Provider Manual. This manual is to help you learn more about The Ohio State University s medical plans, administered by OSU Health Plan Inc.
|
|
- Anissa Robertson
- 7 years ago
- Views:
Transcription
1 2016 Provider Manual This manual is to help you learn more about The Ohio State University s medical plans, administered by OSU Health Plan Inc. We hope you find this information and the enclosed documents useful to your office operation and in serving your patients our members. OSU Health Plan Inc. Provider Relations Department 700 Ackerman Road, Suite 440 Columbus, OH (614) (800) Fax: (614)
2 OVERVIEW What is OSU Health Plan (OSUHP)? Administrator of the medical plans for faculty and staff of The Ohio State University and their dependents. OSUHP is self-funded through Ohio State and is not a health insurance corporation. OSUHP provides the network for approximately 62,000 members on health plans. Campuses in Columbus, Marion, Newark, Lima, Mansfield and Wooster OSUHP provides coverage for members in all 88 counties of Ohio. Main Office Location OSU Health Plan Inc. 700 Ackerman Road, Suite 440 Columbus, OH (614) (800) Fax: (614) (Provider Relations), Fax: (614) (Medical Management) Office hours: 7:30AM 5:00PM, Monday-Friday Website: Our website provides the online convenience of a provider directory for referral ease, educational links, a preferred drug list, and information on OSUHP programs. Provider Relations Department Overseer of provider network, contracting, credentialing, servicing, and educating providers. Contact our department in the following instances: If office has changes regarding Tax Identification Number, address, phone number, etc.; If additional providers join practice or if providers leave; Questions on fees, contracts, or credentialing; and Any other questions from staff or physicians. Provider Updates OSUHP requires all changes or updates to your practice to be put in writing at the time of the change. Please mail or fax updates to the above address, Attention: Provider Relations Tax Identification Numbers (TIN) If you have started a new practice or changed Tax Identification Numbers (TIN), OSUHP will need the update within 30 days of the change. In-network providers will need to reapply for participation with OSUHP if notification has not been received within 30 days of the change. (Applies to changing practices or TIN changes). 2
3 MEDICAL PLANS Ohio State Medical Plans Prime Care Advantage (PCA) No out--of-network benefits Largest medical plan for OSUHP; majority of members on PCA Care coordinated through PCP Members utilizing services in Franklin County will use the OSUHP network. Members utilizing services outside Franklin County will use the Ohio PPO Connect Network. PCP: No office co-payment; Majority of specialists: 80% of network fee schedule paid after deductible Chiropractic, Medical Massage Therapy, Acupuncture: $30 co-payment Occupational Therapy, Physical Therapy, and Speech Therapy: $30 co-payment Obstetrics & Gynecology: $30 co-payment Behavioral Health: 20% co-insurance Deductible of $300 individual/$900 family (co-pays are not subject to deductible) 20% co-insurance for most services that do not have a co-payment Prime Care Choice In- and out-of-network coverage Deductible of $800 individual $2,400 family (in-network) Co-insurance: plan pays 80% for most services (in-network) Prime Care Connect No out-of-network benefits Care coordinated through Primary Care Provider (PCP) Members utilizing services in Franklin County will use the OSUHP network Members utilizing services outside Franklin County will use the Ohio PPO Connect Network PCP & OB/GYN: No office co-payment; Majority of specialists: $10 co-payment Chiropractic, Medical Massage Therapy, Acupuncture: $10 co-payment Occupational Therapy, Physical Therapy, and Speech Therapy: $10 co-payment Behavioral Health: No office co-payment, Urgent Care: $10 Co-payment listed on Member ID Card Basic PPO Plan In- and out-of-network coverage Deductible of $1,200 individual/$3,600 per family (network) Co-insurance: plan pays 75% for most services (network) There is not a co-payment for convenient care for the majority of medical plans. There is a $35 co-payment for urgent care for a majority of the medical plans. 3
4 BILLING CoreSource is the Third-Party Administrator that processes and pays claims for all Ohio State medical plans. For questions on Explanation of Benefits (EOB), call CoreSource at (866) CoreSource accepts claims on a CMS 1500 claim form or electronically. If submitting electronically, call CoreSource. 12-month filing limit (from date of service) Bill with Tax Identification Number, no suffix CoreSource Claims/Eligibility: (866) Fax number: (586) Claims Mailing Address: CoreSource P.O. Box 2310 Mt. Clemens, MI If no resolution is provided by CoreSource, call OSUHP Provider Relations at (614) or (800) , or contact us at our Provider Relations Mail Box. Please send concerns or issues to: OSUHealthPlanPR@osumc.edu OSUHP still has responsibility for performing utilization management for all plans. Outside Franklin County Members who seek care from providers outside of Franklin County will use the Ohio PPO Connect Network. 4
5 AFFILIATE PLANS OSU Student Health Plan The plan administrator and third-party administrator is HealthSmart Benefit Solutions,Inc.underwritten by UnitedHealthCare Insurance Company. OSUHP provides the network for the Student Health Plan approximately 15,000 students but does not administer benefits or claims. To verify eligibility/benefits for Student Health Plan only, contact: HealthSmart Benefit Solutions, Inc at: Hospital pre-admission notification call UnitedHealthcare at Submit claims for Student Health insurance to: Electronic claims: EDI Payer ID Inside Franklin County - Send paper claims to: HealthSmart Benefit Solutions, Inc., 3320 West Market St, Ste 100, Fairlawn, OH Electronic claims: EDI Payer ID Outside Franklin County Send paper claims to Student Resources, P.O. Box , Dallas, TX Services Rendered Inside Franklin County Ohio State students who seek care from providers inside Franklin County will use the OSUHP network. Services Rendered Outside Franklin County Ohio State students who seek care from providers outside Franklin County will use the United HealthCare network or the OSUHP network. If services are not available through an in-network Ohio State provider, students will use the UnitedHealthCare Options PPO Network. 5
