Important Plan Information

We know that health insurance can be confusing, so we've gathered information on the topics listed below to help explain FirstCare's payment policies and other important aspects of your Marketplace plan coverage.

Click on any of the topics below for more details.  

Out-of-Network Liability & Balance Billing

Your plan provides no benefits for services you receive from out‐of‐network physicians or providers,  with specific exceptions as described in your Evidence of Coverage and below . 

Member Claim Submissions

Do you need to file a medical claim directly to FirstCare?

Filing an Appeal

Did you disagree with our resolution on your claim?

Grace Periods & Pending Claims

If you are unable to make your monthly premium payment on time.

Retroactive Denials

A previously paid claim can be reversed by FirstCare—this is a retroactive denial.

Member Recoupment of Overpayments

Did you overpay on your monthly premium invoice?  If so, let us know.  

Medical Necessity & Prior Authorizations

Medically necessary care is health care resulting from an illness or injury, and, for some services, requires prior authorization by FirstCare.

Concurrent Review

This review helps us ensure you are receiving the right care, in the right setting, for your condition.

Drug Exception Timeframes & Enrollee Responsibilities (not required for SADPs)

Sometimes our members need access to drugs that are not listed on the plan's formulary (drug list).

Explanation of Benefits (EOBs)

After receiving covered health services, an EOB will show you what was billed and what FirstCare paid.

Coordination of Benefits (COB)

How to understand who pays your claim first.

Questions? Contact Us!

If you have any questions about your plan, your benefits, or FirstCare—our Customer Service team is standing by, ready to assist you.
  • Please call us at 1-855-572-7238, Monday through Friday, 7 a.m. - 7 p.m. CT

For details on information in other languages, click here.

Member Portal

Log In/Register

FirstCare is here for you.

Interested in a Marketplace plan? Contact us today at 1-866-522-2516.

Already a member? Call Customer Service at 1-855-572-7238.


FirstCare's Direct Enrollment Portal Service Area Map 2022 Marketplace Informational Flyer 2021 Marketplace Informational Flyer Find a Provider Get a Quote Pay Your Premium Automatic Payments Guide A member guide to setting up automatic premium payments for your Marketplace plan Rate Increase Justification

Non-Discrimination Notice

FirstCare does not discriminate or exclude people based on race, color, national origin, age, disability, or sex. Read more here.

Access a Doctor, 24/7/365

FirstCare Virtual Care—powered by MDLIVE lets you connect with a doctor from wherever you are. For more details, click here.

Talk to a Nurse
24-Hour Nurseline

Need care advice? Should you see a doctor? Get the info you need today! FirstCare members can talk to a nurse 24/7 by calling 1-877-505-7947 to get answers 24 hours a day, 7 days a week! TTY users can call 711.

Utilization Management

Ever wonder how we decide what services to authorize for our members? Our utilization management (UM) decisions are based on medical evidence and consensus of health care professionals. For more details, click here. Marketplace Informational Flyer

Population Health Management

Support for Your Health Needs

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