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eRaven

 

 

 

 

Harvard Pilgrim HMO LP

Harvard Pilgrim Best Buy HMO LP offers high-quality coverage at a more affordable premium than a traditional HMO.

You’ll choose a primary care provider (PCP).

You'll be charged co-payments for office visits.

You’ll be subject to an annual deductible.

After the deductible services may be subject to coinsurance or a co-pay. (Refer to the Schedule of Benefits).

Services provided by Low Cost Providers for Labs and Outpatient Surgical procedures are at a minimal cost.

Emergency and Urgent Care services are covered worldwide in accordance with the benefit plan provisions.

Prescriptions Drugs have a co-payment based on a 4 Tier Benefit.

This plan allows you to have a Medical Flexible Spending Account (FSA).

This plan offers Care Management Services in partnership with Benevera Health.

All members have access to telemedicine visits through Doctor on Demand (DoD) and Optum (Behavioral Health Providers). DoD provides treatment for 90% of the most common health conditions affecting the mind and body.

Under this plan your DoD (including Optum) co-pay is $25.00.

Plan Details

HMO LP

Calendar Year Deductible

Individual

$3,000

Family

$6,000

Calendar Year Out-of-Pocket Maximum (Out-of-Pocket  Maximum Includes Deductible)

Individual

$6,500

Family

$13,000

Lifetime Maximum

Unlimited

Coinsurance / Copays

Preventive Care

100%

Primary Care Physician

$25 Copay

Specialist

$50 Copay

Diagnostics X-Ray and Lab

No Charge

Urgent  Care

Convenience Clinic

Urgent Care Clinic

Hospital Urgent Care

 

 

$25 Copay

$50 Copay

$75 after deductible

 Emergency Room

$250 after deductible

(waived if admitted)

Inpatient Hospital Care

100% after deductible

 Outpatient Surgery

100% after deductible

($100 for Select LP Providers)

Pharmacy

Retail RX (up to 30-day supply)

Tier 1

$5

Tier 2

$15

Tier 3

$30

Tier 4

$50

Mail Order  RX (up to 90-day supply)

Tier 1

$10

Tier 2

$30

Tier 3

$60

Tier 4

$150

Rates

NH Staff/CGPS Faculty (12 mos)     NH Staff (10 mos)     RFF (12mos/8mos)

Other Tools

 

For Detailed Plan Documents refer to the links below:

Schedule of Benefits

Summary of Benefits and Coverage

Visit the Harvard Pilgrim Site for additional information:

(833)333-4742

www.harvardpilgrim.org

©2018 Franklin Pierce University
40 University Drive
Rindge, New Hampshire 03461