YOUR TRUSTED HEALTH COMPANION A plan for life.
Being healthy is about more than preventing illness. It s achieving the best possible quality of life, physically and emotionally. That s what CDPHP is all about. As our member, you ll benefit from a wide variety of services, from prescription discounts and free wellness classes to personal, professional support and online tools and resources. It s all here. And it s all included just for being a CDPHP member. 3
Making Good Health Affordable More than 725,000 Providers Nationwide Most CDPHP plans include a national network.* What does this mean for you? Savings, of course. When you choose an in-network doctor, you ll pay significantly less than you would if you went to an out-of-network doctor. In addition, all plans include worldwide coverage for emergency care. And CDPHP makes finding a doctor easier than ever with our online Find-A-Doc tool at findadoc.cdphp.com. From there, we ll guide you through a simple three-step process for finding the doctor or provider you need! 1. Select your plan type or enter your member ID from your CDPHP ID card. 2. Enter a ZIP code or city and state information, and the distance you d like to search. 3. Choose a specialty, or enter a provider or group name. Then hit Search. It s really that simple you ll get a listing of results that meet your criteria. Preferred Locations We also have an extensive list of preferred locations where you can get free or reduced cost services. At preferred lab and radiology sites, services are covered in full with most CDPHP plans. (Find them using the Laboratory Search and X-Ray & Radiology Search tabs in Find-A-Doc.) Most CDPHP plans include lower out-of-pocket costs when you receive services at a preferred ambulatory surgical center. (Find them using the Other Services Search tab in Find-A-Doc.) * Available for EPO and PPO plans. Not available for HMO plans. Refer to your member materials or call member services at the number on your ID card to determine complete benefits. 4
On the go? We ve got you covered there, too. Download the My CDPHP Mobile app at www.cdphp.com/mobile and you ll be able to locate the nearest doctor, hospital, or facility all from your smartphone. Urgent Care When your doctor isn t available, urgent care centers are the next best thing they re convenient and economical. In fact, visits to the ER are generally not covered for nonemergency services. So, if it s not an emergency, you can take advantage of an urgent care center in our network for everything from allergies and colds to rashes and sprains. Free Preventive Care As part of our commitment to making good health affordable, you ll never pay anything out-of-pocket for preventive care services, like: Annual adult physicals Annual OB/GYN screenings Well-child visits Prostate screenings Mammograms 5
Rx Coverage You Can Count On CDPHP is proud to be affiliated with Caremark, a leading national prescription benefit manager. With the Premier Rx network, you can fill prescriptions at any Caremark pharmacy, nationwide. Virtually all chain store pharmacies and most independents participate. Find a pharmacy near you by going to Find-A-Doc at www.cdphp.com. Log onto the secure Caremark website at www.caremark.com or contact Caremark by telephone 24 hours a day, seven days a week to find out: If a particular drug is covered How much you can expect to pay If there is a generic alternative. Rx Corner at www.cdphp.com also contains answers to many frequently asked questions. 6
Take Advantage of Rx Savings Understand the formulary The key to making the most of the savings that your CDPHP prescription coverage offers is understanding the CDPHP formulary, or list of covered drugs that have been proven to offer clinical and cost advantages when compared to other, similar products. Check your CDPHP member ID card to find out which formulary is available with your health plan. The formulary tier assigned to a drug determines how much you will pay for it. Tier 1 drugs generally cost the lowest copayment; tier 2 drugs require the middle copayment; and tier 3 drugs are covered at the highest amount. Excluded drugs are covered only by medical exception. (Your doctor can apply for a medical exception if he or she believes that you need an excluded drug due to medical issues.) Mail Service* If you take maintenance drugs, consider signing up for the Prescription Mail Service, which allows you to obtain up to a 90-day supply of drugs mailed to your home. Maintenance drugs are defined as medications taken regularly to treat or prevent a chronic health condition such as, but not limited to, high blood pressure, diabetes, and asthma. Locate forms and information in Rx Corner at www.cdphp.com. Rx for Less With Rx for Less, you can get deep discounts on specified generic drugs at any CVS, Walmart, Price Chopper, Hannaford, or ShopRite. Visit www.cdphp.com for a full list of drugs in the Rx for Less program.** There s no sign-up process or registration fee members simply present their CDPHP ID card to receive their discount on a variety of common medications, including Asthma medications Blood thinners Blood pressure medications Cholesterol-lowering drugs Anti-depressants Diabetes medications And more Savings for High Deductible Plans With qualified high deductible plans, preventive prescription drugs are not subject to the deductible, so members can immediately start paying the lower, tier-based cost-share instead of the full cost of the drug. Review the CDPHP Preventive Drug List in the Rx Corner of www.cdphp.com for more details. * Specialty pharmacy agents, including injectables and certain drugs used to treat hepatitis C, HIV, multiple sclerosis, and other serious conditions, are not eligible for this program. Get more information about specialty drugs at www.cdphp.com/members/specialty_pharmacy.aspx. ** Rx for Less does not apply to mail order service. 7
