Membership & Account
Q: When should I expect to receive my Member ID Card? A: Members should expect to receive their Member ID Card anywhere from 10-20 days after they have enrolled in a Harbor Health plan. If after this time you have not received it, please call Harbor Health Member Support at (855) 481-0225.
Q: I need my Member ID card but haven't received it in the mail yet. What should I do? A: Members who need their Member ID card before it arrives in the mail should call Harbor insurance support at (855) 481-0225.
Q: Is my insurance active before my card arrives? A: Yes. Your coverage is active as soon as your first payment is received for the effective date of your policy. You don't need your physical card to get care. If you need to see a doctor before your card arrives, call us at (855) 481-0225. We'll give you your Member ID and help make sure your visit goes smoothly.
Q: Where can I find my Member ID number, Group Plan ID, or pharmacy info? A: All of this information will be on your Member ID Card and in your Harbor Health Member Portal. If you need this information before receiving your card or activating your portal, please call Harbor Health Member Support at (855) 481-0225.
Q: What is in a Harbor Health Member Portal account? A: You can view your Member ID card online, manage your plan membership, and view your insurance benefits.
Q: How do I access my Harbor Health Insurance account? A: Once you receive your Member ID Card, you can activate your Member Portal account at harborhealth.com/plans/activate. You need your Legal First Name, Legal Last Name, Member ID (which you can find on your card), and your Date of Birth to activate your account. You do not need a Member Portal account to receive care.
You can find your Member ID on your insurance card.
Q: What is in my Harbor Health Member Portal account? A: You can view your Member ID card online, manage your plan membership, and view your insurance benefits.
Q: I can’t find my Harbor Health account username. Where can I find it? A: Your username was sent to your email when you set up your account. If you’re unsure, please check your email, including your spam folder, for your username. If you can’t find your username or have trouble logging in, you can reset your username & password through the forgot username page: https://app.harborhealth.com/auth/forgot-username
Q: What is the Patient Portal and why do I need one? A: The Athena Patient Portal lets you message your care team, ask billing questions, reschedule appointments, and request refills or get prescription support. You can create an account here. You don't need an account to get care, but once you set one up, it's the easiest way to reach us between visits.
Q: Where can I find more details about my plan benefits? A: View your specific plan information on our Individual & Family Plan Resources page.
Q: Where can I find plan forms like claim forms, referral forms, and pre-authorization forms? A: Download the forms you need in the Plan Documents tab in our Individual & Family Plans Resources page.
Q: How can I find if my medication is covered or on the Harbor Health formulary (drug list)? A: You can access the drug list through here. This will take you to Harbor's formulary lookup tool. If you have any questions about your prescription benefit, call us at (855) 481-1620.
Billing & Payments
Q: How do I pay my monthly premium? A: You can pay online at harborhealth.com/pay or call us at (855) 481-0225 and we'll process it with you over the phone. We accept Visa and Mastercard.
Q: What's the difference between my "Monthly Premium" and "Amount Due"? A: If you qualified for financial help when you enrolled, you may owe less than the full price of your plan. Here's how it works:
- Monthly Premium = the full cost of your plan
- Amount Due = what you actually pay after any tax credits are applied
For example, if your plan costs $500/month and you qualify for $300 in tax credits, you'd owe $200. If your amount due is $0, that means your tax credits cover the full cost—you have coverage at no monthly cost to you.
Q: Can I set up automatic payments? A: Yes. You can set up autopay when you make your first payment, or anytime after through your Member Portal at harborhealth.com/plans/activate. If you need help, call us at (855) 481-0225.
Q: How do I cancel my plan or get a refund? A: All plan changes, including cancellations, go through the Health Insurance Marketplace, not Harbor Health.
- If you enrolled through a broker, contact them directly
- If you enrolled on your own, visit Healthcare.gov or call the Marketplace at 1-800-318-2596
If you're owed a refund after cancellation, it's typically processed within 5-10 days to your original payment method.
Getting Clinical Care & Help If you're seeking to understand more about providers in our network outside of our clinicians at Harbor Health Medical Group or VillageMD, please refer below to the Harbor Network section.
Q: How can I find care at a Harbor Health Clinic? A: For immediate needs, you can schedule a same-day Express Care visit with one of our Harbor Health clinics or a virtual visit. For more specific needs, please visit harborhealth.com and click “Book Now” where you can search by condition. You can also call us at (855) 481-8375 to schedule an appointment. You do not need to have had a prior visit with a Harbor Health PCP before scheduling an Express Care visit.
Q: What should I do if I have an urgent medical need? A: If you have an emergency, dial 911. For other urgent needs, call us at (855) 481-1115. We have a 24-hour nurse line. You may also be able to schedule a same-day Express Care visit on harborhealth.com when you select “Book Now.” You do not need to have had a prior visit with a Harbor Health PCP before scheduling an Express Care visit.
