Updated August 2020. . These specialists cannot balance bill you and cannot ask you to give up your protections not to be balance billed. BENEFITS GUIDE For benefits and rates effective JULY 1, 2023 - JUNE 30, 2024 COMMONWEALTH OF MASSACHUSETTS EMPLOYEES ANNUAL ENROLLMENT: APRIL 5 - MAY 3, 2023 View this Benefits Guide online at mass.gov/GIC TABLE OF CONTENTS 3 What's New For the Upcoming Plan Year 6 Health Insurance Plan Locator Map 7 Health Insurance Plan Rates UniView Vision Life and Disability Medicare Eligible UniCare State Indemnity Plan UniView Vision Eye exams are often early indicators of major health conditions like diabetes, high blood pressure and high cholesterol. You, your provider or someone you trust may ask us to delay your case until you are ready. Enrollment depends on the plan . The GIC is the state agency responsible for the UniCare State Indemnity Plan design and for payment of all benefits. Although there are many similarities between Canada and the United States, there are many differences as well, including how each country handles healthcare and health insurance. Out-of-network doctors and facilities may be allowed to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. Member Appeal Request Form Find Care by Your Plan Not sure which plan you're in? Most often, this coverage is granted only if it would be detrimental to the recipients health to transport the recipient to an American healthcare facility. Charleston, WV 25321-0091. We will let you know in writing that we received your request for an appeal within five calendar days of receiving it. When you request a Fair Hearing, you can also ask for an opportunity to mediate your disagreement. If you need more time to gather your documents and information, just ask. Box 50540 Find a Doctor | UniCare - Anthem UniCare specifically excludes coverage for services or supplies it determines to be investigational and/or not medically necessary. PDF 2022-2023 BENEFITS OVERVIEW - archives.lib.state.ma.us Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. SUBMIT ALL CHANGES NO LATER THAN MAY 4, 2022. Annual enrollment is your once-a-year opportunity to change your health plan or coverage election. You may make certain changes to your elections within 60 days of a qualifying event. When our decision reduces or stops a service you are already receiving, you can ask to continue the services your provider had already ordered while we decide your case. If you call us, you must also file your appeal in writing. Aflac, a leading provider of fixed indemnity plans, said it is studying the proposal and isnt in a position to comment on it yet. PDF UNICARE STATE INDEMNITY PLAN COMPARE OUR PLANS - Anthem Effective July 1, 2021 - Mass.gov When your Fair Hearing case doesnt change our decision, we may require you to pay for the services you received while waiting for a decision. PDF Prior Authorization Request Form - UniCare Healthcare made easier UniCare's health plans are designed with you in mind. Charleston, WV 25305-0540 P.O. 2000-2021 UniCare. We can ask for 14 more calendar days if we need extra time. The point of contention is what if the amount that youre getting doesnt happen to be more than the expense, or you have an amount that is more than the expense. This is called balance billing. This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. Your browser is not supported. UniCare State Indemnity Plan. Your browser is not supported. Please update your browser if the service fails to run our website. Do you lose the whole thing in terms of tax exclusion? Bierma said. Provider Connect should be used for requesting OP authorizations. What types of fitness clubs qualify? (Opens in a new browser tab), What Are My Options If My Medigap Plan Is Discontinued? If you receive Medicare and find yourself frequently traveling to Canada, you may want to consider purchasing travel insurance from a private provider in addition to carrying Medicare benefits. Explore Our Health Plans | UniCare State Indemnity Plan - Anthem PDF Plan Benefits - PLUS - Amazon Web Services, Inc. If a policyholder was reimbursed more than the cost of a hospital stay, the question is whether they would be taxed on the full amount or would they only be taxed on the amount exceeding medical expenses, she said. Box 9016 . To file in writing, you can send your complaint to us by: You or your approved representative may ask to continue services when you first request an appeal by calling or writing to us at the Customer Care Center phone number or address above. If you need help with understanding the Fair Hearing or Mediation processes, you can contact our Community Outreach Specialists. Medical Policies | UniCare State Indemnity Plan - Anthem 2. x]~omhRazRbzfT_O|O\./?'uQs.0;?