17
Plus Plan Member Guide
Plus Plan Member Guide
Table of Contents
Plan Benefits
Prescription Program
Medical Network
Secure Care Covered Preventive Services
General Limitations & Exclusions
Rx Exclusions and Limitations
Value-Added Benefits
Frequently Asked Questions
1
2
3
5
7
9
10
13
Member [email protected] | (214) 436-8883
Member Portal icamembers.com
1
Plan Benefits
This guide is a summary document. If there are any discrepancies between this guide and the Plan Document, the Plan Document terms govern.
Wellness Plan Benefits
Physician Office Visits
Preventative/Wellness Physician Office Visits
Physician’s Office or Clinic Visit for Preventive Care, Screening & Immunization 100%
Preventive/Wellness Diagnostic Tests (x-ray, blood work) 100%
Physician Office Visit (injury or illness)
Copay Amount per Visit $25
Maximum Visits per Membership Year 4
Maximum Amount per Visit after copay $150
Specialist Office Visit (injury or illness)
Copay Amount per Visit $50
Maximum Visits per Membership Year 2
Maximum Amount per Visit after copay $150
2
Prescription Program
SimpleScripts Rx is a MEC (Minimal Essential Coverage) Medication Program that includes 95 ACA (Affordable Care Act) drugs at no-cost, plus great discounts on all other medications. Their Customer Care team operates as a pharmacy savings advocate, helping members find the lowest price on medications available.
SimpleScripts Rx
Rx Program Covers: Drugs such as:
• Aspirin• Bowel Preparation• Breast Cancer Prevention• Contraceptives• Fluoride Supplements
• Folic Acid • Statins • Tobacco Cessation• Vitamin Supplements • and More!
• Atorvastatin• Bupropion• Cholecalciferol• Junel • Lovastatin
• Nonoxynol • Tamoxifen • Viorele • and Much More!
How the Program Works:1. You can search for medications by entering the drug name in the search bar. If a medication is not on the No-cost Medication
Program, a price will be displayed.2. Present your ID Card to the pharmacy of your choice. There are over 67,000 retail pharmacies in the network.3. If you need other medications, you can easily search our website for deeply discounted prices.
Home DeliveryIn addition to retail pharmacies, SimpleScripts Rx offers members a Home Delivery Option, with free standard shipping and affordable express delivery. Members have access to discounts up to 80% and savings on all orders of quality and certified pharmaceutical brands. Orders are placed through a registered and licensed pharmacy using a secured payment encryption method. With a fast and responsive customer support team, members can get assistance quickly if needed.
Diabetic Supply ProgramSimpleScripts Rx also offers a way to save on Diabetic Supplies. Members can choose from quarterly testing programs or purchase supplies as needed. All of the products are shipped to their home. No prescription is needed for OTC testing supplies.
Members Receive:
· Free talking blood glucose meter with first order· 100% satisfaction guaranteed or their money back· Tracking info on all orders via email and/or text· Quarterly auto-shipping programs with option to choose how many times a day they test· Programs start as little as $24.99 per quarter ($8.33 per month)
Member Access
Activate your SimpleScripts Rx Member Portal1. You will receive an email and mailed RX Member ID card from SimpleScripts Rx
on or before your effective date with your Member ID and Rx Group number.2. Go to https://www.simplescriptsrx.com/login.php3. Enter the Member ID and Rx Group number from your RX Member ID Card.4. Create a new password and update your profile.
Questions about your Rx benefits? Please call us at (855) 798-2538
Your card is active and can be used on or after your Effective Date of Coverage.
3
Medical Network
Secure Care plans include the PHCS Network through MultiPlan, Inc., which offers you: Choice - Broad access to 5,000 hospitals, 107,000 ancillary facilities and approximately 917,000 practitioners.Savings - Negotiated discounts that result in significant cost savings when they visit in-network providers, helping to maximize their health services. A PHCS logo on the Secure Care ID card tells both the Member and the Provider that a PHCS discount applies. Quality - MultiPlan applies rigorous criteria when credentialing providers for participation in the PHCS Network, so Members can be assured they are choosing their healthcare provider from a high-quality network.