Q: How can I pay less when I see a specialist? A: When a Harbor primary care provider or in-network PCP refers you to a specialist, you may pay $0 for that visit. Here's how it works:
- See a Harbor primary care provider (or call us and we'll help you find one)
- They refer you to a specialist who's right for your situation
- For many services, that referral means you pay nothing
You're never required to get a referral, but it's one of the ways Harbor is designed to save you money. Not sure if this applies to your situation? Call us at (855) 481-8375 and we'll walk you through it.
Q: **How can I get a referral? How does Harbor help me find a specialist? ** A: If you've been to a Harbor clinic before, call us at (855) 481-8375 or message your primary care provider directly online. Don't have a Harbor Health Medical Group primary care provider yet? Feel free to continue working with your existing primary care provider if they are in-network.
If you’d like to establish with a Harbor Health Medical Group primary care provider, schedule online by clicking “Book Now” or call us at (855) 481-8375. We'll help you find the right specialist, and check their quality and cost. When your primary care provider refers you to a specialist, Harbor Health Insurance covers more of the bill. That's how Harbor is designed to work for you.
Insurance Benefits & Cost
Q: What are the costs for care at Harbor? A: Preventive Care visits at Harbor are always free, and Express Care and Mental Health are $0 for most plans. For plan specific costs, please refer to our Resources page.
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Q: What are $0 costs with the Harbor Health plan? A: Preventive, Express, Mental health are $0 for most plans. For plan specific costs, please refer to our Resources page and view your Explanation of For plan specifics, go to resource page and view your Summary of Benefits and Coverage.
Q: How can I view my costs for care, Explanation of Benefits (EOB) or view what I have satisfied for deductibles or max-out-of-pocket? A: You can access past claim information and costs in the Member Portal. Go to <insert info for where info is found on page, insert hyperlink label that takes member to mPulse, etc>.
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Q: What if I need emergency care at a hospital that's not in Harbor's network? A: Go get care. Emergency services are covered no matter where you are, even at out-of-network hospitals. Your emergency room copay still applies, but you won't be responsible for the full out-of-network cost. If you have questions about a bill after an ER visit, call us at (855) 481-0225.
Q: What does Harbor cover for mental health? A: Mental health visits are $0 for most plans, and you don't need a referral. This includes: Therapy and counseling (in-person or video visits) Psychiatry Telehealth platforms in our network like Sondermind and Headway If you need inpatient or residential mental health care, that requires prior authorization, call us at (855) 481-0225 and we'll help you navigate it. For your specific plan's cost, check your plan information on our Individual & Family Plan Resources page or call us at (855) 481-0225, we're happy to walk through it with you.
Q: How many physical therapy visits are covered? A: Your plan covers up to 30 physical therapy visits per year. That's a combined limit, so if you're doing PT for your shoulder and your knee, both count toward the 30. If you need more visits, your physical therapist can request additional sessions based on medical necessity. Call us at (855) 481-0225 if you have questions about where you stand.
Q: What's covered for pregnancy and delivery? A: Prenatal visits are covered as preventive care at $0. For delivery, In-Area plan members pay $0 for delivery services at Harbor and in-network facilities. Your hospital stay follows federal guidelines: up to 48 hours for vaginal delivery, 96 hours for C-section. For your specific plan's maternity benefits, check your plan information on our Individual & Family Plan Resources page or call us at (855) 481-0225, we're happy to walk through it with you.
Harbor Health Network
Q: My doctor isn't in Harbor's network. Can I still see them? A: If you're in the middle of treatment or have a health condition that requires ongoing care, you may be able to continue seeing your current doctor temporarily. Please see our Continuity of Care member guide or call us at 855-481-0225 and we'll walk you through whether you qualify and help you submit a request. If you don't qualify, you can still see your doctor, you'll just pay the full cost of the visit.
Q: Where can I check which doctors, clinics, labs, and facilities are in-network? A: View the full Provider Directory here. The best way to save on healthcare costs and services is to start with getting care directly from Harbor clinicians: a Harbor primary care doctor, through our Express Care clinics, and getting a referral/specialist through Harbor. As a reminder, if your provider is not in-network and you receive care, you may be responsible for any costs associated with that visit.
Q: I have a surgery scheduled or I'm in the middle of treatment with a doctor who isn't in Harbor's network. Can I continue my care? A: You may be able to. You can fill out and submit a Transition & Continuity of Care Request Form, or call us at (855) 481-0225 and we'll help you submit a request to continue with your current doctor while you complete your treatment. The sooner you call, the better as the approval process can take a few weeks since we coordinate directly with your doctor's office.
Q: What are the turnaround times for Prior Authorization requests? A: For Prior Authorization requests, the turnaround times are 24 hours for urgent requests, and 48-72 hours for non-urgent requests.