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Home My Public Portal AboutGIC EMPLOYEE AND NON-MEDICARE RETIREE AND SUVIVOR EN EFITS -AT-A- G L EMPLOYEES AND NON-MEDICARE RETIREES & SURVIVORS , AV- \ 1000 f ANNUAL 2018 2018 - 2019 Benefits and rates effective Commonwealth of Massachusetts July 1, 2018 4i11.. Group Insurance Commission Learn What's , • Annual Enrollment loll What's Changing This Year: • Health benefit changes for the coming year: In response to your feedback,the GIC has implemented a number of changes to help reduce your out-of-pocket costs and make using your benefits easier, including: • Reduced copays when seeing a Tier 3 specialist(Tier 3 copays • All members will have access to$15 Telehealth coverage will now be$75, down from$90 last year) • Utilizing hospice care will no longer require prior authorization • Members will no longer be charged ambulance copays after • Some regional and limited network products will now have their deductible lower deductibles More information is detailed in the Benefits Decision Guide. • Integration of Medical and Behavioral Health Benefits.To better integrate your care, effective July 1,you will receive behavioral health benefits through your health insurance carrier. Please contact your health insurance carrier to learn more about this change. • Express Scripts will be your prescription drug administrator: If you are enrolled in medical coverage through the GIC,you will automatically receive prescription drug coverage through Express Scripts(ESI). Express Scripts offers cost management resources and live customer service support so you can best understand and manage your prescription costs.You will receive a separate ID card for the Express Scripts pharmacy benefit. Don't forget to bring it with you to the pharmacy when you get your prescriptions filled. If you have questions about this new program,visit express-scripts.com/gicRx or call 855-283-7679. i • WeIIMASS programs will now be offered through your health insurance carrier. Commonwealth of Massachusetts Please contact your carrier for details about their specific wellness programs. Group Insurance Commission IMPORTANT v/ Completed Annual Enrollment forms are due to the GIC by Wednesday,May 2,2018:All forms are available on the GIC website(mass.gov/gic-forms). v/ Employees can enroll in coverage for the first time at Annual Enrollment or within 60 days of a documented qualifying event.Qualifying events include marriage, birth/adoption of a child, involuntary loss of other coverage, spouse's Annual Enrollment or return from an approved FMLA or maternity leave. New hires may enroll in coverage during their first ten days of employment and also during Annual Enrollment. v/ Once you choose health care coverage,you cannot change products until the next Annual Enrollment period. Even if your doctor or hospital leaves the health insurance product, unless you have an eligible qualifying status change, you must remain enrolled in your selected plan until the next Annual Enrollment.You can find a list of qualifying status changes on the GIC's Annual Enrollment website at mass.gov/orgs/group-insurance-commission. v/ Physician and hospital copay tiers change each July 1. Please check with your insurance carrier to see if your provider or hospital tier has changed. v/ Doctors and hospitals within a carrier's network can change during the year,usually because of a health carrier and provider contract issue,practice mergers,retirement or relocation. If your doctor is no longer available,your health insurance carrier will help you find a new one. v/ When checking provider coverage and tiers,be sure to specify the health insurance product's full name, such as"Tufts Health Plan Spirit-or"Tufts Health Plan Navigator,"and not just"Tufts Health Plan."The health insurance carrier is your best source for this information. Benefits-at-a-Glance: Health Insurance Products NATIONAL NETWORK I BROAD NETWORK HEALjRD RANCE 1 IUNICNDEE STATE TUFTS MNITY I ' • ' 1INDEPENDENCE PILGRIM TSSELECT CARE NAVIGATOR , ' ll 1 '1 '1 • 1 