Employee and non-Medicare Retiree/Survivor Health Plan Changes Effective July 1, 2017

NEW PRESCRIPTION DRUG FISCAL YEAR DEDUCTIBLE

There will be a new separate prescription drug deductible of $100 individual/$200 family for all health plans except Fallon Health Direct and Select. 

Oral chemotherapy and preventive care medications covered under the Affordable Care Act will not be subject to the deductible.

FISCAL YEAR MEDICAL DEDUCTIBLE

The fiscal year deductible will increase to $500 individual/$1000 family (regardless of family size).  For the Fallon Health Direct and Select plans, the deductible will increase to $550 individual/$1,100 family.

HEALTH PLANS CLOSED TO NEW MEMBERS

Due to concerns about significant premium increases and spending beyond those premium rates, Fallon Health Select Care, Harvard Pilgrim Independence Plan, and Tufts Health Plan Navigator will be closed to new members:

  • Existing members can stay in or leave these plans and can change their coverage (e.g., individual to family) within 60 days of a qualifying event; however,
  • New employees joining the GIC cannot enroll in these plans;
  • Individuals who are picking up GIC health insurance coverage during Annual Enrollment or within 60 days of a qualifying event cannot enroll in these plans; and
  • Existing GIC members currently enrolled in other health plans cannot switch into these plans.

MEDICATION-ASSISTED TREATMENT

There will no longer be any copayments or prior authorization for Medication-Assisted Treatment for opioid use disorder (generic buprenorphine-naloxone, naloxone, and naltrexone products). These drugs will also not be subject to the prescription drug deductible.

HARVARD PILGRIM INDEPENDENCE AND PRIMARY CHOICE PLANS

  • The prescription drug formulary for these plans will change to a closed formulary similar to the other plans.  This means certain prescription drugs will be excluded from coverage, but will have alternatives available that are more cost effective.
  • Physician office visit and hospital tiering will change to one based on provider group value instead of individual performance. This could affect your copays.  Contact the plan to see each of your  provider’s tiers for the office location you visit.   Also contact the plan to see which tier your hospital is in.

HARVARD PILGRIM INDEPENDENCE PLAN

  • Will implement Primary Care Provider (PCP) tiering based on provider group value: $10 Tier 1/ $20 Tier 2/ $40 Tier 3. Contact the plan to find out which tier your PCP is in.
  • The outpatient behavioral health/substance use disorder office visit copay will decrease to $10 per visit.
  • The out-of-network deductible will increase to $500 per individual and $1,000 per family.

TUFTS HEALTH PLAN NAVIGATOR AND SPIRIT

  • Physician office visit and hospital tiering will change to one based on provider group value instead of individual performance. This could affect your copays.  Contact the plan to see each of your  provider’s tiers for the office location you visit. Also contact the plan to see which tier your hospital is in.

TUFTS HEALTH PLAN NAVIGATOR

  • Will implement Primary Care Provider (PCP) tiering based on provider group value: $10 Tier 1/$20 Tier 2/$40 Tier 3. Contact the plan to find out which tier your PCP is in.
  • The outpatient behavioral health/substance use disorder office visit copay will decrease to $10 per visit.
  • The out-of-network deductible will increase to $500 per individual and $1,000 per family.

UNICARE STATE INDEMNITY PLAN/BASIC AND COMMUNITY CHOICE

  • The telehealth benefit already available to UniCare PLUS members will be expanded to these two plans: $15 copay/telehealth visit.

UNICARE STATE INDEMNITY PLAN/PLUS

  • The out-of-network deductible will increase to $500 per individual and $1,000 per family.

This information provided by the Group Insurance Commission .