GATEWAY AT A GLANCE for Medicare Assured SM Providers
|
|
|
- Rodney Wilson
- 7 years ago
- Views:
Transcription
1 GATEWAY AT A GLANCE for Medicare Assured SM Providers
2 Gateway Health Medicare Assured SM offers options designed to provide more than healthcare for those who qualify. Medicare Assured SM offers medical and prescription drug coverage, and all the benefits of Original Medicare, PLUS more benefits. Healthcare Options Dual Eligible Special Needs Plans (DSNP) Medicare Assured Diamond SM (HMO SNP) and Medicare Assured Ruby SM (HMO SNP) are for people who have BOTH Medicare (Part A and B) and Medical Assistance or assistance from the State. Those eligible can enroll in a new plan any time throughout the year. Chronic Condition Special Needs Plans (CSNP) Medicare Assured Gold SM (HMO SNP) and Medicare Assured Platinum SM (HMO SNP) are for people who have BOTH Medicare (Part A and B) and at least one of the following chronic conditions: diabetes, cardiovascular disorder or chronic heart failure. There are no income requirements for the chronic condition Special Needs Plans. As a SNP, Gateway is required by the Centers for Medicare and Medicaid Services (CMS) to administer a Model of Care Plan. The SNP Model of Care Plan is the architecture for care management policy, procedures and operational systems. Refer to the Model of Care section in the Gateway Health Medicare Assured SM Provider Policy and Procedure Manual for our SNP Model of Care elements. MAPD Plans (HMO) Additional healthcare options offered outside Pennsylvania are Medicare Assured Prime SM and Medicare Assured Select SM (HMO). The only requirement is to be entitled to Medicare Part A, enrolled in Medicare Part B and live in the non-pennsylvania Gateway service area. There are NO Medicaid or chronic condition requirements for these plans. Frequently Asked Questions Do Gateway Health Medicare Assured SM members have any out of pocket expense? A member s out of pocket expense or cost sharing will vary depending upon the level of assistance they may be receiving from the State and Medicare, as well as which Medicare Assured SM plan they have chosen to join. For more benefit information, a copy of the Summary of Benefits for all Medicare Assured SM plans is available at For your convenience, co-pays* for frequently used services are provided below: Dual Eligible Special Needs Plans (D-SNP) Gateway Health Medicare Diamond SM (HMO SNP): PCP-$0, SCP-$0, ER-$0** Gateway Health Medicare Ruby SM (HMO SNP): PCP-$0 or $15, SCP-$0 or $35, ER-$0 or $75** Chronic Condition Special Needs Plans (C-SNP) Gateway Health Medicare Gold SM (HMO SNP): PCP-$20, SCP-$45, ER-$75** Gateway Health Medicare Platinum SM (HMO SNP): PCP-$15, SCP-$35, ER-$75** *This list does not represent every service covered or every applicable co-pay. **Not covered outside the US. except under limited circumstances.
3 Do Gateway Health Medicare Assured SM members have to use plan providers? Members of Gateway Health Medicare Assured SM, with a few exceptions, must use plan providers to get covered services. At the time of enrollment, members must choose a Primary Care Physician (PCP) to provide basic medical care and coordinate the covered services received outside of the PCP s office. Are referrals required for services outside of the PCP s office? Referrals are not required. However, all Gateway Health members are encouraged to coordinate care with their PCP. Claims Submission Guidelines Timely filing criteria for initial bills is 365 days from the date of service. Corrected claims or requests for review are considered if information is received within the 180-day followup period from the date of the initial remittance advice. Practitioners must bill within 180 days from date of an Explanation of Benefits (EOB) from the primary carrier when Gateway is secondary. Paper and EDI claims must be submitted with the required NPI numbers. Claims submitted without the required NPI number will not be loaded and returned to the provider s EDI clearinghouse or billing address on the claim form. Correct/current member information, including Gateway member ID number, must be entered on all claims. Handwritten claims are not accepted. Gateway can not accept verbal requests to retract claim(s) overpayments. Providers must complete and submit a Refund Form (available in the Forms and Reference Material section under Providers on our website) or a letter that contains all of the information requested on this form. This form, together with all supporting materials relevant to the claim(s) reversal request being made, including but not limited to EOB from other insurance carriers and your refund check, should be mailed to: PNC BANK, c/o GATEWAY HEALTH PAYMENTS/REFUNDS, Lock Box #645171, 500 1st Avenue, Pittsburgh, PA CPID PAYER NAME PAYER ID CLAIM TYPE 2298 Gateway Health Medicare Assured SM (PA), (KY, NC, OH) Professional 2912 Gateway Health Medicare Assured SM (PA), (KY, NC, OH) Institutional * All of a patient s applicable diagnosis codes that support their Hierarchical Condition Category (HCC) must be reported at least once per year to CMS. CMS guidelines state that Physicians should code all documented conditions that co-exist at the time of the encounter/visit, and require or affect patient care treatment or management.
