Wentworth Institute of Technology Effective Date January 1, 2014 Agenda Agenda Welcome to Tufts Health Plan Provider Network Plan Design Prescription Coverage Transition of Care Value Added Benefits Customer Service 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 Providence 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 Provider Network 90 hospitals with more than 25,000 providers Network throughout MA, RI and southern NH Search providers 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 behavioral health visits 5 EPO & PPO Coverage Overview NOTE: EPO requires selection of PCP Routine preventive examination: Covered 100% Office visit: $20 per visit High Tech Imaging: $75 copayment per visit Emergency Room: $100 / waived if admitted Inpatient Hospitalization: Covered 100% Surgical Day Care: Covered 100% Diagnostic Labs & X-rays: Covered 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 Coverage Deductible: $250 per member and $500 per family Coinsurance: You pay 20% of covered services, Tufts pays 80% Out of pocket maximum: $2,000 per person and $4,000 per family Emergency Services are always covered the same as the in network benefit Be cognizant of charges above “usual and customary” when receiving services from providers that are not contracted with Tufts Health Plan 7 7 Vision Services Tufts Health Plan Vision Benefits through EyeMed 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 8 Prescription Drug Coverage 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 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 - Save time and money on your prescriptions - Home delivery including free standard shipping to your home - Re-order prescriptions by phone, via mail, or online 9 Transition of Care Assistance (for Ongoing Medical Services) 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-approved by your current carrier Simply contact Tufts Health Plan Member Services to coordinate care Each case is reviewed individually and Tufts Health Plan will communicate with you and your providers 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 overview for providers 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 Curves – www.curvesinternational.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 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 13 Member Services Member Services 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 service AT&T Language Line (140 languages) www.tuftshealthplan.com Benefit Questions, new ID card, or transition of care questions 14 Important Important Reminders Reminders (!) All employees and their dependents will receive 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 … Coverage becomes effective 1/1/2014 Referrals MUST be reissued (call your PCP) Fill your prescriptions Enrollment forms due by 12/6/2013 Please visit 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