36%Average savings on practitioner claims
35%Average savings on
ancillary claims
PHCS Network
Online Provider Referral SystemIf Members are currently seeing a doctor or other healthcare professional who does not participate in the PHCS Network, they may use the Online Provider Referral System. On the Home page, click on Information for Health Plan Members, and then click on Nominate a Provider, which allows Members to nominate the provider in just minutes using an online form. Upon receipt of the form, MultiPlan will contact the nominee to determine whether the provider is interested in joining. If so, they will follow up to recruit the provider.
Confirm Participation in the PHCS NetworkIt is the Members’ responsibility to confirm the provider or facility’s continued participation in the PHCS Network and accessibility under the Specific Services program. When scheduling an appointment, Members need to specify that they have access to the PHCS Specific Services Network, confirm the provider’s current participation in the PHCS Specific Services Network, their address and that they are accepting new patients. Please also be sure to follow any pre-authorization procedures required by the program (usually a telephone number on the ID card). In addition, to ensure proper handling of their bills, Members should always present their Secure Care ID card upon arrival at your appointment.
Find a PHCS Network ProviderMembers can find participating doctors or facilities near them by going to www.multiplan.com and following the instructions below or by calling (888) 263-7543.
Provider Lookup Home page
1 Click on Find a Provider
Find a doctor or facility page
2 Click on the Select Network button and choose PHCS3 Click on Specific Services4 Type in your search criteria and location
Preventive Services Limitations & Exclusions
5
Covered Preventive Services
Covered Preventive Services for Adults (Ages 18 and Older)
Service LimitationsAbdominal Aortic Aneurysm Screening One-time screening for age 65-75 (Men only)
Annual Preventive Care Visit History, Physical exam, Measurements (Height, Weight & Body Mass Index)
Aspirin use for men Ages 65-79 to prevent CVD when prescribed by a physician
Aspirin use for women Ages 55-79 to prevent CVD when prescribed by a physician
Colorectal Cancer Screening Starting at age 50, limited to 1 every 5 years
General Health ScreeningsBlood pressure, Cholesterol screening based on age and individual risk factors, Depression screening, Diabetes screening for adults with high blood pressure, HIV screening, Obesity screening, Sexually transmitted infection (STI) screenings (Chlamydia, Gonorrhea, Syphilis)
Health Counseling Alcohol misuse, Healthy diet, Obesity, Prevention of sexually transmitted infections (STIs), Tobacco use, Use of folic acid
Hepatitis B Screening For adults at high risk, and one time for anyone born prior to 1966
Hepatitis C Screening For adults at high risk, and one time for anyone born prior to 1966
ImmunizationsDiphtheria-Tetanus-Pertussis, Hepatitis A&B, Human Papillomavirus (HPV), Influenza (flu shot), Measles-Mumps-Rubella, Meningococcal, Pneumococcal (Pneumonia), Tetanus, Diphtheria, Pertussis, Varicella (Chickenpox), Herpes Zoster
Lung Cancer Screening Low dose computed tomography (LDCT) for adults age 55-80 who have a 30-pack year smoking history and currently smoke or have quit within the past 15 years