4 Gateway Health Medicare Assured SM Important Phone Numbers Call to Inquire About: Claims Inquiry Provider Services KY: NC: OH: PA: Authorization Medical and Behavioral Health Requests for Admissions to Inpatient Rehab (IRF), Long-Term Acute Care (LTAC) or Skilled Nursing Facilities (SNF) Member Eligibility Requests for Non- Formulary Drugs and Prior Authorizations Expedited Redetermination Care Management Asthma, Cardiac, COPD, Diabetes and Mom Matters Programs Preventive Health Services and Member Outreach Member Complaints, Concerns and Inquiries Concerns and Inquiries Utilization Management navihealth (PA only) KY: NC: OH: PA: For urgent requests: Providers can submit authorization requests via toll-free fax. General Prospective Review: Continued Stay Review for IRF, LTAC or SNF: Therapy Treatments or Visits Submitted to navihealth: DIVA Member Eligibility Line Pharmacy KY: NC: OH: PA: FA: a.m. to 4:30 p.m. (Calls received during nonbusiness hours are referred to ) 8 a.m. to 5 p.m hours a day, 7 days a week Our searchable drug formulary and prior authorization forms are available at Part D Prescriber Appeals Care Management and Complex Case Management Voice mail box monitored 24 hours a day, 7 days a week for requests and status of redetermination requests KY: NC: OH: PA: (option 1) Gateway to Lifestyle KY: Management SM NC: OH: PA: Fax OBNAF to Preventive Health KY: NC: OH: PA: (option 1) FA: Member Services KY: NC: OH: PA: Fraud and Abuse and Compliance 8 a.m. to 8 p.m. (412) or hours a day, 7 days a week medicarecomplianceofficer@gatewayhealthplan.com
5 Helpful Telephone Numbers AT&T Language Line Services Provides qualified medical interpretation services TTY/TDD Assistance with hearing impaired 711 or KY: NC: OH: PA: Practice Change Information Fax: Mailing Address for Medical and Behavioral Health Claim Forms PA: Gateway Health Medicare Assured SM PO Box Birmingham, AL KY, NC & OH: Gateway Health Medicare Assured SM P.O. Box Birmingham, AL Appeals & Grievances P.O. Box Pittsburgh, PA All Other Correspondence Gateway Health SM 444 Liberty Avenue, Suite 2100 Pittsburgh, PA Correspondence Type Claims Reviews Practice Change Information Attention: Claims Review Dept. Visit us online at Gateway Health SM offices will be closed to observe the following holidays: New Years Day, Martin Luther King Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day (and day immediately following), Christmas Eve and Christmas Day. Operations will resume the following business day.
6 Gateway Health Medicare Assured SM Authorization Quick Reference Guide Pennsylvania Gateway Health Medicaid and Medicare Assured participating providers have the ability to submit authorization requests electronically via NaviNet for the following services: Home Health Visit, Home Health Therapy, Inpatient Maternity, Medical care (both inpatient and outpatient), Behavioral health care, Private duty nursing services, Skilled Nursing Facility (SNF) Admission, Medicaid Only (Please note that SNF prior authorization must be obtained for Medicare Assured members through navihealth), Radiology services which require authorization through National Imaging (NIA). A training guide including detailed instructions is available on our website under Provider Updates and Forms and Reference Materials. GATEWAY AUTH NAVIHEALTH AUTH (PA ONLY) SCRIPT AMBULANCE (Non emergent only) AMBULATORY SURGICAL SERVICES No auth required for outpatient surgeries (except chose listed under SPU &/or SURGICAL Services) * No auth required for lab services provided in an ASC lab BONE DENSITOMETRY (Bone Mass Measurement) CT SCANS CHIROPRACTIC SERVICES DIALYSIS DME (Medical Supplies, Prosthetics and Orthotics) Items paid at $500 and over $500 (except for those listed below) Oxygen Concentrator, Stationary Liquid Oxygen, Cough Stimulating Device, Respiratory Assistance Device, Hospital Bed Total Electric, Hospital Bed Heavy Duty Extra Wide, and Powered Air Flotation Bed ELECTIVE ADMISSIONS (Medical and Behavioral Health) GENETIC TESTING HOME HEALTH VISITS HOME INFUSION (*Gateway Pharmacy Authorization May Be Required) INPATIENT ACUTE CARE (Including Transplants and Medical Detox) INPATIENT PSYCHIATRIC OR MENTAL HEAITH CARE INPATIENT REHAB FACILITY INPATIENT REHAB SUBSTANCE ABUSE CARE LONG TERM ACUTE CARE (LTAC) HOSPITAL MRI/MRA NON-PAR PROVIDERS NUCLEAR CARDIOLOGY OUTPATIENT PSYCHIATRIC PARTIAL HOSPITALIZATION OUTPATIENT ECT TREATMENT OUTPATIENT THERAPY (Physical, Speech and Language Occupational, and Cardiac) PET SCANS SKILLED NURSING FACILITY (SNF) CARE SPU and/or SURGICAL SERVICES (except those listed below) Bariatric Surgery/Stapling, Blepharoplasty, Breast Reduction, Carpal Tunnel Surgery, Genital Reconstruction, Hysterectomy, Panniculectomy, Removal of Breast Implant, Rhinoploasty, TMJ Surgery, Transplant/Implants, Varicose Vein Authorizations are the responsibility of the ordering provider. Cosmetic or investigational/experimental procedures are not covered.
