Welcome to Piedmont Community HealthCare. We are honored to be your healthcare coverage provider. We understand that health insurance can be confusing. That is why we are here to help. Below are the frequently asked questions that members may have:
Questions regarding advanced imaging? CLICK HERE
Q: What should I do if I have a dependent child going to college out of the Piedmont service area?
A: Piedmont's HMO plans do not provide out-of-network benefits, with the exception of emergency and urgent care situations. It may be in your child's best interest to sign up for a health insurance policy using their out-of-area address and choose a plan that best meets their needs.
Q: When will I receive my ID card?
A: Exchange members will receive a welcome packet and ID card, via separate mailings, once their premium has been received and posted. If an ID card is needed immediately, you can set up a member account on our website and print a temporary card or CLICK HERE.
Q: When will I receive my 1095-A tax form?
A: Throughout January of each year, the Marketplace generates and sends 1095-A forms to tax filers who enrolled in a Marketplace Qualified Health Plan (QHP) during the prior year.
Q: When will I receive my 1095-B tax form?
A: If you enrolled in an Individual Catastrophic Plan, you will receive your 1095-B tax form from Piedmont. Piedmont will mail the form to tax filers each year on or before January 31st for the prior year.
Q: How do I change or update my mailing address?
A: For Individual Coverage/Marketplace subscribers, your information comes from the Marketplace to Piedmont. You will need to contact the Marketplace at 1-800-318-2596 for ANY changes you may need to make to your current information. This includes canceling your policy.
Q: How do I set up an automatic draft for my monthly premium?
A: You will need to set up your account through our online member portal or CLICK HERE. Please remember that if you change your premium, you must delete the current withdrawal amount and set up a new withdrawal amount. Failure to do this can result in duplicate payments being drafted. To stop an automatic withdrawal, you will need to delete your withdrawal account. Piedmont cannot do this for you. After setting up the automatic draft, payment is usually sent immediately but can take up to 30 days.
Q: I paid my premium online using www.DoXo.com, why am I being charged additional fees?
A: Piedmont is not affiliated with DoXo.com or other third party payment sites. Any fees associated with using these sites to pay your plan premium is charged by the third party payment site and is the responsibility of the member. Please be aware that there is a delay in Piedmont's receipt of payment when using these third party payment sites. Piedmont does not charge any fees with any of our methods of payment.
Q: When are Individual Coverage/Marketplace product invoices mailed out?
A: Invoices are typically mailed on/about the 16th of each month.
Q: When I am the only person covered under your plan on my policy, why does my ID card show “employee only”?
A: Employee is a generic entry. It does not indicate actual employment status and does not affect your coverage or acceptance of your coverage and providers.
Q: CVS Caremark is listed on my ID card for pharmacy benefits. Is this the only pharmacy I can use?
A: No, it is not the only pharmacy you can use. CVS Caremark is the vendor that processes your prescription drug claims. That is why it is shown on your card. You may fill your prescriptions at many different retail pharmacies. A list of participating pharmacies is available on our website or you can call Caremark at 1-800-966-5772.
Q: My providers are not listed in your Provider directory. What are my options?
A: Toward the bottom of the Individual Marketplace Plan Guides/Document webpage (CLICK HERE), there is a “Transition of Care” request form. Please print and complete this form so that we may evaluate your care needs and recommend continued care or transition to an in-network provider, as appropriate. Each request is evaluated individually. You may return this form to us by mailing it to the address listed on the form, faxing it to the number listed on the form or delivering the form directly to our office at 2316 Atherholt Road, Lynchburg, VA. If you have an urgent need or have additional questions, please call our Medical Management department at (434) 947-4463, Ext. 501.
Q: I have the Exchange HMO-POS plan and you are requesting that I select a Primary Care Physician (PCP), why?
A: Establishing a relationship with a PCP is important to your health care. While your plan does not require referrals for you to see Piedmont's in-network providers, your PCP information is maintained along with your demographic information so that we can better assist with care coordination and quality initiatives. If you need help finding an in-network PCP, please call us at (434) 947-4463 or CLICK HERE to search for network providers.
Q: Will my Marketplace plan be terminated automatically when my Medicare, Medicaid, or Employer coverage begins?
A: No, your Marketplace plan is not terminated automatically when you enroll in coverage outside of the Marketplace. To terminate your Marketplace plan, please log onto your Marketplace account on HealthCare.gov/marketplace or call the Marketplace at 1-800-318-2596 (TTY: 1-855-889-4325). If you currently receive Cost Sharing Reductions (CSRs) and/or Advanced Premium Tax Credits (APTCs) on your Marketplace plan and are eligible for other coverage, you may have to pay full price for your Marketplace plan.
If you would like more information on overlapping coverage with Marketplace plans:
Employer (Job-Based) Coverage