Children’s Medical Group Virtual Care

SMARTCARE Visits From Anywhere

Children’s Medical Group Virtual Care

SMARTCARE Visits From Anywhere

When you are feeling unwell, traveling to a medical office may be the last thing you want to do. VirtualCare2go™ provides convenient online medical visits so eligible patients can speak with a medical professional from home, work, or another private location.

Children’s Medical Group employees enrolled in a SMARTCARE medical plan may have access to participating providers through the EHN Preferred Network. Because coverage and medical costs differ between plans, members should verify their benefits before scheduling a virtual visit.

Which SMARTCARE Plans Are Available?

Children’s Medical Group employees may be enrolled in one of the following medical plans:

• SMARTCARE 650100 HSA Plan

• SMARTCARE 350811 Plan

The SMARTCARE 650100 HSA Plan requires members to meet their deductible before the plan begins sharing the cost of covered services. Copays and coinsurance may vary, so members should review their insurance card and benefit documents.

The SMARTCARE 350811 Plan includes:

• $40 copay for a primary care visit

• $100 copay for a specialist visit

The available plan information does not list a specific virtual care copay. Contact Elan Member Services or Coastal Administrative Services before your appointment to confirm whether telehealth is covered and what you may owe.

An insurance card does not guarantee coverage or payment. Eligibility, network participation, medical necessity, deductibles, and the type of virtual service provided may affect your financial responsibility.

Can Children’s Medical Group Employees Use VirtualCare2go?

Eligible employees and covered family members may request an online medical visit through VirtualCare2go for many non-emergency concerns.

Virtual care may be appropriate for symptoms such as:

• Cold and flu symptoms

• Cough, congestion, or sore throat

• Fever and body aches

• Headaches and migraines

• Nausea, vomiting, or diarrhea

• Urinary symptoms

• Minor skin concerns

• Mild allergic reactions

• Medication-related questions

• Other non-life-threatening medical concerns

A virtual visit may not replace an in-person examination, laboratory testing, imaging, or emergency care. The medical professional will review your symptoms and help determine whether online care is appropriate or whether you should be evaluated in person.

You can Book a Virtual Visit or call (817) 508-8169 for scheduling assistance.

Call 911 or go to the nearest emergency room for chest pain, severe difficulty breathing, signs of a stroke, confusion, fainting, uncontrolled bleeding, major trauma, or another life-threatening emergency.

Who Administers the Children’s Medical Group Plans?

Coastal Administrative Services, also known as CAS, is the third-party administrator for the Children’s Medical Group SMARTCARE plans.

CAS and Elan Member Services can assist with:

• Member eligibility

• Benefit verification

• Prior authorization requirements

• Claim-status questions

• Copays, deductibles, and coinsurance

• Provider-network participation

• Telehealth benefit questions

Members and providers may:

• Call Elan Member Services at (833) 845-8854

• Call CAS at (800) 870-1831

• Visit the CAS Website

Elan Member Services can also provide assistance with benefit and claim-status questions.

What Provider Network Does the Plan Use?

The Children’s Medical Group SMARTCARE plans use the EHN Preferred Network. This network includes Baylor Scott & White Quality Alliance providers who have chosen to participate.

Not every Baylor Scott & White Quality Alliance provider participates in this particular network. Members should confirm that the provider and requested virtual service participate before scheduling an appointment.

To search for an in-network provider:

• Visit the EHN Member Portal

• Call Elan Member Services at (833) 845-8854

• Contact BSWQA Care Navigation at 1-844-279-7589

Provide the member identification number shown on your insurance card and ask whether VirtualCare2go participates with your specific SMARTCARE plan.

How Do I Verify My Virtual Care Benefits?

Before scheduling, contact Elan Member Services at (833) 845-8854 or CAS at (800) 870-1831.

Consider asking these questions:

• Does VirtualCare2go participate with my specific SMARTCARE plan?

• Are telehealth or virtual urgent care visits covered?

• What copay, deductible, or coinsurance will apply?

• Is prior authorization required?

• Must I be located in Texas during my appointment?

• Are prescriptions covered separately?

• Are laboratory tests or imaging billed separately?

• Are there any provider-network restrictions?

Ask the representative for a reference number and keep it with your records. Benefit information provided by telephone is helpful, but final coverage is determined when the insurance company processes the claim.

For additional assistance, call VirtualCare2go at (817) 508-8169.

Are Specialist Referrals Required?

The available Children’s Medical Group plan information does not list a specialist-referral requirement.

However, referral and prior authorization rules may vary according to the requested service. Members should contact CAS or Elan Member Services before beginning specialist care to confirm whether additional approval is required.

What Should I Have Ready?

Before your online appointment, please have the following information available:

• Your Children’s Medical Group insurance card

• A photo identification card

• A list of current medications

• Known medication or food allergies

• Relevant medical conditions

• A brief description of your symptoms

• The date your symptoms began

• Your preferred pharmacy information

• Any referral or authorization documents

• A private location with a reliable internet connection

Providing accurate information can help the medical professional understand your concerns and determine the safest next step.

Claims Information for Providers

Children’s Medical Group SMARTCARE claims are administered through Coastal Administrative Services.

Electronic claims: Payor ID IHS07

Mailed claims:

Employers Health Network
P.O. Box 507
Arnold, MD 21012

Providers should verify current claim-submission instructions and member eligibility before sending a claim.

Quality Care Anytime, Anywhere

VirtualCare2go makes non-emergency medical care easier to access through secure online visits. Our team listens to your concerns, evaluates your symptoms, and helps you understand whether virtual treatment or in-person care is the safest next step.

When you need care, Book Today or call (817) 508-8169. Please have your Children’s Medical Group SMARTCARE insurance card available so your benefits can be reviewed before your appointment.