Wentworth Institute of Technology Effectie Date January 1, 2014
Agenda Agenda Welcome to Tufts Health Plan Proider Network Plan Design Prescription Coerage Transition of Care Value Added Benefits Customer Serice Member Enrollment Kit Explanation 2
Welcome To Tufts Health Plan! Tufts Health Plan in business for more than 30 years Headquartered in Watertown MA, with regional offices in Worcester, Springfield and Proidence RI. US News & World Reports Rated amongst the top 1% of health plans nationally! Certified by National Committee for Quality Assurance 3
Tufts Health Plan Proider Network 90 hospitals with more than 25,000 proiders Network throughout MA, RI and southern NH Search proiders at www.tuftshealthplan.com Choose the HMO / POS / PPO network from the drop-down menu under Standard Network Plans 4 4
EPO Referral Process Referral Process It s easy! Required for most specialty care within network (dermatology, orthopedic) through your PCP More than 90% of referrals initiated on-line No referral needed for annual OB/GYN exam, chiropractic care, routine eye exam or outpatient behaioral health isits 5
EPO & PPO Coerage Oeriew NOTE: EPO requires selection of PCP Routine preentie examination: Coered 100% Office isit: $20 per isit High Tech Imaging: $75 copayment per isit Emergency Room: $100 / waied if admitted Inpatient Hospitalization: Coered 100% Surgical Day Care: Coered 100% Diagnostic Labs & X-rays: Coered 100% Prescription Drug Plan Retail (up to 30-day supply) prescription copays: $15 / $30 / $50 Mail order (maintenance Rx s) prescription copays: $30 / $60 / $150 6 6
PPO Out of Network Coerage Deductible: $250 per member and $500 per family Coinsurance: You pay 20% of coered serices, Tufts pays 80% Out of pocket maximum: $2,000 per person and $4,000 per family Emergency Serices are always coered the same as the in network benefit Be cognizant of charges aboe usual and customary when receiing serices from proiders that are not contracted with Tufts Health Plan 7 7
Vision Serices Tufts Health Plan Vision Benefits through EyeMed network: Routine Eye Exams (coered once eery 12 months) Eye-wear discounts on lenses, frames & contact lenses (15-35% off) Discounts aailable for LASIK procedures through network proiders 8
Prescription Drug Coerage Aailable at 99% of pharmacies nationwide 63,000 including CVS, Rite-Aid, Walgreens, Target, Wal-Mart, etc. 30-day supply filled at the retail pharmacy-remember to show your ID card to pharmacist after January 1, 2014 Check your prescription tiers at www.tuftshealthplan.com -Prior Authorization/Step Therapy exception process for Wentworth Institute Benefits to Fast Start (90-supply for most maintenance medications): - No forms to complete to start prescriptions by mail - Sae time and money on your prescriptions - Home deliery including free standard shipping to your home - Re-order prescriptions by phone, ia mail, or online 9
Transition of Care Assistance (for Ongoing Medical Serices) Transition of Care is needed anytime a member is in the middle of a care plan and needs additional resources to insure continuity of care Examples include: scheduled surgery or procedures pre-approed by your current carrier Simply contact Tufts Health Plan Member Serices to coordinate care Each case is reiewed indiidually and Tufts Health Plan will communicate with you and your proiders if necessary For more complex medical issues, contact Michael Burns at Tufts Health Plan by calling 617-923-5406 ext. 8676 and issues will be triaged accordingly Process oeriew for proiders that are not contracted with Tufts Health Plan 10
Fitness & Weight Management Benefit $150 Fitness Reimbursement $150 Weight Program Reimbursement Discounts at local participating Fitness Centers Cures www.curesinternational.com Fitness Together Personal Training www.fitnesstogether.com 11
Value Added Benefits Hospital-based wellness programs ex. nutrition, smoking cessation, stress management (up to 30% off) Boys & Girls Clubs (20% off) Acupuncture & Massage Therapy discounts (25% off) Healthyroads online health/wellness shopping (up to 40% off) Pregnancy Benefits and Childbirth Class reimbursements New Balance Discount 15% off all products at their stores Well magazine! 12
Web-site Decision Support Tools Need to register 24/7 access Proider look-up Your authorizations information Your benefit Information Hospital performance comparisons with Select Quality Care Information on conditions and symptoms Medical & pharmacy claims Health & Wellness calculators 13
Member Serices Member Serices Line (800) 462-0224 Monday - Thursday 8:00 am to 7:00 pm (EST) Friday 10:00 am to 5:00 pm 24 hour answering serice AT&T Language Line (140 languages) www.tuftshealthplan.com Benefit Questions, new ID card, or transition of care questions 14
Important Reminders Important Reminders (!) All employees and their dependents will receie new medical ID Cards Subscriber: xxxxxx-01 Spouse: xxxxxx-02 Dependents: xxxxxx-03 Start using new cards as of January 1, 2014 15 15
Things to Remember Coerage becomes effectie 1/1/2014 Referrals MUST be reissued (call your PCP) Fill your prescriptions Enrollment forms due by 12/6/2013 Please isit the Wentworth Microsite EPO Group Number is 17011-000 PPO Group Number is 46259-000 16
Questions and Answers We look forward to working with Wentworth Institute Employees & Families! 17