PacificSource Enrollment Service Area
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- Roxanne Curtis
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1 PacificSource v
2 PacificSource Enrollment Service Area
3 PacificSource Medicare Advantage Plans
4 The Value of PacificSource Medicare Advantage and the PHIP Partnership Enhanced Medical Benefits Lower copays for: $0 copay for: Hospital stays Doctor office visits Physical therapy Outpatient surgery Advanced imaging (MRI, CT, PET scans) Lab and X-Rays Home Health Care Durable medical equipment Skilled nursing facilities
5 PacificSource Medicare Advantage Plan How Our Plan Works Use network providers for most services Accepted by nearly all the providers in our service area Accepted by every hospital in our area, including OHSU, Oregon Clinic, Legacy Emanuel and Good Samaritan in Portland Freedom to see specialists without a referral Travel coverage US and worldwide
6 PacificSource Medicare Advantage Plan How Our Plan Works Predictable out-of-pocket costs No Deductibles Low copays $0 copay for certain services Safety net of a $3,400 annual out-of-pocket maximum Virtually no paperwork
7 PacificSource Medicare Advantage Special Attributes Extra Benefits Included (not covered by Medicare) Annual routine physicals - $0 copay (including lab tests) Annual routine hearing exams $250 hearing aid reimbursement Routine eye exams $100 reimbursement for eyeglasses or contacts
8 Your Membership Includes: Access to more than 11,000 participating fitness facilities nationwide, or; Choice of Silver&Fit Home Fitness kits (2 per year) if you prefer to workout at home Healthy Aging materials (online or DVD) The Silver Slate newsletter 4 times a year (online, ed, or mailed) Silver&Fit Connected!, a fun and easy way to track your exercise at a facility or through a wearable fitness device or app and earn rewards Other web tools like a facility search, Challenges, and more
9 PacificSource Medicare Advantage Personal Service Quality of service Live telephone answering Local customer service based in Bend Available by phone 7am-8pm In-person assistance in Bend and Springfield offices Nurse case managers a personal advocate to assist those with complex medical needs 24-Hour NurseLine
10 PacificSource Medicare Advantage Emergency and Travel Benefits Urgent Care (Worldwide coverage) Emergency Room (Worldwide coverage) Ambulance - ground or air (Worldwide coverage) Out of Area Travel: Inside the U.S. Out of Area Travel: Outside the U.S. $15 copay $50 copay $50 copay ER, urgent care and ambulance
11 Online Resources for Members In Touch secure online member portal Through InTouch, you can: Search your claims Order new ID cards View your plan materials and benefits View your EOBs Elect to receive plan materials electronically
12 mypacificsource FREE Mobile App Use mypacificsource to: Access your member ID card. Access your office visit copays and out-of-pocket maximum. Find a nearby provider or hospital. Call the 24-hour NurseLine Just open your app store, search for PacificSource Health Plans, and download for FREE.
13 PacificSource Non-Medicare Plans
14 PacificSource Non-Medicare Plans Features PacificSource Core Value Plan PacificSource Select Value Plan Type of Plan HMO-POS Deductible $500 $1,000 Provider Access Primary Care Physician Referral Requirement Network Alternative Care See In-Network or Out-of-Network Providers Required Not Required Statewide and Nationwide network of providers Included
15 PacificSource Non-Medicare Plan Plan Type: HMO-POS An HMO plan with a Point of Service option. Choose a Primary Care Provider See Specialists without a referral Freedom to see doctors outside of the network Provider Network All hospitals and vast majority of doctors throughout Oregon are in-network In-network providers available nationwide
16 PacificSource Non-Medicare Plan How Our Plan Works Use network providers for most services Accepted by nearly all the providers in our service area Accepted by every hospital in our area, including OHSU, Oregon Clinic, Legacy Emanuel and Good Samaritan in Portland Freedom to see specialists without a referral Travel coverage US and worldwide
17 PacificSource Prescription Drug Plan
18 Prescription Drug Plan Current members will receive a new ID card from PacificSource in mid-december One ID card will be used for both medical and prescription benefits Your PacificSource member ID number will remain the same Please show your new ID card at your pharmacy starting January 1, 2016 We are working closely with PHIP to ensure a smooth transition for current members If a PHIP PacificSource member is currently filling a Medicare Part D covered medication with Moda in 2015, it will be covered by PacificSource in 2016, even if the prescription is not on the PacificSource formulary. If you are currently using mail order service for your prescriptions, we will contact you directly with information on how to transition to our mail order vendor.
19 Prescription Drug Plan Medication Therapy Management A free service for our members Telephonic consultation with a clinical pharmacist to review medications and over-the-counter drugs MTM services can: Identify potential medication conflicts Identify opportunities to lower drug costs, Improve management of your health conditions Reduced hospitalizations and hospital readmissions Local pharmacy customer service available (toll free) or (local) Available: 7 a.m. 6 p.m. Monday-Friday
20 Pharmacy Network Benefit Over 68,000 participating pharmacies nationwide Retail Pharmacies Include Albertsons Fred Meyer Safeway Bend Pill Box Haagen Sav-On Bend Memorial Clinic Hiron ShopKo BHS Home Town Drug Target Bi-Mart Len s WalMart Clinic Pharmacy Payless Walgreens Drug Mart Rite Aid Westside CVS/Caremark Mail Order Pharmacies Wellpartner
21 PacificSource Prescription Drug Plan Broad pharmacy access Retail pharmacies Over 68,000 network pharmacies nationwide, including: Shopko, Costco, Rexall, RiteAid, Wal-Mart, Walgreens, Fred Meyer, Safeway, Albertsons, Haggens and many independents. Mail order service CVS Caremark or WellPartner (based in Portland)
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