GIC Medicare Health Plan Options

Harvard Pilgrim First Seniority Freedom
Eligibility
Plan Contact Information
Plan Service Area

Plan Overview
Harvard Pilgrim First Seniority Freedom is a private fee-for-service Medicare plan.  It offers access to any Medicare doctor or hospital that accepts Medicare payment and agrees totreat you and accept Harvard Pilgrim Health Care’s payment.  Contact your doctor and hospital to see if they accept this insurance plan.  You do not need to select a Primary Care Physician or get referrals.   First Seniority Freedom is a Medicare plan under contract with the federal government, which includes Medicare Part D prescription drug benefits.  This Medicare plan’s benefits and rates are subject to change January 1, 2008.


Benefits

Physician Office Visit and Preventive Care
100% after $10 per visit

Outpatient Mental Health Care
100% after $5 per visit

Outpatient Substance Abuse Care
Visits 1-8: 100% after $5 per visit; Visits 9-20: 100% after $25 per visit; Visits 21 and up: 50%

Inpatient Hospital Care
100%

Inpatient and Outpatient Surgery
100%
:
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: $35                                                  Tier 3:   $105

Eligibility
Retirees, Retired Municipal Teachers (RMTs), Elderly Governmental Retirees (EGRs), Survivors, and their eligible dependents  with Medicare  Parts A and B are eligible.  Members  must live in the Plan’s service area.

Service Area
Harvard Pilgrim First Seniority Freedom is available in the following Massachusetts counties:
Essex, Middlesex, Norfolk, Suffolk

Harvard Pilgrim First Seniority Freedom is partially available in the following Massachusetts counties:  Bristol, Plymouth, Worcester
The Plan may not be available in every city and town in these counties.  Call the Plan for details.

Harvard Pilgrim First Seniority Freedom is also available in the following state. 
New Hampshire
Coverage may not be available in every city and town in this state, so contact the Plan for more specific coverage information.
                    
Monthly Rates as of July 1, 2007

Plan Contact Information
Contact the Plan for additional benefit information.

Harvard Pilgrim First Seniority Freedom
1.800.779.7723