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Member Resources

Caprock HealthPlans is much more than your typical third party administrator (TPA) of health benefits, we've become an integral part of the solution to providing affordable healthcare in the U.S. We've done the research for you, followed the trends, listened to our clients and put all of our collective experience toward creating something incredible- Caprock HealthPlans. These options are here to help you understand your benefits, answer service questions and assist in accessing the care needed by you or your family member. Caprock HealthPlans has developed a variety of products and services to allow its members maximum efficiency in the administration of their health plan benefits.

You can obtain claim, eligibility and benefit information when it's convenient for you by using the Internet. Simply enter your group number, and you will be provided with a link specific to your employer group. As one of our members you have exclusive access to our customer care team.

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Claim Review

Since each plan is different it is very important that plan participants refer to their Plans Summary of Benefits or Plan Document to familiarize themselves with the benefits and coverage's offered through your employer. Your Plan Document offers the most comprehensive description offered to you, including information regarding covered services.

Web Portal:

Login to our web portal to access the following tools.

  • » Print EOB's
  • » View my claims
  • » Claims summary
  • » Temporary ID cards
  • » ID card request
  • » View Benefit Information
  • » Coverage Inquiry


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Cobra - Future Service

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers to offer continuous health care coverage to employees and their dependents who would otherwise lose their coverage due to termination of employment or other factors. Caprock HealthPlans makes it easy for you to make payments online.

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Flex Benefits

Flexible Spending Accounts (FSAs) are, easy to use and they save money. As a member you can save on out-of-pocket costs for health care and dependent day care by using pre-tax dollars to pay for them. Expenses like deductibles, co-insurance, co-pays, prescription drugs, eyeglasses, day care services and privately owned insurance policies can quickly add up.

  • » Out-of-pocket expenses
  • » MySource Card


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Products


PPO Network:
A Preferred Provider Organization is a health care organization composed of physicians, hospitals, or other providers which provides health care services at a reduced fee.

CapCost Network:
With our CapCost Network you have a choice in selecting your medical provider, while at the same time reducing Healthcare costs to you and your employer.

Click here for a full list of Products and Services

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Provider Search and Directory

To determine which provider network you participate in, please login to our member portal or contact us at 800-747-9446. Once you have identified which network(s) you have access to, you can find out if a provider is in-network by logging in to our member portal and clicking the provider tab. If you would like to call our Customer Care Team, please call us at 800-747-9446. We will be happy to locate a provider for you. It is very important that you call the provider you select prior to your visit to assure that they are still participants in your network. It is your responsibility to make sure the provider has not changed their participation at the time you see them.

Seeing a participating provider has distinct advantages over visiting a non-participating provider:
  • Participating providers have agreed to accept a pre-established amount as payment in full for service.
  • Your out-of-pocket cost is normally lower, with a co-pay (if any) specified in your health plan. Most plans also have an annual deductible amount.

Non-participating providers, on the other hand, set their own fees. You are responsible for the difference between the reasonable and customary amount and the non-participating provider's total fee. Some non-participating providers will file a claim for you, while others require payment in full from you.


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Pharmacy Benefit Manager

The Rx Comparison search tool helps you find information on a medication that you take or consider taking. If available, the search results will display information and prices on comparable drugs. This way, you can make an informed choice between brand name drugs, generic versions and over-the-counter medications.


One login will access:
  • » Prescription refills
  • » Refill request form
  • » Look-up Rx history
  • » Specific drugs research


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Useful Health Web Links


Caprock HealthPlans presents these links as a convenience to our members. This list is not complete, nor does it constitute an endorsement by Caprock HealthPlans.