Member guide

How to use your Major Medical plan.

Keep reading for some tips and tricks on how to get the most out of your healthcare.

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Clearwater Benefits Administrators boomy health doctor

Renew Your Major Medical Plan

Current members of a Major Medical Copay 3500, Major Medical Copay 4500, Major Medical Copay 8000, Major Medical HSA 5000, or Major Medical MVP plan must renew their plan no later than December 31, 2023 to continue plan coverage for 2024. If you do not complete this form, your coverage will end effective December 31, 2023.

Your Major Medical plan network is changing. Starting January 1 2024, the plan will no longer use the First Health Complementary network. The plan will start using the PHCS Practitioner & Ancillary and PNOAe networks for practitioners/doctors. For hospitals and facilities, the plan will be on an open network. We work directly with facilities to negotiate pricing.

Download our app.

Access more information about your plan, including your digital Member ID card, through our mobile app – available through HealthWallet. Download The Health Wallet app in the App Store or Google Play store or click below on your phone. Then log in with your Date of Birth and your Social Security Number. If you have dependents on the plan, they can log in to their own Health Wallet accounts using their Date of Birth and Social Security Number.

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Accessing Care

To ensure you are receiving the right care, in the right place, for the best cost, Care Coordination is embedded in your plan. Care Coordination is a supporter alongside you, helping you navigate the complex healthcare system, become an active participant in your healthcare journey, and understand each step.

If your plan allows access to In-Network Preferred (Tier 1) benefits for no out-of-pocket cost, you MUST call Care Coordination BEFORE obtaining services.

Find a participating provider through the PHCS Network for Value-Driven Health Plans. To find a provider, visit:

Certain services require prior authorization. To avoid penalty, you MUST call Care Coordination BEFORE obtaining services and they will assist in connecting you with MedWatch, our medical management team. See your plan documents for a complete list of services that require prior authorization.

Contact Care Coordination: 833-612-1674 or visit

Plan Documents

Major Medical Copay 3500

Summary of benefits and coverage

Major Medical Copay 4500

Summary of benefits and coverage

Major Medical Copay 8000

Summary of benefits and coverage

Major Medical HSA 5000

Summary of benefits and coverage

Major Medical MVP

Summary of benefits and coverage

Free paper copies of the SBC are available upon request. To request, please contact us.

Need help?

Healthcare can be confusing – that’s why Clearwater is always here to help you get all of the answers you need.
Reach our customer support team.