7 Member Eligibilty Newly enrolled members receive an Evidence of Coverage (EOC) and Gateway Health Medicare Assured SM ID Card. The card itself does NOT guarantee that a person is currently enrolled in one of the Gateway Health Medicare Assured SM plans. Because of possible changes in a member s eligibility, each participating provider is responsible for verifying a member s eligibility with Gateway before providing services. This can be done by reviewing monthly panel reports, online verification through NaviNet or calling Gateway s telephonic eligibility system (DIVA). Please dial and follow the prompts (also listed below). To Verify Eligibility Using DIVA Call PRESS 1 to verify eligibility. Member identification Number? Using your telephone keypad, enter the member s 8 digit Gateway ID followed by #. If you make a mistake, press * to start over. To return to the main menu, PRESS #. To verify coverage or PCP assignment for today s date of service, PRESS 1. To enter a different date, PRESS 2. Please enter the 8 digit date of service using the following format : Additional Instructions: For more information, PRESS 1. To have this verification faxed to you, PRESS 2. To check a different date, PRESS 3. To check a different member, PRESS 4. If you would like to return to the main menu, PRESS #. If this completes your call, you may hang up now. If you make a mistake, press * to start over. If you need help, PRESS #.
8 Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA PR _MC
GLANCE GATEWAY. Providers AT A. for Medicare Assured SM. Gateway Health Medicare Assured SM 444 Liberty Avenue, Suite 2100 Pittsburgh, PA 15222-1222
GATEWAY AT A GLANCE for Medicare Assured SM Providers Gateway Health Medicare Assured SM 444 Liberty Avenue, Suite 2100 Pittsburgh, PA 15222-1222 YOUR PROVIDER NUMBERS: Group Provider Number : Individual
GLANCE GATEWAY AT A. for Medicaid Providers. GATEWAY HEALTH SM 444 Liberty Avenue, Suite 2100 Pittsburgh, PA 15222-1222
GATEWAY AT A GLANCE for Medicaid Providers GATEWAY HEALTH SM 444 Liberty Avenue, Suite 2100 Pittsburgh, PA 15222-1222 YOUR PROVIDER NUMBERS: Group Provider Number (used for referrals) : Individual Provider
The Deductible is applicable to all covered services except for flat dollar Copayment services.
PRIORITY HEALTH www.priorityhealth.com/mpsers PRIORITYHMO SM PLUS PLAN MICHIGAN PUBLIC SCHOOL EMPLOYEES RETIREMENT SYSTEM (MPSERS) Effective January 1, 2016 through December 31, 2016 The HMO Plus plan
Gateway Health Medicare Assured RubySM (HMO SNP) $6,700 out-of-pocket limit for Medicare-covered services. No No No No. Days 1-6: $0 or $225 copay per
Assured RubySM (HMO Premium $0 monthly plan $0 - $33.90 monthly plan Assured GoldSM (HMO $12.40 - $46.30 monthly plan $43.90 - $77.80 monthly plan In Network Maximum Out-of-Pocket $3,400 out-of-pocket
New York. UnitedHealthcare Community Plan Claims System Migration Provider Quick Reference Guide. Complete Claims. Our Claims Process
Our Claims Process Here are a few steps to ensure you receive prompt payment: 1 Review and copy both sides of the member s ID card. members receive an ID card containing information that helps you process
COMPREHENSIVE PRIOR AUTHORIZATION LISTS NJ FAMILYCARE/MEDICAID & DUAL COMPLETE HMO SNP PRODUCTS EFFECTIVE 7/1/13
TO ALL HEALTHCARE PROFESSIONALS: COMPREHENSIVE PRIOR AUTHORIZATION LISTS NJ FAMILYCARE/MEDICAID & DUAL COMPLETE HMO SNP PRODUCTS EFFECTIVE 7/1/13 BEFORE SEEKING PRIOR AUTHORIZATION, PLEASE VERIFY MEMBER
OFFICE OF GROUP BENEFITS 2014 OFFICE OF GROUP BENEFITS CDHP PLAN FOR STATE OF LOUISIANA EMPLOYEES AND RETIREES PLAN AMENDMENT
OFFICE OF GROUP BENEFITS 2014 OFFICE OF GROUP BENEFITS CDHP PLAN FOR STATE OF LOUISIANA EMPLOYEES AND RETIREES PLAN AMENDMENT This Amendment is issued by the Plan Administrator for the Plan documents listed
PRIORITY HEALTH priorityhealth.com HealthbyChoice Incentives Summary of Benefits TRINITY HEALTH -HbCI 2 1/1/13 12/31/13
PRIORITY HEALTH priorityhealth.com Healthby Incentives Summary of Benefits TRINITY HEALTH -HbCI 2 1/1/13 12/31/13 The Healthby Incentives HMO plan is a Consumer Engaged Health plan that offers a choice
2015 Medicare Advantage Summary of Benefits
2015 Medicare Advantage Summary of Benefits HNE Medicare Premium No Rx and HNE Medicare Basic No Rx January 1, 2015 - December 31, 2015 H8578_2015_034 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2015
MODEL OF CARE OVERVIEW
