January 1, 202 5 – December 31, 202 5 Employee Benefit Guide
Table of Contents
Page 3 4 6 7 8
Welcome Contacts Eligibility Defined Contribution and bswift with Paylocity Enrollment Medical Health Savings Account Flexible Spending Accounts
27 28 31 3 5 36 37 38 40 4 1 4 4
Dental Vision Life & ADD Voluntary Life & ADD Short & Long-Term Disability Additional Benefits AllyHealth Legal Notices
This Guide is for illustrative purposes only and is not a legal contract, contract of employment or guarantee of coverage. Any benefits payable will be subject to the terms and conditions of the insurance policy issued by the insurance company and relevant plan document.
Welcome
Thomas College takes great pride in its employee benefits program. We strive to offer a wide array of benefits to meet the diverse needs of our employees. This summary of benefits is provided as a general overview of the benefit choices available to eligible employees. Employees working at least 30 hours per week are eligible for benefits on the first of the month coincident with or next following 30 days of employment. You must enroll for your benefits within 30 days of eligibility. Once you make benefit elections, they will be in effect for the entire plan year (January—December). You are only allowed to change your benefits during the plan year if you have a qualified life change. A qualified life change is defined as the birth or adoption of a dependent, death of a dependent, change in marital status or involuntary loss of other coverage. To make a change in your benefits, you must submit a completed enrollment form and proof of the qualifying event to Human Resources within 30 days of the qualifying event. Each year, Thomas College has an open enrollment period during which all employees may make changes to their benefits, to be effective on the plan anniversary, January 1. You’ll receive information about your options in advance of each open enrollment period. This summary of benefits is provided to give you a general overview of the benefit choices you have as an employee. It includes important information such as benefit plan resources, contact information for each carrier, and important notices about our plans. Please read all of the benefits information provided to you. While this summary is as up-to-date and accurate as possible, if there are any discrepancies between it and the plan documents, the plan documents will supersede this summary. Employee benefit plans and policies may be changed at any time, and at the sole discretion of Thomas College.
Sincerely, Michelle Joler-Labbe
This Guide is for illustrative purposes only and is not a legal contract, contract of employment or guarantee of coverage. Any benefits payable will be subject to the terms and conditions of the insurance policy issued by the insurance company and relevant plan document.
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Contacts
If you have questions or need more information please do not hesitate to contact Michelle Joler-Labbe or our contacts at CGI Business Solutions
Lisa Nolon, HR Generalist 2 07-859-12 42 lisa.nolon @thomas.edu
Michelle Joler- Labbe , VP of H uman R esources 2 07-859-1240 hr@thomas.edu
Lisa Boucher Senior Benefits Advisor Office: 207-805-8074 Cell: 207-650-3366 Email: lboucher@cgibenefitsgroup.com
Linda Additon Account Executive Office: 207-805-8131 Email: ladditon@cgibenefitsgroup.com
This Guide is for illustrative purposes only and is not a legal contract, contract of employment or guarantee of coverage. Any benefits payable will be subject to the terms and conditions of the insurance policy issued by the insurance company and relevant plan document.
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Additional Contacts
Phone Number
Website
Carrier
Plan Type
Medical Dental
Harvard Pilgrim www.harvardpilgrim.org
888-333-4742 800-537-1715 800-537-1715 866-679-3054 866-679-3054 866-679-3054 866-679-3054
Delta Dental Delta Dental
www.nedelta.com www.nedelta.com www.unum.com www.unum.com www.unum.com www.unum.com
Vision
Life & ADD
Unum Unum Unum Unum
Short-Term Disability Long-Term Disability Accident, Critical Illness & Hospital Indemnity Health Savings Account Flexible Spending Account
HSA Bank
www.hsabank.com
888-383-0088
CGI
www.cgibusinesssolutions.com
This Guide is for illustrative purposes only and is not a legal contract, contract of employment or guarantee of coverage. Any benefits payable will be subject to the terms and conditions of the insurance policy issued by the insurance company and relevant plan document.
