FIND A DOCTOR Page 1 of 22

Transcription

1 FIND A DOCTOR Page 1 of 22

2 Type in Name of Doctor OR ADVANCED SEARCH You can filter your results by: Provider Last OR Group Name Provider Type City County Specialty Plan Zip Code Language Show only providers that are accepting new patients Page 2 of 22

3 MEMBER SUPPORT Find a doctor or Facility (see Find a Doctor) Page 3 of 22

4 PRESCRIPTION INFORMATION Preferred Drug List and Pharmacy Directory are available to be viewed Verify type of product that member is enrolled under Large Employer group Small Group or Individual and Family plan Preferred Drug List for each product indicates the following: All medications that are covered Tier of medication (specific to the member benefits) Quantity Limit Prior Authorization Requirement Step Therapy Age Limit Maximum Fill Limit Maximum Day s Supply Page 4 of 22

5 Preferred Drug List can be changed throughout the year when Hometown Health pharmacy team reviews and updates. If the member s prescription changes on the formulary and would negatively impact the member Hometown Health will notify the member 60 days prior to the change: Examples: Prescription is no longer covered on the Preferred Drug List Prescription changes to next level tier (Generic to Brand or Brand to Non- Preferred) Members can contact: Page 5 of 22

6 MY BENEFITS COVERAGE Page 6 of 22

7 Members can register/submit and view the following Hometown Health Information: Benefit summary Claims (Explanation of Benefits or EOB) Prescription fills Copy of ID card Elect and change PCP (if enrolled under an HMO plan) Re-order ID card Change address (depending on group this feature may not be available) Member will receive an when a new claim is ready to be viewed. Member can elect to go paperless so EOBs are mailed Page 7 of 22

8 HEALTHY TRACKS Healthy Tracks health and wellness program from Hometown Health is a web-based wellness portal that provides many useful tools to help members take control of their health, reduce health risks and help members live a longer, happier life. Some of the tools they ll have access to, include: Health Assessment Food Log & Meal Planner Exercise Logs Progress Report Wellness Workshops Wellness Challenges Page 8 of 22

9 Page 9 of 22

10 MEMBER FORMS HIPAA Authorization Form: For members to allow an authorized person(s) to contact Hometown Health on their behalf and receive correspondence Medical Claim Form: An existing member can submit a claim for in our out of network services. Physician or facility should complete the back of the form and then submit to Hometown Health Claims Department HometownRX Commercial Prescription Drug Claim Form: Member can request reimbursement for a prescription paid for out of pocket Physician Nomination Form: Member can nominate a provider to be contracted with our network Page 10 of 22

11 MEMBER RIGHTS Page 11 of 22

12 FOR PROVIDERS Page 12 of 22

13 FOR BROKERS Page 13 of 22

14 Provides links to brokers for forms, submission guidelines and product information. Page 14 of 22

15 HEALTH & WELLNESS Provides link to Health Tracks website and overview of the program Page 15 of 22

16 HOMETOWN RX Provides link to Preferred Drug List and Pharmacy Directory Page 16 of 22

17 INDIVIDUAL AND FAMILY PLANS Page 17 of 22

18 You can view plans and rates without having to enroll. Page 18 of 22

19 If the member wants to enroll after they select their plan the click Member will be required to create a My Benefits Account and complete enrollment. Page 19 of 22

20 SENIOR CARE PLUS Senior Care Plus members and or prospective members can view benefit information. Page 20 of 22

21 FOR EMPLOYERS ichoose login screen. ichoose is the website that employers use to manage their enrollment. They can enroll & terminate employees & dependents, view enrollment, and change personal information. Secure Document Delivery is where the employer group s monthly bill is uploaded for viewing and printing. Page 21 of 22

22 MEMBERS Directs them to the Member Sign In page for My Benefits Page 22 of 22