GIC Health Plan Options

UniCare State Inddemnity Plan/PLUS
Eligibility
Plan Contact Information
Plan Service Area

Plan Overview
The UniCare State Indemnity Plan/PLUS, is a PPO-type plan that does not require members to select a Primary Care Physician (PCP). The plan offers you a choice of using network providers and paying a copayment, or seeking care from an out-of-network provider for 80% coverage of reasonable and customary charges after a you pay a deductible. Members pay lower office visit co-pays when they see Tier 1 and Tier 2 physicians.  Contact the plan to see if your provider is in the network and how he/she is rated.  Members pay a lower inpatient hospital deductible when they use Tier 1 hospitals.  Contact the plan to see which tier your hospital is in.

The mental health benefits of this plan, administered by United Behavioral Health (UBH), offer you a choice of using network providers and paying a co-payment, or seeking care from out-of-network providers at higher out-of-pocket costs.


In-Network Benefits Effective July 1, 2008

UniCare tiers Massachusetts physicians based on quality and cost efficiency standards.

Primary Care Physician Office Visit
Tier 1 (excellent):   100% after $10 per visit
Tier 2 (good):   100% after $20 per visit
Tier 3 (standard): 100% after $25 per visit

Specialist Office Visit
Tier 1 (excellent):   100% after $15 per visit
Tier 2 (good):   100% after $20 per visit
Tier 3 (standard): 100% after $35 per visit

Out-of-State Primary Care Physician and Specialist Office Visit:  100% after $20 per visit

Outpatient Mental Health and Substance Abuse Care (contact UBH for other mental health and substance abuse benefit details)
100% after $15 per visit
UBH also offers EAP services.

Inpatient Hospital Care – Medical (maximum one deductible per person per calendar year quarter;  waived if readmitted within 30 days in the same calendar year)
Tier 1:   100% after $250 deductible
Tier 2:   100% after $400 deductible

Outpatient Surgery
100% after $75 deductible (maximum one deductible per person per calendar year quarter)

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: $7                                                    Tier 1:   $14
Tier 2: $20                                                   Tier 2:   $40
Tier 3: $40                                                   Tier 3:   $90
Value Tier: $2                                             Value Tier: $4
Specialty drug mail order up to 30 day supply: $10

Eligibility
Employees, retirees, survivors, and their eligible dependents without Medicare are eligible.  Members must live in the plan’s service area.

Service Area
The UniCare State Indemnity Plan/ PLUS is available in the following Massachusetts counties:   Barnstable,  Berkshire, Bristol,  Essex,  Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester

The Plan is also available in the following  states: Connecticut, New Hampshire, Maine, Rhode Island
Coverage may not be available in every city and town in these states. Contact the plan for more specific coverage information.
                     
Monthly Rates as of July 1, 2008

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

Medical Benefits:
UniCare
1.800.442.9300

Mental Health, Substance Abuse and EAP Benefits:
United Behavioral Health (access code: 10910)
1.888.610.9039

Prescription Drug Benefits
Express Scripts
1.877.828.9744