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• Spouse • Dependent child under the age of 26, regardless of that child’s marital or student status • Domestic Partner (medical plan only) • Disabled dependent child regardless of age. Who Is Eligible? If you’re an eligible employee at Thomas College, you can enroll in the benefits outlined in this Guide. As an eligible employee, the following family members are also eligible for medical, dental and vision coverage: Eligibility and Enrollment
The minimum required hours you must work in order to be eligible are 30 hours per week and the waiting period before you can enroll is the first day of the month following 30 days after you are hired or eligible. How Do I Enroll? Enrollment is a simple process that is facilitated by Thomas College and BSwift. The first step is to review your current benefits. Did you move recently or get married? Verify all of your personal information and make any necessary changes. Times when you will need to contact Human Resources to make changes:
• • •
If you are a newly eligible employee and you are enrolling for the first time
If Thomas College is changing plans and/or carriers
If you are adding or dropping a dependent or have a change in your own status (ex: marriage, divorce, etc.)
When Do I Enroll? Open enrollment occurs annually, which is a specific time whereby you can renew or make changes to your elections. Once you make an election, they will be effective for the entire plan year. You can only make changes throughout the year if you experience a qualifying event. What Constitutes as a Qualifying Event? Unless you have a Qualifying Event, you cannot change your benefit elections until the next open enrollment period. Qualifying Events include things like: (1) marriage, divorce or legal separation; (2) birth or adoption of a child; (3) change in a child’s dependent status; (4) death of a spouse, child or other qualified dependent; (5) change in residence due to an employment transfer for you or your spouse; or (6) change in employment status or a change in coverage under another employer- sponsored plan. You have 30 days from the date of the event to notify your employer of the qualifying event. What Happens If I Don’t Enroll? If you decline coverage, you will not have another opportunity to enroll yourself or your eligible dependents until the next annual enrollment period unless you have a qualifying event during the year.
This Guide is for illustrative purposes only and is not a legal contract, contract of employment or guarantee of coverage. Any benefits payable will be subject to the terms and conditions of the insurance policy issued by the insurance company and relevant plan document.
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Defined Contributions
Annual Defined Contribution
Monthly Defined Contribution
Employees Waiving Medical
$541
$45.08 $471.83 $970.92 $907.42
Employee Only
$5,662 $11,651 $10,889 $17,096
Employee + Spouse Employee + Child(ren)
Family
$1,424.67
How do I log on to bswift? You have a single sign on using your Paylocity log in. Log on to Paylocity's Web Pay portal and clinck on the Enterprise Benefits tab. The online enrollment allows employees to elect benefits, update personal information, make life event updates and much more. This portal is available 24/7. Step 1: Log into Paylocity • Go to Login.paylocity.com • Enter your assigned company ID: 104515 • Enter your username and password that you created. • Select Login to access Web Pay. • To enroll in benefits, simply click on HR & Payroll in the upper left-hand corner and click on the Enterprise Benefits icon at the bottom. Step 2: Welcome Screen After reading the welcome screens, click “ Start Your Enrollment ”. Step 3: Enroll or Waive Benefits Step 4: Complete PCP & Beneficiary Information Step 4: Review & Confirm Benefits Review benefit elections and make any changes by clicking ‘edit’.
Click “ I agree, and I’m finished with my enrollment ” at the bottom of the screen.
Click ‘Complete Enrollment ’ on the right-hand side of the screen. YOU’RE DONE!
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Preventive Care
Typical Screenings for Adults Blood Pressure Cholesterol Diabetes Colorectal cancer Depression
You take your car in for maintenance. Why not do the same for yourself? Annual preventive checkups can help you and your doctor identify your baseline level of health and detect issues before they become serious. What is Preventive Care? The Affordable Care Act (ACA) requires health insurers to cover a set of preventive services at no cost to you, even if you haven't met your yearly deductible. The preventive care services you'll need to stay healthy vary by age, gender and medical history. Visit healthcare.gov/prevention for recommended guidelines. Preventive care is covered in full only when obtained from an IN- NETWORK provider. Not all exams and tests are considered preventive.
