Wentworth Institute of Technology
Effective Date January 1, 2014
Agenda
Agenda
 Welcome to Tufts Health Plan
 Provider Network
 Plan Design
 Prescription Coverage
 Transition of Care
 Value Added Benefits
 Customer Service
 Member Enrollment Kit Explanation
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Welcome To Tufts Health Plan!
 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
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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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Vision Services
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
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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 Assistance
(for Ongoing Medical Services)
 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
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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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Important Important
Reminders
Reminders
(!) 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
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Things to Remember …
 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
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Questions and Answers
We look forward to working with
Wentworth Institute Employees & Families!
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Going the Distance to Deliver a Healthier Future