Benefit Comparison. Plan Options for April 1, March 31, 2016 For Massachusetts-based Companies With 1-9 Full-time Employees

Transcription

1 Benefit Comparison Plan Options for April 1, March 31, 2016 For Massachusetts-based Companies With 1-9 Full-time Employees A National Membership Organization for Small Business 554 Main Street P.O. Box Worcester, MA (800)

2 Plan Options for April 1, March 31, 2016 Deductibles, out-of-pocket maximums, and visit limits are calculated on the calendar year for all plans (except Advantage HMO Saver which is calculated from April 1, March 31, 2016 regardless of the effective date of the group). Standard Network Products All Tufts Health Plan participating providers included Covered Services Advantage HMO 1000 GOLD Advantage HMO 1500 GOLD Advantage HMO 1500 Low Rx** SILVER Advantage HMO 2000 GOLD Advantage HMO 2000 (80%)** SILVER Advantage HMO 2000 Low Option SILVER Advantage HMO Saver 2000 SILVER (H.S.A. qualified plan, plan year 4/1/15-3/31/16) Advantage HMO Saver 2900 (H.S.A. qualified plan, plan year 4/1/15-3/31/16) SILVER Commonwealth Advantage HMO 1000 v.2 ** (Gold B) GOLD Commonwealth Advantage HMO 400 with Coinsurance ** (Gold A) GOLD Deductible Individual Deductible $1,000 $1,500 $1,500 $2,000 $2,000 $2,000 $2,000 $2,900 $1,000 $400 Family Deductible $2,000 $3,000 $3,000 $4,000 $4,000 $4,000 $4,000 $5,800 $2,000 $800 Out-of-Pocket Maximum Medical: $3,000/$6,000 Medical: $2,000/$4,000 Medical/Pharmacy/Pediatric Dental 1 $6,000 individual/ $12,000 family $4,750 individual/ $9,500 family $6,600 individual/ $13,200 family $4,000 individual/ $8,000 family $5,500 individual/ $11,000 family $6,600 individual/ $13,200 family $6,450 individual/ $12,900 family $4,800 individual/ $9,600 family Pharmacy: $2,000/$4,000 Pediatric Dental: $1,000 one child/$2,000 two or more children Pharmacy: $1,000/$2,000 Pediatric Dental: $1,000 one child/$2,000 two or more children Preventative Services Routine Physical Exams Outpatient Medical Care Office Visit Copay (PCP/Specialist) 2 $35 per PCP/ $50 per Specialist $35 per PCP/ $50 per Specialist $40 per PCP/ $60 per Specialist $30 per PCP/ $45 per Specialist $20 per PCP/ $35 per Specialist (PCP/Specialist) Speech Therapy (no visit limit); Short-term Physical Therapy (30 visits per calendar year); Short-term Occupational Therapy (30 visits per calendar year) $25 per visit $25 per visit $35 per visit $25 per visit $35 per visit $40 per visit Plan covers 70% Diagnostic Imaging--High Tech Imaging (MRIs, CT/CAT Scans, PET Scans, and Nuclear Cardiology) $200 copay Plan covers 70% Chiropractic Services (12 visits per year) Plan covers 70% Inpatient Hospital Care and Day Surgery Day Surgery after deductible $250 copay after deductbile Plan covers 70% Inpatient Services after deductible $500 copay Plan covers 70% Emergency Care In Emergency Room (copay waived if admitted) after deductible $150 copay Plan covers 70% Prescription Drug Coverage Copayments--at a participating retail pharmacy Copayments--through our mail order service (90 day supply) $20/$40/$60/$100 $20/$40/$60/$100 $35/$85/$100/10%* $20/$40/$60/$100 $20/$75/$100/10%* $20/$75/$100/10%* $20/$75/$100/$125 $25/$55/$90/$120 $20/$30/$50 $15/50%/50% $40/$80/$180/NA $40/$80/$180/NA $70/$170/$300/NA $40/$80/$180/NA $40/$150/$300/NA $40/$150/$300/NA $40/$150/$300/NA $50/$110/$180/NA $40/$60/$150 $30/50%/50% Deductible $0 $0 $250/$500 $0 $0 $0 $2,000/$4,000 $2,900/$5,800 $0 $100/$200 for Tier 2 and Tier 3 Formulary Standard Standard Generic Preferred Program *** Standard Generic Preferred Program *** Standard Standard Standard Standard Standard 1) The out-of-pocket maximum includes the member s medical, pharmacy and pediatric dental copays, deductibles, and coinsurance. 2) Some non-routine services may be subject to deductible or coinsurance if the plan has deductible or coinsurance. * When 10% coinsurance is applied on the fourth RX tier, there is a minimum cost of $100 per fill and a max cost of $250 fill ** These plans feature the mandatory mail order requirement for maintenance medications *** Generic Preferred Program: This program encourages the use of generic prescriptions. If a doctor prescribes a brand name drug that has a generic equivalent, and indicates no substitution for the brand name drug on the prescription, the member will need to pay the difference in price between the brand name drug and the generic drug. All plans include Altus Pediatric Dental coverage. To request a plan without Pediatric Dental coverage, please contact us at