Covered Preventive Services for Women, Including Pregnant Women
Service LimitationsAlcohol Misuse Screening and Counseling Pregnant women
Anemia Screening Routine basis for pregnant women
Annual Well Woman Visit History, Physical exam, Measurements (Height, Weight & Body Mass Index)
Bacteriuria Urinary Tract or Other Infection Screening Pregnant women
Blood Test Screening for Rh Incompatibility Pregnant women
BRCA Counseling and Genetic Testing Women at higher risk
Breast Cancer Mammography Screenings Every year for women age 40 and over
Breastfeeding Comprehensive Support and Counseling from Trained Providers, as well as access to Breastfeeding Supplies
Pregnant and nursing women
Cervical cancer screening including pap smear
Chemoprevention of Breast cancer
Contraception FDA approved contraceptive methods, sterilization procedures and patient education and counseling. Does not include abortifacient drugs
Domestic Violence Counseling
Female Sterilization Tubal ligation
Folic Acid Supplements When prescribed by a Physician for women who may become pregnant
Gestational Diabetes Screening Pregnant women
6
Covered Preventive Services
Covered Preventive Services for Women, Including Pregnant Women (Continued)
Service LimitationsHepatitis B Screening Pregnant women
Human Papillomavirus (HPV) DNA test Every 3 years for women with normal cytology who are 30 or older
Osteoporosis Screening Over age 60
Screening for Sexually Transmitted Infections (STIs), including Chlamydia, Gonorrhea and Syphilis Pregnant women
Tobacco Use Screening and Interventions Expanded counseling for pregnant tobacco users
Covered Preventive Services for Children
Service LimitationsAutism screening Limited to 2 screenings up to age 26 months
Behavioral Assessments Limited to 5 assessments up to age 17
Congenital Hypothyroidism Screening For Newborns
Depression Screening Adolescents age 12 and older
ImmunizationsDiphtheria-Tetanus-Pertussis, Hemophilus influenza type B, Hepatitis A&B, Human Papillomavirus (HPV), Influenza (flu shot), Measles-Mumps-Rubella, Meningococcal, Pneumococcal (Pneumonia), Inactivated Poliovirus, Rotavirus, Varicella (Chickenpox)
Phenylketonuria (PKU) Screening Newborns
Preventive Treatments Gonorrhea preventive medication for eyes of all newborns
ScreeningsHearing loss, sickle cell disease, Hematocrit or hemoglobin screening, Obesity screening, Lead screening, Dyslipidemia screening for children at higher risk of lipid disorder, Tuberculin testing, HIV screening, Cervical dysplasia screening
Sexually Transmitted Infection (STI) Prevention Counseling & Screening Adolescents
Vision Screening Under Age 5
Well Child Exams History, Physical exam, Measurements (Height, Weight & Body Mass Index), Vision acuity test, Oral health assessment, Anticipatory guidance
Medical (Preventive Care Only) Exclusions: 1. Injury or self-inflicted bodily harm 2. Sickness or disease 3. Preventive health services not included under ACA 4. Preventive health services rendered outside of the United States 5. Preventive health services that are performed by a person who is related to the Participant as a spouse, parent, child, brother or sister, whether the
relationship exists by virtue of “blood” or “in law.”
