Wentworth Institute of Technology Effective Date January 1, 2014
Dec 15, 2015
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Welcome to Tufts Health Plan
Provider Network
Plan Design
Prescription Coverage
Transition of Care
Value Added Benefits
Customer Service
Member Enrollment Kit Explanation
Agenda Agenda
Tufts Health Plan in business for more than 30 years
Headquartered in Watertown MA, with regional offices in
Worcester, Springfield and Providence RI.
US News & World Reports
Rated amongst the top 1% of health plans nationally!
Certified by National Committee for Quality Assurance
Welcome To Tufts Health Plan!
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Tufts Health Plan Provider Network
90 hospitals with more than
25,000 providers
Network throughout MA, RI
and southern NH
Search providers at www.tuftshealthplan.com
Choose the “HMO / POS / PPO” network from the
drop-down menu under “Standard Network Plans”
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EPO Referral Process
Referral Process – It’s easy!
Required for most specialty care within network
(dermatology, orthopedic) through your PCP
More than 90% of referrals initiated on-line
No referral needed for annual OB/GYN exam,
chiropractic care, routine eye exam or
outpatient behavioral health visits
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EPO & PPO Coverage Overview
NOTE: EPO requires selection of PCP
Routine preventive examination: Covered 100%
Office visit: $20 per visit
High Tech Imaging: $75 copayment per visit
Emergency Room: $100 / waived if admitted
Inpatient Hospitalization: Covered 100%
Surgical Day Care: Covered 100%
Diagnostic Labs & X-rays: Covered 100%
Prescription Drug Plan
Retail (up to 30-day supply) prescription copays: $15 / $30 / $50
Mail order (maintenance Rx’s) prescription copays: $30 / $60 / $150
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PPO Out of Network Coverage
Deductible: $250 per member and $500 per family
Coinsurance: You pay 20% of covered services, Tufts pays 80%
Out of pocket maximum: $2,000 per person and $4,000 per family
Emergency Services are always covered the same as the in
network benefit
Be cognizant of charges above “usual and customary” when
receiving services from providers that are not contracted with Tufts
Health Plan
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Tufts Health Plan Vision Benefits through EyeMed network:
Routine Eye Exams (covered once every 12 months)
Eye-wear discounts – on lenses, frames & contact lenses (15-35% off)
Discounts available for LASIK procedures through network providers
Vision Services
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Prescription Drug Coverage
Available at 99% of pharmacies nationwide – 63,000 including CVS,
Rite-Aid, Walgreens, Target, Wal-Mart, etc.
30-day supply filled at the retail pharmacy-remember to show your ID
card to pharmacist after January 1, 2014
Check your prescription tiers at www.tuftshealthplan.com
-Prior Authorization/Step Therapy exception process for
Wentworth Institute
Benefits to Fast Start (90-supply for most maintenance medications):
- No forms to complete to start prescriptions by mail
- Save time and money on your prescriptions
- Home delivery including free standard shipping to your home
- Re-order prescriptions by phone, via mail, or online
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Transition of Care is needed anytime a member is in the middle of a care
plan and needs additional resources to insure continuity of care
Examples include: scheduled surgery or procedures pre-approved by
your current carrier
Simply contact Tufts Health Plan Member Services to coordinate care
Each case is reviewed individually and Tufts Health Plan will
communicate with you and your providers if necessary
For more complex medical issues, contact Michael Burns at
Tufts Health Plan by calling 617-923-5406 ext. 8676 and
issues will be triaged accordingly
Process overview for providers that are not contracted with Tufts Health
Plan
Transition of Care Assistance (for Ongoing Medical Services)
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Fitness & Weight Management Benefit
$150 Fitness Reimbursement
$150 Weight Program Reimbursement
Discounts at local participating Fitness Centers
Curves – www.curvesinternational.com
Fitness Together Personal Training
www.fitnesstogether.com
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Value Added Benefits
Hospital-based wellness programs – ex. nutrition, smoking
cessation, stress management (up to 30% off)
Boys & Girls Clubs (20% off)
Acupuncture & Massage Therapy discounts (25% off)
Healthyroads – online health/wellness shopping (up to 40% off)
Pregnancy Benefits and Childbirth Class reimbursements
New Balance Discount – 15% off all products at their stores
Well magazine!
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Web-site Decision Support Tools
Need to register
24/7 access
Provider look-up
Your authorizations
information
Your benefit Information
Hospital performance comparisons with
Select Quality Care®
Information on conditions and symptoms
Medical & pharmacy claims
Health & Wellness calculators
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Member Services
Member Services Line (800) 462-0224
Monday - Thursday 8:00 am to 7:00 pm (EST)
Friday – 10:00 am to 5:00 pm
24 hour answering service
AT&T Language Line (140 languages)
www.tuftshealthplan.com
Benefit Questions, new ID card,
or transition of care questions
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(!) All employees and their dependents will receive new medical ID Cards
Subscriber: xxxxxx-01
Spouse: xxxxxx-02
Dependents: xxxxxx-03
Start using new cards as of January 1, 2014
Important RemindersImportant Reminders
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Coverage becomes effective 1/1/2014
Referrals MUST be reissued (call your PCP)
Fill your prescriptions
Enrollment forms due by 12/6/2013
Please visit the Wentworth Microsite
EPO Group Number is 17011-000
PPO Group Number is 46259-000
Things to Remember …
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