6 AFFILIATE PLANS (continued) Ohio PPO Connect Ohio PPO Connect is a provider-owned, Ohio-based network with a local and regional approach to health care delivery. It brings together the experience and expertise of the following networks to provide state wide coverage: HealthSpan Ohio Health Choice Quality Care Partners The OSU Health Plan Ohio PPO Connect covers over 100,000 lives with exceptional retention rates. Members whose employers have chosen this network will have the Ohio PPO Connect logo on their ID card. Benefits, eligibility, and claims will still flow in the same manner as dictated by each employer or plan sponsor. Contact an OSUHP provider relations representative at (614) if you have additional questions. The Ohio State University Health Plan Inc. is an affiliate corporation of The Ohio State University, 700 Ackerman Road, Suite 440, Columbus, OH or Community Mercy Health Partners, Catholic Health Partners, Mercy Health Southwest Ohio Employees and dependents of Community Mercy Health Partners, Catholic Health Partners, and MercyHealth Southwest Ohio have access to the OSUHP network in Franklin County. Claims/Eligibility, call CoreSource at (866) Submit claims for: Community Mercy Health Partners Catholic Health Partners Mercy Health Southwest Ohio To: CoreSource P.O. Box 2310 Mt. Clemens, MI
7 MEMBER ID CARDS Member is responsible for presenting ID card at time of visit. Member is responsible for co-payment at time of visit. ID card is not a guarantee of payment; providers must contact CoreSource for eligibility. Important information on ID card regarding coverage (see example of ID card). Sample Medical ID Cards Samples of the Ohio State University medical plan insurance: 7
8 8
9 9
10 10
11 11
12 12
13 Sample Medical ID Cards Samples of the student health insurance cards: 13
14 Sample Medical ID Cards Samples of the Community Mercy Health Partners insurance cards: 14
15 Sample Medical ID Cards Samples of the Catholic Health Partners insurance cards: 15
16 Sample Medical ID Cards Samples of the Mercy Health Southwest Ohio insurance cards: 16
17 PROVIDERS Referrals Prime Care Advantage and Prime Care Connect members need to be referred to participating providers. (IN FRANKLIN COUNTY), the network hospitals are the OSU Wexner Medical Center, University Hospital East, James Cancer Hospital and Solove Research Institute, Richard M. Ross Heart Hospital, and Nationwide Children s Hospital. Please see for a listing of all participating hospitals. If Prime Care Advantage / Prime Care Connect members are referred to or self-refer to nonparticipating hospitals, there is no coverage. The only exception is emergency services. If service cannot be provided in-network, service must be prior authorized through Medical Case Management at OSUHP. Access Standards OSUHP has adopted access guidelines by specialty type. All participating Primary Care Physicians (PCP) and Specialists are expected to adhere to these access standards for appointment scheduling. New Patient Appointment PCP Specialist PCP Physical Examinations Routine Follow-Up Appointment PCP Specialist GYN Annual Visit Urgent Care Emergent Care Within 4 weeks Within 4 weeks Within 4 weeks Within 2-3 weeks Within 4 weeks Within 8-12 weeks Within 24 hours immediately Provider Credentialing To comply with the guidelines established by the National Committee for Quality Assurance (NCQA), providers must be fully credentialed before our members can see them. We ask that providers who are in the credentialing process refrain from seeing OSUHP members until they are notified of their effective date for OSUHP network participation. Be assured that once we have received all appropriate documentation from the applicant, the credentialing process is typically completed in 45 days or less. OSUHP does not make credentialing decisions based on an applicant s race, ethnic/national identity, gender, age or sexual orientation, or on type of procedure or patient (i.e., Medicaid) in which the practitioner specializes. 17
18 PROVIDER CLAIMS APPEALS PROCESS A participating provider may submit an appeal to the Third Party Administrator for reconsideration of a claim denial for covered services. This appeal may be submitted on behalf of an OSUHP member (member signature not required), or the member may submit the appeal. A written letter of appeal, along with supporting documentation, should be sent to CoreSource, Attn: Appeals Department, P.O. Box 2310, Mt. Clemens, MI Appeals that are submitted to CoreSource must be received within 180 days** of the provider receiving the Explanation of Benefits (EOB). Appeals will either be reviewed by CoreSource or sent to OSUHP for review as claims fiduciary, depending on the nature of the appeal. Review of the appeal will be completed by CoreSource or OSUHP within a reasonable period of time, but not later than 30 days after receipt of the request for review. If reviewed by CoreSource and the denial is overturned, the claim will be reprocessed. If the denial is upheld, a letter will be sent to the provider, and if applicable to the member, upholding the initial denial. The letter will also state that the provider/member can appeal directly to OSUHP for further consideration. A written request for review must be received within 60 days following the receipt of notice of the Third Party Administrator s decision. If the provider appeals to OSUHP, it will be reviewed by the Medical Director. If the previous denial is overturned, the provider will be notified of the decision in writing within a reasonable period of time, but not later than 30 days after receipt of the request for review. If the Medical Director upholds the denial, the provider/member may submit an appeal to the Benefits Appeals Committee (BAC) at OSUHP. This level of appeal requires the member s signature. The provider should receive a decision 30 days after receipt of the submitted information. If the Benefits Appeals Committee upholds the denial, the provider may submit an appeal to the Ohio Department of Insurance. For additional information regarding the appeal process, please refer to the SPD at **Appeals time frame is 180 days. 18
