Wentworth Institute of TechnologyEffective Date January 1, 2014

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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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Questions and Answers

We look forward to working with

Wentworth Institute Employees & Families!

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