>zyOOeu}a%=o=hSkot ~oT>n Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. P.O. UNICARE STATE INDEMNITY PLAN FITNESS CLUB REIMBURSEMENT For UniCare State Indemnity Plan members What is the fitness club reimbursement? P.O. What happens next: This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. Welcome to UniCare | UniCare State Indemnity Plan Box 91 Check with your health and other insurance carriers about any plan or tier changes. Plans that violate the terms of fixed indemnity plans would lose their classification as excepted benefits, Zuckerman said. . These are called appeals and grievances. If we do not reach an agreement, you can still have a Fair Hearing. You may file a grievance if youre unhappy with our request for 14 more days to complete our review. The proposal would also change the tax treatment of employer-provided fixed indemnity benefits, Christa Bierma, a principal in professional services organization EYs national tax practice, said in an interview. Your dashboard may experience future loading problems if not resolved. UniCare Health Plan of West Virginia, Inc. MEDICARE HEALTH INSURANCE PRODUCTS . If you disagree with our decision about your care or services you requested, you can file an appeal. You cannot be balance billed for these emergency services. Account Login | UniCare State Indemnity Plan - Anthem Fax: 1-844-882-3520, Your care while you wait for a decision ?u.6@5#LKXOoB^ GQ^[30ua6+h| U~t \`D/_^~F .7U)^W&[>Og_>;S|7/n VC;v5ry;i$ nsDlpk+A/`?eA_>}t|Gs/UnpsPp TF7&_7UK?Mo/?v~g89;9. Activation Code Activation codes only apply to a very small percentage of our membership. Medicare Supplement, or Medigap, policies help cover some of the costs that Original Medicare does not. The choice is yours No network UniCare plans cover all providers. Register for an Online Account | UniCare State Indemnity Plan <> An appeal is a formal way of asking us to review and change a coverage decision we made. The Internal Revenue Service Building in Washington. PDF Know Your Gic Benefits - Commonwealth of Massachusetts Municipal UniCare Health Plan of West Virginia, Inc., an Anthem Company. If you need help with understanding the Appeals process, you can contact our Community Outreach Specialists. Cover emergency services by out-of-network doctors or specialists. These supplemental benefits are not a form of limited medical coverage and are therefore distinct from the other products, such as short-term limited duration insurance, discussed in the Presidents proposal.. UniCare State Indemnity Plan/PLUS Broad Network Health New England Regional Network HMO UniCare State Indemnity Plan/ Community Choice Limited Network . Welcome! To file by phone, call the Customer Care Center at 1-800-782-0095 (TTY 711). To file in writing, you can send your appeal to us by: Mail: To register, please select your identification type. If you are unhappy with the result of your appeal, you can ask for a Fair Hearing. Speak with a Licensed Insurance Agent 877-388-0596 - TTY 711 (M-F 8am-9pm, Sat 8am-8pm EST), Speak with a Licensed Insurance Agent Your dashboard may experience future loading problems if not resolved. Member Appeal Representative Form Out-of-network describes doctors and healthcare facilities that havent signed a contract with your health plan. The appeal can be made by phone or in writing. Charleston, WV 25301-3708. Mediation is guided by a professional mediator who does not take sides. 2 0 obj In such instances, the clinical guidelines used for review of these providers are "adopted" for those indicated purposes. We want to make the decision that supports your best health. It may also occur when there is a need for provider education. can be used if someone is submitting the appeal for you. For All Plans For Total Choice, PLUS, and Community Choice Plans For PLUS and Community Choice Plans For All Plans Behavioral Health Contracted Providers Receive reimbursement for up to $100* per family on your membership at a fitness club or other fitness activities such as yoga and Zumba classes, personal trainers, sports teams, and more. Basic search as a guest Select a plan and find out if a doctor, hospital, or other care provider is in-network. , Your care while you wait for a decision 1 And, of course, early detection can mean lower health care costs for everyone. The IRS is proposing that the full amount is taxable to employees because its not a reimbursement thats excluded from employee income by section 105(b) of the tax code, Bierma said. About Us | UniCare State Indemnity Plan - Anthem