7
General Limitations & ExclusionsGeneral Limitations & Exclusions
Administrative Costs. That are solely for and/or applicable to administrative costs of completing claim forms or reports or for providing records wherever allowed by applicable law and/or regulation.After the Termination Date. That are Incurred by the Participant on or after the date coverage terminates, even if payments have been predetermined for a course of treatment submitted before the termination date, unless otherwise deemed to be covered in accordance with the terms of the Plan or applicable law and/or regulation.Alcohol. Involving a Participant who has taken part in any activity made illegal due to the use of alcohol or a state of intoxication. Expenses will be covered for Injured Participants other than the person partaking in an activity made illegal due to the use of alcohol or a state of intoxication, and expenses may be covered for Substance Abuse treatment as specified in this Plan, if applicable. This Exclusion does not apply if the Injury (a) resulted from being the victim of an act of domestic violence, or (b) resulted from a documented medical condition (including both physical and mental health conditions).Broken Appointments. That are charged solely due to the Participant’s having failed to honor an appointment.Complications of Non-Covered Services. That are required as a result of complications from a service not covered under the Plan, unless expressly stated otherwise.Confined Persons. That are for services, supplies, and/or treatment of any Participant that were Incurred while confined and/or arising from confinement in a prison, jail, or other penal institution with said confinement exceeding 24 consecutive hours.Cosmetic Surgery. That are Incurred in connection with the care and/or treatment of Surgical Procedures which are performed for plastic, reconstructive or cosmetic purposes or any other service or supply which are primarily used to improve, alter or enhance appearance, whether or not for psychological or emotional reasons, except to the extent where it is needed for: (a) repair or alleviation of damage resulting from an Accident; (b) because of infection or Illness; (c) because of congenital Disease, developmental condition or anomaly of a covered Dependent Child which has resulted in a functional defect. A treatment will be considered cosmetic for either of the following reasons: (a) its primary purpose is to beautify or (b) there is no documentation of a clinically significant impairment, meaning decrease in function or change in physiology due to Injury, Illness or congenital abnormality. The term “cosmetic services” includes those services which are described in IRS Code Section 213(d)(9).Custodial Care. That do not restore health, unless specifically mentioned otherwise.Deductible. That are amounts applied toward satisfaction of Deductibles and expenses that are defined as the Participant’s responsibility in accordance with the terms of the Plan.Excess. That exceed Plan limits, set forth herein and including (but not limited to) the Maximum Allowable Charge in Salvasen Health’s discretion and as determined by Salvasen Health, in accordance with the Plan terms as set forth by and within this document.Experimental. That are Experimental or Investigational.
Family Member. That are performed by a person who is related to the Participant as a spouse/domestic partner, parent, Child, brother, or sister, whether the relationship exists by virtue of “blood” or “in law”.Foreign Travel. That are received outside of the United States if travel is for the purpose of obtaining medical services, unless otherwise approved by Salvasen Health.Government. That the Participant obtains, but which is paid, may be paid, is provided or could be provided for at no cost to the Participant through any program or agency, in accordance with the laws or regulations of any government, or where care is provided at government expense, unless there is a legal obligation for the Participant to pay for such treatment or service in the absence of coverage. This Exclusion does not apply when otherwise prohibited by law, including laws applicable to Medicaid and Medicare.Government-Operated Facilities. That meet the following requirements:1. That are furnished to the Participant in any veteran’s Hospital, military
Hospital, Institution or facility operated by the United States government or by any State government or any agency or instrumentality of such governments.
2. That can be paid for by any government agency, even if the patient waives his rights to those services or supplies.
Note: This Exclusion does not apply to treatment of non-service-related disabilities or for Inpatient care provided in a military or other Federal government Hospital to Dependents of active duty armed service personnel or armed service retirees and their Dependents. This Exclusion does not apply where otherwise prohibited by law.Illegal Acts. That are for any Injury or Sickness which is Incurred while taking part or attempting to take part in an illegal activity, including but not limited to misdemeanors and felonies. It is not necessary that an arrest occur, criminal charges be filed, or, if filed, that a conviction result. Proof beyond a reasonable doubt is not required to be deemed an illegal act. This Exclusion does not apply if the Injury (a) resulted from being the victim of an act of domestic violence, or (b) resulted from a documented medical condition (including both physical and mental health conditions).Illegal Drugs or Medications. That are services, supplies, care or treatment to a Participant for Injury or Sickness Incurred while the Participant was voluntarily taking or was under the influence of any controlled substance, drug, hallucinogen or narcotic not administered on the advice of a Physician. This Exclusion will apply even if the Participant has a prescription for the drug and the drug is legal in the state where the Participant lives. Expenses will be covered for Injured Participants other than the person using controlled substances and expenses will be covered for Substance Abuse treatment as specified in this Plan. This Exclusion does not apply if the Injury (a) resulted from being the victim of an act of domestic violence, or (b) resulted from a documented medical condition (including both physical and mental health conditions).Incurred by Other Persons. That are expenses Incurred by other persons.Long Term Care. That are related to long term care.Medical Necessity. That are not Medically Necessary and/or arise from services and/or supplies that are not Medically Necessary.
