America s Family Benefit Plan First Choice Health Care Plan Frequently Asked Questions
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- Phillip Pope
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1 Q: What is First Choice? A: First Choice is a Hospital Preferred Provider Network (PPN) which offers enhanced benefit coverage for services provided within the First Choice provider network. Q: What hospitals, facilities and sites are included in the First Choice Preferred Provider Network (PPN)? A: The First Choice Preferred Provider Network (PPN) consists of the First Choice network facilities and affiliated providers: Acute Care Rehabilitation Care Continuing Care Diagnostic & Treatment Home Care Centers Primary Care Sub-Acute Care (Skilled Nursing) Substance Abuse Treatment Patient Service Centers (Lab Services) Ambulatory Surgery Imaging Centers You can access specific information regarding First Choice network at Q: What are the uniquely customized health care benefits provided by First choice? A: First Choice provides a zero ($0) co-pay for the following services rendered at a First Choice network facility or affiliated provider: Diagnostic & Imaging Home Health Care (within Laboratory Testing Erie and Niagara Radiology Counties) Mammograms In-Patient Hospital Outpatient Surgery Admissions Cancer Services Sub-Acute Care (Skilled Nursing) Cardiac Services Sleep Care Physical/Occupational /Speech Therapy Nutritional Counseling Outpatient Substance Diabetic Education Abuse Page 1
2 Q: How are benefits paid for specialized hospital/ambulatory based services outside of the First Choice network? A: First Choice offers benefit coverage for specialized hospital/ambulatory services provided outside of the First Choice network. Admissions are subject to a $500 copay per confinement for the following treatment categories: Roswell Park - Cancer Treatment Women & Children s Hospital - Pediatric Care Erie County Medical Center - Burn Treatment, Trauma, Transplants, Mental Health/Substance Abuse BryLin Hospital Mental Health/Substance Abuse Q: Am I required to change my Primary Care Physician or Specialist? A: No. Since First Choice is a hospital based network, First Choice utilizes the BlueCross BlueShield of WNY participating provider physician network, eliminating the need to change your current physician(s). Remember, it is very important that you communicate to your physician(s) the significance of utilizing First Choice network facilities. Failure to use First Choice network providers as required within the Plan guidelines could result in significant out-of-pocket expenses. If your current doctor does not have admitting privileges to First Choice network facilities, consider selecting a member of the Catholic Medical Partners (CMP). You can access the CMP physician listing electronically by selecting the Physician Roster option located on the Catholic Medical Partners web page at Q: Do I have the ability to choose my health care provider? A: Yes, you still have the flexibility of choice when it comes to your health care provider. However, failure to use the First Choice network for hospital providers will result in greater out-of-pocket expenses. Refer to the Benefit Summary for specific details. Page 2
3 Q: Does First Choice provide coverage for preventive care services? A: The reinforces the commitment to providing members and covered dependents with health coverage that encourages a healthy lifestyle by providing benefits for preventive services such as: Colonoscopy PSA Test Bone Mineral Density Mammograms Screening Colorectal Cancer Well Child Visits and Screening immunizations Routine OB/GYN Visit Abdominal Aortic Pap Smear Aneurysm Screening Annual Routine Physical Adult Immunizations Q: If I am changing from my current plan option to First Choice for the first time during my annual enrollment period and I am currently receiving treatment at a non-first Choice network facility, should I change my place of treatment or doctor? A: No. You will receive a Transition of Care Form. It is important that you complete the Form and return it if: You or your covered family member are currently under the care of a physician and receiving treatment at a hospital facility other than a First Choice network hospital; You or your covered family member is currently confined in a hospital other than a First Choice network hospital; You or your covered family member are currently receiving care for routine scheduled treatments in the outpatient department of a hospital, other than a First Choice network hospital; You or your covered family member have already scheduled an elective surgical procedure to be performed at a hospital facility, other than a First Choice network hospital; You or your covered family member are pregnant and are not scheduled to deliver the baby at a First Choice network hospital; You or your covered family member are currently or have already scheduled treatment for one of the following diagnosis : Cancer Treatments Rehabilitation Therapies Cardiac Surgery or Rehab Organ transplant Page 3
4 Q: How do I determine if it is appropriate to use the emergency room or an urgent care center? A: It is important that you use the emergency room exclusively for emergency care: Emergency conditions are those that could potentially threaten your life, limb or eye sight. If you believe that the absence of medical attention may result in a threat to your life, limb or eye sight and requires immediate medical treatment or has painful symptoms requiring immediate attention to relieve suffering emergency room care is appropriate. First Choice provides coverage for Urgent Care, for a $15 co-pay, when treatment is rendered at the physician s office or an Urgent Care Center. Q: What providers participate in the First Choice Network? A: All Catholic Health hospitals, patient service centers, diagnostic & testing centers, primary care centers, home care, rehabilitation care, and continuing care sites. A comprehensive list of First Choice network providers can be obtained on the First Choice website at Q: What if my provider is not a member of the First Choice network or the BlueCross