Your Evidence of Coverage (EOC) document tells you when you can end your membership in the plan. 2023Tufts Associated Health Plans, Inc. All Rights Reserved ---, Translation Services: | | franais | | | Kreyl Ayisyen | | italiano | | | | polski | portugus | | espaol | ting Vit | deutsch | | Make a list of all prescription drugs, over-the-counter medications, vitamins, diet supplements, natural remedies, and herbal preparations that you take. You are allowed one Annual Routine Hearing exam each plan year. We are pleased you have chosen this Point of Service (POS) Health Plan. PDF City of Lawrence The form asks your physician for information regarding your diagnosis, what other drug(s), if any, has been prescribed for the diagnosis and why it has not worked, and other questions. 1 Sept. 30). Fri. from Apr. For example, if Drug A and Drug B both treat your medical condition, Tufts Medicare Preferred HMO may not cover Drug B unless you try Drug A first. What is a Tufts Medicare Preferred HMO plan Organization Determination? Each column in the "Summary of Benefits" represents a specific product line offered by Tufts Medicare Preferred HMO - Basic, Value or Prime. You can be outside of our service area for up to 6 consecutive months and still be covered for emergency and urgently needed care. Ultrasounds: $100 per day; Others: $200 per day for other services. If coverage is not approved, we will explain why coverage was denied and how to request an appeal call a "redetermination" if you disagree with our decision. Have a list of the generic names of your medications, especially when traveling overseas. Introduction Introduction Welcome to Navigator byTufts Health Plan ("Navigator"). See your Evidence of Coverage (EOC) document for additional details. Where can I find additional information on my plan's prescription drug quality assurance? If you are selected to join a medication therapy management program, we will send you information about the specific program, including information about how to access the program. Information contained in the ANOC includes: If you are renewing into the same plan, you will receive along with your ANOC, a copy of the Evidence of Coverage (EOC) for the plan you are enrolled in. Examples of qualified fitness facilities and health clubs include: If you join a health club or fitness facility that meets the above requirements, you are eligible to receive up to $150 per calendar year toward club membership fees and/or exercise classes. For prescription drug related questions, please call 8 a.m. 8 p.m., 7 days a week (Mon. If you have questions about this process, or if you want to inquire about the status of a grievance or appeal request, you, your physician or your appointed representative may contact us at 1-855-670-5934 (TTY: 711). Tufts Health Plan Medicare Preferred takes the confidentiality of your personal health information very seriously. 1 Sept. 30). Tufts Health Plan Medicare Preferred Ending your membership in Tufts Medicare Preferred HMO or Supplement plans may be voluntary (your own choice) or involuntary (not your own choice). In addition, your EFT deduction will be identified in your monthly bank statement as "Medicare Preferred". 1 Sept. 30). What if my prescription drugs cannot be filled? This would lower your share of the cost for the drug. Fri. from Apr. 705 Mt. If you have questions about any of this processes, or if you want to inquire about the status of a coverage determination request, you, your physician or your appointed representative may contact us at 1-855-670-5934 (TTY: 711). A notice to our members regarding a security incident. Learn more about filing an appeal or coverage determination in Chapter 9, section 1-9 and a grievance in Chapter 9, section 10 of your EOC (Chapter 7 for HMO No Rx Plans). Use the search tools linked below to find primary care doctors, dental care providers, EyeMed Vision Care providers, network pharmacies, and more . A notice to our members regarding a security incident. $150 reimbursement per year for fees related to weight management programs like WeightWatchers, Jenny Craig and hospital-based programs. Staying fit can help keep you healthy. Canton, MA 02021-1166 (774) 228-7135 View Bellingham, MA 02019 Janet Sherman Psychologist, PhD Verified I am a licensed psychologist who has had extensive experience working with adults, adolescents and children in. Health Plan for Faculty and Staff | Access Tufts For more information about managing medication, visit the Medication Management Therapy page. How do I appoint a representative and authorize them to act on my behalf? There are only certain times during the