Some health care services are not covered by the Plan. Coverage is not available from the Plan for charges arising from care, supplies, treatment, and/or services:
8
General Limitations & ExclusionsGeneral Limitations & Exclusions
Military Service. That are related to conditions determined by the Veteran’s Administration to be connected to active service in the military of the United States, except to the extent prohibited or modified by law.Negligence. That are for Injuries resulting from negligence, misfeasance, malfeasance, nonfeasance or malpractice on the part of any caregiver, Institution, or Provider, as determined by Salvasen Health, in its discretion, considering applicable laws and evidence available to Salvasen Health.No Coverage. That are Incurred at a time when no coverage is in force for the applicable Participant and/or Dependent.No Legal Obligation. That are for services provided to a Participant for which the Provider of a service does not and/or would not customarily render a direct charge, or charges Incurred for which the Participant or Plan has no legal obligation to pay, or for which no charges would be made in the absence of this coverage, including but not limited to charges for services not actually rendered, fees, care, supplies, or services for which a person, company or any other entity except the Participant or the Plan, may be liable for necessitating the fees, care, supplies, or services.Non-Prescription Drugs. That are for drugs for use outside of a Hospital or other Inpatient facility that can be purchased over the counter and without a Physician’s written prescription. Drugs for which there is a non-prescription equivalent available. This does not apply to the extent the non- prescription drug must be covered under Preventive Care, subject to the Affordable Care Act.Not Acceptable. That are not accepted as standard practice by the American Medical Association (AMA), American Dental Association (ADA), or the Food and Drug Administration (FDA).Not Covered Provider. That are performed by Providers that do not satisfy all the requirements per the Provider definition as defined within this Plan.Not Specified as Covered. That are not specified as covered under any provision of this Plan.Other than Attending Physician. That are other than those certified by a Physician who is attending the Participant as being required for the treatment of Injury or Disease and performed by an appropriate Provider.Personal Injury Insurance. That are in connection with an automobile accident for which benefits payable hereunder are, or would be otherwise covered by, mandatory no-fault automobile insurance or any other similar type of personal injury insurance required by state or federal law, without regard to whether the Participant had such mandatory coverage. This Exclusion does not apply if the Injured person is a passenger in a non-family owned vehicle or a pedestrian.Postage, Shipping, Handling Charges, Etc. That are for any postage, shipping or handling charges which may occur in the transmittal of information to the Third-Party Administrator; including interest or financing charges.Prior to Coverage. That are rendered or received prior to or after any period of coverage hereunder, except as specifically provided herein.Professional (and Semi-Professional) Athletics (Injury/Illness). That are in connection with any Injury or Illness arising out of or in the course of any employment for wage or profit; or related to professional or semi-professional athletics, including practice.Prohibited by Law. That are to the extent that payment under this Plan is prohibited by law.