MODEL OF CARE OVERVIEW Gateway Health SM (Gateway) currently offers four Special Needs Plans (SNPs): Gateway Health Medicare Assured Diamond SM Is a Dual Eligible Special Needs Plan (DSNP) and covers those
Gateway Health Medicare Assured SM
Gateway Health Medicare Assured SM 2015 PROVIDER POLICY AND PROCEDURE MANUAL Corporate Address: Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA 15222-1222 For inquiries, please call Provider
27. Will the plan pay for radiology done in the provider s office?... 10 28. How do providers request assistance with care management issues?...
Provider Q&A Contents 1. Who is Florida True Health?... 3 2. What is the new product name?... 3 3. Does the plan have a website?... 3 4. How will physicians be paid? (FFS or capitation)... 3 5. What clearing
UnitedHealthcare Choice Plus. UnitedHealthcare Insurance Company. Certificate of Coverage
UnitedHealthcare Choice Plus UnitedHealthcare Insurance Company Certificate of Coverage For the Health Savings Account (HSA) Plan 7PD of Educators Benefit Services, Inc. Enrolling Group Number: 717578
UnitedHealthcare Choice Plus. UnitedHealthcare Insurance Company. Certificate of Coverage
UnitedHealthcare Choice Plus UnitedHealthcare Insurance Company Certificate of Coverage For the Plan 7EG of Educators Benefit Services, Inc. Enrolling Group Number: 717578 Effective Date: January 1, 2012
PREVENTIVE CARE See the REHP Benefits Handbook for a list of preventive benefits* MATERNITY SERVICES Office visits Covered in full including first
Network Providers Non Network Providers** DEDUCTIBLE (Per Calendar Year) None $250 per person $500 per family OUT-OF-POCKET MAXIMUM (When the out-of-pocket maximum is reached, benefits are paid at 100%
Provider Information Guide 2014
MDwise Eskenazi Health Hoosier Healthwise Provider Information Guide 2014 MDwise Eskenazi Health Hoosier Healthwise All members will have an ID card. The Hoosier Healthwise ID card is the standard, state
Prior Authorization List Adults, FHP, CHP
Please verify the member s benefits before requesting prior authorization (PA). Services vary within plans. To check member eligibility, please call Provider Services at 888-362-3368 or visit UnitedHealthcareOnline.com.
HNE Premier 1 (HMO) and HNE Premier 2 (HMO)
2016 Medicare Advantage Summary of Benefits HNE Premier 1 (HMO) and HNE Premier 2 (HMO) January 1, 2016 - December 31, 2016 H8578_2016_429 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I
Summary of Benefits Community Advantage (HMO)
Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list
2016 Summary of Benefits
2016 Summary of Benefits Health Net Healthy Heart (HMO) Alameda and Stanislaus counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0171 CMS Accepted 09172015
National PPO 1000. PPO Schedule of Payments (Maryland Small Group)
PPO Schedule of Payments (Maryland Small Group) National PPO 1000 The benefits outlined in this Schedule are in addition to the benefits offered under Coventry Health & Life Insurance Company Small Employer
UnitedHealthcare Choice Plus. United HealthCare Insurance Company. Certificate of Coverage
UnitedHealthcare Choice Plus United HealthCare Insurance Company Certificate of Coverage For Westminster College Enrolling Group Number: 715916 Effective Date: January 1, 2009 Offered and Underwritten
Independent Health s Medicare Passport Advantage (PPO)
Independent Health s Medicare Passport Advantage (PPO) (a Medicare Advantage Preferred Provider Organization Option (PPO) offered by INDEPENDENT HEALTH BENEFITS CORPORATION with a Medicare contract) Summary
2015 Summary of Benefits
2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3909 Y0041_H3909_PC_15_18889 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how
[2015] SUMMARY OF BENEFITS H1189_2015SB
![[2015] SUMMARY OF BENEFITS H1189_2015SB](/thumbs/32/15705129.jpg "[2015] SUMMARY OF BENEFITS H1189_2015SB")
[2015] SUMMARY OF BENEFITS H1189_2015SB Section I You have choices in your health care One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare). Original Medicare
2015 Medical Plan Summary
2015 Medical Plan Summary AVMED POS PLAN This Schedule of Benefits reflects the higher provider and prescription copayments for 2015. This is not a contract, it s a summary of the plan highlights and is
Covered Benefits. Covered. Must meet current federal and state guidelines. Abortions. Covered. Allergy Testing. Covered. Audiology. Covered.
