HMO. Harvard Pilgrim s. ChoiceNet. Take charge of your health care. Pay less. It s as easy as 1-2-3! EFFECTIVE DATE: 01/01/2018 FORM #2501_01
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1 HMO Harvard Pilgrim s ChoiceNet Take charge of your health care. Pay less. It s as easy as -2-3! EFFECTIVE DATE: 0/0/208 FORM #250_0
2 Learn the -2-3s of ChoiceNet When making purchases of any kind, you look for the best value. You want great quality at a reasonable cost. That s what ChoiceNet is all about. When you choose higher quality, more cost-efficient physicians and hospitals, you ll pay less when you receive care. With ChoiceNet, a tiered provider network, making smart choices about your medical care can help reduce your health care costs. ChoiceNet highlights ChoiceNet includes thousands of Harvard Pilgrim s participating doctors and other clinicians, plus more than 84 hospitals, that have met Harvard Pilgrim s high standards for providing quality care. Harvard Pilgrim places physicians and hospitals into one of three tiers based on cost and quality performance. You will pay different cost sharing based on a provider s assigned benefit tier. 2 In all three tiers, you ll find physicians from Harvard Pilgrim s Honor Roll recognizing local providers whose performances meet high-quality, best-inclass industry standards. Within each tier, you ll pay one copayment level for office visits to primary care providers (PCPs) and a higher copayment for visits to specialists. The amount of the copayment also varies based on the provider s tier. If you see providers who aren t medical doctors, such as chiropractors or optometrists, you ll pay the lowest copayment level since they re automatically placed into Tier. When you see participating providers in a lower tier, you ll pay less. How the three tiers work Using national quality benchmarks, as well as plan medical expense information, we placed affiliated physicians and hospitals in Tier, Tier 2 or Tier 3. Tier includes the most cost-efficient providers. If we had insufficient data, we placed a doctor in Tier 2. When you receive services from a Tier provider, you pay less. Your cost sharing increases when you receive services from higher tier providers. YOUR OUT-OF-POCKET COSTS TIER TIER 2 TIER 3 PCP office visit copayment $ $$ $$$ Specialist office visit copayment $ $$ $$$ Hospital admission $ $$ $$$ Deductible $ $$ $$$ I discovered that Harvard Pilgrim puts its physicians through quality screenings before allowing them into the network. That makes me very comfortable in picking a lower-cost, Tier doctor. The doctor s office near my work is in Tier, and the office practice has even been placed on Harvard Pilgrim s Honor Roll. I m good with that. This plan includes a tiered provider network called ChoiceNet. In these plans, members pay different levels of cost sharing depending on the tier of the provider delivering a covered service or medical supply. A provider s benefit tier may change annually on January. To determine a provider s tier, please consult the Harvard Pilgrim ChoiceNet provider directory by visiting the provider search tool at You also may call Harvard Pilgrim to request a paper copy of the provider directory at no charge.
3 You may see different doctors in different tiers! You re free to choose a PCP from any of the three tiers. When your PCP refers you to specialists, they may be in different tiers. For example, your PCP may be in Tier but he/she may want you to see a Tier 2 or Tier 3 specialist. As long as you have referrals when needed, you can see doctors in all three tiers. You also may want to talk with your PCP about referral recommendations based on the tier level of referrals. More specifically, if a Tier provider refers you to a Tier 3 provider, which increases your cost sharing, it s important to have this conversation with your PCP. How much you spend on your health care depends on where you go for medical care. Know which tiers your doctors are in, as well as the tiers of hospitals you d likely go to, before you need services. What you ll want to know about your ChoiceNet coverage You ll have Harvard Pilgrim s popular Best Buy HMO for medical coverage, which includes a deductible to help keep your premium lower than a traditional plan. In addition: Certain preventive care visits and services are covered in full. 2 You ll pay Tier cost sharing for all providers who aren t medical doctors, including chiropractors 3, optometrists, and physical, occupational and speech therapists. Behavioral health services, including the treatment of substance abuse disorders, always fall in Tier. You can save money on X-rays or high-end radiology tests by going to a lower-cost facility, including many independent or non-hospital based imaging centers and Tier hospitals. Visit and use the provider search tool to find Tier radiology facilities. In an emergency, cost sharing for an ER visit is the same regardless of a hospital s tier If admitted from an ER visit, your hospital admission takes Tier cost sharing For plan details about medical services and applicable costs, refer to your Schedule of Benefits EXAMPLE of out-of-pocket cost differences: Office visit to orthopedic specialist MRI (applies toward your deductible) Surgery (applies toward your deductible) You are a long-time runner with increasing knee pain during the past few years. Your primary care provider referred you to an orthopedic specialist. At the start of the new year, you went to the specialist who