Jane Dotson
First Choice Insurance is a physician- and hospital-owned health insurance company that serves people in the US Northwest, including Washington, Oregon, and Idaho. First Choice Insurance offers self-funded healthcare plans and short-term policies for individuals between jobs or post-graduation. They also offer major medical policies with deductibles ranging from a few hundred dollars to $15,000 per year. First Choice has been associated with Medicaid; in South Carolina, First Choice by Select Health provides Medicaid plans, and Community First Choice (CFC) is a state plan option under the Affordable Care Act of 2010.
| Characteristics | Values |
|---|---|
| Company Name | First Choice Insurance |
| Type of Insurance | Health Insurance |
| Area Served | Washington, Oregon, Idaho, and the U.S. Northwest |
| Plan Type | PPO (Preferred Provider Organization) |
| Medicaid Option | First Choice by Select Health of South Carolina |
| Medicaid Community Option | Community First Choice (CFC) 1915 (k) |
| Additional Services | Employee Assistance Program (EAP), Behavioral Health Program, Medical Management Services |
| Unique Characteristics | High-quality, Affordable, Personalized, Self-Funded Healthcare Plans |
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What You'll Learn
First Choice Insurance: an alternative to traditional health insurance
First Choice Insurance is an alternative to traditional health insurance. It is a physician and hospital-owned health insurance company that began as a Preferred Provider Organization (PPO) in 1985 in Seattle and its surrounding areas. It now serves people in Washington, Oregon, Idaho, and the rest of the US Northwest. First Choice Insurance helps its customers find unique policies to fit their individual, family, or business needs.
First Choice Insurance provides its members with access to providers in a growing PPO network, data-driven health plan administration, and medical management services. Unlike Health Maintenance Organization (HMO) plans, PPO plans do not require members to choose a primary care physician. This means that First Choice members can use any doctor at any hospital under a PPO plan, although they will save money by using in-network PPO healthcare providers. First Choice Insurance also offers short-term policies for those who need inexpensive coverage when between jobs or after graduating from high school or college. These policies can cover an individual from 30 days to 12 months.
First Choice Insurance has been offering medical management services to its members for over 30 years. Through these services, First Choice can handle all specialized case management programs, review provider billing practices via claims review, and provide cost-saving strategies and services for its clients and patients. First Choice also provides its members with a behavioural health program and directory, as well as an Employee Assistance Program (EAP) that has been running for over 15 years. The EAP includes health assessments and referrals, general clinical support, and crisis healthcare services.
In addition to its insurance services, First Choice by Select Health of South Carolina provides access to high-quality healthcare for over 330,000 South Carolinians. First Choice by Select Health was rated higher by network providers than all other Medicaid plans in South Carolina, according to an independent provider satisfaction survey by SPH Analytics in February 2023. First Choice VIP Care Plus also offers a Medicare-Medicaid Plan for those who receive both Medicare and South Carolina Healthy Connections Medicaid.
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First Choice by Select Health of South Carolina
First Choice by SelectHealth of South Carolina is a health insurance plan that provides access to high-quality healthcare for South Carolinians. It is rated higher by network providers than all other Medicaid plans in South Carolina, according to an independent provider satisfaction survey conducted by SPH Analytics, a Press Ganey Solution, and a National Committee for Quality Assurance-certified vendor in February 2023.
First Choice is committed to addressing various social issues that impact a person's health, including healthy lifestyles, support networks, education, and technology. They achieve this through partnerships with community organizations, local businesses, state government, and individuals.
The insurance plan offers a whole-person approach, serving members across the state by providing access to more than just clinical care. For instance, First Choice provides backpacks filled with school supplies for children in grades K-12 and a $25 Walmart gift card for new members who complete a New Member Orientation within 30 days of enrollment.
If you or your family members have health coverage through South Carolina Healthy Connections Medicaid, you may receive an annual review form. First Choice encourages members to maintain their benefits and choose a top-rated health plan that supports their needs. During the COVID-19 Public Health Emergency, the South Carolina Department of Health and Human Services (SCDHHS) kept Medical Assistance (MA) coverage open for most people, including those who were no longer eligible.
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Community First Choice Option: home and community-based services
The Community First Choice Option (CFCO) is an optional set of services under Medicaid that was authorized by the Affordable Care Act in 2010. It became available on October 1, 2011, and provides a 6% increase in federal matching payments to states for service expenditures. The Community First Choice Option allows states to expand access and availability of long-term services and supports that were previously only accessible through a waiver.
The CFCO is designed to be person-centred and consumer-driven, focusing on services that help the recipient maximize their independence and participation in the community. These services include assistance with everyday activities and health-related tasks that can be performed by an aide or direct care worker, such as Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).