Keep Track of Your Health 24/7 Account Access The secure member website gives you convenient, secure access to your health benefit information any time you need it. Use it to view your benefits, track claims, submit claims for your funding accounts, and more. And if you select a CDPHP funding account, you can also use the secure site to check your balances and submit and substantiate your claims. Benefits At Your Fingertips www.cdphp.com/mobile When you use My CDPHP Mobile, you can access important benefit information, like your copay amounts or deductible balances; view, e-mail or fax your member ID card; locate the nearest doctor, hospital, or health care facility while on the go. CDPHP InMotion SM inmotion.cdphp.com This powerful tool allows members to track their fitness activities and helps them achieve their health and fitness goals. It has a mobile app that uses the built-in GPS technology of a smartphone to record essential metrics, like duration, distance, pace, speed, and elevation. What s more, InMotion can be used to establish a daily calorie and nutrition plan. Friendly, Knowledgeable Customer Support Every Time Looking for more personalized contact with us? Call the number on your member ID card to speak with one of our seasoned customer service representatives. 8
Wellness Made Simple, Affordable, and Rewarding Life Points Rewards* Earn Life Points for completing a variety of simple healthy activities, like taking a personal health assessment or getting an annual exam. Life Points can be redeemed for gift cards for hundreds of retailers. Record and track your points through the secure site at www.cdphp.com. Discount Programs You can receive a 20 percent discount at CVS when you purchase CVS-brand health-related items at any of the 7,500 CVS stores nationwide. You can also save up to 30 percent on alternative treatments, like massage therapy, yoga, and chiropractic services through our Complementary & Alternative Medicine (CAM) program. Single-Source Referral Line Points Members in the Right Direction 1-888-94-CDPHP Whether you need assistance dealing with a serious medical issue or you simply want to find ways to improve your health there s a program for you. And the CDPHP single-source referral line can help you find it. Weigh 2 Be SM www.cdphp.com/weight-management Free and open to the public, the Weigh 2 Be website provides the tools and information needed to lose weight safely and effectively and offers support and resources to live and maintain a healthy lifestyle. CaféWell www.cafewell.com/cdphpfit CaféWell is a Social Health Management site that CDPHP offers to provide a safe, anonymous environment for participating in health-related discussions, joining groups, and getting expert wellness information. * Available with most plans 9
Ongoing Support and Information Health Coach Connection SM Delivers Disease Management and Self-Care Support 1-800-365-4180 Health Coach Connection gives members no-cost, 24/7 telephone access to a personal Health Coach, a specially trained health care professional who can provide personalized information and support on complex health issues. Options for Member Counseling 1-888-320-9584 Behavioral Access Center 1-855-293-0785 CONTACT Lifeline The CDPHP Behavioral Health Access Center, staffed by an experienced team of mental health and substance abuse treatment professionals, can refer members to appropriate mental health and substance abuse services. In addition, CDPHP members have after-hours access to the CONTACT Lifeline, a telephone crisis hotline staffed by Family & Children s Service of the Capital Region. Care Management Helps with Complex Conditions The CDPHP care management program addresses the needs of the whole person by facilitating effective communication among all members of the health care team including the member and his or her caregivers. Examples of diagnoses that are appropriate for this program include: high-risk maternity, organ transplants, and multiple sclerosis. Medication Therapy Management Helps Members Avoid Drug Interactions The CDPHP Medication Therapy Management (MTM) program is designed to improve the safety of prescription use and the management of chronic disease. Medication problems (such as the effects of using multiple drugs concurrently, drug interactions, dosing issues, and noncompliance) are identified and resolved. 10
Good Health In Your Community and Online CDPHP Service Center Latham Inside the Capital Region Health Park at 711 Troy-Schenectady Road, the CDPHP Service Center Latham allows members of the community to meet face-to-face with a CDPHP representative to get answers to their health benefits questions, assistance navigating the Affordable Care Act and the NY State of Health TM website, and more. Healthy Living Center The result of a collaboration between CDPHP, Capital District YMCA, and Hannaford Supermarkets, the Healthy Living Center has a variety of free program offerings, as well as CDPHP member services representatives that can answer health insurance questions and help people understand their NY State of Health Marketplace options. The Center is located inside the Hannaford Supermarket at 900 Central Avenue in Albany. Over 300 Free Wellness Classes Each Year CDPHP releases a quarterly schedule of free classes in the community for members. Topics are aimed at varying ages and education levels, and range from yoga to zumba to healthy cooking. Access the schedule online by clicking on Wellness Workshop under the Classes & Events tab at www.cdphp.com. Dedicated Health Care Reform Site Designed to guide you through the sometimes complex world of health care reform, the CDPHP health care reform site explores the issues that matter the most to you and your family. From the latest legislative updates to a reader-friendly glossary, you ll find the tools you need to understand health care reform and how it affects you. Visit the site today at www.cdphp.com/health-care-reform. Visit www.healthyalbany.org for hours and a list of free classes. 11
Get fitness tips, wellness ideas, and more! Connect with us: Member Resources CDPHP www.cdphp.com Weigh 2 Be SM www.cdphp.com/weight-management CDPHP InMotion SM inmotion.cdphp.com CaféWell www.cafewell.com/cdphpfit Single-Source Referral Line 1-888-94-CDPHP Health Coach Connection 1-800-365-4180 Behavioral Health Access Center 1-888-320-9584 1-855-293-0785 (after hours) Consumer-Directed Health Plans www.cdphp.com/consumer-directed-health Contact CDPHP at 1-800-777-2273. Capital District Physicians Health Plan, Inc. Capital District Physicians Healthcare Network, Inc. CDPHP Universal Benefits, Inc. 500 Patroon Creek Boulevard, Albany, NY 12206-10 57 (518) 641-5000 or 1-800-777-7299 www.cdphp.com 14-0671 Form #4177-1214