• FREQUENTLY
  • ASKED
  • QUESTIONS

PivotCare Limited Medical Benefit Plan

You will know immediately following completion of the online application. Your certificate of coverage and ID card will be mailed to you via US mail.
If your answer is YES to any of the medical questions, you will not be eligible for this plan. However, you may have another option. PivotCare Economy, a limited medical benefit plan that requires only one medical question regarding pregnancy will begin accepting applications soon. Please check back to check availability and to see if one of these plans can meet your health care needs.
You will have immediate coverage for preventive health and accident benefits. Beginning on the policy’s effective date, there is a 30-waiting period for covered sickness, mental and nervous treatment and substance abuse benefits.
When you go to a doctor or medical facility that is a member of the First Health national PPO network, just show your PivotCare card. Medical service claims will be sent to Allied National for processing. An Explanation of Benefits (EOB) will be mailed to you, showing the re-priced (discounted) fee, how much was paid to the provider, and how much, if anything, you may still owe. If your payment is MORE than the billed medical service, a check for the remaining benefit will be mailed to you.
If you see a provider who is in the First Health PPO network, just show your PivotCare ID card. Allied National, Pivot Health’s administrator, will process your claim and send you an Explanation Of Benefits (EOB), showing you the amount paid to the provider and the amount, if any, that will be paid to you or that you may still owe.
  1. If you have not satisfied your deductible:
    • Present your health insurance company's ID card. If you are at an in-network provider, your claim will be sent to your insurance company and they will send you an EOB (Explanation of Benefits), telling you how much you owe after they have discounted the service fee. Send a copy of the EOB, along with a copy of the form from your doctor, lab, etc. that details the procedure and procedure code or a copy of the UB04 form from the hospital or institution where you received care (ask for it from the billing dept.) to Allied National. Allied National will send you an EOB, showing how much they paid. After Allied National has made payment on behalf of PivotCare according to your plan benefit design, you may still owe a balance to your provider. NOTE: Medical providers generally encourage patients to sign an "Assignment of Benefits"  form upon admission. If you have done this, it is an indication to the claims administrator that you would like the benefit amounts paid to the provider instead of to you. If you want to avoid this, do not provide your PivotCare card to the provider, to ensure all payments come directly to you.
  2. If you have satisfied your deductible:
    • Follow the procedure detailed in (a) above. When you receive your EOB showing the coinsurance amount you may be responsible to pay, send it, along with a copy of the procedure detail form from your doctor, lab, etc. (showing the procedure code and amount you paid) or a UB04 form from the hospital or institution where you received care (ask for it from the billing dept.) and a copy of the EOB to Allied National. They will send you a check for any amount that may be due you, based on your plan benefit design. NOTE: Medical providers generally encourage patients to sign an "Assignment of Benefits"  form on admission. If you have done this, it is an indication to the claims administrator that you would like the benefit amounts paid to the provider instead of to you. If you want to avoid this, do not provide your PivotCare card to the provider to ensure all payments come directly to you.
Allied National C/O Zelis
Box 247
Alpharetta GA 30009
EDI Payor ID 07689

Pivot Health Short Term Medical Plan

You will know immediately following completion of the online application. One you have been approved, you will be able to download and print your certificate of coverage and ID card. The effective date of coverage is next day for accidents, unless a later date is selected. For sickness, medical and prescription drug claims, coverage begins 5 days after the effective date.
Yes, if your answer is YES to any of the 5 medical underwriting questions, you will not be approved for coverage.
Pivot Health offers you the convenient opportunity to apply for up to 4 back-to-back insurance certificates at one time, enabling you to have continuous coverage for nearly 12 months, unless prohibited by state regulations. The website will ask you some additional questions regarding your eligibility if you reside in one of those states.
If you opt for back-to-back coverage, you will not have to qualify again for the three additional 90-day coverage periods , and you can cancel at any time. A new certificate of insurance will be sent, following each 90-day coverage period. Each certificate will have an effective date that starts the day after the previous coverage expires. You will be notified of a new coverage ID card in your online member portal, which you can print and use for the following period. To recap, the benefits are:
  1. Rates are locked for up to 4 consecutive 90 days periods.
  2. No new medical qualifications.
  3. No new pre-existing condition waiting period.
  4. Only one enrollment fee for up to 4 coverage periods
  5. You may cancel at any time.
  6. Some benefit waiting periods are waived after the first 90-day coverage period.