Provider Error. That are required as a result of unreasonable Provider error.Self-Inflicted. That are Incurred due to an intentionally self-inflicted Injury or Illness not definitively (a) resulting from being the victim of an act of domestic violence, or (b) resulting from a documented medical condition (including both physical and mental health conditions).Subrogation, Reimbursement, and/or Third-Party Responsibility. That are for an Illness, Injury or Sickness not payable by virtue of the Plan’s subrogation, reimbursement, and/or third-party responsibility provisions.Unreasonable. That are not reasonable in nature or in charge (see definition of Maximum Allowable Charge) or are required to treat Illness or Injuries arising from and due to a Provider’s error, wherein such Illness, Injury, infection or complication is not reasonably expected to occur. This Exclusion will apply to expenses directly or indirectly resulting from circumstances that, in the opinion of Salvasen Health in its sole discretion, gave rise to the expense and are not generally foreseeable or expected amongst professionals practicing the same or similar type(s) of medicine as the treating Provider whose error caused the loss(es).Vehicle Accident. That are for treatment of any Injury where it is determined that a Participant was involved in a motorcycle Accident while not wearing a helmet or in an automobile Accident while not wearing a seatbelt (or car seat), even if the cause of the Illness or Injury is not related to the failure of the Participant to wear a helmet or seatbelt (or car seat). This Exclusion does not apply: (a) to Participants who were passengers on public transportation, ride for hire or livery services or (b) when a seatbelt or helmet is not required by law.War/Riot. That Incurred as a result of war or any act of war, whether declared or undeclared, or any act of aggression by any country, including rebellion or riot, when the Participant is a member of the armed forces of any country, or during service by a Participant in the armed forces of any country, or voluntary participation in a riot. This Exclusion does not apply to any Participant who is not a member of the armed forces and does not apply to victims of any act of war or aggression.With respect to any Injury which is otherwise covered by the Plan, the Plan will not deny benefits otherwise provided for treatment of the Injury if the Injury results from being the victim of an act of domestic violence or a documented medical condition. To the extent consistent with applicable law, this exception will not require this Plan to provide benefits other than those provided under the terms of the Plan.
CLAIMS ASSISTANCEPremier Access, Inc.Attn: Claims DepartmentP.O. Box 1468Arlington, TX 76004EDI Payor ID: #43152
Notice to MA consumers: This program does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00.
9
Rx Limitations & Exclusions
(1) Read the Drug Formulary to see which drugs are covered.
(2) Retail Pharmacies are limited to a 30-day supply. Mail Order drugs are limited to a 90-day supply in most cases. Some medications qualify for a 30 day fill via mail order.
(3) In certain cases, if a drug is available from alternative sources, SimpleScripts Rx will make all options available to the covered person. If a drug is not on the formulary, (Non-Formulary with Exceptions) SimpleScripts Rx will provide advocacy to the Covered Person for such medications.
This is a Pharmacy Subscription Service. THIS IS NOT INSURANCE. We provide you direct access to medications at negotiated PBM pricing, and Home Delivery Pharmacy pricing on a pre-paid basis. Your Rx Card offers solutions for high-priced specialty medications via an International Pharmacy or PAP service. In addition, a discount pharmacy solution is available, where you search discount options and are directed to a specific pharmacy for super-low pricing. Sometimes, this can be your lowest price option.
SimpleScripts Rx is NOT Insurance. Discount Only - Discounts are available exclusively through participating pharmacies. The range of the discounts will vary depending on the type of prescription and the pharmacy chosen. This part of the program does not make payments directly to pharmacies. Members are required to pay for all prescription purchases. Cannot be used in conjunction with insurance. You may contact customer care anytime with questions or concerns, to cancel your registration, or to obtain further information. This program is administered by Medical Security Card Company, LLC, Tucson, AZ.
Your Rx Card is not available in the following states: ME, MD, VT, WA. Pricing is subject to change without notice. Most pharmacies will accept Your Rx Card, but it is not guaranteed. The final price is determined by your local pharmacy. Formulary and pricing are subject to change. Please see website for current pricing.
Covered Prescription Drugs
Disclosures
Expenses Not CoveredThis benefit will not cover a charge for any of the following:
(1) Generic Drugs. Expense incurred for brand name prescription drugs which exceed the cost of the generic brand, when the Generic drug is available, and the name brand is dispensed.
(2) Outside the United States. Prescriptions filled outside the United States for non-Emergency medical conditions
(3) Refills. Refills greater than the number of times specified by a Physician. Refills after one year from the date of order by a Physician.
(4) Administration. Any charge for administering the Prescription Drug.
(5) Consumed on premises. Any drug or medicine that is consumed or administered at the place where it is dispensed.
