The Choice is Yours About your 2017 Harvard Pilgrim Plans at New England Baptist Hospital

Transcription

1 The Choice is Yours About your 2017 Harvard Pilgrim Plans at New England Baptist Hospital

2 H arvard Pilgrim Health Care is proud to provide coverage for New England Baptist Hospital. Here s how to get the most from your Harvard Pilgrim benefits. Please review your plan information, such as Schedules of Benefits, Evidence of Coverage, Online Prescription Drug Brochure and the New England Baptist Hospital Medical Plan Comparison Chart. Once you have enrolled in a plan, you will receive a member ID card in about two weeks. If you will be seeing a new doctor, it is a good idea to schedule an initial visit once your coverage is effective. Three things you need to know about your plan choices before you decide 1 There are ways your plan options are the same: Both PPO plans give you access to more than 53,000 doctors and clinicians in the region and 179 hospitals with no need for referrals. You also can see doctors who do not participate with the plan, but with higher cost sharing, like coinsurance and deductibles. 2 But there are differences you should consider: You ll get to keep more in your pay with the Baptist PPO Advantage Plan with HSA, but you will have a higher deductible. Except for preventive care, all services including prescription drugs go to your deductible on the Baptist PPO Advantage Plan with HSA. If you enroll in the Baptist PPO Advantage Plan with HSA, you may participate in a Health Savings Account to help pay your deductible. New England Baptist Hospital also makes contributions to the HSA on your behalf as long as you are contributing a minimum of $250 for single coverage and $500 for all other coverage levels. 3 How much care do you or your family members need? Do you or a family member have any ongoing chronic medical conditions that require certain tests or treatments? What would you have to pay under each option? For example, if you had a history of knee problems, what would you have to pay if you needed to have surgery and stay in the hospital? What if you wanted to see a specialist who didn t participate in the plan? Try to estimate your expenses based on what your experience has been. Use your benefit chart or look at each plan s Schedule of Benefits that outlines your responsibility for sharing costs of care.

3 Be well, save money and use your plan at Our Web site for members is designed to make it easy for you to get information and do the things you need to do to make the most of your plan. Here are just a few of the things you can do: Look up your benefits, copays, claims history, deductible status, and authorization activities. Take advantage of discounts and savings on eyeglasses and contact lenses, dental care, nutrition and weight management programs, sneakers, fitness clubs and much more. Learn how your plan covers preventive care and medical conditions such as asthma, diabetes, COPD and high blood pressure. Access helpful tools and resources to live a healthier, happy life: find a doctor or a specialist, take a personal health assessment, connect with a personal health coach and more. ** See back cover for details on Wellness Rewards!

4 For All Plans Emergency care Harvard Pilgrim covers all medical emergencies (e.g., heart attack, stroke, shock, major blood loss, choking, severe head injury, loss of consciousness, seizures or convulsions). Just go to the nearest emergency facility or call 911 or another local emergency number. If you are hospitalized, call your PCP and Harvard Pilgrim within 48 hours, or as soon as you can (or ask someone to do this for you). Urgent/sick care For non-emergency care (like a sore throat, earache or flu), you should call your doctor s office and ask for a same-day appointment. If your doctor is unavailable, you may be directed to a covering clinician or a Harvard Pilgrim participating urgent care center, or a convenience care clinic such as MinuteClinic. An urgent care center or convenience care clinic can get you taken care of more quickly, and will cost you less. To find a participating urgent care clinic or convenience care clinic, visit Then select your plan, click on Specialists, then select Urgent Care Centers or Convenience Care Clinic. You may also use Doctor on Demand for a physician video visit from your smartphone, tablet or computer. No referral is required, and you can connect with a physician in minutes. Availability is more limited during overnight hours. Visit for details. Emergency and sick care while traveling In addition to emergencies, if you become sick or injured outside of the Harvard Pilgrim service area, we will cover any unforeseen care you may need whether you re in another part of the country or another part of the world. Examples of conditions we cover while you re outside the service area include: earaches, flu, poisoning, broken bones, medical emergencies and prescription drugs. Call Member Services for payment and claims information at (888)

5 Prescription drug coverage Prescriptions are priced in a four-tier prescription drug benefit, including a money-saving $5 Tier 1. In most cases, your doctor can prescribe a lower-tier drug to effectively treat your condition. There are a small number of drugs that Harvard Pilgrim either does not cover or covers with some restrictions. Generally these drugs do not have FDA approval, or are used primarily for cos metic purposes or to treat weight loss. Tier 1, our lowest copayment tier, consists of low-cost generics and includes many prescriptions. You pay just $5 for any prescription drug in Tier 1. Tier 2 consists primarily of higher-cost generic drugs. These drugs contain the same active ingredients as their brand-name counterparts. Tier 2 may also include brandname drugs that Harvard Pilgrim has determined to be more effective, less costly or to have fewer side effects than similar medications. Tier 3 consists mostly of brand-name drugs without generic equivalents. These drugs have been selected by the plan based on review of the relative safety, effectiveness and cost of the many brand-name drugs on the market. In some cases, Tier 3 may include generic drugs determined to be more costly than their brand-name alternatives. Tier 4 is made up of drugs that are not included in Tier 1, Tier 2 or Tier 3. You pay the highest copayment or coinsurance amount for Tier 4 drugs. Prescription Mail Service You can enjoy savings and the convenience of home delivery for maintenance medications (prescriptions for ongoing, chronic conditions). Standard shipping is free and you save a full, one month s copayment when using our mail order program for Tier 1, Tier 2, Tier 3 and Tier 4 maintenance medications (up to a 90-day supply). Go to or request order forms by calling us at (888) Commitment to quality Harvard Pilgrim is proud of the level of quality it brings to members every day and is consistently among the nation s highest-rated health plans.* * Harvard Pilgrim Health Care is currently rated 4.5 out of 5 for its private HMO/POS and PPO plans in NCQA s Private Health Insurance Plan Ratings NCQA s Private Health Insurance Plan Ratings NCQA s Private Health Insurance Plan Rankings, , HMO/POS/PPO.

6 2017 Wellness Rewards Don t forget that you have two great ways to earn Wellness Rewards from New England Baptist Hospital and Harvard Pilgrim: 1You can receive an annual premium health insurance credit of $400. 2You can also earn a stand-alone incentive of $100 for completing wellness activities. And don t forget these great benefits! The EatRight Rewards program rewards employees who buy healthy foods at the grocery store. Mail order prescription drugs are convenient and can save you money. Celebrating 65 SM is Harvard Pilgrim s educational program for people who are thinking about retiring; visit 65 for details. And HPHConnect for Members can help you make the most of your plan. Questions? * If you have questions about the wellness programs, call the Wellness Service line at (877) * If you have questions about your coverage, just call one of our service representatives. If you are already a member, call (888) If you are not yet a member, call (800) For TTY service, call Worcester Street, Wellesley, MA (800) cc3458_nehb 10_16