Exams performed by specialists are not generally considered preventive and may not be covered at 100 percent. Additionally, certain screenings may be considered diagnostic, not preventive, based on your current medical condition. You may be responsible for paying all or a share of the cost for those services. If you have a question about whether a service will be covered as preventive care, contact your medical plan. Understanding the Prescription Formulary can save you Money If your doctor prescribes medicine, especially for an ongoing condition, don’t forget to check your health plan’s drug formulary. It’s a powerful tool that can help you make informed decisions about your medication options and identify
the lowest cost selection. What is a formulary?
A drug formulary is a list of prescription drugs covered by your medical plan. Most prescription drug formularies separate the medications they cover into three, four or five drug categories, or “tiers”. These groupings range from least expensive to most expensive cost to you. Get the most from your coverage!
To get the most out of your prescription drug coverage, note where your prescriptions fall within your plan’s drug formulary tiers and ask your doctor for advice. Generic drugs are usually the lowest cost option. Generics are required by the Food and Drug Administration (FDA) to perform the same as brand-name drug counterparts.
This Guide is for illustrative purposes only and is not a legal contract, contract of employment or guarantee of coverage. Any benefits payable will be subject to the terms and conditions of the insurance policy issued by the insurance company and relevant plan document.
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Medical Plans
Thomas College offers fully insured health plans through Harvard Pilgrim. Eligible employees may choose to enroll in one of four medical plans offered. The options include a Point of Service Plan (POS), a Preferred Provider Plan (PPO) and two Qualified High Deductible Health Maintenance Plans (HMO). You are required to choose a Primary Care Physician (PCP) on the POS and HMO plans and get referrals to specialists. You do not need to choose a PCP on the PPO plan and you can receive care from medical professionals and hospitals in or out of Harvard's provider network. Your cost will be lower when you receive care from in- network providers.
POS $1,000
Benefits
IN-NETWORK $1,000/ $2,000
OUT-OF-NETWORK
$2,000/ $4,000
Deductible (Ind/Family)
Prescription Out of Pocket Maximum Medical Out of Pocket Maximum Medical & Prescription Total Out of Pocket Maximum
$1,000/ $2,000
$3,000/ $6,000
$6,000/ $12,000
$4,000/ $8,000
$7,000/ 14,000
Coinsurance Percentage
You Pay 20%
You Pay 40%
PCP Office Visits Specialist Office Visits Preventive Care
40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded
No cost 1st visit, then $25 copay $40 copay Covered in Full
Inpatient Hospital Outpatient Hospital Diagnostic Lab & X-Ray Services Complex Imaging (MRI, CT, PET Scans) Chiropractic Care Physical, Speech and Occupational Therapy Urgent Care Facility
20% After Ded 20% After Ded 20% After Ded 20% After Ded
$25 Copay $40 Copay $ 25 Copay
Emergency Room Services
$150 Copay
Prescription Drugs (Rx) Tiers 1 / 2 / 3 /4 / 5 (30 Day Supply)
$5 / $20 / $30 / $50 /30% up to $250 Per RX
Harvard Pilgrim Billed Monthly Rates
Per Pay Period Deductions
$7 11.42
$1 10.58 $ 257.84 $2 37.88 $3 60.66
Employee Only
$1,5 29.55 $1,4 22.84 $2,2 06.11
Employee + Spouse Employee + Child(ren)
Family
Note: For more detailed information on benefits, limitations and exclusions refer to the Summary of Benefits and Summary Plan Description. Please contact Harvard Member Services at the number on the back of your ID Card with questions regarding coverage or claims.
This Guide is for illustrative purposes only and is not a legal contract, contract of employment or guarantee of coverage. Any benefits payable will be subject to the terms and conditions of the insurance policy issued by the insurance company and relevant plan document.