ordered an MRI to make his diagnosis. After the MRI, the specialist confirmed you needed knee surgery. So far, you have incurred only these three medical expenses in the new plan year. Provider charge (cost of service*) What you pay for a Tier provider What you pay for a Tier 2 provider What you pay for a Tier 3 provider $90* $30 copay $40 copay $60 copay $,300* $,000 (Your Tier deductible is $,000) $6,070* $0 (deductible met) $,300 (Your Tier 2 deductible is $,500) $200 (Remaining amount toward deductible) $,300 (Your Tier 3 deductible is $2,000) Total $ $7,560 $,030 $,540 $2,060 $700 (Remaining amount toward deductible) * Provider charges shown are examples only. Doctors, imaging facilities and hospitals differ in costs. Providers in Tier and Tier 2 typically charge less than providers in Tier 3. ChoiceNet FACT More than 75% of Harvard Pilgrim s PCPs, specialists and hospitals are in Tier and Tier 2. ChoiceNet FACT When you re admitted to a Tier hospital for an appendectomy, it costs an average of 32% less than at a Tier 3 hospital. I never really gave a second thought when my PCP referred me to a specialist. Now that I can pay less to see certain specialists, I m starting to ask my PCP questions when referrals are in order. Like does he have a strong reason for referring me to a certain specialist? Could he refer me to a doctor in a lower-cost tier? Our conversations have been interesting. And just recently, I was able to get a referral to a specialist in Tier. Saving money without compromising quality is important to me. 2 For benefit details, refer to your Best Buy HMO How it Works brochure and Schedule of Benefits. 3 Not all plans include chiropractic coverage
4 3 What matters most: your providers The relationships you have with your doctors are important. With an HMO, your relationship with a PCP is essential, as he/she coordinates all of your care and refers you to specialists when needed. Knowing your PCP s tier, and the tiers of any specialists he/she may refer you to, is important. If you have established relationships with certain doctors, you ll want to make sure you find out what tier they are in to help you plan for your health care costs. You ll also want to find out which hospitals they have admitting privileges to, and their tiers. Here s how to find out if your doctors participate, as well as their tier: Visit to determine your doctors tiers. Make sure you select the ChoiceNet HMO provider directory. Call Harvard Pilgrim for assistance at (800) For TTY service, call 7. Once you know your doctors tiers, write them down or enter them into your mobile phone. You ll want to keep them handy. Services that offer greater choice no referrals needed Some services don t require referrals in an HMO. This means you can select the participating provider of your choice and not worry about necessary authorizations. You can do this for: Routine gynecological care Chiropractic care 4 Routine eye exams 4 We ve trusted our family practitioner for years, especially since he s helped us through some serious medical issues. Although he s in Tier 3, we re okay paying more to see him since we value our relationship with him. We re glad we still have the choice to keep him as our doctor. For specific benefit information, refer to your Best Buy HMO How it Works brochure and Schedule of Benefits. ChoiceNet FACT When you need X-rays or high-end radiology tests, you can save money by going to a lower-cost imaging center, including many independent or nonhospital based imaging centers. Cost sharing applies at these types of facilities. If you go to a hospital, what you pay depends upon the hospital s tier. 4 If covered by your plan.
5 Help for your health care decisions Harvard Pilgrim is here to help you be an informed consumer. You ll find resources that make it easier to understand tiers and health care costs plus tools to encourage you to take charge and live a healthier life. Here are some resources to support your tier decisions and help you get the most out of your plan and your money: ChoiceNet provider directory. In our printed and online versions, you ll learn about participating providers and their tiers, as well as which providers are recognized for quality through the Harvard Pilgrim Honor Roll. From wellness tools to links to reliable health information resources, members have many tools and resources at their fingertips 24/7, including links to state Web sites that provide public cost and quality information. Harvard Pilgrim s Member Services representatives. They re available to answer any questions and support you; they re also a big part of the reason why you can expect great service from Harvard Pilgrim. Questions you can ask to encourage conversations with your doctors. Included with your plan information you ll find a list of questions that you may want to bring with you to medical appointments. They re designed to help you better understand your options while possibly saving you money. I never really questioned how much an MRI for my worn-down knee would cost. But when I learned that fees for a scan can vary widely from one place to the next, I started paying attention. Now I talk to my orthopedist about available options, like having the scan at a non-hospital based MRI center so I can pay the lowest possible cost. With ChoiceNet, the choice to switch providers and find lower-cost options is always yours to make. You re in control of how you spend your health care dollars. You decide what works best for you.