BlueShield provider network? A: The provides national out-of-network coverage. However, out-of-network services are subject to a deductible and 30% coinsurance based upon the BlueCross BlueShield fee schedule. There is a $2,500 individual/ $5,000 family out-of- pocket maximum in place to protect you against catastrophic losses. Q: What is considered an out-of-network service? A: Any service provider that does not participate in the First Choice network or the BlueCross BlueShield physician network. Scheduled services rendered by a provider outside of the eight counties of the Western New York area will be paid as an out-ofnetwork benefit. Q: Is it necessary for me to obtain a specialist referral? A: No referral is necessary when you utilize services within the First Choice network or the BlueCross BlueShield participating network. If your current doctor does not have admitting privileges to a First Choice network hospital or an affiliated provider, consider selecting a member of the Catholic Medical Partners (CMP). Their website address is You also have the option to not utilize a First Choice provider however, this will result in higher out of pocket expenses for you. Page 4
5 Q: If my physician draws blood or takes a specimen test during my office visit which is sent to a non-first Choice network laboratory for testing, will I incur any out-of-pocket expenses other than my office visit co-pay? A: No, you are not responsible for any additional charges as a result of your physician sending blood work or specimen cultures to a non-first Choice network laboratory. If you receive an invoice, contact the BlueCross BlueShield Customer Service Department at to request a claim adjustment. Q: As a new First Choice member, am I subject to any pre-existing condition rules? A: No, there are no pre-existing condition rules. The First Choice plan is compliant with Affordable Care Act (ACA) guidelines which prohibits pre-existing condition requirements. Q: How does the work for a dependent living outside of the Western New York area? A: Routine medical services must be performed within the eight (8) counties of Western New York. In the case of an emergency, the dependent members should go to the nearest emergency room for treatment. First Choice utilizes the BlueCross BlueShield national provider network which provides benefit coverage to eligible dependents residing outside of the Western New York area. If there is a BlueCross BlueShield affiliated network in the area where your dependent lives, you may apply for a Guest Membership (scheduled services provided outside of the First Choice and BlueCross BlueShield affiliated networks are subject to deductible and coinsurance). Q: Who should I contact with questions regarding First Choice? A: All questions and inquiries regarding First Choice Health Plan may be directed to First Choice Customer Service at For questions related to a specific health claim, contact the BlueCross Blue Customer Service Department at Page 5
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J3A59 National Guardian Life Insurance Company 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.studentplanscenter.com
MAYFLOWER MUNICIPAL HEALTH GROUP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PPO REVIEW OF BENEFITS
Fiscal Year 2015 2016 MAYFLOWER MUNICIPAL HEALTH GROUP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PPO REVIEW OF S ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Important Questions Answers Why this Matters: What is the overall deductible?
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.uhs.wisc.edu/ship or by calling 1-866-796-7899. Important
Independence Blue Cross Plan Summary PPO Core Medical Plan
TO: FROM: SUBJECT: MLH Medical Plan Participants MLH Human Resources Benefits Team Independence Blue Cross Plan Summary PPO Core Medical Plan Attached you will find the Independence Blue Cross (IBC) Plan
Yes, $100 individual/$300 family for speech therapy. There are no other specific deductibles. Is there an out of pocket limit on my expenses?
Yale Health Plan: Faculty, Managerial & Professional, Post-doctoral Associates and Fellows Coverage Period: 1/1/2015 12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage
Important Questions Answers Why this Matters: What is the overall deductible?
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://knowyourbenefits.dfa.ms.gov or by calling 1-866-586-2781.
Pace University CIGNA Medical Detailed Benefit Summaries July 1, 2015 - June 30, 2016
Consumer Core HDHP In Net $50 (ONLY APPLICABLE TO THOSE Network Core $25 ALREADY ENROLLED) Network Choice Fund In Network In Network In Network Deductible $1,300/$2,600 (Cumulative) N/A N/A Coinsurance
Blue 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
SCAN Health Plan. 2015 Summary of Benefits
SCAN Health Plan 2015 Summary of Benefits Y0057_SCAN_8712_2014F File & Use Accepted 09032014 ( a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health Plan with a Medicare contract)
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
You can see the specialist you choose without permission from this plan.
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.sas-mn.com or by calling 1-800-328-2739. Important Questions
Student Health Insurance Plan Insurance Company Coverage Period: 07/01/2015-06/30/2016
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.studentplanscenter.com or by calling 1-800-756-3702.
SUMMARY OF BENEFITS. Out-of-Network Care: $10,000 per policy year
OUTPATIENT BENEFITS Most Primary Care office visits at SHC are provided at no charge. This is not an insured benefit but is provided by NYU to all matriculated students including students who waive the
Important 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
Zoom Health Plan, Inc. (ZOOM+): ZOOM+ Oregon Standard Gold Coverage Period: January 1, 2016 December 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.zoomcare.com or by calling 1-844-ZOOM-777. Important
Standard Life And Accident Insurance Company: PremiumSaver
This is only a summary. This plan is supplemental to your group s major medical plan. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document