2021 Benefit Changes (Commercial & Medicare)
Posted on November 4, 2020
New Commercial Plans and Changes for 2021
Thrive First 500:
Members have “first dollar” coverage for the first $500 of most medical services, excluding services that are not subject to deductible like Rx. After the first $500 of services are paid by Health New England, the $3,000 deductible will begin to apply. Once deductible is met, members pay $0 for routine PCP and specialist office visits and lab services.
• Available in HMO and PPO options
• Available to Large Group only
• Effective 01/01/2021
• $3,000/$6,000 Deductible
First $500 does not apply to PPO Out-of-Network benefits.
Thrive 3000
• Available in HMO and PPO options
• Available to Large Group only
• Effective 01/01/2021
• $3,000/$6,000 Deductible
• $7,000/$14,000 MOOP
• No Deductible on PCP
Acupuncture*
• $20 Copay (Deductible may apply)
• 12 visits per member per calendar year
• Optum Acupuncture Network
Massage Reimbursement*
• 2 visits per family per calendar year
• New Massage Reimbursement form will be available on healthnewengland.org/forms beginning 1/1/21
Cologuard® – Prior Authorization Removed (Applies to Commercial & Medicare)*
Beginning January 1, 2021, a prior authorization (PA) will no longer be required for Cologuard®, or FIT-DNA test, as this is considered preventive care.
*These changes may not apply to all self-funded groups. Deductibles apply for HDHP plans.
Medicare Advantage Plan Changes for 2021
Medicare Supplement Plan Changes for 2021
