Effective Date 1/1/2014 1
Tufts Health Plan Overview Tufts Health Plan in business for 30+ years Headquartered in Watertown MA, with regional offices in Providence RI, Worcester and Springfield More than 1,000,000 members in RI and MA Ranked amongst the top 1% of health plans in the United States Published by US News & World Report Certified as excellent by National Committee for Quality Assurance 2
Provider Network TUFTS HEATH PLAN Network includes more than six thousands hospitals across the country (every hospital in RI/MA) with more than 700,000 participating providers nationwide Search for providers at www.tuftshealthplan.com and click on the Doctor Search link under the I m A Member tab and select Carelink under National Network Plans 3
PPO Product Overview Members are NOT required to select a Primary Care Provider (PCP) Members have both in and out of network coverage Referrals are not required for specialty care 4
Carelink Advantage PPO Plan Overview In-Network Benefits: Routine preventive examination: covered in full (no copay) Office visits for physician and mental health services : $20 per visit In-network deductible: $3,000/$6,000 In-network out-of-pocket maximum: $5,000/$10,000 Calendar year deductible applies to services such as inpatient & outpatient hospitalization, emergency room, diagnostic lab work & x-rays, speech & short term therapies Rx copayments for retail 30-day: $10/$35/$60 Rx copayments for mail 90-day: $20/$70/$120 5
Carelink Advantage PPO Plan Overview Out of Network Benefits: Out of network deductible: $4,000/$8,000 Out of network out-of-pocket maximum: $10,000/$20,000 Coinsurance is 20% Usual & Customary reimbursement and balance billing 6
Prescription Drug Coverage Retail CVS/Caremark national R(x) vendor- Review How to Use Your Pharmacy Benefit flyer for details Available 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 beginning 1/1/14 Check your prescription tiers at www.tuftshealthplan.com -Prior Authorization, Step Therapy, and dispensing limits may apply to some prescriptions Curascripts (Specialty Pharmacy) 7
Prescription Drug Coverage Mail Order Benefits to Fast Start 1. No forms to complete to start prescriptions by mail 2. Save time and money on your prescriptions 3. Home delivery including free standard shipping (within 10-14 days) to your home 4. Refills by phone, online, mail Refill your prescriptions through current carrier prior to January 1, 2014 if possible 8
Transition of Care Transition of Care is needed anytime a member is in the middle of a treatment plan and needs additional resources to ensure continuity of care. Examples include: scheduled surgery or procedures already pre-approved, complex medical conditions Simply contact THP Member Services to coordinate care Each case is reviewed individually and Tufts Health Plan will communicate with you and your providers if necessary 9
Vision Services Tufts Health Plan Vision Benefits through Eye Med network: Routine Eye Exams (covered once every 12 months) Eye-wear discounts on lenses, frames & contact lenses (15-35% off) Discounts available for LASIK procedures through network providers 10
Fitness & Weight Management Benefit $150 Fitness Reimbursement Boys & Girls Clubs in RI & MA CVS Caremark ExtraCare Health Card ChooseHealthy.com New Balance discounts Discounts on Acupuncture & Massage Therapy 11
Web-site Decision Support Tools Need to register 24/7 access Provider 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 12
Member Services Monday - Thursday 8:00 am to 7:00 pm Friday 10:00 am to 5:00 pm 24 hour answering service AT&T Language Line (140 languages) www.tuftshealthplan.com Benefit Questions, new ID card, or transition of care questions 13
Member Kit Explanation Summary of Benefits and Coverage Your Pharmacy Benefit flyer Transition of care flyers Fitness and wellness flyer Discount programs flyer Privacy notice 14
Visit the Pet Food Experts Microsite! 15
Things to remember Coverage becomes effective 1/1/2014 Complete your enrollment form and return to Human Resources ASAP PPO Group number is 36747-000 16