3 Plan Options for April 1, March 31, 2016 Limited Network: Steward Community Choice and Select Network plans provide access to a network that is smaller than Tufts Health Plan s standard network. In these plans, members have access to network benefits only from the providers in the Steward Community Choice or Select Networks. Please consult the Steward Community Choice or Select Network provider directory by visiting the provider search tool at tuftshealthplan.com and click on Find a Doctor to determine the providers in the Steward Community Choice or Select Limited Provider Networks. If you need a paper copy of the provider directory, please contact member services. LIMITED NETWORK PLANS Covered Services Select Advantage HMO ** GOLD Select Advantage HMO ** SILVER Steward Community Choice Copay ** PLATINUM Steward Community Choice 1000 ** GOLD Deductible Individual Deductible $1,000 $2,000 NA $1,000 Family Deductible $2,000 $4,000 NA $2,000 Out-of-Pocket Maximum Medical/Pharmacy/Pediatric Dental 2 $6,000 individual/$12,000 family $6,600 individual/$13,200 family $3,500 individual/$7,000 family $6,000 individual/$12,000 family Preventative Services Routine Physical Exams Outpatient Medical Care Office Visit Copay (PCP/Specialist) 3 $35 per PCP/ $50 per Specialist $20 per PCP/ $35 per Specialist (PCP/Specialist) Speech Therapy (no visit limit); Short-term Physical Therapy (30 visits per calendar year); Short-term Occupational Therapy (30 visits per calendar year) $25 per visit $35 per visit $20 per visit $25 per visit Diagnostic Imaging--High Tech Imaging (MRIs, CT/CAT Scans, PET Scans, and Nuclear Cardiology) $100 per visit Chiropractic Services (12 visits per year) $35 per visit Inpatient Hospital Care and Day Surgery Day Surgery Inpatient Services Emergency Care In Emergency Room (copay waived if admitted) $150 per visit Prescription Drug Coverage Copayments--at a participating retail pharmacy $20/$40/$60/10%* $30/$75/$100/10%* $15/$30/$50/10%* $20/$40/$60/10%* Copayments--through our mail order service (90 day supply) $40/$80/$180/NA $60/$150/$300/NA $30/$60/$150/NA $40/$80/$180/NA Deductible (calendar year) $0 $0 $0 $0 Formulary Generic Preferred Program *** Generic Preferred Program *** Standard Standard 1) Select provider network, with a limited service area that excludes Berkshire, Dukes, and Nantucket counties. Please note that emergency room, inpatient, and day surgery copayments are included in the out-of-pocket maximum. 2) The out-of-pocket maximum includes the member s medical, pharmacy and pediatric dental copays, deductibles, and coinsurance. 3) Some non-routine services may be subject to deductible or coinsurance if the plan has deductible or coinsurance. * When 10% coinsurance is applied on the fourth RX tier, there is a minimum cost of $100 per fill and a max cost of $250 fill ** These plans feature the mandatory mail order requirement for maintenance medications *** Generic Preferred Program: This program encourages the use of generic prescriptions. If a doctor prescribes a brand name drug that has a generic equivalent, and indicates no substitution for the brand name drug on the prescription, the member will need to pay the difference in price between the brand name drug and the generic drug. All plans include Altus Pediatric Dental coverage. To request a plan without Pediatric Dental coverage, please contact us at

4 TUFTS HEALTH PLAN MEMBER DISCOUNTS Member Discounts Help You Save on Products and Services That Promote Good Health Tufts Health Plan will help you reach your wellness goals with discounts on nutrition, mind and body, fitness, and other services related to good health through the following providers and vendors.* HEALTHY EATING Counseling You can receive 25% off the cost of visits with a registered dietitian or licensed nutritionist participating in our network. To find a dietician or nutritionist, visit tuftshealthplan.com. On the Members tab, click I m a member, then Doctor Search. On the left of the page, click Other Services, then choose Dietitians & Nutritionists under Select a service. Supplements Save up to 40% on a wide variety of vitamins, supplements, and popular energy and protein bars through ChooseHealthy. com. Standard shipping is also free for members. MIND AND BODY Mindfulness and Stress Reduction Save 15% on the cost of tuition for the 8-week Stress Reduction Program at UMass Medical School s Center for Mindfulness in Shrewsbury. The program is designed to help people draw on their inner resources to relax, improve selfesteem, and reduce pain. Acupuncture and Massage Save 25% on acupuncture treatments and massage therapy. To find a participating provider, go to tuftshealthplan.com and click on Find a Doctor, then search under Other Services. Natural Therapies Save up to 40% on aromatherapy, homeopathic remedies, meditation, yoga, and other natural remedies. To learn more, go to ChooseHealthy.com. WEIGHT MANAGEMENT Nutrisystem With Nutrisystem s 28-day program, you get breakfast, lunch, dinner, and snacks delivered right to your door. The meals and snacks offer the right amount of food and nutrition to help you with your weight loss goals. You can also work with weight loss counselors, and get activity plans, tools and trackers to help you stay on your program. Tufts Health Plan members receive the following discounts/ benefits from Nutrisystem: } 12% discount off the current promotion price of the Core or Select program ($28 $43 monthly savings) } Plans for many lifestyle types, including vegetarians and diabetics MORE WAYS TO SAVE To learn more about our wide range of member discounts, go to tuftshealthplan.com and click on Member Discounts on the Members tab. Brain Fitness New! Effective January 1, 2015, members can receive 17% off the price of a subscription to BrainHQ, an online cognitive training program. This program offers brain exercises that can help people improve memory, attention, social connection, and more. tuftshealthplan.com/momentum

