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Tuality Employees & Families FAQs

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If I need a new member ID card, how can I request one?

Contact Tuality Health Alliance member service at 503-844-8104. We will be happy to provide you with a replacement ID card.

If I have My Health Plan through Tuality, how do I choose a primary care physician?

My Health Plan gives you access to the THA and HRNW network of providers. THA does not require you to register a primary care physician and you have the freedom to change at any time.  In order for your services to be covered, you are required to see an in-network provider.  Visit our Find a Provider section under Tuality Employees & Families.

If I have My Extended Network through Tuality, how do I choose a primary care physician?

My Extended Network gives you access to the Tuality, HRNW and First Choice Health Network providers.  To see participating physicians and hospitals in the Tuality and HRNW networks, visit our Find a Provider section under Tuality Employee & Families.

How can I access information about First Choice Health Network?

To access information about physicians and hospitals associated with First Choice Health Network, visit their website at www.fchn.com.  THA does not require you to register a primary care physician and you have the freedom to change at any time. In order for your services to be covered, you are required to see an in-network provider.

Do I have alternative care benefits?

Both My Health Plan and My Extended Network have Naturopath and Chiropractic benefits available.  The participating providers are available for both plans under the First Choice Health Network. To see participating providers, please go their website at www.fchn.com. At this time, massage and acupuncture services are plan exclusions and not covered on either plan.  For more specific information about the benefits, please visit our Medical Benefits section under Tuality Employees & Families.

How do I access a Specialist?

If you have My Health Network:

In this situation, ICM will refer you to the most appropriate First Choice Health Network Provider.

If you have My Extended Plan:

To see participating specialists for THA and HRNW, please visit our Find a Provider section page. To see participating specialists for the First Choice Health Network, please use the online directory on their website at www.fchn.com. Specialist office visits do not require a referral or authorization as long as you are staying in-network for your plan. Any care outside of the THA, HRNW, or FCHN would require an authorization by ICM.

Does my plan have behavioral health benefits?

Yes, both MY Health Plan and My Extended Network can access behavioral health services through the First Choice Health Network.  You can see participating providers by using their online directory at www.fchn.com.  Outpatient/office visit services do not require a referral or authorization.

What if I have an out-of-area dependent?

First, you must register all out area dependents with the Tuality Human Resources Department to ensure proper coverage.  If the dependent resides in Oregon, Washington, Idaho, Montana, Wyoming, North Dakota, South Dakota, or Alaska they must use providers within the First Choice Health Network for both My Health Plan and My Extended Network benefits.  To see participating FCHN providers, please use their online directory at www.fchn.com.  If they reside and seek care outside of the FCHN service area, coverage will be provided for any licensed provider, but provider charges will be limited to usual and customary charges.  Please visit our Medical Benefits section under Tuality Employees & Families for details.

What do I do in an emergency?

Seek qualified help immediately. You and your family members are covered for emergency medical services anywhere, 24 hours a day.

An emergency is a sudden and unexpected onset of an injury or serious illness that, if not treated immediately, may result in serious medical complications, loss of life or permanent impairment of bodily functions. Some examples include (but are not limited to) chest pains, loss of consciousness, excessive bleeding, broken bones, loss of breathing or convulsions.

In an emergency, call for emergency assistance or go to the nearest hospital emergency room immediately. You, your family or your doctor must call Innovative Care Management within 24 hours in the event of an admission to a hospital.

Am I covered for emergency and urgent care away from home?

Yes, you're always covered wherever you are. If you are out of the country, you are required to pay for the services and seek reimbursement.  Visit our Medical Benefits section under Tuality Employees and Families for more information.

How do I obtain pre-authorization for hospitalization or a surgery?

Prior to a planned hospital admission or surgery, your doctor must call Innovative Care Management to request a prior authorization.  Even though the request comes from the doctor, it is the patient’s responsibility to ensure that an authorization is in place.  If a required authorization is not obtained, payment can be denied.  For more information about prior authorization requirements and benefits visit our Medical Benefits section under Tuality Employees & Families.

What are explanations of benefits (EOBs) and how do I get copies?

Explanation of benefits (EOBs) are mailed to your home after every claim is processed for you and any dependents on your plan.  If you misplaced or need additional copies of EOBs, you can obtain those by accessing the THA Member Portal. Privacy laws indicate each adult must sign up for individual accounts.  However, dependent (children) claims information will show up in the subscriber’s portal.

How do I submit for reimbursement?

When you receive care, your doctor's office usually takes care of filing your claim. However, to ensure your claim is sent to the proper address you must show your doctor's receptionist or billing department your ID card. It is important that you ask that they update their computer records with the claim address information shown on the back of the card.  If receive a service where you are required to pay upfront and it is not able to be billed directly to THA, you'll need to submit a claim form to the appropriate address for the plan. In order to qualify for reimbursement, you do have to pay for the service in full and it has to meet all plan guidelines. Claim forms can be found under the Submit a Claim section under Tuality Employees & Families. Once completed, please submit the information to:

Tuality Health Alliance
P.O. Box 925
Hillsboro, OR 97123
Phone:  503-844-8104
Fax 503-681-1927
THA.Customerservice@tuality.org

Where can I get my prescriptions filled?

Visit our Tuality Employees & Family section under Dental/Vision/Prescriptions Benefits" for complete information about where to get prescriptions filled.

What is the difference between Family Practice and Pediatrics?

Family Practice is qualified to care for the entire family (all age groups). Pediatrics specializes in the overall well-being of children. Most pediatricians can treat children from birth to adolescences.

How do I contact member services, and when are they available?

Member Service is available Monday through Friday, from 8am to 5pm, at 503-844-8104. You can email us anytime at THA.Customerservice@tuality.org