Making the most of your health Plan. Wellness Resources and Services for Pratt Institute

Transcription

1 Making the most of your health Plan Wellness Resources and Services for Pratt Institute

2 55 Water Street, New York, New York Dear Pratt Institute Employee: Welcome to EmblemHealth! Pratt Institute has chosen EmblemHealth for your health care benefits. We put care first every day, helping members stay healthy, get well and live better. We re committed to doing the little things and the big things that add up to something wonderful: you feeling good. Get Started Pratt Institute has selected HIP Prime HMO as the right plan for you. To enroll, your benefit administrator. The plan's benefits will start on January 1, Soon after you enroll you ll get a Welcome Kit in the mail, which will include the. You ll also get your ID When you re healthy, you feel better. We want to make it easy for you to use health-related products and services so you can feel your best. much more. Making the Most of Your Health Plan, is designed so that you get the most out of the great features In this folder s pocket is the plan, costs, lists of excluded services and other important information. Keep these materials in a safe place to refer back to them when using your coverage. Customer Care We re here to help. So give us a call if you have any questions. We can be reached at , Monday through Friday, from 8:30 am to 5 pm. We look forward to providing you and your family with access to quality health care. Sincerely, Charlene A. Maher Senior Vice President, Marketing and Sales Group Health Incorporated (GHI), GHI HMO Select, Inc. (GHI HMO), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies.

3 55 Water Street, New York, New York Dear Pratt Institute Employee: We are honored that for 15 consecutive years Pratt Institute has chosen EmblemHealth for your health care benefits. We are commited to doing what we have always done: Putting your care first every day and helping your stay healthy, get well and live better. It's doing the little things - and the big things - that add up to something wonderful: you feeling good. Get Started Pratt Institute has selected HIP Prime HMO as the right plan for you. If you want to stay in your current plan, you don t have to do anything your coverage will continue automatically. If you need to make a change to your plan, your benefit administrator. Your benefits will start on January 1, Soon you ll be receiving your new ID card the key to all the benefits available under your selected plan. When you re healthy, you feel better. We want to make it easy for you to use health-related products and services so you can feel your best. much more. Making the Most of Your Health Plan, is designed so that you get the most out of the great features In this folder s pocket is the plan, costs, lists of excluded services and other important information. Keep these materials in a safe place to refer back to them when using your coverage. Customer Care We're here to help. So give us a call if you have any questions. For HIP-branded plans, call , Monday through Friday, from 8:30 am to 5:00 pm. We look forward to providing you and your family with access to quality health care. Sincerely, Charlene A. Maher Senior Vice President, Marketing and Sales Group Health Incorporated (GHI), GHI HMO Select, Inc. (GHI HMO), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies.

4 TRANSACTION FORM FOR GROUP ACCOUNTS I. SUBSCRIBER INFORMATION Last Name First Name M.I. Sex Social Security Number Street Address Apt. City State ZIP Code Were you ever a member of EmblemHealth? NO YES If YES, member ID Marital Status: Single Married Domestic Partner Birth Date: Telephone #: Mo. Day Yr. Home: ( ) Work: ( ) Young Adult Coverage: 26 And Under Family Single Parent ID: Disabled? NO YES Prior Health Insurance Information: Carrier Name: Coverage Begin Date: / / Coverage End Date: / / Primary Care Physician Name: (Not required for EPO/PPO members) ID Number: Are you covered by any other health insurance or Medicare? NO YES If YES, indicate: Insurance Co. Name: Insurance Co. Telephone #: ( ) Type of Coverage: Policy #: Effective Date: / / Address: GO PAPERLESS and save trees (see back of application)* Subscriber Employment Status: Applicant working at least 20 hours per week OB/GYN Selection Name: (Optional) ID Number: Check One: New Enrollment Reinstatement Termination Change to Ind. Status: Add Dependent Remove Dep. Address Change Name Change Transfer: To Another Carrier EmblemHealth Group Change: From: To: II. ENROLLMENT INFORMATION IF YOU ARE ENROLLING YOUR SPOUSE/DP AND/OR CHILDREN, PLEASE LIST EACH ONE BELOW SEE ELECTION OF COVERAGE FOR ELIGIBILITY Last Name (if different) First Name Social Security Number Sex Relationship Birth Date if Disabled Mo. Day Yr. Primary Care Physician Name/ID Number (Not required for EPO/PPO members) OB/GYN Selection Name/ID Number (Optional) DEPENDENT Spouse DP Child Current/Prior Health Insurance Information: Carrier Name: Coverage Begin Date: / / Coverage End Date: / / DEPENDENT Child Current/Prior Health Insurance Information: Carrier Name: Coverage Begin Date: / / Coverage End Date: / / DEPENDENT Child Current/Prior Health Insurance Information: Carrier Name: Coverage Begin Date: / / Coverage End Date: / / Note: A birth/marriage certificate or 1040 Form will be required for spouse/dependents with different last name. Your signature is required to process this form. Your signature attests that you have read the reverse side of this form. Applicant must sign here: Date: / / III. EMPLOYER INFORMATION THIS SECTION TO BE COMPLETED BY EMPLOYER/CONTRACTOR GROUP Name of Group: Group Number: EmblemHealth GHI GHI HMO HIP Pratt Institute Plan Name: Requested Effective Date: Medical: / / Dental: / / Type of Individual Family Coverage: Employee & Spouse/DP Employee & Child Hire Date: Waiting Period: Date Submitted: Approved By: (Group Plan Administrator) Instructions to Benefit Administrators or Group Representatives: For groups with 50 employees or fewer, you MUST complete Section A on the reverse side of this form. Required documentation MUST be attached to this Transaction Form to be processed. 8/12