(6) Devices. Devices of any type, even though such devices may require a prescription. These include (but are not limited to) therapeutic devices, artificial appliances, braces, support garments, or any similar device.
(7) Drugs used for cosmetic purposes. Charges for drugs used for cosmetic purposes, such as anabolic steroids, Retin A or medications for hair growth or removal.
(8) Experimental. Experimental drugs and medicines, even though a charge is made to the Covered Person.
(9) FDA. Any drug not approved by the Food and Drug Administration. Also, any dosage that exceeds the dosage recommended by the United States Food and Drug Administration (FDA) to treat the condition unless outlined in the plan document
(10) Growth hormones. Charges for drugs to enhance physical growth or athletic performance or appearance.
(11) Immunization. Immunization agents or biological sera.
(12) Impotence. A charge for impotence medication.
(13) Infertility. A charge for infertility medication.
(14) Inpatient medication. A drug or medicine that is to be taken by the Covered Person, in whole or in part, while Hospital confined. This includes being confined in any institution that has a facility for the dispensing of drugs and medicines on its premises.
(15) Investigational. A drug or medicine labeled: “Caution - limited by federal law to investigational use”.
(16) Medical exclusions. A charge excluded under Medical Plan Exclusions.
(17) No charge. A charge for Prescription Drugs which may be properly received without charge under local, state or federal programs.
(18) Non-legend drugs. A charge for FDA-approved drugs that are prescribed for non-FDA-approved uses.
(19) No prescription. A drug or medicine that can legally be bought without a written prescription.
(20) Therapeutics. Therapeutic devices or appliances, including hypodermic needles and syringes other than when used for insulin; support garments; other non-medical items, regardless of their intended use.
(21) Other. Immunizing agents, biological sera, blood or plasma and laetrile.
Notice to MA consumers: This program does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00.
Value-Added Benefits
11
Value-Added Benefits
Member Access• Visit LetsGetChecked.com
• Click on Our Health Tests and Select Your Test
• On the Checkout Screen, add WELLNESS25 to the Promo Code
How It Works
Examples of Tests Offered
LetsGetChecked
*25% discount does not apply to COVID-19 tests
1. Order the right test for you. We have a wide range of tests to cover your health needs. Order with next day delivery and avoid sitting in a doctor’s office or clinic.
2. Collect your sample.Activate your test and collect your sample in the morning. Return your sample on the same day, using the prepaid shipping label provided.
3. Review confidential results quickly.Once your sample arrives in the laboratory, confidential results will be available from your secure online account within 2 to 5 days.
Wellness Tests
Sexual Health TestsWomen’s Health Tests Men’s Health Tests
• COVID-19* • Cortisol• Thyroid• Cholesterol
• Liver• Kidney• Iron• Vitamin D-B
• Folate• Omega-3• Diabetes• Celiac
• Lyme Disease • Heart Disease• Colon Cancer Screening• C-Reactive Protein (CRP)
• Chlamydia• Gonorrhea• Trichomoniasis• Herpes Simplex 1 & 2• HIV
• Syphilis• Gardnerella• Mycoplasma• Ureaplasma• Hepatitis B & C
• Progesterone• Ovarian Reserve• Female Hormone• HPV
• Testosterone• Prostate-Specific
Antigen (PSA)
LetsGetChecked is all about personal health testing with open and patient-led health screening. By empowering people to use technology in a simple but effective way, LetsGetChecked gives members greater control of their personal health. With the convenience and safety of at-home tests, members can still manage their health and wellness, while saving 25% on all testing.* Tests through LetsGetChecked do not require a physician’s order.
12
Don’t leave your emergency treatment to chance, sign up for ICE Tracer today!
Value-Added Benefits
How Does it Work?
Lifesaving information on the View Profile consists of:
• Insurance Details
• Medical History
• Medications
• Hospitalizations
Accident Occurs A traumatic event occurs requiring the assistance of
Emergency Personnel.
