GIC Health Plan Options

Health New England
Eligibility
Plan Contact Information
Plan Service Area

Plan Overview
Health New England is an HMO that requires members to select a Primary Care Physician (PCP) to manage their care; referrals to network specialists are not required.  With an HMO, you receive care through the plan’s network of doctors, hospitals, and other providers.  There are no out-of-network benefits, with the exception of emergency care.  Members pay lower office visit co-pays when they see Tier 1 or Tier 2 physicians.   Contact the plan to see if your provider is in the network and how he/she is rated.

Benefits effective July 1, 2008

Pediatric Physician Office Visit
100% wellness office visit; 100% after $15 per diagnostic visit

Primary Care Physician Office Visit
Health New England tiers Primary Care Physicians based on quality and cost efficiency standards.
Tier 1 (excellent): 100% after $10 per visit
Tier 2 (good):       100% after $15 per visit
Tier 3 (standard): 100% after $25 per visit


Specialist Physician Office Visit
Health New England tiers the following specialists based on quality and cost-efficiency standards: Cardiologists, Dermatologists, Endocrinologists, Gastroenterologists, Obstetricians/Gynecologists, Orthopedists, Otolaryngologists (ENTs), and Rheumatologists.
Tier 1 (excellent):  100% after $15 per visit
Tier 2 (good):       100% after $25 per visit
Tier 3 (standard): 100% after $35 per visit

Outpatient Mental Health and Substance Abuse Care
100% after $15 per visit

Inpatient Hospital Care – Medical (maximum four co-pays per person per calendar year; waived if readmitted within 30 days in the same calendar year)
100% after $250 per admission

Outpatient Surgery (maximum four co-pays annually per person)
100% after $100 per occurrence

Emergency Room
100% after $50 co-pay per visit (waived if admitted)


Prescription Drug Co-payments
Retail up to 30-day supply:                    Mail Order up to 90-day supply:
Tier 1: $10                                                   Tier 1:   $20
Tier 2: $20                                                   Tier 2:   $40
Tier 3: $40                                                   Tier 3:   $120

Eligibility
Employees, Retirees, Retired Municipal Teachers (RMTs), Elderly Governmental Retirees (EGRs),  Survivors, and their eligible dependents without Medicare are eligible.   Members  must live in the Plan’s service area.

Service Area
Health New England is available in the following Massachusetts counties: Berkshire, Franklin, Hampden, Hampshire

Health New England is partially available in the following Massachusetts county: 
Worcester
The plan may not be available in every city and town in this county.  Contact the plan for details.
                     
Monthly Rates as of July 1, 2008

Plan Contact Information
Contact the plan for additional information on
participating providers and benefits.

Health New England
1.800.842.4464