Harvard Pilgrim Member ID Card Guide

Harvard Pilgrim Member ID Card Guide
These plan descriptions and ID cards are only a sample of our product portfolio. For a full list and
detailed plan information, check our online Provider Manual at www.harvardpilgrim.org.1
National Plans
Access America
Harvard Pilgrim Health Care’s national product offered
jointly with UnitedHealthcare.
• Members access their care through:
- Harvard Pilgrim’s network in MA, ME, and NH.
- UnitedHealthcare’s network in all other states.
• Copayment and deductible information can be found on
the member’s ID card.
• Access HPHConnect or call the Provider Service Center at
800-708-4414 for eligibility, benefits, prerequisites and cost
sharing information.
• Contact United Behavioral Health Access Line at
888-777-4742 for behavioral health services.
Choice and Choice Plus “Passport Connect”
Choice and Choice Plus are two national products offered
through Passport ConnectSM, an alliance between UnitedHealthcare and Harvard Pilgrim Health Care.
• Access online services at www.UnitedHealthCareOnline.
com (requires a user ID and password, call 866-842-3278),
or
• Call the provider toll-free number at
800-708-4414 for eligibility, benefits and/or cost-sharing
information.
• Provider networks may vary depending on services provided (e.g., Chiropractic services are provided by American
Chiropractic Network).
• Access www.ubhonline.com for behavioral health services.
Choice Plus and Options
Choice Plus and Options are two national PPO products
jointly offered by Harvard Pilgrim Health Care and UnitedHealthcare.
• No PCP or referral requirements.
• Members access their care through:
- Harvard Pilgrim’s network in MA, ME, and NH.
- UnitedHealthcare’s network in all other states.
• Access HPHConnect or call the Provider Service Center at
800-708-4414 for eligibility, benefits, prerequisites and cost
sharing information.
• Provider networks may vary depending on services provided
(e.g., Vision services are provided by Spectera).
• Access www.ubhonline.com for behavioral health services.
Student Insurance Plan
The Student Insurance Plan is a PPO product offered by Harvard Pilgrim Health Care, and administered by UnitedHealthcare StudentResources.
• Copayment information will be found on the front of the card.
• Contact StudentResources at 800-977-4698 for prerequisites,
eligibility, claims submission processes, benefit limits and/or
cost-sharing information.
• Pre-admission notifications are not required.
• Contact StudentResources at 800-977-4698 to request care
management services.
• Provider networks may vary depending on services pro- vided (e.g., Pharmacy services are provided by Medco).
• Access www.ubhonline.com for behavioral health services.
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Harvard Pilgrim Member ID Card Guide
These plan descriptions and ID cards are only a sample of our product portfolio. For a full list and
detailed plan information, check our online Provider Manual at www.harvardpilgrim.org.1
HMO Plans
The following information applies to all Harvard Pilgrim HMO plans.
• PCP is responsible for managing care for the member.
• Copayment information can be found on the member’s ID card.
• Use HPHConnect or call the Provider Service Center at 800-708-4414 (MA, ME and NH) or 866-691-8882 (CT) for benefits limits,
prerequisites and cost sharing information.
• Contact United Behavioral Health Access Line at 888-777-4742 for behavioral health services.
Harvard Pilgrim HMO
Traditional managed care HMO product.
Core Coverage HMO
The Harvard Pilgrim Core Coverage HMO is an HMO option
with a deductible and coinsurance.
Tiered Copayment HMO
Tiered Copayment HMO plans offer a two-level copayment
option for office visits.
• Tier 1 level copayment applies to some outpatient services, including most primary care, obstetrical care, gynecological care, mental health care and substance abuse
rehabilitation.
• Tier 2 level copayment applies to most outpatient specialty care.
Tiered Copay Open Access (OA) HMO (CT)
Tiered Copay Open Access (OA) HMO is an HMO option
that allows members to obtain medical care from participating providers with no PCP or referral to specialists
required.
Tiered Copay OA HMO offers two copayment variations
depending on the type of service and the type of provider.
• Copayment Level 1 applies to some outpatient services,
including most primary care, mental health care, and
substance abuse rehabilitation.