You have 60 calendar days after you get a written notice from us to file an appeal. The UniCare State Indemnity Plan follows all Medical Policies, Clinical Criteria, and certain adopted Clinical UM Guidelines, and processes claims in accordance with these determinations. Fax: 800-848-3623 . Free Insurance Comparison Secured with SHA-256 Encryption Unicare offers health insurance plans, pharmacy plans, dental insurance, life insurance, disability insurance, behavioral health plans, COBRA, short-term insurance plans, and flex pay accounts There are eleven insurance plan options for individuals who opt for an MHealth Insured Elect plan The proposal would prevent employers from pairing fixed indemnity coverage with minimum essential, or bare bones plans such as preventive care-only plans, Zuckerman said. Lets make healthy happen. PLAN BENEFITS - PLUS For UniCare State Indemnity Plan/PLUS members Effective July 1, 2019 Summary of PLUS plan benefits This summary shows the PLUS plan benefits for many medical and behavioral health services. UniCare Customer Care Center 1-800-782-0095 (TTY 711) Although Medicare does not directly provide benefits to Americans in Canada, there are a few exceptions based on situational challenges. How to Renew GET YOUR ID CARD As a UniCare member, you have the right to ask us to reconsider decisions we have made and to make complaints. endobj The Biden administration is trying to crack down on perceived abuses by employers that offer fixed indemnity coverage with characteristics of comprehensive medical coverage, but its proposal looks headed for a fight with the insurance industry. and sending it to us. Member Grievance Form As a UniCare member, you have the right to ask us to reconsider decisions we have made and to make complaints. In these cases, the most they may bill you is your plans in-network cost-sharing amount. Find a Plan Need an account? Log in to your account and send us a message. This can happen when you cant control who is involved in your care like when you have an emergency or when you schedule a visit at a facility in your plans network but are unexpectedly treated by an out-of-network doctor. 1 0 obj Please check your urgent care center's website for additional information. Log in to keep reading or access research tools. UniCare is the health benefits company trusted by more individuals insured through the Commonwealth o 877-388-0596 - TTY 711 (M-F 8am-9pm, Sat 8am-8pm EST). Enrollment depends on the plans contract renewal. Upon receipt of your appeal request, you also have access to a copy of your appeal case file. To file by phone, call the Customer Care Center at 1-800-782-0095 (TTY 711). When our decision reduces or stops a service you are already receiving, you can ask to continue the services your provider had already ordered while we are making a decision on your appeal. PDF Plan Benefits - Community Choice - Amazon Web Services, Inc. Learn More Welcome to the UniCare State Indemnity Plan We offer a variety of plans for people insured through the Group Insurance Commission (GIC). To check your plan benefits or to locate a vision care provider near you, contact the UniView Vision member services office at 888-884-8428. Charleston, WV 25321-0091 Health Insurance for Providers | Unicare.com - Anthem You must ask us to continue your services within 10 calendar days from the date of the notice that says your care will change or by the time the action takes effect. Find Care | Unicare.com - Anthem Fax: 1-844-882-3520 Taxpayers have relied on a 1969 IRS Revenue Ruling (69-154) that only payments that exceed their medical expenses are excluded from income for tax purposes, Bierma said. Student ID . Part of the reason for this is that Canada has its own healthcare system for its citizens, but another element of the equation is that Medicare requires a contractual agreement between itself and participating healthcare providers in order to cover costs. If you receive other services at these in-network facilities, out-of-network doctors or other healthcare professionals cannot balance bill you, unless you give written consent to give up your protections. Find the information you need about your healthcare benefits by chatting with a representative in real-time. Currently we represent 18 organizations, which offers 52,101 products in your area. It cant be on a per-term or per-service basis, she said. 200, Charleston, WV 25311, in writing or by phone. Youre never required to give up your protections against balance billing. Authorizations must be submitted to Beacon. 