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1. For emergency services in accordance with the section of the Agreement titled “Emergency Services,”
2. Post Stabilization Services, unless the Member waives Balance Billing protections,
3. Services by a Non-Participating Provider at a Participating Facility, unless the Member waives Balance Billing protections,
4. Air ambulance services,
5. Services from a Non-Participating Provider that are subject to Prior Authorization,
6. For exceptions described in the section of the Agreement titled “Non-Participating Provider to Provide a Covered Service.”
7. Exceptions in accordance with the section of the Agreement titled “Continuity of Care,” and
8. Exceptions in accordance with the section of the Agreement titled “Transition of Care.”
Once you have obtained covered services from a participating provider, the provider is responsible for submission of claims to Passport for determination of payment under your plan. You are not responsible for submitting claims to Passport for payment of benefits under your plan.
However, if a participating provider fails to submit a claim, you may wish to send receipts for covered services to Passport. With the exception of any required cost sharing amounts (such as a deductible, copayment or coinsurance), if you have paid for a covered service or prescription that was approved or does not require approval, Passport will pay you back. You must submit your claim for reimbursement within 12 months from the date you made the payment.
Please refer to your evidence of coverage, policy or certificate. You will need to mail a copy of the bill from the doctor, hospital or pharmacy and a copy of your receipt and the Member’s Name, Subscriber ID, and Date of Birth. If the bill is for a prescription, you will need to include a copy of the prescription label. Mail this information to Passport’s customer support center at the following address:
Passport by Molina Healthcare
5100 Commerce Crossings Drive
Louisville, KY 40229
A grace period is a period of time after a member’s premium payment is due and has not been paid in full. If a subscriber hasn’t made full payment, they may do so during the grace period and avoid losing their coverage. The length of time for the grace period is determined by whether or not the subscriber receives an advance payment of the premium tax credit (APTC).
A prior authorization is an approval from Passport for a requested health care service, treatment plan, prescription drug or durable medical equipment. A prior authorization confirms that the requested service or item is medically necessary and is covered under your plan. Passport’s Medical Director and your doctor work together to determine the medical necessity of covered services before the care or service is given. This is sometimes also called prior approval.
You should consult your agreement to determine what services require prior authorization under your plan. If you do not obtain prior authorization for the specified services, claims for benefit payment may be denied, impacting your out of pocket costs.
For routine prior authorization requests, Passport will provide a decision within 5 days of receipt of the request.
Medical conditions that may cause a serious threat to your health are processed within 24 hours from receipt of all information, or shorter as required by law.
Passport has a list of drugs, devices, and supplies that are covered under the plan's pharmacy benefit. The list is known as the formulary. The formulary shows prescription and over-the-counter products plan members can get from a pharmacy using Passport coverage. It also shows coverage requirements, limitations, or restrictions on the listed products. The formulary is available at MolinaMarketplace.com. A hardcopy is also available upon request.
If your prescription drug is not listed on the formulary, your provider may request a formulary exception by sending a form and supporting facts to let Passport know how the drug is medically necessary for your condition. The process is similar to requesting prior authorization for a formulary drug. If the request is approved, we will notify your provider. If it is not approved, we will notify you and your provider, including the reasons why. Drugs that are not on the formulary may cost you more than similar drugs that are on the formulary if covered on exception.
There are two types of formulary exception requests:
Expedited exception request – this is for urgent circumstances that may seriously jeopardize your life, health, or ability to regain maximum function; or for requesting nonformulary prescription drugs you have already been taking for a while. Drug samples given to you by a provider or a drug maker will not count as drugs you have been taking for a while. To have your request expedited, indicate on the form that the request is urgent.
Standard exception request – this is for non-urgent circumstances.
Notification - following your request, we will send you and/or your provider notification of our decision no later than:
•24 hours following receipt of an expedited exception request
•72 hours following receipt of a standard exception request
If you think your request was denied incorrectly, you and your provider may seek additional review by Passport or an Independent Review Organization (IRO). Details are outlined in the notification you will receive with the reasons why the exception request was denied.