Covered Benefits Services Abortions Allergy Testing Audiology Birth Control Services Blood & Blood Plasma Bone Mass Measurement (bone density) Case Management Chemotherapy Chiropractor Services (manipulation/subluxation)
Preauthorization Requirements * (as of January 1, 2016)
OFFICE VISITS Primary Care Office Visits Primary Care Home Visits Specialist Office Visits No Specialist Home Visits PREVENTIVE CARE Well Child Visits and Immunizations Adult Annual Physical Examinations
2015 Summary of Benefits
2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3952 Y0041_H3952_KS_15_18734 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how
Tribute. 2015 Summary of Benefits. Health Plan of Oklahoma. Tribute Health Plan of Oklahoma HMO SNP
Tribute Health Plan of Oklahoma Tribute Health Plan of Oklahoma HMO SNP 2015 Summary of Benefits This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we
Medical Management Requirements Effective January 1, 2008
December 1, 2007 Dear Provider and Colleague: Please be advised that effective January 1, 2008, Health Plan will change its Medical Management Policies to include new requirements for prior authorizations
Cost Sharing Definitions
SU Pro ( and ) Annual Deductible 1 Coinsurance Cost Sharing Definitions $200 per individual with a maximum of $400 for a family 5% of allowable amount for inpatient hospitalization - or - 50% of allowable
AVMED POS PLAN. Allergy Injections No charge 30% co-insurance after deductible Allergy Skin Testing $30 per visit 30% co-insurance after deductible
AVMED POS PLAN This Schedule of Benefits reflects the higher provider and prescription copays for 2015. This is not a contract, it s a summary of the plan highlights and is subject to change. For specific
CSAC/EIA Health Small Group Access+ HMO 15-0 Inpatient Benefit Summary
CSAC/EIA Health Small Group Access+ HMO 15-0 Inpatient Benefit Summary (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE
Managed Care Organization and Provider Forum Region 3 June 24, 2013
Managed Care Organization and Provider Forum Region 3 June 24, 2013 Humana Headquartered in Kentucky Fortune 100 company Leading national healthcare company 12 million medical members 8 million specialty
Healthy Michigan MEMBER HANDBOOK
Healthy Michigan MEMBER HANDBOOK 2014 The new name for Healthy 1 TABLE OF CONTENTS WELCOME TO HARBOR HEALTH PLAN.... 2 Who Is Harbor Health Plan?...3 How Do I Reach Member Services?...3 Is There A Website?....
Healthy Michigan MEMBER HANDBOOK
Healthy Michigan MEMBER HANDBOOK 2015 The new name for Healthy 1 TABLE OF CONTENTS WELCOME TO HARBOR HEALTH PLAN.... 2 Who Is Harbor Health Plan?... 3 How Do I Reach Member Services?... 3 Is There A Website?....