5 VISION CARE CompreHealth HMO and HIP-Branded Plans As a member of one of our plans underwritten by HIP, you will receive a standard level of optical benefits: Eye exams and written prescriptions for corrective lenses are covered every 24 months. You also get a selection of eyeglasses for your optical copayment every 24 months. If you prefer, you can use an $80 credit toward eyeglasses not included in the selection, and you just pay the difference. HOW THE OPTICAL PROGRAM WORKS Step 1: Find a Network Optometrist Check Find a Doctor on for a network optometrist, and see if he or she is accepting new patients. Step 2: Get Your Eyes Examined and Obtain a Prescription eyeglass frames and lenses made at the participating optical provider. Depending on your particular coverage, you may be able to get your eye exam at a non-participating provider. Step 3: Choose Your Frames or Lenses Once you have your prescription, go to a network optical provider to have your covered or discounted eyeglass frames and lenses made for you. cosmetic lining are also covered. All frames conform to current guidelines established by the American National Standards. Note: If you use an out-of-network provider or choose eyeglasses or contact lenses not in the collection, you will pay higher out-of-pocket costs. Refer to HIP policy form HMO EMHMOCONTR (0508), et al.

6 VISION CARE GHI- and EmblemHealth-Branded Plans As a member of one of our plans underwritten by GHI, your vision benefits are administered by Davis Vision, Inc., a leading national administrator of routine vision care programs. Eligibility for vision care benefits is determined by the same rules that apply to your other health care benefits. As an eligible member, you will receive a standard level of optical benefits: Eye exams and written prescriptions for corrective lenses are covered every 24 months. You also get any eyeglasses or contact lenses from the Davis Vision Collection for your optical copay every 24 months. If you prefer not to use the Davis Vision Collection, you can use a credit toward any other eyeglasses, and you just pay the difference. Or you can use up to a $45 credit toward any other contact lenses, and you just pay the difference. HOW THE OPTICAL PROGRAM WORKS Step 1: Find a Network Optometrist Please call Davis Vision at to get the names and addresses of the network providers nearest you, or go to and use the Find a Doctor feature. If you use a TDD, please call You may also receive services from an out-of-network provider, although you will receive the greatest value if you select a Davis Vision provider. Make sure to identify yourself as a member of EmblemHealth. Step 2: Get Your Eyes Examined and Obtain a Prescription eyeglass frames and lenses made at the participating optical provider. Step 3: Choose Your Frames or Lenses Once you have your prescription, go to a participating optical provider to have your eyeglasses with perform eye exams and will have the Davis Vision Collection of frames to choose from. Note: If you use an out-of-network provider or choose eyeglasses or contact lenses not in the collection, you will pay higher out-of-pocket costs.

7 WELLNESS PROGRAMS Quality health benefits are about more than just providing coverage when you are sick. They are also about helping you to achieve your personal wellness goals. So that you are at your healthiest every day. At EmblemHealth, health coverage is about total care. See how our free EmblemHealth PATH programs and discounted access to wellness services can help you stay healthy. You can choose the services that are right for you. WELLNESS PROGRAMS Eligible members can take charge of an illness through PATH, our wellness programs. PATH (Positive Actions Toward Health) programs complement the care provided by your doctor by helping you better manage your condition and meet your health goals. Here are some of EmblemHealth s PATH programs: Healthy Beginnings PATH Pregnancy Management Program Made for women who want to do everything they can to have a healthy baby, this program gives the mom-to-be important health information, so she can make healthy choices before getting pregnant, during pregnancy and after her baby is born. Tobacco-Free PATH Program Cancer Society and Alere Wellbeing. Plan members age 18 and older who join our program will receive educational materials by mail, a personalized quit plan developed by trained quit-smoking experts, unlimited phone counseling and full coverage for smoking cessation medication. Weight Management heart disease. Losing weight can be challenging, and we re here to help you improve your eating and exercise habits, which can lead to positive health changes. Emblem Behavioral Health Services We have a range of mental health and substance abuse services and resources to help you stay healthy, both physically and mentally.