5 idiet With idiet s 12-week in-person or online program, you will receive step-by-step practical guidance, personalized support and advice from an idiet certified trained group leader. The idiet is scientifically designed to help make sure participants are hunger free and doing what it takes (following the menus, trying more cooking, making sure to eat the snacks) so they don t feel deprived. idiet is offering a 15% discount ($45 savings) to Tufts Health Plan members who are interested in enrolling in the Engage (entry level) or Advance (experienced dieter) idiet, an easyto-follow program for healthy, long-term weight loss. Enrollment in the program includes: access to a full suite of useful tools such as the idiet book, supporting handouts, food samples, menus and recipes, educational videos, and web based support e.g. Weight Tracker. Jenny Craig When you re ready to lose weight, why count, track and worry over every meal? Jenny Craig makes it simple. You and your dedicated, personal consultant will design a meal plan that is portion-perfect. Pick what sounds delicious, and you ll be on your way to losing weight with your very next meal. } 50% off* Jenny Craig All Access enrollment, plus your first month is free! } Visit to receive your special offer coupon. * 50% discount on $99 enrollment. Enrollment and monthly fees required. Plus the cost of food. Plus the cost of shipping, if applicable. No cash value. Not valid with any other offer or discounts. New members only. Restrictions apply. Must provide proof of plan membership upon request. Jenny Craig is a registered trademark. Used under license. FITNESS CENTERS } Save 20% on annual memberships and pay no fee for joining at Tufts Health Plan network fitness centers in Massachusetts, New Hampshire, and Rhode Island. The network includes almost 80 health and fitness centers. } Save 50% when you join a participating New England Curves club. } Save 10% on a personal training package at Fitness Together and receive a free fitness evaluation. } Save 20% on an Appalachian Mountain Club membership and receive discounts on lodging, subscriptions, and programs. } Members 18 years old and younger pay no fee to join network Boys & Girls Clubs in Massachusetts and Rhode Island. Members also receive a 20% discount on the cost of most programs. If you re not ready to join a fitness center, you and your family can go to a fitness center in the Tufts Health Plan network and pay a small copayment of $6-$10 for each visit, up to five times a month. For a full list of fitness centers in the Tufts Health Plan network, go to tuftshealthplan.com and click on Find a Doctor, then search under Other Services. MORE SAVINGS LifeMart Tufts Health Plan members now have access to discounts through LifeMart. LifeMart offers online shopping with discounts up to 40% on more than 4 million products and services, including groceries, clothing, hotels, restaurants, child care centers, weight loss programs, and electronics. You ll find deals and coupons for products and services from Apple, New Balance, Wells Fargo, Target, Kohl s, Gymboree, and more. Discounts on Glasses and Contacts With the EyeMed Vision Care program, you can receive 35% off the price of frames, along with discounts on lenses and lens options, when you buy a pair of eyeglasses from an EyeMed network provider. EyeMed Vision Care also offers a replacement contact lens program, 20% off the price of nonprescription sunglasses, and 5%-15% off the cost of LASIK and PRK laser vision correction. To find an eye care provider in the EyeMed Vision Care network, go to tuftshealthplan.com and click on Find a Doctor. Home Instead Senior Care Receive a $100 one-time credit toward home care support services when you show your Tufts Health Plan ID card. These include help preparing meals, light housekeeping, and other nonmedical home care services. A free home-safety inspection is also provided once you contract for home care services. This includes a review of the home entrance, kitchen, bathrooms, and more. This benefit is available to eligible family members of Tufts Health Plan members. *This information has been provided by the vendors below and has not been independently confirmed by Tufts Health Plan. Check with your health care provider regarding any health or medical condition and before beginning any new treatment, exercise, or nutrition regimen.

6 These charts provide benefit highlights for general comparison purposes only. There are also services that the plans do not cover. Please see a Summary of Benefits for more information or refer to your Member Benefit Document for complete information. A National Membership Organization for Small Business 554 Main Street P.O. Box Worcester, MA (800) Int_Comp_SBSB_2015_2/15