-8858 long distance or Contact Us via email for more information.
Other
Can't find what you are looking for?
Your questions are important to us. Please use our Online form with your questions or comments
about the website.
Our Customer
Service Representatives are also available via phone.
Customer Service Center Hours: 7:30 am –
5:00 pm EST
AultCare Members: 330-438-6360
Toll free 800-344-8858