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Medical Plan PPO
PPO $2,500
Plan Features
IN-NETWORK $2,500/ $5,000
OUT-OF-NETWORK $5,000/ $10,000
Deductible (Ind/Family)
Prescription Out of Pocket Maximum Medical Out of Pocket Maximum Medical & Prescription Total Out of Pocket Maximum
$1,000/ $2,000
$5,000/ $10,000
$10,000/ $20,000
$6,000/ $12,000
$11,000/ $22,000
Coinsurance Percentage
You Pay 20%
You Pay 40%
PCP Office Visits Specialist Office Visits Preventive Care
40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded 40% After Ded
No cost 1st visit, then $25 C opay $50 Copay Covered in Full
Inpatient Hospital Outpatient Hospital Diagnostic Lab & X-Ray Services Complex Imaging (MRI, CT, PET Scans) Chiropractic Care Physical, Speech and Occupational Therapy Urgent Care Facility
20% After Ded 20% After Ded 20% After Ded 20% After Ded 20% After Ded $50 Copay $ 25 Copay
Emergency Room Services
$150 Copay
Prescription Drugs (Rx) Tiers 1 / 2 / 3 /4 / 5 (30 Day Supply)
$5 / $20 / $30 / $50 /30% up to $250 Per RX
Harvard Pilgrim Billed Monthly Rates
Per Pay Period Deductions
$7 27.87
$1 18.17 $ 274.16 $2 53.07 $3 84.21
Employee Only
$1, 564.91 $1, 455.75 $2, 257.13
Employee + Spouse Employee + Child(ren)
Family
Note: For more detailed information on benefits, limitations and exclusions refer to the Summary of Benefits and Summary Plan Description. Please contact Harvard Member Services at the number on the back of your ID Card with questions regarding coverage or claims.
This Guide is for illustrative purposes only and is not a legal contract, contract of employment or guarantee of coverage. Any benefits payable will be subject to the terms and conditions of the insurance policy issued by the insurance company and relevant plan document.
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Medical Plan High Deductible HMO
HMO HSA $3, 3 00
HMO HSA $5,000
Plan Features
IN-NETWORK $3, 3 00/ $6, 6 00 $5,000/ $10,000
IN-NETWORK
$5,000/ $10,000 $6,000/ $12,000
Deductible (Ind/Family)
Out-of-Pocket Maximum (Ind/Family)
Coinsurance Percentage
You Pay 20%
You Pay 20%
PCP Office Visits Specialist Office Visits Preventive Care
20% After Ded 20% After Ded Covered in Full 20% After Ded 20% After Ded 20% After Ded 20% After Ded 20% After Ded 20% After Ded 20% After Ded 20% After Ded
20% After Ded 20% After Ded Covered in Full 20% After Ded 20% After Ded 20% After Ded 20% After Ded 20% After Ded 20% After Ded 20% After Ded 20% After Ded
Inpatient Hospital Outpatient Hospital Diagnostic Lab & X-Ray Services Complex Imaging (MRI, CT, PET Scans) Chiropractic Care Physical, Speech and Occupational Therapy Urgent Care Facility
Emergency Room Services
Prescription Drugs (Rx) Tiers 1 / 2 / 3 /4 / 5 (30 Day Supply)
After Ded: $5 / $20 / $30 / $50 / 30% up to $250 Per RX
After Ded: $5 / $20 / $30 / $50 / 30% up to $250 Per RX
* Deductible waived for Preventive Prescriptions
Harvard Pilgrim Billed Monthly Rates
HMO HSA $3, 3 00
HMO HSA $5,000
$6 06.75
$ 495.99
Employee Only
$1,3 04.51 $1,2 13.52 $1, 881.54
$ 1,066.38
Employee + Spouse Employee + Child(ren)
$ 991.98
$ 1,538.05
Family
Per Pay Period Deductions
HMO HSA $3, 3 00
HMO HSA $5,000
$6 2.27 $15 3.98 $14 1.27 $21 0.85
$11. 15 $4 4.07 $ 39.02
Employee Only
Employee + Spouse Employee + Child(ren)
Family $5 2.32 Note: For more detailed information on benefits, limitations and exclusions refer to the Summary of Benefits and Summary Plan Description. Please contact Harvard Member Services at the number on the back of your ID Card with questions regarding coverage or claims.
This Guide is for illustrative purposes only and is not a legal contract, contract of employment or guarantee of coverage. Any benefits payable will be subject to the terms and conditions of the insurance policy issued by the insurance company and relevant plan document.