• Copayment Level 2 applies to most outpatient specialty
care.
Harvard Pilgrim Health Care—Harvard Pilgrim Member ID Card Guide
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Harvard Pilgrim Member ID Card Guide
These plan descriptions and ID cards are only a sample of our product portfolio. For a full list and
detailed plan information, check our online Provider Manual at www.harvardpilgrim.org.1
HMO Plans, continued
Focus NetworkSM - MA Limited Network HMO Plans
The Harvard Pilgrim HMO, Best Buy HMO and Tiered Copay
HMO Plans are also available with a limited provider network
Focus NetworkSM - MA.
• Defined provider network
- Easy Access (member cost sharing and referral requirements mirrors HMO plans)
- Authorized Access (requires prior authorization for all
non emergent services)
Harvard Pilgrim GIC Primary Choice Plan HMO (MA)
The Harvard Pilgrim GIC Primary Choice Plan is an HMO plan
that has a limited network with a tiered copayment
structure for Massachusetts state and municipal employees.
• The Primary Choice Plan includes:
- Three-level copayment options for office visits.
- Two-level copayment options for inpatient admissions to
acute care hospitals.
• Copayment variations depend upon the type of service and
the tier assignment of the provider.
PPO Plans
The following information applies to the PPO plans represented in this document.
• PPO members are not required to choose a PCP or obtain referrals for specialty services.
• Copayment and deductible information can be found on the member’s ID card.
• Use HPHConnect or call the Provider Service Center at 800-708-4414 for benefits limits, prerequisites and cost sharing information.
• Contact United Behavioral Health Access Line at 888-777-4742 for behavioral health services.
Harvard Pilgrim ChoiceNet Best Buy Tiered Copayment PPO Plan (Also available as HMO)
• Two levels of coverage:
- In-Network
- Out-of-Network
• Cost sharing will fall into one of three tiers as determined
by the physician’s and hosptal’s tier assignments.
Harvard Pilgrim GIC Independence Plan Tiered Copayment PPO (MA) (Also available as HMO)
The Harvard Pilgrim GIC Independence Plan PPO is for Massachusetts state and municipal employees.
• Three copayment tiers for office visits and for patient admissions to acute care hospitals.
Harvard Pilgrim Health Care—Harvard Pilgrim Member ID Card Guide
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Harvard Pilgrim Member ID Card Guide
These plan descriptions and ID cards are only a sample of our product portfolio. For a full list and
detailed plan information, check our online Provider Manual at www.harvardpilgrim.org.1
PPO Plans, continued
Harvard Pilgrim Hospital Prefer PPO (MA, NH)
• Two levels of coverage:
- In-Network
- Out-of-Network
• Cost sharing for hospital services will fall into one
of three tiers as determined by the hospital’s tier
assignment.
Harvard Pilgrim Core Coverage PPO (ME)
The Harvard Pilgrim Core Coverage PPO allows members
to seek medical care from participating or non-participating providers.
• Individual members
- Copayment applies to each of the first three office
visits per calendar year to an in-network medical or
mental health provider
• Families
Copayment applies to the first six visits per calendar year
-
All subsequent visits are subject to deductible, then coinsurance in network.
Harvard Pilgrim PPO 3 Free PCP Plan (CT)
The Harvard Pilgrim PPO 3 Free PCP Plan allows members
to seek medical care from participating providers or nonparticipating providers.
3 Free PCP PPO services that are exempt from cost sharing
are:
• The first three In-Network medical office visits with a primary care provider.
• The first three In-Network behavioral health visits with a
licensed mental health professional.
POS Plans
The following information applies to the POS plans repesented in this document.
• POS members choose between in-network services or out-of-network services.
- in network covered services are either subject to copayment or are covered in full.
- Out-of-network covered services are subject to a deductible.
• Copayment and deductible information can be found on the member’s ID card.
• Use HPHConnect or call the Provider Service Center at 800-708-4414 for benefits limits, prerequisites and cost sharing information.
• Contact United Behavioral Health Access Line at 888-777-4742 for behavioral health services.
Harvard Pilgrim POS
POS members choose between in-network services
(performed by the member’s PCP and/or participating
providers with a proper PCP referral), or out-of-network
services (performed by participating providers without
the member’s PCP referral and/or by non-participating
providers).