To be eligible for CFCO services, individuals must meet specific criteria, including being eligible for medical assistance under their state's Medicaid plan and having an institutional level of care determined by a functional assessment. They must also be living in their own home or a family member's home, not in a congregate setting.
In states like New York, Texas, and Washington, the implementation of CFCO has expanded access to services and supports, offering more options to support individuals in remaining in community settings. For example, in New York, CFCO services are provided through Managed Care Organizations and Local Departments of Social Services. Texas's Community First Choice program enables Texas Medicaid to provide the most cost-effective approach to basic attendant and habilitation service delivery. Washington State's Community First Choice Option is administered by the Washington State Department of Social and Health Services (DSHS), providing clients with more service options to remain in community settings.
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First Choice Insurance: self-funded healthcare plans
First Choice Insurance offers self-funded healthcare plans to employers, helping them save money and gain more control over healthcare spending and risk management. They provide integrated solutions and customised services to build self-funded healthcare plans, specialising in third-party claims administration, in-depth data analysis, and cost containment.
First Choice Insurance aims to deliver personalised, quality service to its clients while reducing costs and keeping their members healthy. They offer access to a wide range of networks, including major national PPOs and industry-leading pharmacy service providers, allowing employers to identify the right providers based on their geographic and care needs.
First Choice Insurance's self-funded healthcare plans offer flexibility and customisation, allowing employers to design plans that meet their specific needs. They provide administration of COBRA, dental, vision, pharmacy, and HSA/FSA plans, as well as annual plan performance reviews, financial analysis, and online enrollment.
Additionally, First Choice Insurance offers medical management services through their nurses and behavioural health counsellors, who administer programs such as case management, utilisation review, and pre-authorization services. They also provide predictive modelling data that helps clients address the health of their workforce more effectively.
First Choice Insurance is committed to providing high-quality, affordable healthcare resources and services. By partnering with self-funded employers, they offer innovative third-party administration, employee benefits, and cost containment strategies. Their self-funded healthcare plans are designed to meet the unique needs of small to large organisations across the Northwestern United States.
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First Choice Insurance: short-term policies
First Choice Insurance offers short-term policies for individuals who need inexpensive coverage when they are between jobs or after graduating from high school or college. These policies can provide coverage for a period ranging from 30 days to 12 months. The cost of such plans depends on the individual's age, tobacco usage, and the chosen deductible.
Short-term policies are ideal for those who are transitioning between jobs and require temporary coverage until they can enrol in a new employer-provided insurance plan. It is also a suitable option for recent graduates who are no longer covered under their parents' insurance plans. With the cost of medical care consistently rising, short-term policies can provide peace of mind and financial protection in the event of unexpected medical expenses.
First Choice Insurance aims to provide unique and personalised healthcare solutions to individuals, families, and businesses. They offer a range of services, including medical management, provider billing reviews, and cost-saving strategies. First Choice also has an Employee Assistance Program (EAP) that helps employers maintain a healthy and productive workforce by providing health assessments, referrals, clinical support, and crisis healthcare services.
In addition to short-term policies, First Choice Insurance offers major medical policies that provide substantial coverage for medical expenses. These policies typically have a deductible ranging from a few hundred dollars to $15,000 per calendar year. By choosing First Choice Insurance, individuals can rest assured that they will have access to quality healthcare resources at affordable prices.
It is important to note that First Choice Insurance is not specifically Medicaid insurance. However, they do coordinate care for individuals who receive both Medicare and South Carolina Healthy Connections Medicaid through their First Choice VIP Care Plus plan. Additionally, their Community First Choice Option allows states to provide home and community-based attendant services to eligible Medicaid enrollees.
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Frequently asked questions
First Choice Insurance is a physician and hospital-owned health insurance company that serves people in the Washington and Northwest area of the United States. It began as a PPO in 1985 in Seattle and its surrounding areas and has since expanded to serve all of Washington, Oregon, Idaho, and the rest of the US Northwest.
First Choice Insurance offers high-quality and personalized healthcare resources and services at an affordable price. They provide their members with access to providers in a growing PPO network, data-driven health plan administration, medical management services, and an Employee Assistance Program (EAP).
First Choice by Select Health of South Carolina is a health insurance plan that provides access to high-quality healthcare for more than 330,000 South Carolinians. It was rated higher by network providers than all other Medicaid plans in South Carolina, according to an independent provider satisfaction survey by SPH Analytics in February 2023.
The Community First Choice Option allows states to provide home and community-based attendant services and supports to eligible Medicaid enrollees under their State Plan. This option was established under the Affordable Care Act of 2010 and became available on October 1, 2011.
First Choice VIP Care Plus is a Medicare-Medicaid plan that coordinates care for individuals who receive both Medicare and South Carolina Healthy Connections Medicaid.
