{"id":4596,"date":"2016-05-27T14:11:33","date_gmt":"2016-05-27T14:11:33","guid":{"rendered":"http:\/\/hnetalk.com\/member\/?p=4596"},"modified":"2016-05-27T14:11:33","modified_gmt":"2016-05-27T14:11:33","slug":"how-gic-specialist-tier-structure-determines-copays-gic-only","status":"publish","type":"post","link":"https:\/\/hnetalk.com\/member\/how-gic-specialist-tier-structure-determines-copays-gic-only\/","title":{"rendered":"How GIC specialist tier structure determines copays (GIC only)"},"content":{"rendered":"<p>Have you ever wondered how your copay for a provider visit is determined? If you have and you\u2019re a Commonwealth of Massachusetts Group Insurance Commission (GIC) member,* you may find the following information helpful.<\/p>\n<p><strong>Primary care providers<\/strong><br \/>\nPrimary care providers (PCPs) are not tiered. Therefore, for a PCP office visit, a standard $20 copay will apply.<\/p>\n<p><strong>Specialist tier structure<\/strong><br \/>\nThe GIC has selected to use a tier structure for certain Health New England providers based on quality and\/or cost efficiency. Providers in the following specialties are considered tiered:<br \/>\n\u2022 Cardiology or Cardiovascular Disease<br \/>\n\u2022 Endocrinology<br \/>\n\u2022 Gastroenterology<br \/>\n\u2022 Surgery<br \/>\n\u2022 Obstetrics &amp; Gynecology<br \/>\n\u2022 Orthopedics<br \/>\n\u2022 Otolaryngology (Ear, Nose and Throat)<br \/>\n\u2022 Pulmonology<br \/>\n\u2022 Rheumatology<\/p>\n<p>There are three specialist tier assignments that determine your copay responsibility:<br \/>\n\u2022 Tier 1 (denoted by ***) = Copay of $30<br \/>\n\u2022 Tier 2 (denoted by **) = Copay of $60<br \/>\n\u2022 Tier 3 (denoted by *) = Copay of $90<\/p>\n<p>You can find tier assignments when you search for a specialist in Health New England\u2019s GIC Provider Directory at <a href=\"http:\/\/www.healthnewengland.org\/gic-provider-search\" target=\"_blank\">healthnewengland.org\/gic-provider-search<\/a>.<\/p>\n<p><strong>Non-tiered specialists<\/strong><br \/>\nSome specialists do not have a tier assignment. In the case that a specialist is denoted by NT\/ID, it means that either the specialist is not tiered by the health plan or there wasn\u2019t enough data to assign a tier.<\/p>\n<p>For any specialist that is not tiered, a $60 copay will apply.<\/p>\n<p>Should you have any questions about specialist tiers or about your plan, contact Health New England Member Services at (413) 787-4004 or toll-free at (800) 310-2835. For TTY\/TDD, call (800) 439-2370. Representatives are available to assist you Monday \u2013 Friday, 8:00 am \u2013 6:00 pm.<\/p>\n<p>*<em>This information pertains to GIC members who are active employees or retirees without Medicare Parts A &amp; B.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Have you ever wondered how your copay for a provider visit is determined? If you have and you\u2019re a Commonwealth of Massachusetts Group Insurance Commission (GIC) member,* you may find the following information helpful. Primary care providers Primary care providers (PCPs) are not tiered. Therefore, for a PCP office visit, a standard $20 copay will [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":4597,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[9,19],"tags":[424,422,448,423,425],"class_list":["post-4596","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gic","category-newsletter","tag-copays","tag-gic","tag-gic-provider-search","tag-specialists","tag-tier-structure"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/hnetalk.com\/member\/wp-content\/uploads\/2016\/05\/doctor-laptop-e1463670955544.jpg?fit=700%2C467&ssl=1","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZGa-1c8","_links":{"self":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/4596","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/comments?post=4596"}],"version-history":[{"count":5,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/4596\/revisions"}],"predecessor-version":[{"id":4650,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/4596\/revisions\/4650"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/media\/4597"}],"wp:attachment":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/media?parent=4596"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/categories?post=4596"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/tags?post=4596"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}