Following your Plan's rules and procedures will help to keep your out-of-pocket costs down:
- Get Referrals - If you are in a GIC HMO, call your Primary Care Physician (PCP) for necessary referrals before seeing a specialist.
- Ask your doctor for drug alternatives - bring your HMO or Express Scripts (Indemnity and Navigator members) drug formulary list with you to your doctor's visit to find the most appropriate, cost effective prescription.
- Notify your Plan of emergency room visits and inpatient admission - call them within 24 hours.
- Check your handbook to see if pre-authorization is required - Commonwealth Indemnity Plan members need to call before scheduling certain procedures or therapies, such as radiology or physical therapy. HMO members - be sure to get a referral from your PCP.
- Before scheduling provider appointments, check with your Plan to be sure the provider is a network member -- Commonwealth Indemnity Plan PLUS, Commonwealth Indemnity Plan Community Choice, Harvard Pilgrim Independence Plan and Navigator by Tufts Health Plan members pay higher out-of-pocket costs for non-network services; HMO members usually cannot access out-of-network care except in emergencies. Indemnity members -- see related out-of-state coverage information.
- If you have a covered student over age 19, keep your student verification forms up to date.
- Consider using your community hospital for routine care. Although your out-of-pocket costs do not vary between hospitals, use of expensive, teaching hospitals for non-tertiary care affects health care premiums for everyone.
Living healthy also lowers your health care costs. Eat right, exercise and don't smoke.
This information provided by the Group Insurance Commission.