year, or certain situations, when you may voluntarily end your membership in the plan. Thats why we work hard to create affordable health plan options for our clients and members. Where can I view the Tufts Health Plan Medicare Preferred website's legal, security, and privacy practices? You can ask us to waive coverage restrictions or limits on your drug. Fri. from Apr. Learn More Learn More 1 Sept. 30). What is a Tufts Medicare Preferred HMO plan Coverage Determination? Fri. from Apr. After hours, weekends and on holidays, please leave us a message. Step Therapy: In some cases, Tufts Medicare Preferred HMO requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. These services generally include computed tomography (CT) and magnetic resonance imaging (MRI). Prior Authorization: Tufts Health Plan Senior Care Options requires you or your physician to get prior authorization for certain drugs. 1 Sept. 30). Where can I find Tufts Health Plan Medicare Preferred Privacy Practices information? If you are unsure, check with your benefits administrator before enrolling. However, if taken improperly, they could seriously jeopardize your well being. Enter your zip code to see the plan premium. Quincy, MA 02171. What if your drug requires Prior Authorization? Multi-language Interpreter Services (Tufts Health Unify), Understanding Your Behavioral Health Benefits, Multi-language Interpreter Services (Tufts Health Unify). Together, we're delivering ever-better health care experiences to everyone in our diverse communities. - Fri. from Apr. For example, Tufts Medicare Preferred HMO provides 30 tablets per prescription for zolpidem. Discuss your medical condition or concerns with your PCP. 1 Sept. 30). Remember, you do not need to pay anything extra to participate. Learn More Tufts Health Plan In these instances, you have the right to make formal complaints to Tufts Health Plan Medicare Preferred. If you make your request through email please be sure to include your full name and mailing address in the message bodyto avoid any delays in receiving your copy of theProvider/Pharmacy Directory. member ID card, please call us at: 800-462-0224, Point32Health is the parent organization of Tufts Health Plan and Harvard Pilgrim Health Care. Where do I send this form? Using the same pharmacy is especially important when you are trying out a medication for the first time because they will be better able to monitor any potential interactions between medications. A team of pharmacists and doctors developed the programs for us. What happens if I'munaware of changes or updates to our Formulary? Always tell your doctor or nurse about any past allergic reactions. $0 per visit in-network; $65 per visit out-of-network. What if your drug is excluded from coverage? The Tufts Health Plan Senior Care Options Appeals and Grievances Department may assist you with this process. After hours and on holidays, please leave a message and a representative will return your call the next business day. Fri. from Apr. Members can use authorized or unauthorized level of benefits, but will have higher cost-share for unauthorized care (i.e., care received without a referral or from out-of-network providers). You can ask Tufts Medicare Preferred HMO to make an exception to our coverage rules. An important part of coordinating your care is when your PCP refers you to a specialist for services he/she isnt able to provide. Call the specialists office to make an appointment. If your drug is contained in tier 2, tier 3, or tier 4, you can ask us to cover it at a lower cost-sharing tier applicable to your brand or generic drug. Your PCPs referral circle represents the specialists and facilities your PCP has selected to work with in his/her area. Or by fax to: 1-617-972-9405 or 1-617-972-9487. If our initial decision is to deny your request, you may appeal the decision. Tufts Health Plan provides members with a comprehensive network of health care professionals and providers. This request includes the right to request a special type of coverage determination called an exception if you believe: Step 1: What You Need to do to Request Coverage. Keep this list in your purse or wallet and show it to your health care provider during an office visit, emergency room visit, or upon admission to a hospital or skilled nursing facility. We must also explain how you can make a complaint about our decision to end your membership. You have been prescribed a drug that is not on your Plans list of covered drugs. If you are a Tufts Health Together (MassHealth), Tufts Health RITogether (Rhode Island Medicaid), Tufts Health Unify (Medicare-Medicaid plan), or Tufts