First Responders ArriveEmergency Personnel are trained to locate
important information such as Drivers License and Medical IDs. They find the ICE
Tracer card behind the victim’s DL.
Vital Information AccessedEmergency Personnel have the victim’s
name, blood type, emergency contact info and other vital medical information by
using the ICE Tracer technology.
As a member you receive a free monthly membership to ICE Tracer. Your membership also allows you to add and manage family members. Durable, plastic cards are available for purchase within your account at a discounted rate of $5.00 each.
• Identifying Member Information
• Emergency Contacts / Physicians
Emergency Medical ID & PHR Information
In an emergency, getting personal health information to medical personnel quickly is critical. ICE Tracer is an Emergency Medical Solution & Personal Health Record (PHR) System that provides First Responders and Medical Personnel fast access to vital medical information in order to prevent mistakes. Members can easily add and manage medical information. ICE Tracer provides quick access to stored medical documents as well as access to health information while traveling.
Member Access
• Visit www.icetracer.com.
• Click on Register in the top right corner.
• Fill out the registration form with your information.
• On Step 4, put in the group code: PHS.
• Upon registration, you will be designated a personal Membership ID# that is embedded into a QR Code.
• Please email [email protected] for more information or questions.
Frequently Asked Questions
Value-Added Benefits
14
Frequently Asked QuestionsQ. What is Secure Care? A. Secure Care is a market-based solution developed to assist individuals and families across the nation. The solution provides
benefits for preventive care, copays for Primary Care and Specialist visits, a prescription program, as well as Fixed Indemnity benefits for Inpatient and Outpatient services on certain levels.
Q. When can I begin using my benefits? A. You can begin using the benefits on your membership’s effective date, subject to the terms and conditions of the plan.
Q. Will I receive identification cards and materials?A. Yes, you will receive a letter in the mail with personalized identification cards for your wallet. You will be able to view, download
and print your Member Materials on our Member Portal– icamembers.com. Members will also find phone numbers, web links and information describing how to use their benefits.
Q. How do I check if my physician or specialist is in-network?A. Simply go to www.multiplan.com and click on “Find a Provider”– see page 3 for full details about the network. You should use
an in-network provider to maximize your savings. If you use an out-of-network provider, they may charge an additional fee.
Q. Does this plan cover an annual mammogram at an imaging center (not a doctor’s office)?A. Secure Care will cover the screening if the claim is coded as a preventive visit. Under ACA, mammograms are covered
starting at age 40. NOTE: Be sure the Doctor’s office pre-authorizes the procedure and confirms the procedure is coded as “preventive”.
Q. How do I access the SimpleScripts Rx Benefit?A. Visit www.simplescriptsrx.com/login.php. The website has all the information you need to lookup and identify covered
drugs, locate pharmacies, get directions and more.
Q. If I move to another state, will I be able to continue in my plan?A. Yes, you will continue in your current plan if you move to another state. The plans are not available outside the U.S. and
cannot be used while traveling or relocating outside the U.S.
Q. How will I identify the monthly drafts from my account?A. All drafts will have “hmemberbill.com” listed as the originator of the drafts.
Q. Can I make changes to my plan? A. You may make changes to your plan if you experience an event listed below:
• Change in legal marital status – marriage, divorce, annulment, death of a spouse or legal separation• Change in dependent children – birth, adoption, legal guardianship or death of a child• Loss of spousal coverage – loss of job, etc. • Dependent children “age out” – child’s age exceeds the age limitations of the membership
To make changes to your plan, please call Customer Service at (214) 436-8883.
Q. When I turn 65, what happens to my policy?A. Your policy will be termed at midnight on the day of your 65th birthday.
Q. Who do I contact if I have questions about my benefits?A. Please contact Customer Service at (214) 436-8883 and one of our friendly representatives will be glad to help you!
Frequently Asked QuestionsSecure C
are Plus Plan Guid
e _04.13.21