The Healthy Michigan Plan Handbook
The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). The Healthy Michigan Plan provides health
Health Plan of Nevada, Inc. ( HPN ) Small Business Point-Of-Service ( POS ) Rider to the Small Business Evidence of Coverage ( EOC )
Health Plan of Nevada, Inc. ( HPN ) Small Business Point-Of-Service ( POS ) Rider to the Small Business Evidence of Coverage ( EOC ) This Rider is a supplement to your EOC issued by HPN. Subject to the
CHAPTER 7: UTILIZATION MANAGEMENT
OVERVIEW The Plan s Utilization Management (UM) program is collaboration with providers to promote and document the appropriate use of health care resources. The program reflects the most current utilization
2015 Summary of Benefits
2015 Summary of Benefits Plans 003 and 004 H6298_14_027 accepted Summary of Benefits January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list
Summary of Benefits. Prime (HMO-POS) and Value (HMO) January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE 1-888-408-8285 (TTY: 711)
Summary of s and January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE For more information about benefits or enrollment, call us or visit our website at www.martinspoint.org/medicare. 1-888-408-8285
UnitedHealthcare Choice Plus. UnitedHealthcare Insurance Company. Certificate of Coverage
UnitedHealthcare Choice Plus UnitedHealthcare Insurance Company Certificate of Coverage For the Health Savings Account (HSA) Plan 4X8 of Southern State Community College Enrolling Group Number: 755032
Effective January 1, 2014 through December 31, 2014
Summary of Benefits Effective January 1, 2014 through December 31, 2014 The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
January 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Value Plan (HMO) H3312-060 H3312.060.1
January 1, 2016 December 31, 2016 Summary of Benefits H3312-060 H3312.060.1 Y0001_2016_H3312_060 Accepted 9/2015 Summary of Benefits January 1, 2016 December 31, 2016 This booklet gives you a summary of
How To Compare Your Medicare Benefits To Health Net Ruby Select (Hmo)
2015 Summary of Benefits Health Net Ruby Select (HMO) Maricopa and Pinal counties Benefits effective January 1, 2015 H0351 Health Net of Arizona, Inc. Material ID # H0351_2015_0258 CMS Accepted 08302014
SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Grand County Open Access Plus Effective 1/1/2015
SUMMARY OF BENEFITS Cigna Health and Life Insurance Co. Grand County Open Access Plus Effective General Services In-Network Out-of-Network Primary care physician You pay $25 copay per visit Physician office
Geisinger Gold Preferred Complete Rx (PPO) offered by Geisinger Indemnity Insurance Company
Geisinger Gold Preferred Complete Rx (PPO) offered by Geisinger Indemnity Insurance Company Annual Notice of Changes for 2016 You are currently enrolled as a member of Geisinger Gold Preferred Complete
GIC Medicare Enrolled Retirees
GIC Medicare Enrolled Retirees HMO Summary of Benefits Chart This chart provides a summary of key services offered by your HNE plan. Consult your Member Handbook for a full description of your plan s benefits
Summary of Benefits January 1, 2016 December 31, 2016. FirstMedicare Direct PPO Plus (PPO)
Summary of Benefits January 1, 2016 December 31, 2016 FIRSTCAROLINACARE INSURANCE COMPANY FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties This booklet
$250 copay per admit. $250 copay per admit
BENEFIT IN- NETWORK OUT- OF- NETWORK Deductible NONE NONE Out- of- Pocket Maximum $6,350 Single/ $12,700 Family NONE HOSPITAL INPATIENT FACILITY - NON MATERNITY Medical/Surgical Skilled Nursing Facility
The Healthy Michigan Plan Handbook
The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). Eligibility for this program will be determined
Annual Notice of Changes for 2015
Keystone 65 Select Medical-Only (HMO) offered by Independence Blue Cross Annual Notice of Changes for 2015 You are currently enrolled as a member of Keystone 65 Select Medical-Only. Next year, there will
SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Laramie County School District 2 Open Access Plus Base - Effective 7/1/2015
SUMMARY OF BENEFITS Cigna Health and Life Insurance Co. Laramie County School District 2 Open Access Plus Base - Effective General Services In-Network Out-of-Network Physician office visit Urgent care
2016 Summary of Benefits
2016 Summary of Benefits Health Net Violet Option 3 (PPO) Douglas and Josephine counties, OR Benefits effective January 1, 2016 H5520 Health Net Life Insurance Company H5520_2016_0202 CMS Accepted 09162015
UnitedHealthcare Insurance Company of the River Valley Attachment D - Schedule of Benefits
UnitedHealthcare Insurance Company of the River Valley Attachment D - Schedule of Benefits Please refer to your Provider Directory for listings of Participating Physicians, Hospitals, and other Providers.
Optimum HealthCare Sales Video Script - H5594_14SalesVideo_CMS Approved
Optimum HealthCare Sales Video Script - H5594_14SalesVideo_CMS Approved Thank you for joining us for this special presentation on Optimum HealthCare s Medicare Advantage Plans. Today we will explain the
2015 Summary of Benefits
2015 Summary of Benefits Value (HMO-POS) Essentials Rx (HMO-POS) (H4270) January 1, 2015 - December 31, 2015 Western Wisconsin (26 Counties) H4270_082914_1 CMS Accepted (09032014) SECTION I INTRODUCTION
FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct PPO Plus (PPO)
FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties 1 P age SECTION I - INTRODUCTION TO SUMMARY
2015 Summary of Benefits
2015 Summary of Benefits Health Net Ruby Select (HMO) Placer and Sacramento counties, CA Benefits effective January 1, 2015 H0562 Health Net of California, Inc. Material ID # H0562_2015_0285_B_CMS Accepted
Annual Notice of Changes for 2015
Cigna HealthSpring Premier (HMO POS) offered by Cigna HealthSpring Annual Notice of Changes for 2015 You are currently enrolled as a member of Cigna HealthSpring Premier (HMO POS). Next year, there will
County of San Bernardino - Retiree Shield Signature High Option
An Independent Member of the Blue Shield Association County of San Bernardino - Retiree Shield Signature High Option Benefit Summary (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California
January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1
January, 205 December 3, 205 Summary of Benefits H3928-00 80.06.360.-LA Y0022_205_H3928_00_LA Accepted 9/204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what we
Arizona State Retirement System Plan Benefit Information for Medicare Eligible Members
Arizona State Retirement System Plan Benefit Information for Medicare Eligible Members Benefits Effective January 1, 2012 UHAZ12HM3349753_000 H0303_110818_013543 Summary of the UnitedHealthcare plans
Summary of Services and Cost Shares
Summary of Services and Cost Shares This summary does not describe benefits. For the description of a benefit, including any limitations or exclusions, please refer to the identical heading in the Benefits
Iowa Wellness Plan Benefits Coverage List
Iowa Wellness Plan Benefits Coverage List Service Category Covered Duration, Scope, exclusions, and Limitations Excluded Coding 1. Ambulatory Services Primary Care Illness/injury Physician Services Should
Physicians Plus Insurance Corporation Coverage Period: 01/01/2016 12/31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.pplusic.com or by calling 1-800-545-5015. Important Questions
PROVIDER TRAINING APRIL 7, 2015
PROVIDER TRAINING APRIL 7, 2015 Melanie Hodoh As the New third party administrator (TPA) for the CMSP Governing Board, Advanced Medical Management, Inc. (AMM) would like to thank you for partnering with
welcome to the select care network
welcome to the select care network SELECT CARE NETWORK WHAT IS THE SELECT CARE NETWORK? is a carefully tailored network designed to support a suite of commercial plans that EmblemHealth is offering in
Quick Guide 2016. Peoples Health Choices 65 #14 (HMO) Jefferson, Orleans and Plaquemines parishes
Quick Guide 2016 $0 mium* Plan Pre Peoples Health Choices 65 #14 (HMO) Jefferson, Orleans and Plaquemines parishes *You must continue to pay your Medicare Part B premium. H1961_PH16C65S1QG Accepted Thank
Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company
Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company Insureds 2009 Contents How to contact us... 2 Our claims process...
Personal Blue PPO QHDHP $5,000/$10,000
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at capbluecross.com or by calling 1-800-962-2242. Important
SUMMARY OF BENEFITS. Cigna-HealthSpring Achieve (HMO SNP) H3949-024. January 1, 2016 - December 31, 2016. 2015 Cigna H3949_16_32723 Accepted
SUMMARY OF BENEFITS January 1, 2016 - December 31, 2016 Cigna-HealthSpring Achieve (HMO SNP) H3949-024 2015 Cigna H3949_16_32723 Accepted SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS This booklet gives
COVERAGE SCHEDULE. The following symbols are used to identify Maximum Benefit Levels, Limitations, and Exclusions:
Exhibit D-3 HMO 1000 Coverage Schedule ROCKY MOUNTAIN HEALTH PLANS GOOD HEALTH HMO $1000 DEDUCTIBLE / 75 PLAN EVIDENCE OF COVERAGE LARGE GROUP Underwritten by Rocky Mountain Health Maintenance Organization,
January 1, 2015 December 31, 2015 Summary of Benefits. Altius Advantra (HMO) H8649-003 80.06.361.1-UTWY A
January, 205 December 3, 205 Summary of Benefits H8649-003 80.06.36.-UTWY A Y0022_205_H8649_003_UT_WYa Accepted /204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of
Alternate PPO/Alternate Rx
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at capbluecross.com or by calling 1-866-802-4761. Important
Prior Authorization Requirements for Florida Effective March 1, 2015
for Florida Effective March 1, 215 General Information The following list represents our prior authorization requirements for UnitedHealthcare in Florida. All services rendered by a non-contracted physician,
UnitedHealthcare Medicare Solutions Notification/Prior Authorization Requirements Effective Jan. 1, 2016
This list represents our advance notification/prior authorization review requirements as referenced in the UnitedHealthcare Physician, Health Care Professional, Facility and Ancillary Provider 2016 Administrative
Harvard Pilgrim s Stride SM. (HMO) Medicare Advantage Plan. Value Rx Plus Annual Notice of Change
HP15ANOCMNEPLUS 2015 Harvard Pilgrim s Stride SM (HMO) Medicare Advantage Plan Value Rx Plus Annual Notice of Change Maine Cumberland and York Y0098_15092 Accepted Harvard Pilgrim Stride Value RX Plus
What is the overall deductible? Are there other deductibles for specific services?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/cuhealthplan or by calling 1-800-735-6072.