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Harvard
Pilgrim Member ID Card Guide
These plan descriptions and ID cards are only a sample of our product portfolio. For a full list and
detailed plan information, check our online Provider Manual at www.harvardpilgrim.org.1
POS Plans, continued
Harvard Pilgrim Best Buy POS
The POS Best Buy is a POS option with deductible,
coinsurance and copayment cost-sharing components for
in-network and out-of-network services.
• Once the deductible is satisfied, services may be subject
to copayment or coinsurance.
• Some services are covered in full.
Medicare Plans
Harvard Pilgrim Medicare Advantage Plans—StrideSM (HMO) and StrideSM of New Hampshire (HMO)
A Medicare Advantage plan offered to Medicare beneficiaries in nine counties within Massachusetts (Bristol,
Norfolk, Suffolk, and Worcester), Maine (Cumberland
and York), and New Hampshire (Hillsborough, Rockingham, and Merrimack).
• Members must:
- Be enrolled both in Medicare parts A & B
- Choose a Primary Care Physician participating in
Harvard Pilgrim’s Medicare Advantage HMO network
Harvard Pilgrim Medicare Supplement Plan
A “Medigap” plan is a health insurance policy sold by a
private insurance company, to fill the gaps in Original
Medicare coverage.
• Members are not required to choose a primary care
physician.
• Members can receive treatment from any Medicare
participating provider in the United States.
• Member’s ID cards include the HPHC Insurance Company logo and “Medicare Supplement” as in the
sample provided.
Harvard Pilgrim Medicare Enhance Plan
A “wrap” plan that complements members’ Medicare
coverage by paying the Medicare deductibles and coinsurances after applicable plan copayments and
deductibles are met.
• Medicare Enhance plan options include:
- Medicare Enhance
- Medicare Enhance Preventive Plus
- Medicare Enhance Preventive Plus with deductible
Harvard Pilgrim Med Enhance Plan (CT)
A “wrap” plan that complements members’ Medicare
coverage by paying the Medicare deductibles and coinsurances. It supplements Medicare coverage in Connecticut and is also known as an indemnity plan. Members
must be enrolled in Medicare Parts A and B. They do
not choose a primary care physician and are required
to receive treatment from a Medicare participating
provider.
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Third Party Administrator
Plans Administered by Health Plans Plus
Health Plans, Inc. is a regional third-party administrator that offers administrative and consulting services to health and
benefit plan sponsors, including self-funded employers, associations of employers and union-negotiated
programs.
• Health Plans, Inc. Claims Call Center
- Indicate that you are calling about a Harvard Pilgrim member
- Call 800-532-7575, Mon.–Fri., 8:30 A.M.–5:00 P.M.
• For information regarding eligibility, specific benefits, and/or cost-sharing:
- Access the information via NEHEN, NEHENNet,
EDI Direct or by calling Health Plans, Inc. at
800-532-7575
• Contact United Behavioral Health Access Line at
888-777-4742 for behavioral health services
Dental Plan
The Essential Health Benefits (EHB) Pediatric Dental Plan
A comprehensive dental program covering a full range of services including cleanings, fillings, major and minor restorative work, and medically necessary orthodontics for covered members up to age 19. This benefit is offered to small
group (50 or fewer employees) and individuals in MA,
ME and NH, and is separate from any medical benefits covered under the member’s health plan.
Members of the Harvard Pilgrim EHB Pediatric Dental
Plan must receive care through UnitedHealthcare’s
Dental Benefit Providers, Inc., a nationwide network
of dentists, to get coverage for these services.
For information regarding member eligibility and
benefits refer to the phone number on the back of the member’s ID card or call 1-800-822-5353. Network providers can
also register and check member eligibility at www.dbp.com.
1 A member’s card image may vary by product and employer. Some ID cards display additional logos, such as HPHC Insurance Company or Health Plans,
Inc., wholly-owned subsidiaries of Harvard Pilgrim Health Care, Inc. National plan ID cards include logos for both Harvard Pilgrim Health Care and UnitedHealthcare. Members may also present additional types of employer-customized ID cards.
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