Health Plan Senior Care Options (65+ Medicare-Medicaid plan) member: You may need to renew your coverage this year. Your PCP knows your medical history and will be involved in coordinating all aspects of your care. An organization determination is our initial decision about whether we will cover the medical care or service you request, or pay for a service you have received. Call Member Services at 1-800-701-9000 (HMO) or 1-866-623-0172 (PPO) (TTY: 711). If you have questions about any of these processes, or if you want to inquire about the status of a coverage determination request, you, your physician or your appointed representative may contact us at at 1-800-701-9000 (HMO) or 1-866-623-0172 (PPO) (TTY: 711). Related. To Receive Your Wellness Allowance, complete the fitness benefit form below: Tufts Health Plan Medicare Preferred HMO Plans Wellness Allowance Reimbursement Form (PDF), Tufts Health Plan Senior Care Options Wellness Allowance Reimbursement Form (PDF). The EOCs are also available on the plan documents page of our website. Representatives are available 8 a.m. 8 p.m., 7 days a week (Mon. Our Member Services team knows how our plans work and can answer your questions. Interested in learning more about the aggregate number of appeals, grievances and exceptions filed with Tufts Health Plan Senior Care Options? Where To Find More Information About Your Prescription Drug Coverage. Each year an EOC booklet is mailed to you. $150 per year towards eyewear purchased from any provider. This is the most you will pay in a plan year for covered medical expenses. The confidential voice mail box is checked routinely by our on-callpharmacist to address requests for Part D pharmacy coverage. If you are requesting a formulary exception, your physician must provide a statement to support your request. An organization determination is our initial decision about whether we will provide the medical care or service you request, or pay for a service you have received. Navigator by Tufts Health Plan Four helpful things for Tufts Health Plan Senior Care Options members with a prescription drug plan to know: 1. You have the right to ask us for an "exception" if you believe you need a drug that is not on our list of covered drugs (formulary) or believe you should get a drug at a lower co-payment. Hearing requests should be sent to: Executive Office of Health and Human Services If your brand drug is in Tier 4: Non-preferred Brand Drugs, you can ask us to cover it at the cost-sharing amount for Tier 3: Preferred Brand Drugs. October 15 through December 7 is the Annual Election Period for Medicare Advantage plans and Prescription Drug Plans (PDPs). The service area for this plan are:Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk, Hampden, or Worcester counties. If you have a medical emergency, get help as quickly as possible by calling 911 for an ambulance or by going to the nearest emergency room, hospital, or urgent care center. If you would like a copy of our Notice of Privacy Practices sent to you, just call Member Services at 1-800-701-9000 (HMO) or 1-866-623-0172 (PPO) (TTY: 711). What happens if I am unaware of changes or updates to the Formulary? If you have any questions, just call Member Services at 1-800-701-9000 (HMO) or 1-866-623-0172 (PPO) (TTY: 711). If you choose to switch to Original Medicare during this period, you can also enroll in a separate Medicare prescription drug plan at the same time. Coverage Determination Request Form (PDF). Includes worldwide emergency transportation coverage. Auburn Street People with Medicare Part A are automatically deemed to meet the Massachusetts minimum coverage requirements and therefore are not required to file a Form MA 1099-HC. Auburn Street Many health plans require a referral or prior authorization for coverage of services, and not all services are covered depending on your health plan. If you are unable to find your Tufts Health Plan If you are a Tufts Health Together (MassHealth), Tufts Health RITogether (Rhode Island Medicaid), Tufts Health Unify (Medicare-Medicaid plan), or Tufts Health Plan Senior Care Options (65+ Medicare-Medicaid plan) member: You may need to renew your coverage this year. For example, the last ANOC/EOC was mailed in September for delivery to you no later than September 30th, and contained information for the following plan year. Retiree Health Plans | Access Tufts What if you just joined Tufts Health Plan Senior Care Options and did not know that your drug was not covered? A notice to our members regarding a security incident. Learn more. Fri. from Apr. The Transportation Security Administration websitehas helpful