Getting the most out of your healthcare coverage.
Resources for Members
Please see our materials and tools below to help you get started.
Request ID Card
Need a new ID Card or an extra one? Click the button to fill out a form and we will send you one right away. Usually within 5 business days.
HIPAA Authorization of PHI Release
This form is used to release your protected health information as required by federal and state privacy laws. Your authorization allows the health plan to release your protected health information to a person or organization that you choose.
Member Portal Reference Guide
members.verdegard.com gives you direct, 24/7 access to your personal claims and account history, benefit and expense limits, plan documents and forms, locate a provider and other support tools.
Transition of Care Form
Transition of Care coverage allows you to continue to receive services for specified medical and behavioral conditions for a defined period of time with health care professionals who do not participate in the FirstCare Health Plans network until the safe transfer of care to a participating doctor or facility can be arranged.
Prior Authorization Form
Under medical and prescription drug plans, some treatments and medications may need approval from your health insurance carrier before you receive care. Prior authorization is usually required if you need a complex treatment or prescription. Coverage will not happen without it.
Provider/Facility Enrollment
If you would like to add a provider to our network, please click the button below to download a form or fill out our online form.
Coordination of Benefits (COB)
Allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities (i.e., determine which insurance plan has the primary payment responsibility when an individual is covered by more than one plan).
Explanation of Benefits (EOB)
An explanation of benefits (EOB) shows you the total charges for your visit. It is not a bill. Download our form to understand your explanation of benefits.
Member Reimbursement
Use this Member Reimbursement form to ask for payment for eligible care you’ve already paid for with a credit card, cash or check.
FAQ’S For Members
Who is Verdegard
Verdegard is a third-party administrator (TPA) that provides employers and health benefit plan members with services to help them get the most from their benefit plan.
What does Verdegard do for me?
We provide you with prompt, personalized service. As a plan member served by us, you have a customer service team of helpful people available to assist you and answer questions about your health benefits. For example, you can ask us about the medical care your plan covers or about a specific health claim. One phone call is all it takes to reach us and speak to someone who can help you get the answers you need. You may also receive other services, depending on your health plan’s features, to help you and your covered family members use the health care system and receive appropriate health care at a reasonable cost.
What does it mean to be self-funded?
A self-funded benefit plan is financed by your employer, not an insurance carrier. Your employer pays for most of your health plan and claim costs.
What is a PPO?
Most TPAs work with a preferred provider organization (PPO). A PPO is a network of health care providers who have agreed to discount (reduce) what they charge for services when treating members of a benefit plan. When you choose to see an in-network PPO health care provider, you will pay less for their services than if you had chosen an out-of-network (non-PPO) health care provider. You have the option to see non-PPO providers, but you will pay more for their services. Your member ID card contains important information regarding your plan’s PPO.
What is a RBP?
Referenced-Based Pricing (RBP) delivers transparency in the pricing of major medical services based on economical reimbursement levels. It is designed to be fair and reasonable based on various pricing data sets. RBP can save up to 40% when compared to traditional PPO networks. RBP offers self-insured health plans a defined benefit structure based on fair and reasonable economical reimbursement levels. Based on multiple data points, RBP allows employers to set a certain reimbursement dollar amount per procedure.
What is a MEC or MiniMED?
A MEC plan is health insurance that meets the federal government’s standard for coverage. It meets the Affordable Care Act requirement for having health coverage.
A MiniMED plan is a health plan that features very limited benefits. These plans are offered by. certain employers, unions and purchased by individuals who buy on their own.
Who should I call for questions?
If you are calling about benefits and eligibility, claims status, enrollment, or provider services contact Advanta at (866) 206-7920. If you are a member of the Navajo Nation, please dial (800) 448-3585.
How do I get a new ID card? And how long does it take?
Call (866) 206-7920 or contact us via our online form.
New ID cards will be mailed within 5 business days from request.
What are my benefits?
Refer to your plan documents or call (866) 206-7920. If you are a member of the Navajo Nation, please dial (800) 448-3585.
What should I do in case of an emergency?
For immediately medical attention or an emergency, please call 911. After your treatment you may need to contact Verdegard at (866) 206-7920. If you are a member of the Navajo Nation, please dial (800) 448-3585.
Check the back of your ID card for additional information.
Who is considered a dependent?
Dependent means the participant’s spouse and each eligible child under 26 years of age.
How can I find out if my healthcare provider is a participating provider?
Contact Advanta at (866) 206-7920. If you are a member of the Navajo Nation, please dial (800) 448-3585.
