SOTA Benefits Members Access Virtual Medical Care

Virtual Primary Care with SOTA Plan Benefits

When you or a family member feels unwell, leaving home may be the last thing you want to do. VirtualCare2go™ connects eligible patients with medical professionals through secure online primary and urgent care appointments.

Members enrolled in an employer-sponsored SOTA Benefits plan may be able to use their medical benefits for virtual care. Telehealth coverage, network participation, and member costs vary by employer plan and should be verified before scheduling.

What Is SOTA Benefits?

SOTA Benefits is a health insurance program manager that designs healthcare plans for employers and brokers. Depending on the employer’s plan, benefits may include direct health-system contracts, a national provider-network wrap, virtual telemedicine, and Direct Primary Care.

SOTA states that some plan designs include a $0 deductible and no copays in many situations. These features do not apply identically to every employer, provider, or medical service. Members should verify the benefits connected to their current enrollment before receiving care.

What Virtual-Care Benefits Are Available?

A SOTA Benefits employer plan may include:

• Virtual telemedicine

• Virtual primary care

• Virtual urgent care

• Direct Primary Care

• National provider-network access

• Care-navigation support

• Prescription-assistance resources

• $0 deductible plan designs

• No copays for certain services

The insurance card may identify separate organizations for the medical network, claims processing, prescription benefits, prior authorization, and member support.

Review the front and back of the card for:

• Employer and plan name

• Medical network

• Member and group identification numbers

• Telehealth or virtual-care copay

• Primary and urgent care copays

• Deductible and coinsurance

• Member-services telephone number

• Provider-search website

• Prior-authorization information

• Claims-submission instructions

Virtual appointments, prescriptions, laboratory testing, diagnostic imaging, procedures, and follow-up services may be processed separately.

An insurance card does not guarantee coverage or payment. Final responsibility may depend on eligibility, provider participation, deductible status, medical necessity, authorization requirements, plan exclusions, and the services provided.

For VirtualCare2go scheduling assistance, call (817) 508-8169.

Can SOTA Benefits Members Use VirtualCare2go?

Members enrolled in an eligible SOTA Benefits employer plan may be able to use VirtualCare2go for many non-emergency primary and urgent care concerns when an online evaluation is medically appropriate.

The virtual medical team can evaluate concerns such as:

• Cold and flu symptoms

• Cough, congestion, and sore throat

• Fever and body aches

• Allergies and sinus concerns

• Ear discomfort

• Headaches and migraines

• Nausea, vomiting, or diarrhea

• Urinary symptoms

• Minor infections

• Rashes and mild skin concerns

• Medication questions

• Routine primary care concerns

• Certain chronic-condition follow-ups

• Follow-up appointments that do not require an in-person examination

The patient must be physically located in Texas throughout the appointment.

Some concerns require an in-person examination, laboratory testing, diagnostic imaging, or emergency care. The medical professional will explain the appropriate next step when virtual care is not suitable.

Call 911 or visit the nearest emergency room for chest pain, severe breathing difficulty, signs of a stroke, fainting, confusion, uncontrolled bleeding, major trauma, or another life-threatening emergency.

What Is the Difference Between Virtual Primary and Urgent Care?

Virtual primary care may help with routine health concerns, medication questions, certain chronic-condition follow-ups, and other ongoing medical needs that do not require an in-person examination.

Virtual urgent care focuses on non-life-threatening symptoms that require timely attention, including respiratory symptoms, urinary concerns, minor infections, stomach symptoms, headaches, and certain skin concerns.

The same medical plan may apply different benefits or member costs based on how the appointment is classified. Ask whether the visit will be processed under telehealth, primary care, urgent care, Direct Primary Care, or another benefit category.

Does a $0 Deductible Mean Virtual Care Is Free?

No. A $0 deductible does not automatically mean that every virtual appointment or related service is provided at no cost.

Depending on the employer’s plan, the member may still be responsible for:

• A telehealth copay

• A primary or urgent care copay

• Coinsurance

• Out-of-network charges

• Prescription costs

• Laboratory or imaging charges

• Procedure or supply charges

• Noncovered services

• Services received without required authorization

Some SOTA plan designs may provide $0 out-of-pocket access for certain virtual or primary care services. Members should verify whether those benefits apply to VirtualCare2go, the treating medical professional, and the requested service.

How Do I Verify My Virtual-Care Benefits?

