FAQ & Glossary

Clearwater Benefits is a healthcare vendor. Clearwater Benefits offers a wide variety of high quality, highly affordable healthcare solutions tailored to meet individuals’ unique needs via traditional insurance plans, healthshare-based solutions, and supplemental insurance offerings.

Wallace Specialty Group Health offers Major Medical plans.

Major Medical Copay 3500, Major Medical Copay 4500, Major Medical Copay 8000:
These plans are best for those who expect to utilize healthcare services more frequently. Enjoy copays for common services like doctor visits and prescriptions, plus a range of deductible options to control your out-of-pocket costs. If members stay within our Tier 1 Preferred Network they can access $0 care for many services. 

Major Medical HSA 5000:
This plan is for those interested in having and contributing to a Health Savings Account.

Major Medical Minimum Value Plan (MVP):
This plan is best for those who do not expect to go to the doctor frequently and want to have coverage for large unexpected medical costs.

Care Coordination access depends on the plan you have selected.

On Major Medical Copay 3500, Copay 4500, and Copay 8000 plans, Care Coordination is embedded in the plan as a Tier 1 In-Network Preferred provider. Most services other than primary care and emergency services are eligible, but reference your plan documents for a complete list.

When Care Coordination is able to find a provider in your area that we recommend, your care is completely free. Our team will work diligently to find you a recommended provider, however there are instances where no provider is available. Care Coordination benefits are not guaranteed.

On Major Medical HSA 5000 and MVP plans, use of Care Coordination to access benefits or avoid penalty is required for most services. Reference your plan documents for a complete list.

When you need a service that is eligible for Care Coordination, we recommend contacting us at least 21 days before obtaining services. When you choose to see the provider we recommend, your care is completely free.

Our team will work diligently to find you a recommended provider, however there are instances where no provider is available. Care Coordination benefits are not guaranteed.

Care Coordination does not have a doctor lookup. The providers we recommend depend on a variety of factors. 

No, Care Coordination works to find and recommend you a fair-priced, high quality provider.

If you want to choose your own provider, you can use your plan’s applicable in-network or out-of-network services.

Yes, we can recommend providers for a second opinion.

Yes, Care Coordination must be contacted and a provider must be recommended for each service in order to be eligible for waived out-of-pocket costs.

On Major Medical HSA 5000 and MVP plans, use of Care Coordination to access benefits or avoid penalty is required for most services. Reference your plan documents for a complete list.

For other plans, Care Coordination is an added benefit and is not required. If you want to choose your own provider, you can use your plan’s applicable in-network or out-of-network services. 

You should contact your Care Coordination team to find out what documents are required for the service you need.

Call 888-537-2344 or visit www.urmedwatch.com.