6 Want more information about ChoiceNet, and how you can get the most out of your health care dollars? Visit or call us. If you re already a Harvard Pilgrim member, call Member Services with questions at (888) For TTY service, call 7. If you re not yet a member, call (800) Harvard Pilgrim Health Care includes Harvard Pilgrim Health Care, Harvard Pilgrim Health Care of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company. cc4238_hmo 9_7
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Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at https://eoc.anthem.com/eocdps/fi or by calling 1-800-542-9402.
State of Wisconsin: Arise IYC Health Plan Coverage Period: 1/1/17-12/31/17
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan
: Samford University Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage For: Individual + Family Plan Type: PPO This is only
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.summacare.com or by calling 1-800-996-8701. Important
$ 0 See the chart starting on page 2 for your costs for services this plan covers.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.sharphealthplan.com/calpers or by calling 1-855-995-5004.
Important Questions Answers Why this Matters:
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: Premium Plan This is only a summary. If you want more detail about your coverage and costs, you
COSE MEWA : HRA W RX
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at MedMutual.com/SBC or by calling 800.540.2583. Important Questions
Anthem BlueCross Classic $40 HMO What this Plan Covers & What it Costs Coverage Period: 12/01/ /30/2013 Individual/Family HMO
Anthem BlueCross Classic $40 HMO What this Plan Covers & What it Costs Coverage Period: 12/01/2012-11/30/2013 Individual/Family HMO This is only a summary. If you want more detail about your coverage and
You can see the specialist you choose without permission from this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.crystalrunhealthinsurancecompany.com or by calling 1-844-638-6506.
$0 Single/$0 Family for In- Network Providers. See the chart starting on page 2 for your costs for services this plan covers.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-855-634-3383. Important Questions
Nationwide Life Insurance Co.: University of Southern Maine (International) Coverage Period: 8/1/13-7/31/14
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.chpstudent.com or by calling 1-800-633-7867. Important
WPS HealthyChoices Group Guide. Effective January 1, Be Happy. Live Healthy.
WPS HealthyChoices Group Guide Effective January 1, 2015 Be Happy. Live Healthy. Table of Contents: Introduction 2 Choose 4 Save 5 Control 6 Covered Benefits 7 2 With high-quality coverage, affordable
$0 See the chart starting on page 2 for your costs for services this plan covers.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at https://www.chchealth.org/affordablehealth/planbrochure/silver.aspx
Encompass A. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.independenthealth.com. or by calling 1-800-501-3439.
The chart on page 2 describes any limits that may be applicable. See the chart on page 2 for information about excluded services.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.werally.com or by calling 1-855-293-9774. Important Questions
AvMed Network: $1,500 individual / $3,000 family Doesn t apply to preventive care. What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.avmed.org or by calling 1-800-376-6651. Important Questions
Important Questions Answers Why this Matters:
Anthem BlueCross Value HMO 20/30/20% Select Plus HMO / $10/$30/$45/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2014-12/31/2014 Coverage For: Individual/Family
Important Questions. Why this Matters:
Important Questions What is the overall deductible? This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/ca/calpers
Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: All Coverage Tiers Plan Type: HMO This is only a summary. If you want more detail about your coverage and costs, you
University of New Hampshire Student Health Plan: Self-Funded Coverage Period: 8/24/13 8/22/14
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.chpstudent.com or by calling 1-800-633-7867. Important
Coverage for: Individual Plan Type: HMO. Important Questions Answers Why this Matters:
Harford County Public Schools Blue Choice Open Access Coverage Period: 07/01/2015 06/30/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type:
For Employees, Retirees, (and/or Dependents) of The State of Florida Health Plan Enrollment Information
For Employees, Retirees, (and/or Dependents) of The State of Florida 2013 Health Plan Enrollment Information Table of Contents AvMed Overview...2 Benefit Summary State of Florida HMO Health Plan...7 Benefit
My HPN Silver 3-73 $20/40/70/250
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.myhpnonline.com or by calling 702-838-8294 or 1-877-752-8026.
The Harvard Pilgrim Best Buy HMO Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Massachusetts The Harvard Pilgrim Best Buy HMO Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 12/01/2017 11/30/2018 Coverage for: Individual
Anthem Blue Cross Your Plan: Premier HMO 10/100% - MUST Trust Your Network: California Care HMO
Anthem Blue Cross Your Plan: Premier HMO 10/100% - MUST Trust Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process.
CHI Health Coverage Period: 01/01/ /31/2017 Employee Assistance Program
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Plan Type: (EAP) This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in
Important Questions Answers Why this Matters: Network: $500 Individual / $1,000 Family Non-Network: $1,000 Individual / $2,000 Family
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthscopebenefits.com or by calling 1-800-262-4772.