Healthsync tiered health benefit plans to be offered January 1, 2019

We are pleased to announce the introduction of the next generation of tiered health benefit plans. Beginning January 1, 2019, we will offer the Healthsync plan portfolio to our customers. This portfolio is built on preferred tiers within our existing commercial provider networks where Value Tier 1 providers will meet certain cost and quality criteria and offer additional services to members.

 

There will be two (2) tiers (cost share levels) for members of Healthsync health benefit plans who utilize their in-network benefits (i.e. within the applicable network.) In addition to allowing these members to use different tiered levels of primary care providers (PCPs) and acute care hospitals, the following specialties will also be tiered: allergy/immunology, cardiology, endocrinology, gastroenterology, nephrology, obstetrics and gynecology (OB/Gyn), ophthalmology, orthopedic surgery, otolaryngology (ENT), pulmonology, rheumatology and urology. (All other specialty care will not be tiered.)

 

Members who receive services from PCPs, specialists or acute care hospitals who/that are designated as Value Tier 1 will have lower cost shares than those who receive the same services from PCPs, specialists or acute care hospitals who/that are Participating Tier 2. (Members who utilize their out-of-network benefits, if and to the extent they have them, are subject to applicable out-of-network cost shares.)  Value Tier 1 PCPs, specialists and acute care hospitals will have an identifier in our provider directory. 

 

If you have any questions, please contact your Provider Relations Representative.