Information about cost sharing amounts can be found on our benefits at a glance brochure or by entering your prescription and pharmacy information into the check drug cost tool. To use the check drug cost tool, click on the “Drug Look-Up” link for your plan on our view plans webpage.
Please note: Cost sharing for any prescription drugs obtained by you using a prescription drug manufacturer discount card or coupon, will not apply toward any deductible or annual out-of-pocket maximum under your plan.
The Engage Cost Estimator Tool is for Molina Marketplace members to get a cost estimate for a procedure or service before receiving medical care from both in and out-of-network providers.
Estimates consider the plan of benefits, benefit accumulations, benefit limits, and out-of-pocket accumulations at the time of the inquiry.
No, they are only estimates and will not be the final cost. Estimates do not include unexpected charges for unexpected services/procedures or balance billing from out-of-network providers. Contact your provider for the final cost.
Estimates are not a guarantee that benefits will be provided for the service. Contact your provider to confirm services for any medical care.
In your MyMolina portal, go to the ‘Contact Us’ to find your Customer Support telephone number or send a message to us.
Open enrollment for 2024 is November 1, 2023 through January 16, 2024.
Complete your enrollment application by December 15, 2023 for a January 1, 2024 effective date.
Conditions that may qualify for a Special Enrollment Period include the following life events. Contact the Health Insurance Exchange in your state if any of the following conditions impact you, or you need additional clarification:
•Getting Married, divorced or legally separated
•Have a child, adopt a child, or place a child for adoption
•Death of someone on your plan
•Change your place of residence
•Have a change in income or household size
•You lose your health coverage, including no longer being eligible for Medicaid, losing your coverage through your job, or exhausting your COBRA coverage
•Have a change in disability status
•You return from active-duty military service
•You become a citizen, national or lawfully present individual
•If you are a member of a federally recognized American Indian or Alaska Native tribe, you can enroll anytime and change plans no more than once per month.
•Leaving incarceration
Other qualifying life events may apply. For more information, visit kynect.ky.gov.
Without health insurance, you may suffer catastrophic financial losses due to illness or injury.
Health plans in the Marketplace cannot deny health insurance coverage because of a medical condition you had before signing up for coverage. Coverage for any pre-existing medical condition you may have begins the effective date of your coverage.
Within 10 days after you pay your first premium. For coverage starting on the first of the month we will send out ID cards approximately the 26th of the month.
To make a payment for your monthly premium, go to MyPassport.com and click on the $ icon. We provide several payment options for your convenience. We accept Visa, MasterCard and Discover Card or electronic check. You can also sign up for automatic payments through AutoPay. It is convenient and worry free!
For additional ways visit our Make a Payment page.
To determine which participating provider is in your area go to the Provider Online Directory and follow the steps below.
To determine which participating provider is accepting new patients go to the Provider Online Directory and follow the steps below.
Yes. You may select a different health plan until December 15, for a January 1 start date. Please go to kynect.ky.gov to review your plan options.
Please go to Kynect and update your information.
Yes, you and your dependents will be automatically enrolled in Passport, if they were covered by your previous insurer.
If you are eligible for tax credits and your family size and/or income has not changed, you will continue to receive tax credits.
Log in to www.MyPassport.com to view your personal benefit information. If you don’t already have an account, you can register for one using your Member ID.
Yes, but you need to continue to pay your current/previous insurer until the end of the year.
Log in to www.MyPassport.com to view your personal benefit information. If you don’t already have an account, you can register for one using your Member ID.
After you make your initial payment, you will receive your ID card within 10 days.
While all the efforts are being made to keep your premiums low, premiums may increase depending on your family size and/or income. You will be notified by Passport through your monthly invoice on the exact monthly premium amounts.
For your convenience, we have a Provider Online Directory where you can search for available choices in your area. Go to Provider Online Directory
Yes, if your doctor is in Passport’s network. To find out if your doctor is in Passport’s network, go to Provider Online Directory
To view all of our covered formularies, go to Molina Healthcare Drug Formulary
You can contact member services to answer any questions you may have