19 MEDICAL GUIDELINES SERVICES REQUIRING MEDICAL NECESSITY REVIEW AND/OR PRIOR AUTHORIZATION Medical Necessity: To be medically necessary, covered services must: Be rendered in connection with an injury or sickness; Be consistent with the diagnosis and treatment of your condition; Be in accordance with the standards of good medical practice; Not be for your convenience or your physician's convenience and Not be considered experimental or investigative; Prior Authorization: Notification requesting coverage is required before receipt of certain designated services, elective admission to a hospital or facility, or specific medications prescribed for certain uses. Participating facilities need to notify the Medical Management Department at OSU Health Plan within 48 hours of an urgent/emergent admission. Providers need to provide clinical documentation to OSU Health Plan at least five business days prior to a specified outpatient or elective inpatient procedure. Failure to obtain prior authorization for these designated services can result in penalty or denial of benefits.¹ Please refer to the Specific Plan Details Document found at for specific benefit information and plan limitations. Utilization Review is required for all inpatient admissions. Providers must contact OSU Health Plan Medical Management department prior to services being provided at (614) or (800) , within 48 hours for urgent/emergent and 5 business days prior to elective admissions 2. Clinical documentation can be faxed to and should include all the following information: Procedure requested Diagnosis Physician and Facility Date of Service Medical record documentation to support medical necessity (such as patient history, progress notes, conservative treatment(s) failed, etc.) Claims submitted with unlisted procedure and unlisted medication codes will require documentation to identify what procedure/medication is being billed and require medical necessity review. Please note that this list is not all-inclusive. We receive requests for coverage for new technologies, equipment, supplies, tests and procedures daily. All facility based behavioral health services: Inpatient Outpatient includes partial hospitalization and intensive outpatient treatment Substance Abuse treatment All inpatient Admissions include: Elective admissions 2 Extended care facilities Hospice care Medical Rehabilitation Surgical Urgent/emergent admissions 19
20 SERVICES REQUIRING MEDICAL NECESSITY REVIEW AND/OR PRIOR AUTHORIZATION (cont.) Outpatient Services/procedures/treatment which require medical necessity review FIVE (5) business days prior to receipt of treatment include but are not limited to:** Abdominoplasty/panniculectomy Abortion Autologous Chondrocyte Implantation Back Pain Invasive Procedures Blepharoplasty/ptosis repair Bone Growth Stimulators Breast reconstruction/repair 2 Breast reduction surgery Chemical peels/dermabrasion Coronary CT Durable Medical Equipment over $2,000 Frenectomy Genetic testing Gynecomastia Surgery Hernia Repair Home health care/services Hospice services Infertility treatment Medical Supplies over $2,000 Orthognathic surgery Orthotics over $2,000 Outpatient radiology: MRIs, CTs, PETs Procedures for Obstructive Sleep Apnea (e.g., UPPP) Prolotherapy Prosthetics over $2,000 Rhinoplasty Skin phototherapy/laser procedures Temporary Codes Unlisted Codes Varicose Vein procedures Weight loss surgery/procedures Weight management programs Wound Vac **This list is not all inclusive. All experimental and investigational services and cosmetic services are specifically excluded under the OSU Medical Plans. Medications The following medications require medical necessity authorization for coverage under the MEDICAL benefit. Botulinum Toxins Hemophilia outpatient medications/infusions Remicade / Orencia / Actemra / Entyvio 20
21 SERVICES REQUIRING MEDICAL NECESSITY REVIEW AND/OR PRIOR AUTHORIZATION (cont.) ¹ Prior authorization (see osuhealthplan.com/providers, Prior Authorization) of certain designated services is required to determine medical necessity. If prior authorization, where indicated, is not obtained from OSU Health Plan, claims for these services may be denied or a penalty applied consisting of 20% of the fee, up to $1,000 per admission of service. Prior authorization penalties do not apply toward the annual deductible or annual out-of-pocket limit. 2 Scheduled C-sections and certain breast reconstruction procedures do not require clinical documentation prior to admission. C-sections will require clinical information if the stay exceeds 4 days. Breast reconstruction procedures will require clinical information prior to admission unless billed with ICD-10 C C50.929, C79.81, D D05.92, Z85.3, Z80.3, and/or Z Z
22 OUTPATIENT OBSERVATION SERVICES POLICY- effective 1/1/16 Description Observation care is a well-defined set of specific, clinically appropriate services, which include ongoing short term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital. Observation services are commonly ordered for patients who present to the emergency department and who then require a significant period of treatment or monitoring in order to make a decision concerning their admission or discharge. Observation services are covered only when provided by the order of a physician or another individual authorized by State licensure law and hospital staff bylaws to admit patients to the hospital or to order outpatient tests. Hospitals may bill for patients who are directly referred to the hospital for outpatient observation services. A direct referral occurs when a physician in the community refers a patient to the hospital for outpatient observation, bypassing the clinic or emergency department (ED) visit. Effective for services furnished on or after January 1, 2003, hospitals may bill for patients directly referred for observation services. Coverage When a physician orders that a patient receive observation care, the patient s status is that of an outpatient. The purpose of observation is to determine the need for further treatment or for inpatient admission. Thus, a patient receiving observation services may improve and be released, or be admitted as an inpatient. All hospital observation services, regardless of the duration of the observation care, that are