Check Out Your Healthcare Benefit Changes
Effective January 1, 2020
New Acupuncture Benefit for MA Schools
Recognizing the increased interest in alternative therapies for pain management, Massachusetts edHEALTH schools are implementing a new acupuncture benefit effective January 1, 2020. The benefit is consistent with the current chiropractic benefits:
 
When you use a network provider, you receive:
Up to 20 visits per year
Same cost sharing as chiropractic benefits :
  • $25 per visit copay for traditional HMO and PPO Plans – see your plan handbook for details on whether the deductible applies.
  • Once deductible met for high-deductible plans, covered in full or with 10% or 35% coinsurance – see your plan handbook for details.
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Hearing Aid Coverage Benefit Expanded Beyond Age 22
In response to the growth of adult-onset hearing loss, the Plan Design committee has expanded the hearing aid benefit beyond the age 22 mandated under Massachusetts law. Now, all employees and covered family members will have hearing aid benefits:
$2,000 per ear for most plans per 36 months.
Specialty Pharmacy Implemented
If you are taking or are prescribed a specialty medication, you must order your medication through Optum® Specialty Pharmacy, formerly called BrioxaRx®, effective January 1, 2020. A specialty medication is an injectable, oral, or inhaled medication that:
  • Has unique storage and/or shipping requirements
  • Usually requires ongoing clinical oversight and additional education for best management
  • May not be available at a retail pharmacy
Through the Optum Specialty Pharmacy, you will receive:
  • Access to your medications at the lowest cost
  • 24/7 access to pharmacists
  • Support through clinical and adherence programs
  • Any medication-related supplies at no additional cost
  • Proactive refill reminders
  • Timely delivery and shipping in confidential packaging
  • Free video consultations with a clinician
  • Free videos that provide tips about select specialty conditions
Where to Find Benefit Details
To find out details on your healthcare program, check out your Summary Plan Description (SPD), also known as the handbook. This is a detailed guide to what benefits the plan provides and how the plan works.
 
SPDs are available on your online account. Log in with your user name and password to view, search, and/or print this important document. If you are not enrolled in an online account, register.
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