Premier Silver

Transcription

1 Premier Silver

2 We re Tufts Health Plan, and we re redefining what a health plan can be. Being willing to learn about your health care options is the first step in getting the most out of your plan while controlling your out-of-pocket costs. At Tufts Health Plan, we are committed to empowering members to make better health care decisions through simple and easy to understand materials and tools. This dedication to our members is why Tufts Health Plan is consistently recognized locally and nationally as one of the top health plans in the country. The National Committee for Quality Assurance gave our Commercial plan 5 out of 5 for quality, making us the only health plan in the nation to receive the rating for both its HMO and PPO products for * This commitment to quality demonstrates how, every day, we re finding more ways to redefine what a health plan can do. In the following pages, you ll learn about the many services and benefits we offer and how to take advantage of them as a member. The right plan can make all the difference in the world for you and your health, and Tufts Health Plan wants to make it simple for you. Simple, after all, is what health care should be. *NCQA s Private Health Insurance Plan Ratings Tufts Health Plan s HMO/POS Plan was rated a 5 out of 5; Tufts Health Plan s PPO Plan in MA rated a 5 out of 5. Tufts Health Plan PPO plan in RI rated a 4 out of 5.

3 Premier Silver 2000 Annual Deductible Annual Pharmacy Deductible Annual Out-of-Pocket Expense Limit (Medical, Pharmacy, and Pediatric Dental Combined) Network OFFICE VISITS Annual Physical Preventive Care including routine Maternity care PCP Office Visit (non-preventive / non-routine) $2,000 Individual $4,000 Family $250 Individual $500 Family $7,350 Individual $14,700 Family Tufts Health Plan Standard Network Covered in Full Covered in Full $30 Specialist Office Visit $50 Physical & Occupational Therapy $50 Outpatient Behavioral Health $30 HOSPITAL CARE Emergency Room $700 after deductible is met (waived if admitted) Outpatient Services $750 after deductible is met Inpatient Services $1,000 after deductible is met IMAGING AND LABS Diagnostic Lab Services $25 after deductible is met Diagnostic X-rays $25 after deductible is met MRI / High-tech Imaging Services PHARMACY (RETAIL COPAYS) Tier 1: Includes many generic drugs Tier 2: Includes some generics and brand-name drugs Tier 3: Includes some generics and brand-name covered drugs not selected for Tier 2 $500 after deductible is met $20 (30-day supply) $60 (30-day supply) $90 (30-day supply) after pharmacy deductible is met

4 Tufts Health Plan s Momentum. Most people don t think of their health plan until they need it. But we re thinking about you all the time. We call this way of looking at your overall well-being Momentum. Tufts Health Plan Momentum includes tools and programs that help you get healthy and stay healthy. Preventive Care We offer guidelines and recommendations for many types of health screenings, depending on your age and lifestyle. All are designed to keep you healthy. Healthy Birthday An obstetrical nurse care manager supports moms at risk for preterm labor or with underlying complex medical conditions through pregnancy and delivery, to help ensure a positive transition to home. Priority Newborn Care A specialty nurse care manager provides family-centered support for parents of new babies born with complex medical needs, across all care settings and at home. Condition Management Sometimes people with a chronic condition, such as diabetes or heart failure, may benefit from some help managing their health. If you re a candidate and would like to participate, you ll get a nurse care manager who can assist you with education, symptom management, prescription management and much more.

5 Wellness Programs Our wellness programs are designed to help you create a healthier lifestyle. We offer online tools like customized meal planning, and even personalized lifestyle coaching on certain plans. Family Services A family has so many different needs. Primary care, specialist care, maternity care, and of course, urgent care. Our network includes providers and services that fit your lifestyle. Maternity Care We go the extra mile. Once your baby (or babies!) arrives, you could be eligible for post-delivery support and services, including a home visit to make sure everything is fine and to answer any questions you might have. Behavioral Health Your plan may also include behavioral health benefits. If so, we have programs, resources and a comprehensive network of behavioral health professionals ready to help. Some areas you may have questions about or need assistance with are autism, substance use disorders, depression, anxiety or other behavioral health conditions. 24-Hour Nurse Line Tufts Health Plan offers members access to Nurse24 SM, our 24-Hour Nurse line. Registered nurses are available 24 hours a day, 7 days a week to answer your questions, and we offer translators in more than 200 languages. Vision Care When you need eye exams or other related vision care, Tufts Health Plan offers access to the EyeMed Vision Care network, which features more than 24,000 eye care providers that can offer discounts on prescription glasses, contact lenses, LASIK surgery and more.

6 Learn more about your plan Details about your health care plan can be found in your Summary of Benefits. Some highlights include: Explanation of any deductibles and copays Covered services and treatments Take a look and learn all about your plan and its benefits, and be sure to call us with any questions. Welcome to Tufts Health Plan. We re looking forward to a long and healthy relationship with you.

