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Enrolling In Patient Choice (South Dakota)
How do I enroll?
When you enroll in a plan that uses the Patient Choice network, you and each of your eligible family members choose a Care System or network of health care providers and facilities. Each family member is free to select a different Care System.
When your family members sign up for Care Systems in different cost groups, the highest cost group choice determines the cost of your whole family’s coverage for the plan year.
To help you select the Care System and health care providers that will best serve your needs, see “Choosing a Care System” below.
Once you and each of your family members have selected a Care System, simply complete the enrollment form(s) provided in your enrollment materials.
Choosing a Care System
When you choose a Care System, you’re making an important purchasing decision. Depending on what you need from your Care System and its affiliated providers and care facilities, you’ll want to weigh your options carefully before making your decision. It’s important because:
- The physicians and hospitals in the Care System are accountable to you for the quality and cost of the services you receive.
- The contribution you make toward the cost of your coverage depends on the cost group your selected Care System falls into*.
*For varying reasons, not all employers base coverage contributions on cost group differences. See your employer’s enrollment material for specific information.
- Your Care System is the key to receiving in-network coverage for your care. When you obtain services from the providers, hospitals and other facilities affiliated with your Care System, they are considered in-network services.
Each Care System has unique characteristics. To find the Care Systems that are right for you and your family, check out our online directory to consider the following:
- Care System Listings - Learn more about the unique characteristics of each Care System and their affiliated providers, hospitals and facilities.
- Cost - If cost is a critical part of your decision, check the Care System cost group.
Care Systems fall into either a low or high cost group. Cost group I ($) indicates the lowest cost and cost group II ($$) represents higher cost.
The amount you contribute towards the cost of your coverage may vary depending on the Care System you choose. See your employer’s enrollment materials for the actual contributions levels by cost group.
- Physician Choice -
If your relationship with a specific physician is of high importance to you, use the online to locate the Care System that will meet your needs.
You can also learn more about the physicians participating in the Patient Choice Care System network, including information about their board certification, education, and whether or not they provide the care you need.
- Hospital Choice -
If accessing services at a specific hospital is important to you, use the online directory to find the hospitals affiliated with each Care System.
You can also learn more about a hospital’s performance and experience by using our “Compare Hospital Quality” tool. It allows you to compare hospitals based on a specific condition or procedure.
- Service -
When it comes to service, only you can determine what is important for you and your family. As you begin to make your health care choices, consider service factors such as office hours, the ability to get care without a long wait and how well the doctor communicates with patients. Ask for recommendations from family and friends. And check the Patient Choice web site to learn more about the programs and capabilities that each Care System has in place to serve your needs.
You can also call or visit the doctor’s office and ask questions that are important to you, such as:
- If I called right now for a routine visit, how soon could I be seen?
- If the doctor is not available, where do you send me?
- Will the doctor discuss health problems over the phone?
- Does the doctor work with nurse practitioners or physician assistants?
- Location - Consider Care Systems that include providers and hospitals in a certain geographic area that are convenient for you.
Obtaining Services
When you schedule an office visit, let the clinic know you are a Patient Choice member and verify that the provider continues to serve your Care System. When you arrive for your appointment, show your identification card.
If you have not received your card yet, let the clinic know you are a new member. The clinic will verify your membership.
In- and Out-of-network
Services furnished by the health care providers and facilities within your selected Care System are considered “in-network” services, with eligible expenses covered at the in-network benefit level—the highest level available through your employer’s plan.
Services furnished by health care providers and facilities that are not listed as affiliated with your selected Care System are considered “out-of-network” services, with eligible expenses covered at the out-of-network benefit level. Your out-of-pocket costs will be higher for out-of-network services. See your Summary Plan Description or call Customer Service at the telephone number listed on your medical identification card for more information.
Changing Your Care System Selection
You and/or other members of your family may change their Care System selections at various times throughout the year as long as the new Care System selection is in a lower cost group than the one in which you initially enrolled.
Your cost for coverage will remain the same throughout the plan year, even if you (or a family member) change to a Care System in a lower cost group.
To change your Care System selection, contact Customer Service at the telephone number listed on your identification card.
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