No No Yes Yes Yes No No Yes Yes Yes WTIMM. Mal • I Out-of-pocket Maximum Individual/Family $5,000/$10,000 $5,000/$10,000 $5,000/$10,000 $5,000/$10,000 $5,000/$10,000 Fiscal Year Deductible Individual/Family $500/$1,000 $500/$1,000 $500/$1,000 $500/$1,000 $500/$1,000 Primary Care Provider $15/visit for Tier 1:$10/visit Tier 1:$10/visit Office Visit $20/visit Centered Care PCPs; Tier 2:$20/visit $20/visit Tier 2:$20/visit $20/visit for other PCPs Tier 3:$40/visit Tier 3:$40/visit Preventive Services Most covered at Most covered at Most covered at Most covered at Most covered at 100%—no copay 100%—no copay 100%—no copay 100%—no copay 100%—no copay Specialist Physician Office Visit Tier 1 /Tier 2/Tier 3 $30/$60/$75/visit $30/$60/$75/visit $30/$60/$75/visit $30/$60/$75/visit $30/$60/$75/visit Retail Clinic and $20/visit $20/visit $20/visit $20/visit $20/visit Urgent Care Center Outpatient Behavioral Health/Substance Use $20/visit $20/visit $10/visit $20/visit $10/visit Disorder Care Emergency Room Care $100/visit $100/visit $100/visit $100/visit $100/visit (waived if admitted) (waived if admitted) (waived if admitted) (waived if admitted) (waived if admitted) Inpatient Hospital Care— Maximum one copay per person per calendar year quarter.Waived if readmitted Medical within 30 days in the same calendar Tier 1 $275/admission $275/admission $275/admission $275/admission $275/admission Tier 2 with no tiering $500/admission $500/admission $500/admission $500/admission Tier 3 $1,500/admission $1,500/admission $1,500/admission $1,500/admission Outpatient Surgery Maximum one copay per calendar quarter or four per year,depending on product.Contactthe carrier for details. Tier 1 /Tier 2/Tier 3 $250/occurrence $110/$110/$250/ $250/occurrence $250/occurrence $250/occurrence occurrence High-Tech Imaging Maximum one copay per day. (e.g.,MRI,CT and PET scans) $100/scan $100/scan 1 $100/scan $100/scan $100/scan Prescription Drugs Prescription Drug 1•d II 11 Family Retail (up to a 30-day supply) Tier 1/Tier 2/Tier 3 $10/$30/$65 $10/$30/$65 $10/$30/$65 $10/$30/$65 $10/$30/$65 Mail Order Maintenance Drugs (up to a 90-day supply) Tier 1 /Tier 2/Tier 3 $25/$75/$165 $25/$75/$165 $25/$75/$165 $25/$75/$165 $25/$75/$165 op.ys and deductibles that app2018. Benef its-at-a-G lance: Health Insurance ProductsSill REGIONAL NETWORK I LIMITED NETWORK HEALTH NEW NHP PRIME UNICARE STATE TUFTS HEALTH FALLON HEALTH HARVARD ENGLAND (Neighborhood INDEMNITY PLAN/ PLAN SPIRIT DIRECT CARE PILGRIM PRIMARY Health Plan) CHOICE PLAN 1 EPO 1 1 HMO Yes Yes No No Yes Yes No Yes No No Yes Yes $5,000/$10,000 $5,000/$10,000 $5,000/$10,000 $5,000/$10,000 $5,000/$10,000 $5,000/$10,000 $400/$800 $500/$1,000 $400/$800 $400/$800 $400/$800 $400/$800 $15/visit for $20/visit $20/visit Centered Care PCPs; $20/visit $15/visit $20/visit $20/visit for other PCPs Most covered at Most covered at Most covered at Most covered at Most covered at Most covered at 100%—no copay 100%—no copay 100%—no copay 100%—no copay 100%—no copay 100%—no copay Tier 1 $30/Tier 2$60/ $30/$60/$75/visit $30/$60/$75/visit $30/$60/$75/visit $30/$60/$75/visit $30/$60/$75/visit visit(No Tier 3) $20/visit $20/visit $20/visit $20/visit $15/visit $20/visit $20/visit $20/visit $20/visit $20/visit $15/visit $20/visit $100/visit $100/visit $100/visit $100/visit $100/visit $100/visit (waived if admitted) (waived if admitted) (waived if admitted) (waived if admitted) (waived if admitted) (waived if admitted) Maximum one copay per person per calendar year quarter.Waived if readmitted within 30 days in the same calendar $275/admission $275/admission $275/admission $275/admission $275/admission $275/admission with no tiering with no tiering with no tiering $500/admission with no tiering $500/admission No Tier 3 No Tier 3 Maximum one copay per calendar quarter or four per year,depending on product.Contact the carrier for details. $250/occurrence $250/occurrence $110/occurrence $250/occurrence $250/occurrence $250/occurrence Maximum one copay per day. Contact the carrier for details. $100/scan $100/scan $100/scan $100/scan $100/scan $100/scan Prescription Drug Deductible-:$100 Individual/$200 Family $10/$30/$65 $10/$30/$65 $10/$30/$65 $10/$30/$65 $10/$30/$65 $10/$30/$65 $25/$75/$165 $25/$75/$165 $25/$75/$165 $25/$75/$165 $25/$75/$165 $25/$75/$165 Out-of-pocket maximums apply to medical and behavioral health benefits across all health insurance products. Prescription drug(Rx)benefits are included in the out-of-pocket maximums for all health insurance carriers. Where You Live Determines Which Health Insurance ' Product You May Enroll In. MAINE 1 VERMONT NEW HAMPSHIRE 1 1 ESSEX NEW FRANKLIN YORK WORCESTER MIDDLESEX SUFFOLK � HAMPSHIRE BERKSHIRE NORFOLK HAMPDEN 1 u RHODE BRISTOL PLYMOUTH CONNECTICUT ISLAND BARNSTABLE ' Q 1 1 o DUKES '- NANTUCKET Is the Health Product Available Where You Live? BARNSTABLE HAMPSHIRE Independence, NHP,Navigator,Spirit,Basic, Direct*,Select,Independence,Primary Choice, Community Choice,PLUS HNE,Navigator,Spirit*,Basic,PLUS,Community Outside Massachusetts: Choice BERKSHIRE CONNECTICUT Select,Independence,Primary Choice,HNE, MIDDLESEX Independence, HNE*,Navigator*, Navigator,Spirit*,Basic,Community Choice, Direct,Select,Independence,Primary Choice,NHP, Basic,PLUS* PLUS Navigator,Spirit,Basic,Community Choice,PLUS MAINE BRISTOL NANTUCKET Independence,Basic,PLUS Direct,Select,Independence,Primary Choice,NHP, Independence, NHP, Navigator,Basic,PLUS Navigator,Spirit,Basic,Community Choice,PLUS NEW HAMPSHIRE NORFOLK Select*,Independence,Navigator*, DUKES Direct,Select,Independence,Primary Choice,NHP, Basic,PLUS Independence, NHP,Navigator,Basic,PLUS Navigator,Spirit,Basic,Community Choice,PLUS NEW YORK ESSEX PLYMOUTH Independence*, Navigator*,Basic Direct,Select,Independence,Primary Choice,NHP, Direct,Select,Independence,Primary Choice,NHP, Navigator,Spirit,Basic,Community Choice,PLUS Navigator,Spirit,Basic,Community Choice,PLUS RHODE ISLAND Independence, Navigator,Basic,PLUS FRANKLIN SUFFOLK Select,Independence,Primary Choice,HNE,Nav- Direct,Select,Independence,Primary Choice,NHP, VERMONT igator,Spirit,Basic,Community Choice,PLUS Navigator,Spirit,Basic,Community Choice,PLUS Independence*, Navigator*,Basic, PLUS HAMPDEN WORCESTER Direct*,Select,Independence,Primary Choice, Direct,Select,Independence,Primary Choice, HNE,NHP,Navigator,Spirit, Basic,Community HNE,NHP,Navigator,Spirit,Basic,Community Choice,PLUS Choice,PLUS *Not every city and town is covered in this county or state;contact the health insurance carrier to find out if you live in the service area.The product also has a limited network of providers in this county or state;contactthe health insurance carrier to find out which doctors and hospitals participate. For More • • Contact MARK THE DATE! Forms (mass.gov/gic/forms) are due WEDNESDAY, MAY 2 for Changes Effective July 1, 2018 Annual Enrollment offers you the opportunity to review your benefit options and enroll in or change your coverage. If you want to keep your current benefits,you do not need to complete any paperwork,as your coverage will continue automatically. ACTIVE STATE AND MUNICIPAL EMPLOYEES: Return completed forms to your GIC Coordinator. NON-MEDICARE RETIREES AND SURVIVORS: Mail completed annual enrollment forms to the GIC to the address below. For more information about specific products or benefits, contact your carrier. Be sure to indicate you are a GIC member. HEALTH INSURANCE Fallon Health Direct Care 1.866.344.4442 fallonhealth.org/gic Select Care Harvard Pilgrim Health Care Independence Plan 1.800.542.1499 harvardpilgrim.org/gic Primary Choice Plan Health New England 1.800.842.4464 hne.com/gic Neighborhood Health Plan 1.866.567.9175 nhp.org/gic NHP Prime Tufts Health Plan Navigator 1.800.870.9488 tuftshealthplan.com/gic Spirit UniCare State Indemnity Plan Basic Community Choice 1.800.442.9300 unicarestateplan.com PLUS Pharmacy Benefits Manager 1.855.283.7679 express-scripts.com/gicRx Express Scripts Commonwealth of Massachusetts Group Insurance Commission • P.O. Box 8747, Boston, MA 02114 Group Insurance Commission 617.727.2310 • TDD/TTY711 • mass.gov/gic C,* Recycled Paper