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.

Continuity of Care / Transition of Care

General information about the transition assistance program.

Wellness Assessment & Programs

General information about Health and Wellness Benefits.

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.


Notice of Privacy Practices and Authorization to Release PHI Form.

What Does It All Mean? Health Insurance Glossaries

Health insurance terms and phrases can be confusing, so here's a list to help you: Quality Improvement Program

Frequently Asked Questions

Questions that are commonly asked by members.

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

Members with hearing loss can call the Relay Texas number 711. Relay Texas is a free telephone interpreting service to help people with hearing or speech disabilities.

For details on information in other languages, click here.

Member Portal

Log In/Register

FirstCare is here for you.

Interested in a Marketplace plan?

FirstCare Health Plans: 1-866-522-2516

Baylor Scott & White Health Plan: 1-866-522-2515

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


FirstCare's Direct Enrollment Portal Service Area Map 2023 Marketplace Informational Flyer Find a Provider Get a Quote Pay Your Premium Automatic Payments GuideHelp setting up automatic premium payments for your Marketplace plan Rate Increase Justification Technology Assessment Program Marketplace Member Guide

Non-Discrimination Notice

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

Learn more

Access a Doctor, 24/7/365

FirstCare Virtual Care—powered by MDLIVE lets you connect with a doctor from wherever you are.

Virtual Care

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.

Utilization Management

Population Health Management

Support for Your Health Needs

Send to a Friend

* Required field

Captcha The math problem above is intended to reduce spam.