medically reasonable and necessary are covered by OSU Health Plan. In most circumstances, observation services are supportive and ancillary to the other separately payable services provided to a patient. Criteria Outpatient observation services are covered for up to 48 hours and may include: a) Use of a bed within a hospital for the purpose of observing the member s condition b) Periodic monitoring by the hospital s staff to evaluate an outpatient s condition and/or determine the need for a possible admission to the hospital as an inpatient Outpatient observation services should not be used for routine diagnostic services and outpatient surgery/procedures. If the physician or healthcare professional is uncertain if an inpatient admission is appropriate, then the physician or healthcare professional should consider admitting the patient for observation. For coverage to be appropriate for an inpatient admission, the patient must demonstrate signs and/or symptoms severe enough to warrant the need for medical care and must receive services of such intensity that they can be furnished safely and effectively only on an inpatient basis. In the majority of cases, the decision whether to discharge a patient from the hospital following resolution of the reason for the observation care or to admit the patient as an inpatient can be made in less than 48 hours, usually in less than 24 hours. In only rare and exceptional cases do reasonable and necessary outpatient observation services span more than 48 hours. Any case exceeding 48 hours of observation care will require medical director review. (Refer to UMPP Medical Director Review Process) 22
23 OUTPATIENT OBSERVATION SERVICES POLICY - effective 1/1/16 (cont.) Limitations The following outpatient observation services are not covered as the services are not medically reasonable or necessary: a) Services that are not reasonable and necessary for the diagnosis or treatment of the member. b) Outpatient observation services that are provided only for the convenience of the member or his/her family or physician. (e.g., following an uncomplicated treatment or a procedure, physician busy when patient is physically ready for discharge, patient awaiting placement in a long term care facility). c) Services that are covered under a medically appropriate inpatient admission, or services that are part of another service, such as postoperative monitoring during a standard recovery period, (e.g., 4-6 hours), which should be billed as recovery room services. Similarly, in the case of patients who undergo diagnostic testing in a hospital outpatient department, routine preparation services furnished prior to the testing and recovery afterwards are included in the payment for those diagnostic services. Observation should not be billed concurrently with therapeutic services such as chemotherapy. d) Standing orders for observation following outpatient surgery. References Medicare Benefit Manual (Pub ) Chapter Outpatient Observation Services available at (Accessed November 13, 2015) 23
24 QUALITY IMPROVEMENT To ensure that all service complaints are monitored and addressed in a timely manner, all member and provider complaints will be forwarded to the Quality Improvement (QI) Director for research and review. Complaints may involve internal service issues or service by an OSUHP third-party administrator (TPA). All complaints should be in writing on a Member Concern Record, which can found on our website or through Customer Service and will be handled by the Quality Improvement Department. Service complaints received from a member will have a thirty (30) day turnaround time frame from receipt. Service complaints will be acknowledged in five (5) business days of receipt. 24
25 PHARMACY SERVICES Express Scripts, Inc. (ESI) is the Pharmacy Benefit Manager (PBM) for the Ohio State medical plans. The Ohio State University Express Scripts, Inc. Contact List Member Help - ESI Home Delivery Opt Out Provider Help - ESI Accredo OR (provide members this number) (provider general line, also includes prior authorization) (direct for prior authorization only) Phone: Must wait for prompt and then choose New Patient Option 1 Existing Patient Option 2 Provider Help Option 3 Please see link below for the 2016 Express Scripts National Preferred Formulary for The Ohio State University 25
26 THE OHIO STATE UNIVERSITY TRANSITIONAL WORK PROGRAM The Ohio State University Office of Human Resources, Benefits-Integrated Disability has a Transitional Work Program to allow employees who have an occupational or non-occupational injury/illness with temporary physical and/or psychological restrictions to continue to work throughout their recovery as they rehabilitate to their full capacity. As a provider, you may be contacted by Ohio State about this program on behalf of your patient. The Transitional Work Policy benefits your patient/ohio State employee in several ways including: 1. Earning full pay and benefits; 2. Keeping fit and healthy, both physically and mentally; and 3. Providing exposure to different job tasks supporting professional development. For questions regarding this program, contact: Dave Magee, Director of Integrated Absence Management and Vocational Services, or Cortney Silva, Team Lead for Transitional Work at (614)
27 Your Plan for Health (YP4H) is The Ohio State University s approach to fostering a culture of well-being and optimal performance. YP4H provides programs and resources to empower benefits-eligible faculty, staff, or family members to pursue a life of health and wellness. The focus of the initiative is to help members reach the healthiest state possible by offering programs and incentives for identifying and acting on health conditions, promoting smart, cost-efficient choices based on individual needs, and taking control of health-care spending. The cornerstone of this initiative is the Personalized Health and Well-Being Assessment (PHA), a questionnaire that, coupled with a biometric health screening numbers, establishes a health baseline and sets a direction for employees to pursue health, wellness, and disease management. Additional services include educational programming, health fairs, flu vaccinations, personal health coaching, and care coordination. Annual Biometric Health Screenings