The following questions & answers are presented only as general information about the plans offered by Piedmont Community Health Plan and Piedmont Community HealthCare. The documents provided to you by your employer, such as Summary Plan Description, Certificate of Coverage and Schedule of Benefits, will prevail for all benefits, conditions, limitations and exclusions. Additional information is also available from your employer's human resource department and from Piedmont Community Health Plan customer service, at 434-947-4463, or toll-free at 1-800-400-7247.
Questions regarding college-bound dependents? CLICK HERE
Questions regarding advanced imaging? CLICK HERE
Questions regarding balance billing?
Questions regarding Member ID Cards? CLICK HERE
When will I receive my 1095-B or 1095-C tax form?
If you had employer sponsored insurance for 2019, you will receive your tax form from the appropriate source:
• Small Group Fully-insured - sent by Piedmont (1095-B)
• Large Group Fully-insured - sent by Piedmont (1095-B)
• Large Group Self-insured - sent by employer (1095-C)
If you are uncertain if your plan is fully or self-insured, ask your HR manager or call Piedmont at (434) 947-4463 / toll-free 800-400-7247.
What is Piedmont Community Health Plan?
Piedmont Community Health Plan, Inc. is a healthcare insurance carrier/company located in Lynchburg, VA, and owned by Centra Health System.
What is Piedmont Community HealthCare?
Piedmont Community HealthCare is wholly owned subsidiary of Piedmont Community Health Plan, Inc. It offers PPO plan designs through a fully insured funding arrangement. The company was licensed in 1998 and began selling in March 1999. Both Piedmont Community HealthCare and Piedmont Community Health Plan utilize the same network of providers. Piedmont Community HealthCare is offered to both small and large employer groups.
How big is the Piedmont Community Health Plan network?
The network used by both Piedmont Community Health Plan and Piedmont Community HealthCare includes more than 98 percent of the local physicians, both local hospitals in the Lynchburg area, Bedford Memorial Hospital, Community Memorial in South Hill, and Southside Community Hospital in Farmville. Agreements are also in place with Medical College of Virginia (MCV) and University of Virginia Hospital (UVA) to provide care that cannot be accommodated by the hospitals listed above.
The service area includes the cities of Danville, Harrisonburg, Lynchburg, Staunton and Waynesboro and the counties of Amherst, Appomattox, Augusta, Bedford, Buckingham, Campbell, Charlotte, Cumberland, Halifax, Lunenburg, Mecklenburg, Nelson, Nottoway, Pittsylvania, Prince Edward, and Rockingham. Piedmont Community Health Plan has arrangements with providers in all of these areas.
What is a PPO plan?
The Preferred Provider Organization (PPO) is a plan design offered by Piedmont Community Health Plan and Piedmont Community HealthCare. There are two levels of benefits: in-plan and out-of-plan. As long as the member uses providers in the network for covered services, the member receives in-plan or the higher level of benefits. Pre-certification is required for all hospital related services, whether inpatient or outpatient. When the member utilizes providers who are not in the network, the member receives out-of-plan benefits for covered services. This means a lower level of benefits or more out-of-pocket costs for the member.
What is a HMO plan?
The Health Maintenance Organization (HMO) is a plan design offered by Piedmont Community Health Plan and Piedmont Community HealthCare. With an HMO, there is only one level of benefits: in-plan. As long as the member uses providers in the network for covered services, the member receives in-plan or the higher level of benefits. Pre-certification is required for all hospital related services, whether inpatient or outpatient. When the member utilizes providers who are not in the network, the services are not a covered benefit except in cases of emergency or where prior authorization and been granted. HMO plans are focused on Primary Care Physician (PCP) integrated care through prevention and wellness.
What are the advantages of Piedmont Community Health Plan and Piedmont Community HealthCare?
- A community-based organization accessible to its customers.
- Local management with local knowledge and understanding to make the most informed decisions.
- Local staff empowered to serve each employer and covered employees and families.
- A medical management program designed by the local medical community that promotes the concept that your physician will manage your care.
- A strong commitment among participating physicians and other network participants to manage employer health benefit costs.
- The most comprehensive network available in the Lynchburg area.
- Affordable healthcare for employers and desirable health care benefits for employees and their families.
- Piedmont will assist adolescents in transition from their pediatrician to an adult primary care provider if needed.
How can I receive more information on Piedmont Community Health Plan or Piedmont Community HealthCare?
Contact us at (434) 947-4463 or 1-800-400-PCHP (7247).
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