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Wentworth Institute of Technology Effective Date January 1, 2014.

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Presentation on theme: "Wentworth Institute of Technology Effective Date January 1, 2014."— Presentation transcript:

1 Wentworth Institute of Technology Effective Date January 1, 2014

2 2  Welcome to Tufts Health Plan  Provider Network  Plan Design  Prescription Coverage  Transition of Care  Value Added Benefits  Customer Service  Member Enrollment Kit Explanation Agenda

3  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 Welcome To Tufts Health Plan! 3

4 4 Tufts Health Plan Provider Network  90 hospitals with more than 25,000 providers  Network throughout MA, RI and southern NH  Search providers at  Choose the “HMO / POS / PPO” network from the drop-down menu under “Standard Network Plans” 4

5 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

6 6 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

7 7 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

8 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 Vision Services 8

9 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 -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

10  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 ext and issues will be triaged accordingly  Process overview for providers that are not contracted with Tufts Health Plan Transition of Care Assistance (for Ongoing Medical Services) 10

11 Fitness & Weight Management Benefit  $150 Fitness Reimbursement  $150 Weight Program Reimbursement  Discounts at local participating Fitness Centers  Curves –  Fitness Together Personal Training 11

12 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

13 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

14 Member Services Member Services Line (800)  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)   Benefit Questions, new ID card, or transition of care questions 14

15 15 (!) 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 Important Reminders 15

16  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  PPO Group Number is Things to Remember … 16

17 Questions and Answers We look forward to working with Wentworth Institute Employees & Families! 17


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