Complimentary on-campus screenings are provided by registered nurses on site at The Ohio State University. Members may also obtain their values from the PCP. Measurements include blood pressure, A1C, body mass index, HDL and total cholesterol. The member will receive a copy of their values and are counseled on ways to improve their numbers via nutrition and physical activity and stress management. Members are encouraged to share this information with their PCP and are connected to various services available to them at Ohio State, such as health coaching and fitness center discounts. Personal Health and Well-Being Assessment Members complete an assessment to help identify personalized health and wellness goals based on the information they submit. Team and individual challenges are available to help members track their progress toward those goals and have fun while doing it from weight loss to increased daily water consumption. Mobile device integration are also available to track healthy behaviors on the go even easier! Members will be able to connect apps like FitBit Tracker or Swimsense to their YP4H account to track challenges and incentives through their smartphone or tablet. Educational Programming Each month, a variety of educational programs are offered to members. A wide range of topics are presented within the areas of weight management, stress management, physical activity, nutrition, and related areas. Presenters offer valuable health and wellness information via webinars and face-to-face classes. Members can access this information via the osuhealthplan.com website, where they also have access to the archived webinars. Rally for Wellness Health Fair There are many health fairs available to Ohio State employees throughout the year. The largest fair is the annual Rally for Wellness Health Fair. Every year about 70 exhibitors attend the Fair to provide participants the opportunity to connect with many Ohio State and local community wellness resources available to them. Participants can also take advantage of several other services, including: biometric health screenings, chair massages, and cooking and exercise demos. 27
28 Flu Immunizations The OSU Wexner Medical Center provides non-discretionary flu vaccinations to their employees. The OSUHP offers flu vaccinations at no cost at various sites throughout campus. Members on the OSUHP can also receive their flu vaccination at no cost from an in-network pharmacy. 10-Minute Chair Massage Therapy Several Massage Therapists are contracted to provide chair massages to employees on both the main and regional campuses. Chair massages are designed to relieve stress, tension, and alleviate neck and shoulder pain, as well as bring a focus of health and well-being to the work day. Personal Health Coaching Services OSUHP offers Personal Health Coaching for Ohio State benefits eligible faculty, staff, and their adult dependents as a complimentary service for Your Plan for Health. This confidential and voluntary service is designed to assist members in achieving personal wellness. With the support of a Personal Health Coach, members can work on their personal health and wellness goals such as weight management, nutrition, physical activity, tobacco cessation, and stress management. We have coaches with a range of clinical and behavioral backgrounds, including exercise physiologists, social workers, health educators, tobacco cessation specialists, and dietitians. Each coach is trained in all areas to promote a holistic approach to meeting personalized health needs. Program participants appreciate the support, awareness, and accountability with their personal health coach that helps keep them on track for reaching their optimal health. OSUHP health coaches also link members to resources on campus and in the local community for added support. 24/7 Nurse Line All benefit-eligible faculty, staff, and dependents can call anytime to speak with a nurse for helpful medical information. Call (800) and press option 1 for 24/7 nurse line. Disease Management/Care Coordination Those who live with asthma, diabetes, heart disease, and chronic obstructive pulmonary disease can gain support from a team of health professionals (including pharmacists, nurses, health coaches and behavioral health professionals) to help with management of their condition and lifestyle changes. Care Coordinators provide education, guidance, and resources available to support personal health and wellness goals. Care Coordination is available to faculty and staff and their dependents that are enrolled in an eligible Ohio State medical plan and are identified for one of these programs based on an analysis of medical and prescription drug claims. 28
29 OHIO STATE EMPLOYEE ASSISTANCE PROGRAM (OSU EAP) OSU EAP The OSU EAP is designed to provide rapid access to a variety of support and information regarding stressful life situations for employees and their dependents/family. In addition to rapid access to face-toface counseling, the OSU EAP also can help with a variety of other issues that affect everyone daily. All services are provided without cost in a confidential environment. Counselors are available in almost all Ohio Counties. 24-hour EAP Phone Line All benefit-eligible faculty, staff, and their dependents and family members can call anytime and speak with a licensed mental health counselor for quick assistance with personal or work/life related problems. Eligible dependents include parents, parents-in-law, and anyone living within the faculty or staff member s household. Call (800) for help. Robust Web Based Information, Self-Assessment and Resources The OSU EAP webpage (www,osuhealthplan.com/ohiostateeap) contains a large selection of informative articles, resource lists or search assistance for services and a variety of tools to do self-assessments. This can be accessed in total confidentiality. Employees and their families can use the EAP for help with: Childcare and Eldercare Resources Depression Family Conflict Financial Consultation Grief and Loss Identify Theft Support Legal Consultation Stress and Anxiety Substance Abuse Work Challenges Managerial Support 29
Provider Manual. This manual is to help you learn more about The Ohio State University s medical plans, administered by OSU Health Plan Inc.