Medi-Pak Advantage: Frequently Asked Questions
Medi-Pak Advantage: Frequently Asked Questions General Information: What Medicare Advantage product is Arkansas Blue Cross Blue Shield offering? Arkansas Blue Cross and Blue Shield has been approved by
Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare
Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare Annual Notice of Changes for 2016 You are currently enrolled as a member of Essentials Choice Rx 24 (HMO-POS). Next year, there will
2015 Summary of Benefits
2015 Summary of Benefits Health Net Healthy Heart (HMO) Placer and Sacramento counties, CA Benefits effective January 1, 2015 H0562 Health Net of California, Inc. Material ID # H0562_2015_0273 CMS Accepted
PPO Schedule of Payments (Maryland Large Group) Qualified High Deductible Health Plan National QA2000-20
PPO Schedule of Payments (Maryland Large Group) Qualified High Health Plan National QA2000-20 Benefit Year Individual Family (Amounts for Participating and s services are separated in calculating when
Plans. Who is eligible to enroll in the Plan? Blue Care Network (BCN) Health Alliance Plan (HAP) Health Plus. McLaren Health Plan
Who is eligible to enroll in the Plan? All State of Michigan Employees who reside in the coverage area determined by zip code. All State of Michigan Employees who reside in the coverage area determined
Northeastern University 2015 Medical Benefits
Northeastern University 2015 Medical Benefits Northeastern s 2015 Open Enrollment Effective Date: January 1, 2015 2015 Medical Plan Options Blue Choice New England Core POS Plan New Plan Blue Choice New
Summary of Benefits. King, Pierce, Snohomish, Spokane and Thurston Counties. premera.com/ma
Summary of Benefits 2016 HMO King, Pierce, Snohomish, Spokane and Thurston Counties premera.com/ma Plus Section 1 Introduction to the and Plus This booklet gives you a summary of what we cover and what
2014 Summary of benefits plan comparison
2014 Summary of benefits plan comparison The tables below summarize the 2014 Benefits for the Samaritan Choice Medical Plan options (Basic, Wellness and High-Deductible Plans). Pease refer to your plan
Important Questions Answers Why this Matters:
Bronze 60 EPO - Network Name: EPO Coverage Period: Beginning on or after 1/1/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family Plan Type: EPO
Health Partners Plans Provider Manual Health Partners Medicare Benefits Summary
5 Health Partners Plans Provider Manual Health Partners Medicare Benefits Summary Purpose: This chapter provides a benefit summary for Health Partners Medicare members, by plan. Topics: Health Partners
Soundpath Medicare Advantage Plan Information
Soundpath Medicare Advantage Plan Information Thank you for your interest in the Soundpath Health Medicare Advantage plan. Below are links to the items which are part of the Enrollment Packet you would
SCAN Health Plan. 2015 Summary of Benefits
SCAN Health Plan 2015 Summary of Benefits Y0057_SCAN_8713_2014F File & Use Accepted 09032014 SCAN Classic (HMO) (a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health Plan with
Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare
Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare Annual Notice of Changes for 2016 You are currently enrolled as a member of Essentials Choice Rx 25 (HMO-POS). Next year, there will
VIP HMO MEDICARE PLAN 2014 Summary of Benefits For Medicare-Eligible Retirees Residing in Manhattan, Brooklyn, Bronx, Staten Island & Queens
214 Summary of Benefits PROFESSIONAL SERVICES PCP office visits Specialist office visits Annual physical exam/preventive care Physical, Speech & Occupational Therapy Flu & Pneumonia Vaccinations Diagnostic
January 1, 2015 December 31, 2015
BLUESHIELD FOREVER BLUE MEDICARE PPO VALUE AND BLUESHIELD MEDICARE PPO 750 (PPO) (a Medicare Advantage Preferred Provider Organization (PPO) offered by HEALTHNOW NEW YORK INC. with a Medicare contract)
Dental Orientation. Molina Healthcare
Dental Orientation Molina Healthcare Scion Provider Web Portal The Scion Electronic Outreach Team is calling all providers offices to provide information and help with registration. Some offices may receive
What is the overall deductible? Are there other deductibles for specific services?
: MyPriority POS RxPlus Silver 1800 Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Subscriber/Dependent Plan Type:
Summary of Benefits JANUARY 1 THROUGH DECEMBER 31, 2015. HealthPlus MedicarePlus Essential HealthPlus MedicarePlus Classic CMS Contract #H1595
Summary of Benefits JANUARY 1 THROUGH DECEMBER 31, 2015 HealthPlus MedicarePlus Essential HealthPlus MedicarePlus Classic CMS Contract #H1595 For Medicare-eligible beneficiaries residing in Arenac, Bay,
Hawaii Benchmarks Benefits under the Affordable Care Act (ACA)
Hawaii Benchmarks Benefits under the Affordable Care Act (ACA) 10/2012 Coverage for Newborn and Foster Children Coverage Outside the Provider Network Adult Routine Physical Exams Well-Baby and Well-Child
2015 Summary of Benefits
2015 Summary of Benefits January 1, 2015 December 31, 2015 Houston/Beaumont Area Y0067_PRE_H4506_SETX_SB41_0814 CMS Accepted 09/13/2014 HMO-SETX-SB K41 2015 Section I Introduction to Summary of Benefits