tips to get you through airport checkpoints quickly and securely, including which medications and supplies you can transport by plane. During this period, anyone already enrolled in a Medicare Advantage Plan can switch to Original Medicare. Read here. These screenings and tests help detect conditions that can lead to a heart attack or stroke. Below are some helpful Medication Travel Tips: A vacation override allows you to bring a larger supply of your prescription medication with you when traveling out of the country or to a remote location. If you require urgently needed care: If you are outside of our service area and cannot get care from a network provider, our plan will cover urgently needed care that you get from any provider. The programs can help make sure that our members are using the drugs that work best to treat their medical conditions and help us identify possible medication errors. Up to 2 aids per year through Hearing Care Solutions: $250 copay for Standard level hearing aid; $475 copay for Superior level hearing aid; $650 copay for Advanced level hearing aid; $850 copay for Advanced Plus level hearing aid; $1,150 copay for Premier level hearing aid. When you are requesting a formulary, tiering, or utilization restriction exception, you should submit a statement from your physician supporting your request. For all plan information, contact UNITE HERE HEALTH: 833-637-3519. In this situation, you will have to pay the full cost (rather than paying just your copayment) when you fill the prescription. These programs are voluntary and free to members. Use the plan name to search for providers that accept that plan. Where can I find additional information on benefits, service area, conditions/limitations and out-of-network coverage? Call Member Services at 1-855-670-5934 (TTY: 711) for a copy of our Tufts Health Plan Senior Care Options Appeals and Grievances Report. For perks effectual July 1,2022 - Joann 30,2023. Fri. from Apr. If you do go to an out-of-network pharmacy for the reasons listed above, you will have to pay the full cost (rather than just paying your copayment) when you fill your prescription. Mail the completed form with your receipt to the address on the form. For example, these programs help us make sure that our members are using appropriate drugs to treat their medical conditions and help us identify possible medication errors. If your generic drug is in Tier 2: Non-preferred Generic Drugs, you can ask us to cover it at the cost-sharing amount for Tier 1: Preferred Generic Drugs. You do not need to call your PCPs office first when you have a medical emergency. Representatives are available 8 a.m. 8 p.m., 7 days a week (Mon. Make a photocopy of one of the following: We encourage you to keep copies of all the paperwork you send to us. Here are some easy ways to stay safe and reduce or eliminate medication mishaps: By following these suggestions, you can help make sure the medications that are prescribed for you are safe and accurate. When you join a plan offered by Tufts Health Plan Medicare Preferred, Medicare will tell us how much extra help you are receiving and we will then let youknow the amount you will pay. MEMBER GUIDE - Tufts Health Plan 1 Sept. 30). Representatives are available 8 a.m. 8 p.m., 7 days a week (Mon. Is my Pharmacy in the Tufts Health Plan Senior Care Options network? Tufts Health Plan Doctor Search - Tufts Medicare Preferred Learn more about filing a coverage determination in Chapter 8, section 1-9 of your EOC. If you havent had a chance to prepare your medication list but need to visit the doctor or go to the emergency room, simply gather all the bottles of your medications/vitamins/herbal preparations, etc. No, if you are a member of one of the following plans Tufts Medicare Preferred HMO or Tufts Medicare Preferred Supplement plans, you are not required to submit the Form MA 1099-HC. This form is used to request coverage for medications that require prior authorization, step therapy exceptions, quantity limit exceptions, tier exceptions and coverage of non-formulary or new-to-market drugs. Introduction - Mass.gov 100 Hancock Street, 6th floor Your physician should send the completed form to: Attn: Pharmacy Utilization Management Department A notice to our members regarding a security incident. Representatives are available 8 a.m. - 8 p.m., 7 days a week (Mon. Representatives are available 8 a.m. 8 p.m., 7 days a week (Mon. Our fitness club reimbursement is part of our commitment to helping you lead an active lifestyle. Can I apply for an exception if my drug requires Prior Authorization, Step Therapy, has a Quantity Limit, or is