2014 Provider Manual This manual is to help you learn more about The Ohio State University s medical plans, administered by OSU Health Plan Inc. We hope you find this information and the enclosed documents
More informationOFFICE 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
More informationThe 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
More informationPRIORITY 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
More informationEssentials 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
More informationCSAC/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
More informationEssentials 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
More information2014 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
More informationCoverage level: Employee/Retiree Only Plan Type: EPO
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 documents at www.dbm.maryland.gov/benefits or by calling 410-767-4775
More informationNational 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
More informationHealth 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
More informationVirginia. A guide for individuals and families. The health insurance benefits you want, at a cost you can afford
Virginia A guide for individuals and families CoventryOne is an individual product (for individuals and families) offered by Coventry Health Care, an Aetna company. The health insurance benefits you want,
More informationCovered 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)
More informationAugust 2014. SutterSelect Administrative Manual
August 2014 SutterSelect Administrative Manual Introduction This SutterSelect Administrative Manual has been prepared as a resource for providers who are caring for members of SutterSelect health plans.
More informationGood health happens together
Good health happens together CITY OF BALTIMORE 2016 HEALTH CARE OPTIONS WHAT S INSIDE BENEFITS OVERVIEW WELLNESS RESOURCES ONLINE TOOLS Thank you for considering UnitedHealthcare. We are proud to again
More informationAlternate 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
More informationSummary 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
More informationPersonal 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
More informationWhat is the overall deductible? Are there other deductibles for specific services?
Small Group Agility MS200 Coverage Period: Beginning on or after 01/01/2015 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
More informationSUMMARY 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
More informationMedical 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
More informationUnitedHealthcare 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.
More informationSummary 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
More informationTHAT S RIGHT FOR YOU PLATINUM BLUESM WITH RX (COST) Medical and prescription drug benefits you want. Value you deserve. FIND THE PLAN CORE CHOICE
2016 PLATINUM BLUESM WITH RX (COST) Medical and prescription drug benefits you want. Value you deserve. OPTIONS YOU WANT Platinum Blue can help pay the deductibles, copayments and coinsurance Original
More informationNATIONWIDE INSURANCE $20-40 / 250A NATIONAL MANAGED CARE SCHEDULE OF BENEFITS
WASHINGTON NATIONWIDE INSURANCE $20-40 / 250A NATIONAL MANAGED CARE SCHEDULE OF BENEFITS General Features Calendar Year Deductible Lifetime Benefit Maximum (Does not apply to Chemical Dependency) ($5,000.00
More informationSummary of Benefits and Coverage What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the plan document at www.mpiphp.org or by calling 1-855-275-4674. Important Questions Answers
More informationNew 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
More informationUnitedHealthcare 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
More informationGreater Tompkins County Municipal Health Insurance Consortium
WHO IS COVERED Requires both Medicare A & B enrollment. Type of Coverage Offered Single only Single only MEDICAL NECESSITY Pre-Certification Requirement None None Medical Benefit Management Program Not
More information2016 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
More informationIndependent 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
More informationPPO 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
More informationImportant Questions Answers Why this Matters: In-network: $0/Individual; $0/Family Out-of-network: $500/Individual; $1,000/Family
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 or by calling 1-800-445-7490. Important Questions
More informationWhat 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:
More informationHNE 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
More informationHow To Pay For Health Care With Bluecrossma
PPO Student/Affiliate Plan MIT Student/Affiliate Extended Insurance Plan Coverage Period: 2014-2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual, Couple,
More informationLEGACY PLAN Medical In-Ntwk Out-of-Ntwk
Preventive Services Age, gender and frequency criteria Adult physical/immunizations Well child visits/immunizations Screenings 0 Co-Insurance (after deductible) Out-of-Pocket Maximums Office Visit (copays)
More informationUnitedHealthcare 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
More information2016 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
More informationHEALTH INSURANCE FOR INDIVIDUALS AND FAMILIES. Insuring Minnesota One Life At A Time. www.preferredone.com
foreveryone HEALTH INSURANCE FOR INDIVIDUALS AND FAMILIES Insuring Minnesota One Life At A Time www.preferredone.com for EveryOne Insuring Minnesota One Life At A Time Thank you for your interest in the
More informationFIRSTCAROLINACARE 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
More information!"#$%$&!"'()*+,-".-,/ &01*+("12"31+4156"$,+0"!*7("819".5(<(/4*<("&,5( :(()";(,-40"&,5( !"#$%$&!",/)"'()*+,5(