2023-2024 BENEFITS GUIDE - Mass.gov Enroll, Make Changes, or Decline Coverage HealthCompare Insurance Services represents Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. What Are My Options If My Medigap Plan Is Discontinued. Attn: Grievance & Appeals Department Explore Our Plans Search your medical plan without logging in. The Biden administration is trying to crack down on perceived abuses by employers that offer fixed indemnity coverage with characteristics of comprehensive medical coverage, but its proposal looks headed for a fight with the insurance industry. You can also ask a trusted representative to make that request for you. 7f3c4# B7*d`THo Authorizations for UniCare Members . Address: City, state and ZIP code: Referring provider Contracted Noncontracted (complete the below box if individual provider is NOT billing) Servicing provider Contracted Noncontracted (complete the below box if individual provider is billing) There will be a lack of consensus on how fixed indemnity payments should be treated for tax purposes, Bierma said. When you visit a doctor or other healthcare specialist, you may owe certain out-of-pocket costs, such as a copay, coinsurance, and/or a deductible. Andover, MA 01810-0916 . UniCare Insurance Review & Ratings (2023) | USInsuranceAgents.com Treasury, IRS Want to Clarify Fixed Health Payment Treatment (1), Biden Administration Cracks Down on Junk Health Insurance (2), Proposal seeks to prevent employers from circumventing Obamacare. If we have all the information we need, we will call you and send you a written notice of our decision within 72 hours of receiving your request. If your appeal review needs to be expedited (reviewed more quickly than the standard time frame) because you have an immediate need for health services, you do not need to follow up in writing after you call us. You can also send us a complaint by filling out a 350 Capitol St., Room 251 The coverage is considered an excepted benefitone not subject to Affordable Care Act mandates such as preventive care coverage requirements and prohibitions on lifetime and annual limits on essential health benefits. 1. This program may or may not be included in your UniCare coverage. Effective July 1, 2021 - Mass.gov If you visit a doctor or specialist or visit a healthcare facility that isnt in your health plans network, you might owe additional charges or be responsible for the entire bill. It is not going to be well taken.. UniCare State Indemnity Plan | LinkedIn Welcome to UniCare | UniCare State Indemnity Plan Stay Informed About the COVID-19 Virus Your health is our priority. Appeals extensions: UniCare State Indemnity Plan . If you think you've been wrongly billed, you can contact the Employee Benefits Security Administration (EBSA), the No Surprise Help Desk (NSHD) at 1-800-985-3059 or cms.gov/nosurprises or your State Regulator, if your . A Non-Government Resource For Healthcare All Rights Reserved 2023. Andover, MA 01810. Questions?Visitunicarestateplan.comorcallUniCare CustomerServiceat877-633-6396. AI-powered legal analytics, workflow tools and premium legal & business news. UniCare provides administrative services such as claims processing, member services, and utilization management for the GIC. Please update your browser if the service fails to run our website. If you have questions about your benefits, call the DXC Technology Help Desk at 888-483-0797. Traditional fixed indemnity insurance pays a specific amount of cash, such as $100 per day for a hospital stay. Effective July 1, 2021 - Mass.gov You can call the Customer Care Center at 1-800-782-0095 (TTY 711) if you need help filing an appeal. You may also ask for 14 more days if you need more time. without CIC. This would require international contractual obligations between the United States government and the Canadian government and would likely become a complicated financial situation quickly, especially considering each provider would need to to receive payment upon the provision of healthcare services. In Canada, citizens take advantage of publicly subsidized healthcare for all Canadians. You can use the Find Care tool on our website to find doctors and hospitals in your plans network. Last Updated 07/21/2023 The dates below are used for Medicare compliance and do not apply to provider data updates. Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit. You would get the $100 either way, she said. Login Now Member ID If we sent you a member ID card, enter that ID number so we can find you in our system. The IRS issued chief counsel advice dated May 9 but released in June making similar clarifications to the tax treatment of wellness indemnity plan payments from employer-funded plans. If you are not happy with how we resolved your issue, you can file an appeal with our Grievances and Appeals Department. Another situation where Medicare may cover healthcare provided in Canada would be when transport to an American healthcare provider would not be feasible. Medicare.Org Is A Non-Government Resource That Provides Information Regarding Medicare, Medicare Advantage, And More. You can ask someone you trust (such as a legal representative, a family member or friend) to file the complaint for you. Effective July 1, 2021 . PDF The Commonwealth of Massachusetts Group Insurance Commission Before and during the appeal, you or your representative can see your case file, including medical records and any other documents and records being used to make a decision on your case. 2 6/01/2021 1:39 PM UniCare Community Choice Handbook (20212022)- . If you think youve been wrongly billed, you can contact the Employee Benefits Security Administration (EBSA), the No Surprise Help Desk (NSHD) at 1-800-985-3059 or cms.gov/nosurprises or your State Regulator, if your plan is fully insured, to ask whether the charges are allowed by law. Get the mobile app Get translation and interpretation services free of charge. Learn about your benefits, available providers, and member resources that offer convenience, support, and savings. 7 talking about this. Supplemental benefits are highly valued by Americans who will demand that access to these products be maintained and supported, Neely said. Questions about medical or behavioral health coverage UniCare State Indemnity Plan . City of Lowell 4 0 obj with CIC. Monday through Friday, 5 a.m. to 8 p.m. PT Box 9016. Canada is one of the United States closest allies on the world stage, but it is also a very important trade partner. We are uniquely positioned to tailor what we do to those who receive their health coverage through the GIC. Contact Us | UniCare - Anthem We will not make things hard for you or take any action against you for filing a complaint. endobj Effective for dates of service on and after March 1, 2019, new clinical criteria will be included in our clinical criteria review process. You also arent required to receive care out of your plans network. For self-funded plans, claims are administered by UniCare Life & Health Insurance Company. Access clinical criteria for injectable, infused, or implanted prescription drugs and therapies covered under the medical benefit. You can ask questions and give any information (including new medical documents from your providers) that you think will help us to approve your request. Follow View all 13. WVCHIP Your pharmacy benefits are covered under the state program and managed by ESI. To contact the reporter on this story: Sara Hansard in Washington at shansard@bloomberglaw.com, To contact the editors responsible for this story: Brent Bierman at bbierman@bloomberglaw.com; Cheryl Saenz at csaenz@bloombergindustry.com. You can also ask a trusted representative to make that request for you. The proposal is trying to prohibit employers from trying to cobble together fixed indemnity coverage with some other minimum coverage that doesnt have to comply with Affordable Care Act mandates, Julia Zuckerman, vice president and senior consultant of employee benefits consulting firm Segals compliance practice, said in an interview. You can also decide not to go through mediation and just ask for a Fair Hearing. Effective for dates of . For a complete and detailed description of benefits and Plan provisions, see your member handbook. You'll also find a list of what's new for each plan on July 1, 2023. Medical Insurance | City of Somerville P.O. Check pages 9-11 for product details The Plan offers a $100 reimbursement benefit toward membership at a fitness club. We provide this list of non-hospital-owned urgent care centers in Massachusetts, which is updated periodically. Thats not fixed indemnity coverage.. UNICARE STATE INDEMNITY PLAN BASIC Member handbook for active employees and Non-Medicare retirees Effective July 1, 2021 SERIES 1. If a State Fair Hearing is requested, the State will hear your case and give you a decision in writing within 90 days of the date you asked for a State Fair Hearing. Yes, your form shows which months you had Group Insurance Commission coverage with Harvard Pilgrim Health Care, Tufts Health Plan, or the UniCare State Indemnity Plan. This includes services you may receive after youre in stable condition, unless you give written consent to give up your protections against balance billing once youre stable. ceH7[$G;d' M)H;ZE .QjU3Mb>T.]MNFc5}&&qY7VGh4~[^;XRZ8f?AdC[?~woAqy0-~.
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