7 A few simple answers to a few common questions. Is there a simple way to learn about my plan? If you re not yet a member, you can learn more about your plan selection by visiting tuftshealthplan.com or by reviewing the Summary of Coverage. Once you become a member, you ll receive a member Ekit. It s interactive, concise, and easy to use. You can also sign up for mytuftshealthplan.com to learn more about your coverage. Is my doctor in the network? Our Doctor Search tool makes it easy to see if your doctor s in the plan that s being offered to you. Just visit tuftshealthplan.com, click Find a Doctor, Select a Plan, and search. Is there an easy way to manage my plan once I m a member? When you sign up at mytuftshealthplan.com, you ll have at-aglance access to your plan. The answers to many of your questions will be at your fingertips. You ll be able to check your claims, review deductibles, take personal health assessment, check your physician options and cost and much more. Is there a way to know how much services or treatments may cost BEFORE your visit? At Tufts Health Plan, we think you should know what to expect. Our health care search tool on mytuftshealthplan.com can help you plan ahead. Simply log on to mytuftshealthplan.com to: + Find doctors and hospitals who are in your network and nearby + Get estimated costs for your procedures and services + Check your out-of-pocket cost estimates for procedures - based on your health benefits + Determine the services, timelines, and costs to expect during a treatment of care, from diagnoses through follow-up If you have questions, can t find the service you are looking for, or need help estimating the cost of your treatment, please call and we ll be happy to help. How will you help transition my care while I m switching health plans? Our goal is to ensure a smooth transition for every member. Let us know if you re receiving ongoing treatment for a condition, and we ll help figure out the best course of action to take.

8 Now that you know about us, we d love to get to know you better. We d love to answer any questions you might have, so please feel free to ask. We take great pride in providing our members with the plans, information and ease of use they need in order to be healthy and stay healthy. Massachusetts Member Services (TDD/711) Monday Thursday, 8 a.m. 7 p.m. Friday, 8 a.m. 5 p.m. You can send us a secure by going to mytuftshealthplan.com and following the instructions to enter your and password. Once you ve entered the site, click on Contact Us from the menu at the top of the page and fill out the form provided. If you are not registered, please provide your address and then create a password. Translation Available: With the help of Language Line Solutions, Tufts Health Plan speaks over 200 languages. Please Note: may not be encrypted and may be accessed and viewed by other Internet users without your knowledge while in transit to us. For that reason, please do not submit confidential health care or personal information to us via . For information on all of your health plan options, call the Health Connector at 877.MA.ENROLL ( ). TTY: Mount Auburn Street, Watertown, MA tuftshealthplan.com You may obtain a summary of Tufts Health Plan s key Utilization Management/Case Management procedures and Tufts Health Plan s privacy practices at tuftshealthplan.com Tufts Health Plan 10/17 GENERAL-BROCHURE-1017

9 DISCRIMINATION IS AGAINST THE LAW Tufts Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Tufts Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Tufts Health Plan: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact Tufts Health Plan at If you believe that Tufts Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Tufts Health Plan, Attention: Civil Rights Coordinator Legal Dept. 705 Mount Auburn St. Watertown, MA Phone: ext , [TTY number or 711] Fax: OCRCoordinator@tufts-health.com You can file a grievance in person or by mail, fax, or . If you need help filing a grievance, the Tufts Health Plan Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C , (TDD) Complaint forms are available at tuftshealthplan.com THP-OCR-NOTICE-0816

10 For no cost translation in English, call the number on your ID card. للحصول على خدمة الترجمة المجانیة باللغة العربیة یرجى الاتصال على الرقم المدون على بطاقة الھویة الخاصة بك. Arabic Chinese 若需免費的中文版本, 請撥打 ID 卡上的電話號碼 French Pour demander une traduction gratuite en français, composez le numéro indiqué sur votre carte d identité. German Um eine kostenlose deutsche Übersetzung zu erhalten, rufen Sie bitte die Telefonnummer auf Ihrer Ausweiskarte an. Greek Για δωρεάν μετάφραση στα Ελληνικά, καλέστε τον αριθμό που αναγράφεται στην αναγνωριστική κάρτας σας. Haitian Creole Pou jwenn tradiksyon gratis nan lang Kreyòl Ayisyen, rele nimewo ki sou kat ID ou. Italian Per la traduzione in italiano senza costi aggiuntivi, è possibile chiamare il numero indicato sulla tessera identificativa. Japanese 日本語の無料翻訳については ID カードに書いてある番号に電話してください Khmer (Cambodian) ស រម ប សវបក រប ដយឥតគ ត ថ ជ ភ ស 缨 ខ រ ស មទ រស ព ក ន លខ ដលម ន ល ប ណ សម ល សម ជ ករបស អ ក Korean 한국어로무료통역을원하시면, ID 카드에있는번호로연락하십시오. Laotian ສາລ ບການແປພາສາເປ ນພາສາລາວທ ບ ໄດ ເສຍຄ າໃຊ ຈ າຍ, ໃຫ ໂທຫາເບ ຢ ທ ເທງບ ດປະຈ າຕ ວຂອງທ ານ. Navajo برای ترجمھ رایگا فارسی بھ شماره تلفن مندرج در کارت شناساي ی تان زنگ بزنید. Persian Polish Aby uzyskać bezpłatne tłumaczenie w języku polskim, należy zadzwonić na numer znajdujący się na Pana/i dowodzie tożsamości. Portuguese Para tradução grátis para português, ligue para o número no seu cartão de identificação. Russian Для получения услуг бесплатного перевода на русский язык позвоните по номеру, указанному на идентификационной карточке. Spanish Por servicio de traducción gratuito en español, llame al número de su tarjeta de miembro. Tagalog Para sa walang bayad na pagsasalin sa Tagalog, tawagan ang numero na nasa inyong ID card. Vietnamese Để có bản dịch tiếng Việt không phải trả phí, gọi theo số trên thẻ căn cước của bạn. List-Languages-THP-ID-07/16