Decoding your plan coverage
Posted on May 27, 2016
As a valued member of Health New England, we want to make sure you have coverage for medical care when you need it and that you understand what is covered.
Using in-network providers
The Health New England provider network includes doctors, specialists, hospitals and pharmacies in your area. By using a provider that is in-network, you can be sure that you are covered.* Also, when you see a specialist that is part of our network, you do not need a referral, making it easier to get the care you need.
Another advantage to choosing a provider in the Health New England network is that in-network doctors and medical practitioners have access to your medical history and records, and they can work together to provide you appropriate care.
In order for Health New England to pay for your care (copays/deductibles apply), you must stay in-network for non-emergency health care services such as a doctor or specialist visit, lab work or x-rays, and prescriptions. Otherwise, you may be responsible for the full cost of your visit. PPO plan members may use out-of-network providers for these services. However, staying in-network is more convenient and cost-effective.
To search for in-network providers, go to healthnewengland.org/provider-search.
For GIC members, search for in-network providers at healthnewengland.org/gic-provider-search.
*In accordance with your plan benefits.
After-hours coverage
Medical issues and questions don’t always come up during regular office hours, so Health New England has after-hours care options available to you as part of your membership.
First, consult with your doctor’s office about their after-hours care options. Many doctors now offer weekend hours and an after-hours call service to help you. However, if you can’t reach your doctor after hours, we offer some alternatives for you.
For non-emergency medical issues such as a cold, flu, urinary tract infection and more, you can access U.S. board-certified physicians through phone or video consultation 24/7 by registering for Teladoc™. This service is available for the same copay as a PCP visit. Learn more at healthnewengland.org/Teladoc or call 1-800-Teladoc to get started. (Teladoc is available for most members; however, some self-funded plan members are not eligible.)
If you’re just looking for health advice, call the free Health New England 24/7 nurse line. You can ask licensed nurses and clinicians questions about health-related issues and medications. To reach the nurse line, call (866) 389-7613 or email nurseline@hne.com.
If the above options don’t work for you and you need to visit an urgent care center, go to healthnewengland.org and click on “Find a Provider” at the top of the page to search for the nearest covered urgent care center in your area.
If you have a true medical emergency, call 911 or go to the nearest emergency room (ER) immediately. Your emergency room copay and cost sharing will apply.
If you have any questions about your coverage or your plan benefits, our Member Services representatives are available to assist you at (800) 310-2835, Monday – Friday, 8 a.m. – 6 p.m.
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