Before scheduling, call the member-services number on your SOTA Benefits insurance card and ask:

• Does VirtualCare2go participate with my medical network?

• Is the treating medical professional in-network?

• Are virtual primary care appointments covered?

• Are virtual urgent care appointments covered?

• Is telemedicine available through a designated platform?

• Is my deductible $0?

• Does a copay or coinsurance apply?

• Are prescriptions, laboratory tests, or follow-up services billed separately?

• Is prior authorization required?

• Is a primary care referral required?

• Are there telehealth or service-area restrictions?

• Will I have a time-of-service responsibility?

Write down the representative’s name, the date of the call, and the reference number provided.

VirtualCare2go can collect your insurance information and review available benefits before the appointment. However, the organization administering the plan provides the official explanation of benefits, and final coverage is determined after the claim is processed.

How Do I Identify My Medical Network?

SOTA Benefits plans may use different medical networks based on the employer, service area, and plan design.

Look for the network’s name or logo on the front or back of the insurance card. When contacting member services, provide:

• Employer name

• Medical plan name

• Provider network

• Member identification number

• Group number

• Requested virtual service

• Patient’s Texas location

Ask the representative to verify both VirtualCare2go and the individual treating medical professional. Participation with one SOTA Benefits plan does not guarantee participation with every employer plan.

Is Prior Authorization Required?

Prior authorization requirements depend on the member’s plan and the requested service.

Ask whether approval is required for:

• Virtual primary care

• Virtual urgent care

• Laboratory testing

• Diagnostic imaging

• Certain medications

• Specialist referrals

• Follow-up treatment

• Other recommended services

Prior authorization does not guarantee claim payment. Current eligibility, medical necessity, provider participation, deductible requirements, plan exclusions, and other rules may still affect the claim.

Are Referrals Required?

Referral requirements vary by SOTA Benefits plan.

Some members may schedule virtual appointments directly. Other plans may require members to use a designated primary care provider or obtain a referral before certain services are covered.

Laboratory testing, diagnostic imaging, specialist care, procedures, and follow-up treatment may have separate referral or authorization requirements. Confirm the current rules with the administrator listed on your insurance card.

How Should I Prepare for My Virtual Appointment?

Before the appointment, prepare:

• SOTA Benefits insurance card

• Photo identification

• Employer and plan name

• Medical network information

• Current medication list

• Known medication or food allergies

• Relevant medical records

• Recent laboratory or imaging results

• Referral or authorization documents

• A description of your symptoms

• The date your symptoms began

• Preferred pharmacy information

• Benefit-verification reference number

• Questions for the medical professional

Choose a quiet, private, and well-lit location with reliable internet access. Make sure your phone, tablet, or computer is charged and that its camera, microphone, and speakers work correctly.

The patient must remain physically located in Texas throughout the appointment.

What Should I Expect During the Visit?

The medical professional will review your symptoms, medical history, current medications, and allergies. You may be asked to describe or show visible symptoms using your device’s camera.

Depending on your medical needs, the care plan may include:

• Medication recommendations

• At-home care instructions

• Laboratory testing

• Diagnostic imaging orders

• Follow-up appointments

• In-person evaluation

• Specialist referral

• Emergency care when necessary

The medical professional will explain the recommended next step and answer questions about your treatment plan.

Claims and Billing Information

Providers should use the current insurance card to identify the claims administrator and submission instructions for the member’s exact SOTA Benefits plan.

Verify:

• Electronic payer identification number

• Claims mailing address

• Member eligibility

• Employer and plan name

• Medical network

• Telehealth benefits

• Virtual primary and urgent care coverage

• Provider participation

• Prior-authorization requirements

• Referral requirements

• Timely filing limits

Claims information associated with another SOTA Benefits employer plan should not be used unless the current administrator confirms that it applies.

After the claim is processed, the member may receive an explanation of benefits. This document is not a bill. It explains how the claim was reviewed, what the plan paid, and what amount may be the member’s responsibility.

Compassionate Virtual Care Wherever You Are

VirtualCare2go makes it easier to speak with a medical professional when leaving home or work is inconvenient or uncomfortable. The virtual medical team will listen to your concerns, determine whether online care is appropriate, and clearly explain the recommended next step.

When you are ready, book a virtual appointment or call (817) 508-8169. Please have your SOTA Benefits insurance card available so your eligibility, network, and virtual-care benefits can be reviewed before the appointment.