Employee and Non-Medicare Retiree/Survivor Health Plan Changes
Effective July 1, 2013

ALL HEALTH PLANS

Wellness Benefits:  To encourage exercise and smoking cessation, the GIC is implementing two new benefits.:

    • Gym membership reimbursement benefits of at least $100 per family.  Some plans supplement this amount. 
    • Tobacco and smoking cessation counseling benefits will be standardized across all plans to include individual or group counseling via phone or face to face up to 300 minutes with no copayment.  There are, no restrictions to counseling access, and no requirement to complete a smoking cessation program or treatment( including nicotine replacement products) as a pre-condition of access to counseling

Portable Oxygen Concentrators will be covered under the Durable Medical Equipment benefit.

State and Federal Mandates 

    • Hearing Aids covered up to $2,000 per ear  per person for children up to age 22 per 36-month period.
    • Cleft Lip and Cleft Palate coverage for children under age 18.  Includes medical, dental, oral and facial surgery; surgical management; and follow-up care for the treatment of cleft lip and cleft palate.
    • Oral Cancer medications will be covered on a basis no less favorable than covered for intravenously administered or injected cancer medications.
    • Women’s Preventive Care, as required by federal health reform, not subject to deductibles or copays New Summary of Benefits and Coverage document, as required by federal health care reform, provides a summary of a GIC plan’s benefits and cost-sharing requirements.  View and print all GIC SBCs from our website:  www.mass.gov/gic/sbc.

        Employee and Non-Medicare Plans  

  • Fallon Select Plan

     Hospital Copay Tiering Implemented:  Fallon Select will tier hospitals based on quality and/or cost with copays of $250, $500 and $750. 

     Neighborhood Health Plan

     Maintenance Medications:  members taking certain maintenance medications will be required to fill their prescriptions in 90-day supplies, through either mail order or certain retails pharmacies.

     Tufts Navigator and Tufts Spirit Health Plans

     Mental Health and Substance Abuse Benefits Carrier:  The GIC has selected Beacon Health Strategies as the new mental health carrier.  There are no mental health and substance abuse benefit changes and Beacon will work with members and their providers to ensure a smooth transition. 

     All UniCare State Health Plans

    • PCP Copay: In keeping with the GIC’s efforts to encourage care coordination by Primary Care Providers (PCPs), PCPs will no longer be tiered and the copay will be $20.
    •  Specialist Copays:  Copays for specialists will change to $25 Tier 1, $30 Tier 2, and $45 Tier 3.
    • Mental Health and Substance Abuse Benefits Carrier:  The GIC has selected Beacon Health Strategies as the new mental health carrier.  There are no mental health and substance abuse benefit changes and Beacon will work with members and their providers to ensure a smooth transition.  

This information provided by the Group Insurance Commission.