submitted anytime during the year to your institution HR/Benefits Office, and the tobacco premium will be waived beginning the first of the month following submission of the form. Important: A member is
More information2015 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
More informationSERVICES IN-NETWORK COVERAGE OUT-OF-NETWORK COVERAGE
COVENTRY HEALTH AND LIFE INSURANCE COMPANY 3838 N. Causeway Blvd. Suite 3350 Metairie, LA 70002 1-800-341-6613 SCHEDULE OF BENEFITS BENEFITS AND PRIOR AUTHORIZATION REQUIREMENTS ARE SET FORTH IN ARTICLES
More informationBlue Cross of NEPA: Custom PPO Option 10014 Coverage Period: 03/01/2015-02/29/2016
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.bcnepa.com or by calling 1-888-345-2346. Important Questions
More informationSUMMARY 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
More informationNationwide Life Insurance Co.: University of Phoenix NJ Coverage Period: 9/24/13-8/23/14
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.chpstudent.com or by calling 1-800-633-7867. Important
More informationImportant Questions Answers Why this Matters:
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 or by calling 1-800-445-7490. Important Questions
More informationPersonal Alliance 3000 Silver OFF
Personal Alliance 3000 Silver OFF Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2016-12/31/2016 Coverage for: Individual / Family Plan Type: HMO This is
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.9 Case Management Services G.12 Special Needs Services
More information2015 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
More informationPersonal Alliance 4500 Bronze ON
Personal Alliance 4500 Bronze ON Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2016-12/31/2016 Coverage for: Individual / Family Plan Type: HMO This is
More information[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
More informationPreauthorization 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
More informationImportant Questions Answers Why this Matters:
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 or by calling 1-877-453-5645. Important Questions
More informationCigna Open Access Plans for Tennessee
Individual & Family Plans Insured by Connecticut General Life Insurance Company Cigna Open Access Plans for Tennessee medical & PHARMACY INSURANCE with the ONE-AND-ONLY YOU IN MIND. 858436 a 12/12 Services
More informationNo Charge (Except as described under "Rehabilitation Benefits" and "Speech Therapy Benefits")
An Independent Licensee of the Blue Shield Association Custom Access+ HMO Plan Certificated & Management Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix)
More informationLand of Lincoln Health : Family Health Network LLH 3-Tier Bronze PPO 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.landoflincolnhealth.org or by calling 1-844-FHN-4YOU.
More informationGundersen Health Plan: MN NJ Silver $2000-0% Coverage Period: 01/01/2015-12/31/2015
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.gundersenhealthplan.org or by calling 1-800-897-1923.
More informationHMO Blue New England Enhanced Value Coverage Period: on or after 01/01/2015
HMO Blue New England Enhanced Value Coverage Period: on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual and Family Plan Type: HMO This
More informationCounty 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
More informationSummary 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
More informationJanuary 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
More informationState Health Plan: High Deductible Health Plan 50/50 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 http://www.shpnc.org and click on High Deductible Health
More informationHealthy 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?....
More informationUnitedHealthcare 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
More information2015 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
More informationUnitedHealthcare 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
More informationIn-Network: $5,000 self-only / $10,000 family, not to exceed $6,450 from any one person. Does not apply to preventive care or vision hardware.
Personal Alliance 5000 Bronze ON Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2016-12/31/2016 Coverage for: Self Only / Family Plan Type: HMO HSA This
More informationImportant Questions Answers Why this Matters:
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.alaskacare.gov or by calling 1-800-821-2251. Important
More informationSchedule of Benefits for the MoDOT/MSHP Medical Plan Medicare ASO PPO 20088 Effective 1/1/2016
Schedule of Benefits for the MoDOT/MSHP Medical Plan Medicare ASO PPO 20088 Effective 1/1/2016 This Schedule of Benefits summarizes your obligation towards the cost of certain covered services. Refer to
More informationPhysician, 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...
More informationManaged Care Medical Management (Central Region Products)
Managed Care Medical Management (Central Region Products) In this section Page Core Care Management Activities 9.1! Healthcare Management Services 9.1! Goal of HMS medical management 9.1! How medical management
More informationAmerican Maritime Officers Medical Plan Employer Identification Number: 13-5600786 Plan Number: 501 Group Number: 0081717
AMENDMENT #4 American Maritime Officers Medical Plan Employer Identification Number: 13-5600786 Plan Number: 501 Group Number: 0081717 This Amendment is duly adopted and effective as of October 1, 2014.
More informationYou re one step closer to simple health care.
welcometouhc.com You re one step closer to simple health care. SIMPLE - A GUIDE TO YOUR 2016 UNITEDHEALTHCARE BENEFITS Health care can be hard. We re here to help you through it. You can count on us to
More informationMedical Benefits. The Regional Health Plan is a self insured plan. The claims administrator is NGS CoreSource.
