Non-Medicare Retiree/Survivor Health Plan Changes
Effective July 1, 2016

 

Non-Medicare Health Plan Changes

All non-Medicare health plans will now cover the following additional preventive care benefits with no copay or deductible costs:

  • Additional contraceptive coverage
  • Genetic testing for breast and related cancer asymptomatic women if such testing is recommended by an attending provider
  • Extension of women's preventive services to dependent children
  • Sex-specific preventive services (e.g., mammograms and Pap smears) regardless of gender identity
  • Anesthesia for preventive colonoscopies, if medically necessary

HARVARD PILGRIM INDEPENDENCE PLAN

  • Due to concerns about significant premium increases and spending beyond those premium rates, Harvard Pilgrim Independence is closed to new members:
  • Existing HPHC Independence members can stay in the plan and can change their coverage (e.g., individual to family) within 60 days of a qualifying event;
  • No new groups or new employees joining the GIC can enroll in this plan;
  • Individuals who are picking up GIC health insurance coverage during Annual Enrollment cannot enroll in the plan; and
  • Existing GIC members currently enrolled in other health plans cannot switch into this plan.

 

Employees can enroll in or switch to the Harvard Pilgrim Primary Choice Plan.  Retirees and survivors who become Medicare eligible can enroll in the Harvard Medicare Enhance Plan. If Harvard Independence’s first six months of spending in FY17 demonstrates a significant improvement, the GIC may reopen the plan to new hires.  If that is the case, we will notify GIC Coordinators of the change.

  • The out-of-network out-of-pocket maximum will increase to $5,000 per individual; $10,000 per family.

 

HEALTH NEW ENGLAND

The urgent care center copay will decrease to $20 per visit

 

TUFTS HEALTH PLAN NAVIGATOR

  • The out-of-network out-of-pocket maximum will increase to $5,000 per individual; $10,000 per family.
  • The urgent care center copay will decrease to $20 per visit.

 

TUFTS HEALTH PLAN SPIRIT

The urgent care center copay will decrease to $20 per visit

 

UNICARE STATE INDEMNITY PLANS – BASIC, COMMUNITY CHOICE AND PLUS

  • Mental health/substance abuse visits with a Primary Care Provider will now be covered.
  • The urgent care center copay will stay the same or decrease to $20 per visit.
  • New SmartShopper program – members receive a check of $25-$500 (depending on procedure) if they call or use the website to find a provider and then visit that lower-cost provider.
  • Virtual colonoscopies will now be covered.
  • Coverage of Early Intervention services will increase to 100% and not be subject to the deductible.

 

UNICARE STATE INDEMNITY PLAN/BASIC

The preventive examination frequency will increase to meet the Mass Health Quality Partners standards:

    • Age 19-21: Annually
    • Age 22-49: Every one to three years, depending on risk factors
    • Age 49+: Annually

 

UNICARE STATE INDEMNITY PLAN/PLUS

The out-of-network out-of-pocket maximum will increase to $5,000 per individual; $10,000 per family.

 


This information provided by the Group Insurance Commission .