Non-formulary? A pharmacist or other health professional will give you a comprehensive review of all your medications. As soon as possible, you or someone else should call to tell us about your emergency (usually within 48 hours), because we need to follow up on your emergency care. A notice to our members regarding a security incident. Physical, Occupational, and Speech Therapy. The Prescription Drug Transition Process (PDF) document can answer the following questions: We have programs that can help our members with special situations. For questions call Member Services at 1-855-670-5934 (TTY: 711). View the Tufts Health Plan Coverage webpage for details on submitting a Coverage Determination online. Our representatives are available 8 a.m. 8 p.m., 7 days a week (Mon. 1 Sept. 30). Please make a note to look for these documents in the mail in September. A tier number will be listed next to each drug. Faxed requests can be sent 24-hours a day, 7 days a week. Please refer to your Evidence of Coverage (EOC) document for additional details. Reimbursement forms for 2023 must be received by Tufts Health Plan no later than March 31, 2024. Hearing or speech-impaired members with TTY machines can call the Massachusetts Relay Association at 711for assistance contacting your PCP after hours. If our initial decision is to deny your request, you may appeal the decision. You, your physician or your appointed representative may file a coverage determination by calling Member Services at 1-800-701-9000 (HMO) or 1-866-623-0172 (PPO) (TTY: 711). What are the Quality Assurance Policies and Procedures? . Include the exact name of the prescription, dosage, frequency that it is taken, and the name of the physician who prescribed it. If you don't get approval, Tufts Health Plan Senior Care Options may not cover the drug. If you want a Provider/Pharmacy Directorymailed to you, or if you need help finding a network provider and/or pharmacy, please call 1-800-890-6600 (TTY: 711). If a non-contracting provider renders . The Wellness Allowance Reimbursement Form has all the instructions you need for getting your reimbursement. Fri. from Apr. Call Member Services for a copy of our Tufts Medicare Preferred HMO Appeals and Grievances Report. If your drug has a quantity limit, you can ask us to waive the limit and cover more. $20 per visit in-network; $65 per visit out-of-network. Seeing doctors inside the network will generally have lower costs for services than seeing a doctor outside of the network. Beneficiaries interested in qualifying for extra help with Medicare Prescription Drug Plan costs should call: The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. Call Member Services at 1-855-670-5934 (TTY: 711). Fri. from Apr. Fri. from Apr. When you join an HMO plan, you select a doctor to be your Primary Care Physician (PCP). Please refer to your EOC for additional details. Health Insurance Plan Options For Benefits Prior to June 30, 2023: Table of Contents Mass General Brigham Health Plan (Previously AllWays Health Partners) Harvard Pilgrim Health Care Health New England Tufts Health Plan UniCare Prescription Drug Benefits - Express Scripts RELATED A notice to our members regarding a security incident. Prescriptions are medications that treat illness and help maintain your health. $0 per service in-network; 40% coinsurance out-of-network. One doctor (your PCP) oversees your care and collaborates with a team of specialists to help you get the care you need. Review the below detail and enjoy your trip! A .mass.gov website includes to an official government organization in Maryland. 1-617-673-0956. In-network: Medicare-covered services plus additional telehealth services. If you are requesting a formulary or tiering exception, your physician must provide a statement to support your request. A specialist isnt able to refer you to another specialist. Member cost share varies by tier. To help monitor quality of care and manage health care costs, Tufts Health Plan Senior Care Options conducts utilization management activities for all its members. Where can I find information about using my prescription drug plan? Frequently Asked Questions | Tufts Health Plan Medicare Preferred If any new medications have been prescribed, make sure you have the prescriptions to take with you. Important Information. The withdrawal will occur on the following business day if the 9th falls on a Saturday, Sunday, or holiday. This was designed to help consumers compare coverage not only within Tufts Medicare Preferred HMO product lines (Basic, Value and Prime) but our competitors as well.
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