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HMO availability in the Diocese
actual availability is by zip code
United Healthcare | All counties except Sullivan and Ulster |
Aetna/US Healthcare | All counties |
Empire BC/BS 90/70 Empire BC BS High Deductible (HSA) | All counties |
MVP HMO & POS | Ulster, Dutchess, Putnam, Orange |
2011 HEALTHCARE REFORM
LIFETIME BENEFIT MAXIMUM
The plans have been amended to comply with all healthcare reform provisions that are effective in 2011, a significant change effective January 1, 2011:
The Annual and Lifetime Benefit Maximum has been eliminated.
DEPENDENT CHILDREN
Children remain eligible for coverage to age 30.
HOWEVER, NOW THEY DO NOT HAVE TO:
Live at home, be full time students, be unmarried, or have no dependents of their own.
EXTENSION OF DEPENDENT CHILDREN COVERAGE
Eligible children under age 30 whose coverage ended, or who were denied or were not eligible for coverage because the dependent d failed to meet the Plan's eligibility requirements, are eligible to enroll now. Employees may request enrollment for such children from this date through January 31, 2011. Enrollment will be effective January 1, 2011.
Managed care plans
The UHC Choice Plus, Aetna HMO, Empire BC/BS 90/70 and MVP plans are all managed care plans.
MVP - You must choose a Primary Care Physician (PCP) when you enroll and complete the HMO enrollment form. You can change your PCP at any time. If you need the care of a specialist, for the service to be covered in-network, you must get a referral from your PCP to a specialist who participates in the network.
Aetna- AETNA HMO (877) 380-8584
1. Go to www.aetna.com/docfind
2. Click on the "continue to DocFind" icon
3. Complete required items on General Search
4. In the Select Plan window, AETNA plans are sorted under subheadings. For AETNA HMO, select HMO under Aetna Standard Plans.
5. Click START SEARCH
You need to choose a PCP and get referrals for in-network specialist visits.
Mental Behavioral Supplemental - Therapy/Counseling
All members in the Aetna, United Healthcare and Empire BC BS Health Plans are receiving their benefits for Mental Behavioral supplemental through Cigna Behavioral Health.
You can contact CBH at 1-866-395-7794 and they will assist you in utilizing your mental health benefits.
If you have questions you can speak to Libby Miller at the Episcopal Medical Trust by calling her at 1-800-441-7118.
United HealthCare Choice Plus-
UnitedHealthcare (866) 204-8533
1. Go to www.myuhc.com
2. Under Links and Tools (upper right) select Find Physician, Laboratory or Facility
3. Select Search for Physician
4. For Selecta Plan, choose: UnitedHealthcare Choice Plus
5. Enter your zip code and click CONTINUE
6. Select a specialty and click CONTINUE
You do not need to choose a PCP or get referrals for in-network specialist visits. We strongly suggest, however, that you choose for yourself an United Healthcare doctor to coordinate and oversee your care. Like all managed care plans, United Healthcare requires that you or your doctor pre-certify many services such as hospital admissions, surgical procedures, and many diagnostic tests.
Empire BlueCross BlueShield (800) 352-3152
1. Go to www.empireblue.com/medicaltrust
2. Click on Find A Doctor
3. Click on Across The Country
4. A new window will open Under Select a Plan, choose the PPO/EPO option and continue with the directions on the screen, entering your geographic information.
Out-of-network options
The United Healthcare Choice Plus and MVP Point-of-Service plans also permit you to seek services outside the managed-care network. You must file claims for these out-of-network services and meet substantial deductibles and co-insurance percentages. Many out-of-network services also require pre-certification before you seek the services. Please be careful to check so you obtain pre-certification of the service when required.
Medical Rates and Plans
Comparison of Aetna & United HealthCare
Explanation of Prescription Benefits
See Also:
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