The Regional Health Plan is a self insured plan. The claims administrator is NGS CoreSource. For a complete outline of your benefits, please refer to the Regional Health INTRANET site Employee Hub/Summary
More informationPLAN DESIGN AND BENEFITS POS Open Access Plan 1944
PLAN FEATURES PARTICIPATING Deductible (per calendar year) $3,000 Individual $9,000 Family $4,000 Individual $12,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being
More informationWhat Your Plan Covers and How Benefits are Paid BENEFIT PLAN. Prepared Exclusively for Vanderbilt University. Aetna Choice POS II Health Fund Plan
BENEFIT PLAN Prepared Exclusively for Vanderbilt University What Your Plan Covers and How Benefits are Paid Aetna Choice POS II Health Fund Plan Table of Contents Schedule of Benefits... Issued with Your
More informationUtilization Management
Utilization Management Utilization Management (UM) is an organization-wide, interdisciplinary approach to balancing quality, risk, and cost concerns in the provision of patient care. It is the process
More informationMember s responsibility (deductibles, copays, coinsurance and dollar maximums)
MICHIGAN CATHOLIC CONFERENCE January 2015 Benefit Summary This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional limitations
More informationPPO Hospital Care I DRAFT 18973
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.ibx.com or by calling 1-800-ASK-BLUE. Important Questions
More informationThe 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
More informationWhat 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.
More informationSchedule of Benefits. Plan Information Participating Provider Non-Participating Provider
Schedule of Benefits UPMC Consumer Advantage HSA PPO - Premium Network Primary Care Provider: 10% after Deductible Specialist: 10% after Deductible Deductible: $1,950 / $3,900 Rx: 10% after Deductible
More informationSection 6. Medical Management Program
Section 6. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.
More informationImportant Questions Answers Why this Matters:
Student Employee Health Plan: NYS Health Insurance Program Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual or Family
More informationImportant Questions Answers Why this Matters:
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 https://www.cs.ny.gov/employee-benefits or by calling 1-877-7-NYSHIP
More informationHigh Deductible and HSA Qualified Plans
High Deductible and HSA Qualified Plans For individuals and families HIGH DEDUCTIBLE PLANS Insuring Minnesota One Life At A Time w w w.preferredone.com Dear Prospective Members: Thank you for your interest
More informationImportant Questions Answers Why this Matters:
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 http://www.whyviva.com/memberaccess.aspx or by calling 1-800-294-7780.
More informationBlue Cross Premier Bronze Extra
An individual PPO health plan from Blue Cross Blue Shield of Michigan. You will have a broad choice of doctors and hospitals within Blue Cross Blue Shield of Michigan s unsurpassed statewide PPO network
More informationRA04/16.906. Offering healthcare coverage for individuals, families and employers backed by the health system you know and trust, Baptist Health.
Offering healthcare coverage for individuals, families and employers backed by the health system you know and trust, Baptist Health. TABLE OF CONTENTS ABOUT BAPTIST HEALTH PLAN...3 GETTING STARTED WITH
More informationCOMPARISON OF BENEFITS* FOR CITY OF EUGENE AFSCME-REPRESENTED EMPLOYEES
COMPARISON OF BENEFITS* FOR CITY OF EUGENE AFSCME-REPRESENTED EMPLOYEES Effective July 1, 2016 Medical/Vision/Pharmacy coverage is administered by PacificSource Health Plans Dental coverage is administered
More informationHEALTH PLAN COMPARISON
City of San José HEALTH PLAN COMPARISON For Employees Represented by AEA, AMSP, CAMP, CEO, IAFF, IBEW, MEF and OE#3 SERVICE Kaiser Permanente Blue Shield HMO QUESTIONS ABOUT PLAN DESIGN AND PROVIDER NETWORKS
More informationRegence BluePoint 20/40 Plan Highlights For Groups of 51+ 1/1/2015
Plan Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for In Network providers. If a member chooses an Out of Network provider, the member
More informationBenefit Highlights for UNC Greensboro students
bcbsnc.com/uncg Benefit Highlights for UNC Greensboro students Effective 08/01/2016 StdGrp, 4/16 U9096a, 5/16 Table of Contents This brochure is a general summary of the insurance plan offered by Blue
More informationSummary of Benefits and Coverage What this Plan Covers & What it Costs - 2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the plan document at www.mpiphp.org or by calling 1-855-275-4674. Important Questions Answers
More informationCENTRAL MICHIGAN UNIVERSITY - Premier Plan (PPO1) 007000285-0002 0004 Effective Date: July 1, 2015 Benefits-at-a-Glance
CENTRAL MICHIGAN UNIVERSITY - Premier Plan (PPO1) 007000285-0002 0004 Effective Date: July 1, 2015 Benefits-at-a-Glance This is intended as an easy-to-read summary and provides only a general overview
More informationFor Retirees of City of Memphis. Features that Add Value. Freedom of Choice. Quality Service Is Part of Quality Care
For Retirees of City of Memphis Features that Add Value The Cigna Medicare Surround indemnity medical plan helps pay some of the health care costs that your Medicare Part A or Part B do not cover such
More information2015 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
More informationFOREIGN SERVICE BENEFIT PLAN
Summary of 2016 Benefits for the FOREIGN SERVICE BENEFIT PLAN Caring for Your Health Worldwide Summary of 2016 Benefits for the FOREIGN SERVICE BENEFIT PLAN High Option Benefits MEDICAL SERVICES SECTION
More information