FAQ & Resources: Your Healthcare Guide

• Is WebTPA my insurance company? No, WebTPA is not an insurance company. WebTPA is a third-party administrator that processes claims and provides member support on behalf of Prudential. We have a dedicated team to assist you with questions about your benefits, providers, and claims. We also have a team of experienced nurses to assist with managing healthcare needs through several care management programs.
  
  

• What do I tell my provider when they ask me to share my insurance provider? Show your health plan ID card to your provider’s office and tell them WebTPA is your health plan’s claims administrator and Aetna is your provider network. You can also provide this flyer to your doctor. 

• How do I know what plan I'm on? Your plan name can be found on the front of your ID card beneath your member ID number.
  
  

• Where can I find my ID card? You will be mailed a new ID card when you first enroll or changes are made to the health plan. You can also view, print, or order new ID cards by logging into your My Health Hub account on your desktop or the mobile app.
  

  
  

• Who do I contact if I have a question about a claim? If you have questions about a medical claim, call WebTPA Member Services at 800-230-5107 or email prudential@webtpa.com.

• What is a provider network? A provider network is a group of doctors, healthcare professionals, facilities, and hospitals that your health plan has contracted with to provide health services at lower rates.
  
  
• What do in-network and out-of-network mean?
  • In-network: Providers that have a contract of negotiated rates with your health plan.
  • Out-of-network: Providers that do not have a contract of negotiated rates with your health plan.

• Why should I visit an in-network provider? Visiting an in-network provider usually results in lower out-of-pocket costs, including coinsurance, copays, and deductibles.
  
  
• How do I find out if a provider is in-network? Click “Find Care” in the navigation bar at the top of this page to search for an in-network provider near you. You can also click here to find care.
  
  
• Can I visit an out-of-network provider? If you are on the basic EPO or HSA plan you cannot visit out of network providers, unless it's an emergency. For all other plans, you can visit a provider outside of your network, but you will likely be responsible for larger, out-of-network healthcare costs. You may also need to file your claims directly to WebTPA.
  
  
• What if I have an emergency and can't check if my doctor is in-network? A federal law called the No Surprises Act (NSA) ensures that certain emergency services are covered at in-network rates. To learn more, click here.
  
  
• What if I need help finding a provider? For assistance with finding a provider that’s right for you, call WebTPA Member Services at 800-230-5107 or email prudential@webtpa.com.
  
  
• For more information about your network, click here.

• What is a Primary Care Physician? A Primary Care Provider (PCP) is a medical professional who provides a range of general medical care throughout a patient’s life, such as routine check-ups, annual wellness exams, and vaccine administration. Additionally, PCPs coordinate specialized care by referring patients to medical specialists when needed.
  
  
• What are the benefits of having a PCP? Forming a relationship with a PCP ensures you have access to a trusted healthcare professional who is familiar with your medical history and dedicated to your long-term health. Benefits include:
  • Treatment of common health issues
  • Access to a range of wellness services
  • Guidance surrounding disease prevention and healthy living
  • Ongoing management of chronic conditions (like diabetes and high blood pressure)
  • Peace of mind knowing your health is in the hands of a provider who understands you and your needs
    

To search for a provider in the Aetna network, click here.
To find an Advanced Primary Care (APC) Provider through Apaly, click here.

• Annual Enrollment: A specific period during the year when individuals can enroll in, make changes to, or cancel a health insurance plan.
  
  
• Claim: A request for a benefit (including reimbursement of a health care expense) made by you or your health care provider for items or services.
  
  
• Coinsurance (COINS): Commonly referred to as COINS, coinsurance is a percentage of the cost of services you pay for after you meet your deductible. This percentage generally varies if your care is in-network or out-of-network.
  
  
• Copay: A flat dollar amount you pay each time you receive covered treatment, services, or supplies.
  
  
• Deductible: An amount you owe during a coverage period (usually one calendar year) for covered health care services before your plan begins to pay.
  
  
• Dependent: An individual (such as a spouse or child) covered by a subscriber’s health insurance plan.
  
  
• Explanation of Benefits (EOB): An explanation regarding a claim showing the in-network discount (if applicable), how much the plan paid, what the patient may have to pay, and why a claim was denied or approved.
  
  
• Flexible Savings Account (FSA): A type of savings account that lets you set aside before-tax money to pay for qualified health-related expenses. This money generally must be used by the end of the plan year.
  
  
• Health Savings Account (HSA): A type of savings account that lets you set aside before-tax money to pay for qualified medical expenses. This money does not expire and can be carried over year-to-year. You can use your HSA for deductibles, copays, coinsurance, and other expenses.
  
  
• Out-of-pocket maximum: The most you could pay during a coverage period (usually one calendar year) for your share of the costs of covered services.
  
  
• Plan Limit: The maximum amount your health plan will pay for specific in-network procedures.
  
  
• Premium: The amount that must be paid for your health insurance or plan.
  
  
• Provider: A provider is a person or facility that provides health care services. The term provider often refers to a doctor; however, it can also mean medical clinics, hospitals, and other healthcare professionals (such as nurse practitioners or specialists).
  
  
• Subscriber: An individual who applies or pays for health insurance coverage.
  
  
• Summary of Benefits and Coverage (SBC): A document intended to help you compare and select health insurance coverage that best meets your needs by providing easy-to-understand language of health benefits.
  
  
• Summary Plan Document (SPD): A document that details what benefits a health plan provides and how the plan works, including when employees become eligible to participate in the plan, covered services and exclusions, and other group specific information.