Our Excellent Employee Health Benefits Plans
Please view our perfect Simplified Benefit summaries below to find the perfect plan for your group
Understanding and Using Your Benefits
Your benefits include a nationally-recognized PPO network called PHCS. When you need a primary care physician, specialist, lab work or imaging, all you have to do is verify that they are in the PHCS network. You can either call your provider and ask them if they are in network or you can go to the website, https://www.multiplan.com/webcenter/portal/ProviderSearch. Once there select your network, PHCS, then select practioner and ancillary. This will allow you to search for any type of specialist, pediatrician, or primary care physician in your area. Once you have found one and set your appointment, it is as easy as showing up with your benefit card. the doctor’s office will verify coverage, then you pay the applicable copays and/or deductibles and you are done!
A unique benefit within your plan is the addition of Referenced Based Reimbursement, provided through 6 Degrees, for any hospital, surgical, or any other needs outside of your normal doctor’s visits. Referenced Based Reimbursement is an open access network that allows you to go to any hospital or care facility. Hospitals and Surgical Centers typically bill based on a percentage of what the government pays for a procedure through Medicare. Traditional PPO or HMO networks will pay 350% to 450% of Medicare. With 6 Degrees, your Referenced Based Reimbursement provider this charge is typically reduced to cvis160% to 200% of Medicare. What does this mean to you, the member? 6 Degrees helps keep your benefits costs lower because your expenses are lower. When you need to have a procedure done at a hospital or outpatient care facility, you need to get it pre-certified by your Third-Party Administrator. Call the number on the back of your benefits card and talk to your member representative. They will work with you and 6 degrees to set up your appointment. 6 degrees will have already set up payment procedure before you ever arrive to have your procedure done. Normal copays and deductibles do apply. If there is an emergency and you find yourself in the E.R., when you present your benefit card for processing, it is important to let the Processor know that you have an open access Referenced Based Reimbursement plan. They might say they do not accept that coverage, don’t worry, they do. Have them call the number on the back of your benefit card for confirmation of your benefits. Typically, with an emergency, after care has been provided and up to a few months after, you might receive a bill from the hospital for an unpaid balance for the care you received. In this case, notify your Third-Party Administrator and they, along with 6 degrees, will take responsibility and work on this bill for you. Never set up a payment plan or payment to the provider – you are not responsible for a billed amount except copays and deductibles. Once you receive the bill, contact your member advocate and your Third-Party Administrator and they will walk you through how to submit the bill to be repriced and taken care of by your health benefits plan. Of course, all co-pays and deductibles apply.
If you are not sure what hospital to go to or want to do research before talking to your member advocate at your TPA, you can use the Medivi system below to look up cost and quality scores for any public hospital in your area. The Medivi program will tell you how much you can save through referenced based reimbursement and which hospitals in your area has the best quality score. For more information on the Medivi system, please click here…. https://6degreeshealth.com
If you are not sure what hospital to go to or want to do research before talking to your member advocate at your TPA, you can use the Medivi system below to look up cost and quality scores for any public hospital in your area. The Medivi program will tell you how much you can save through referenced based reimbursement and which hospitals in your area has the best quality score. For more information on the Medivi system, please click here.
Your prescription drug benefit is managed by Shield PBM and is easy, reliable, and will save you time and money on your prescriptions. Your maintenance prescription drugs will be delivered to your house with a 90-day supply once you submit your prescription to Shield PBM. You save considerable money by getting a 90-day mail order supply versus paying monthly at your local pharmacy. Have a new prescription or need medication now? That’s perfectly fine, through your Shield portal you can get the medication immediately at your local pharmacy with a prescription from your doctor. It works just like any other form of prescription coverage except you might pay lower than your prescription copay. Sheild has negotiated major discounts on many commonly used medications. Here is how it works…let’s say the prescription you need typically costs your health benefits plan $53. You have a $20 copay and the benefit plan pays the other $33. With Shield, they have negotiated that price down to $7. Now all you pay is the $7. You just saved $18 on that prescription! Also, typically, if you get your prescriptions monthly, you would have to pay that copay each month. With shield PBM you pay copays for a two-month supply and receive 3 months, its almost like a “buy 2 get 1 free” deal on your prescription drugs. Who doesn’t like free?
Did you receive a prescription for a very expensive medication and you are not sure if you can afford the copay or deductible depending on your benefit plan description? Don’t worry, Shield is there to help you! Shield will automatically deny your claim for a prescription drug with a copay of $250 or more, but as they do this they will immediately go to work and will contact you to see if they can get you into a Patient Assistant Program. This program has been able to reduce high prescription copays down from $250 to no cost to the member.
Shield saves you time, money, and hassle on getting the prescription drugs that you or your family needs.
Make sure to go to your Shield Portal and Sign up for benefits by clicking here.
Let’s say you are on vacation somewhere, or you are at home and don’t want to go to your primary care physician or to the costly urgent care center down the street full of sick patients. For zero cost to you, you have access to a telemedicine doctor who can help you with the most common reasons somebody might go to the doctor. 1800 MD can diagnose symptoms and prescribe medication right over the phone and because they are integrated with Shield, they can seamlessly send your prescription to Shield PBM for processing and pickup. For more information on 1800MD please click here.