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Commonly Asked Questions Regarding the Viva Health Small Group Plans

  • Do I need a referral to see a specialist?
    If you are a Viva Access member (AC), then no, you do not need a referral to receive specialty care. You may visit any physician within our network without a referral. However, Viva Health Members (VH) need a referral from the primary care physician (PCP) to receive specialty care. You may visit any physician within our network with a referral from your PCP. The name of your PCP appears on your member ID card. If you have not selected a primary physician please contact Member Services at (800)294-8870 to make your selection.
  • What should I do in an emergency situation?
    If you experience a medical emergency condition you should seek immediate help at the nearest emergency facility. An emergency medical condition is defined as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in (i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious dysfunction of any bodily organ or part. If you are admitted to the hospital, contact Viva Health at 1-800-294-7780 within 48 hours or as soon as possible. Even if you are not admitted to the hospital, you should notify Viva Health within the following 48 hours. Notification does not guarantee payment. Payment is based on a whether the condition met the definition of an Emergency Medical Condition.
  • How do I add my newborn baby?
    To add a dependent to your coverage you must complete an application. Please ask your employer about the application process. The application must be received within 30 days of the birth of your child. Please fax the application to (205) 558-7546 or mail to: Enrollment Dept. 417 20th Street North, Suite 1100, Birmingham, AL 35203.
  • How can I add my new spouse or my current spouse onto my coverage?
    To add a spouse to your coverage you must add them within 30 days of the marriage or 30 days from the date he/she lost other coverage. If neither of these events (i.e. marriage or losing coverage) have happened, you will need to wait until your employer's next open enrollment period to add your spouse. You must complete an application and fax or mail it to Viva Health. Please refer to your employer for further information.
  • What is Open Enrollment?
    Open enrollment is the time when the group's health insurance is renewing. During this time of the year dependents may be added to your coverage. An application must be completed and returned to Viva Health. You have 30 days from when the plan renews to complete and return the application to Viva Health.
  • How does the prescription service work?
    When you receive your member identification cards the pharmacy information will be printed on the back of your card. This information will be located in the top right-hand corner. If the participating pharmacy experiences any problems they should contact the Caremark help desk at the phone number located on the back of your i.d. card. The enclosed information contains an envelope with the Caremark logo on the outside. Within this envelope you will find mail order forms, claim forms, a preferred drug listing, and a list of participating pharmacies
  • How do I change my address, primary care physician, or receive a new ID card?
    Please call Customer Service at 558-7474 in Birmingham or (800) 294-7780 to make any changes on your membership record or to request a member ID. card. You may also e-mail us at VIVAmemberhelp@uabmc.edu for an immediate response.