Member FAQ
The following Questions & Answers are presented only as general information about the plans offered by Piedmont Community Health Plan and Piedmont Community HealthCare. The documents provided to you by your employer, such as Summary Plan Description, Evidence of Coverage, Certificate of Coverage and Schedule of Benefits, will prevail for all benefits, conditions, limitations and exclusions.
If your plan requires that you select a primary care physician to coordinate your medical care, then you are covered by a Point of Service plan. Members who are covered by a Preferred Provider Organization plan are not required to select a primary care physician. However, both plans require that members use a physician or other provider who is a member of the Piedmont Community Health Plan network.
Additional information is also available from your employer's human resource department and from Customer Service, Piedmont Community Health Plan at 434-947-4463 or toll-free at 1-800-400-7247.
LocalSelect Point of Service (POS) Plan Questions
LocalSelect Provider Organization (PPO) Plan Questions
What is Piedmont Community Health Plan?
Piedmont Community Health Plan, Inc. is a locally owned managed care company located in Lynchburg, Virginia. It is jointly owned by Centra Health, which consists of Lynchburg General Hospital and Virginia Baptist Hospital, and the physicians that participate in its network. Piedmont Community Health Plan offers Point of Service (POS) plans and Preferred Provider Organization (PPO) plans.
What is Piedmont Community HealthCare?
Piedmont Community HealthCare is wholly owned subsidiary of Piedmont Community Health Plan, Inc. It offers POS and PPO plan designs through a fully insured funding arrangement. The company was licensed in 1998 and began selling in March 1999. Both Piedmont Community HealthCare and Piedmont Community Health Plan utilize the same network of providers. Piedmont Community HealthCare is offered to both small and large employer groups.
How big is the Piedmont Community Health Plan Network?
The network used by both Piedmont Community Health Plan and Piedmont Community HealthCare includes more than 98 percent of the local physicians, both local hospitals in the Lynchburg area, Bedford Hospital and Southside Community Hospital in Farmville. Agreements are also in place with Medical College of Virginia (MCV), University of Virginia Hospital (UVA), and the University of North Carolina Hospital (UNC) to provide care that cannot be accommodated by Lynchburg General Hospital, Virginia Baptist Hospital, Bedford Hospital, Southside Community Hospital and Halifax Regional Hospital.
The service area includes the cities of Bedford and Lynchburg and the counties of Albemarle, Amherst, Appomattox, Bedford, Buckingham, Campbell, Charlotte, Cumberland, Halifax, Lunenburg, Mecklenburg, Nelson, Nottoway, Pittsylvania, and Prince Edward. Piedmont Community Health Plan has arrangements with providers in all of these areas.
How do I know if my plan is a POS or a PPO?
The documents provided by your employer describe your plan, including coverage, benefits, conditions, limitations and exclusions. If your plan requires that you select a primary care physician to coordinate your medical care, then you are covered by a Point of Service (POS) plan. Members who are covered by a Preferred Provider Organization (PPO) plan are not required to select a primary care physician. However, both plans require that members use a physician or other provider who is a member of the Piedmont Community Health Plan network.
What is a POS Plan?
The Point of Service (POS) plan design is the most popular plan design offered by Piedmont Community Health Plan and Piedmont Community HealthCare. With the POS plan design, each member must select a primary care physician. There are two levels of benefits: in-plan and out-of-plan. As long as the member receives covered services from their primary care physician or has a referral from their primary care physician, the member receives a higher level of benefits. Otherwise, the member still receives benefits for covered services, but they are a lower level of benefits, which means more out-of-pocket costs. For more information, see the Frequently Asked Questions on Point of Service.
What is a PPO Plan?
The Preferred Provider Organization (PPO) plan design is also offered by Piedmont Community Health Plan and Piedmont Community HealthCare. There are two level of benefits: in-plan and out-of-plan. As long as the member uses providers in the network for covered services, the member receives in-plan or the higher level of benefits. Pre-certification is required for all hospital related services, whether inpatient or outpatient. When the member utilizes providers that are not in the network, the member receives out-of-plan benefits for covered services. This means a lower level of benefits or more out-of-pocket costs for the member. For more information, see the Frequently Asked Questions on Preferred Provider Organization.
Are other plans available?
Piedmont Community HealthCare is offered through the Federal Employee Health Benefits (FEHB) program. This plan differs slightly from the standard options available from other employers. A full description of the benefits provided to Federal Employees by Piedmont Community HealthCare is available by clicking here.
Are individual plans available?
No, not at this time. Piedmont Community Health Plan and Piedmont Community HealthCare only offer employer group plans. Group employers must have at least two full-time employees.
What are the advantages of Piedmont Community Health Plan and Piedmont Community HealthCare?
- A community-based organization accessible to its customers.
- Local management with local knowledge and understanding to make the most informed decisions.
- Local staff empowered to serve each employer and covered employees and families.
- A medical management program designed by the local medical community, which promotes the concept that your physician will manage your care.
- A strong commitment among participating physicians and other network participants to manage employer health benefit costs.
- The most comprehensive network available in the Lynchburg area.
- Affordable healthcare for employers and desirable health care benefits for employees and their families.
How can I receive more information on Piedmont Community Health Plan or Piedmont Community HealthCare?
Contact us at (434) 947-4463 or 1-800-400-PCHP (7247).
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