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Preventive Drug Benefit for HSA Plans Effective January 1, 2025
Value formulary Your coverage includes a preventive drug benefit. This means that preventive drugs (medications to help prevent chronic conditions and illnesses) are covered outside of your plan’s deductible. Instead, you will pay the applicable copayment or coinsurance amount. Over-the-counter products are not included in this benefit. This is a list of the most commonly prescribed preventive drugs. Limitations and restrictions may apply. Brand-name drugs have a capital letter; all others are generic drugs.
Anticoagulants & platelet aggregation inhibitors for STROKE PREVENTION anagrelide aspirin-dipyridamole Brilinta cilostazol clopidogrel dipyridamole Eliquis enoxaparin fondaparinux
Antineoplastics for BREAST CANCER
glimepiride glipizide glipizide extended-release glipizide/metformin
Lyumjev metformin metformin ER miglitol nateglinide Ozempic pioglitazone
anastrozole exemestane letrozole Soltamox tamoxifen toremifene
glucagon glyburide glyburide/metformin Gvoke Humalog Humalog Mix
pioglitazone/glimepiride pioglitazone/metformin repaglinide Rybelsus Symlin SymlinPen Synjardy
Blood glucose regulators for DIABETES*
Humulin Janumet Janumet XR Januvia Jardiance Jentadueto Lantus Lantus Solostar
acarbose alogliptin Baqsimi Bydureon Byetta Cycloset diazoxide suspension Farxiga
Fragmin heparin Jantoven prasugrel warfarin Xarelto Zontivity
Synjardy XR tolbutamide Toujeo Solostar
* Note: Diabetic supplies (i.e., blood glucose meters, test strips, lancets, syringes) are covered under Preventive Drug Benefit with prescription. This Preventive Drug List is not all-inclusive and is subject to change to comply with IRS guidance and as formulary updates are made. For the current Harvard Pilgrim Health Care formulary please see harvardpilgrim.org/rx . Flyer Last Updated October 8, 2024; effective 1/1/25.
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Tradjenta Trijardy XR Trulicity Xigduo XR
Cartia XT carvedilol carvedilol ER chlorothiazide chlorthalidone
irbesartan irbesartan/ hydrochlorothiazide Isradipine isosorbide dinitrate isosorbide mononitrate Katerzia suspension labetalol lisinopril lisinopril/ hydrochlorothiazide losartan losartan/ hydrochlorothiazide Matzim LA methazolamide methyldopa methyldopa/ hydrochlorothiazide metolazone metoprolol succinate metoprolol tartrate metoprolol/ hydrochlorothiazide midodrine
Nitro-Dur nitroglycerin (patch) Nymalize olmesartan/amlodipine/ hydrochlorothiazide olmesartan/HCTZ pentoxifylline perindopril phenoxybenzamine HCL
Cardiovascular agents for HEART DISEASE/ HYPERTENSION
clonidine Corlanor
Digitek Digoxin diltiazem diltiazem 24hr ER diltiazem CD diltiazem SR Diuril doxazosin mesylate droxidopa Edarbi enalapril enalapril/ hydrochlorothiazide Entresto eplerenone eprosartan ethacrynic acid felodipine ER fosinopril fosinopril/ hydrochlorothiazide furosemide guanfacine HCL nebivolol hydralazine hydrochlorothiazide indapamide
acebutolol acetazolamide acetazolamide capsule ER Aliskiren amiloride/ hydrochlorothiazide amlodipine amlodipine/atorvastatin amlodipine/benazepril amlodipine/olmesartan amlodipine/valsartan amlodipine/valsartan/hctz atenolol atenolol/chlorthalidone
pindolol prazosin
propranolol propranolol/ hydrochlorothiazide propranolol ER quinapril quinapril/ hydrochlorothiazide ramipril ranolazine
Sorine Sotalol Sotalol AF
benazepril benazepril/ hydrochlorothiazide betaxolol, oral bisoprolol fumarate bisoprolol/ hydrochlorothiazide
spironolactone spironolactone/ hydrochlorothiazide Taztia XT Tekturna HCT telmisartan/amlodipine telmisartan + HCTZ terazosin
minoxidil moexipril nadolol nicardipine nifedipine nifedipine ER nimodipine nisoldipine nisoldipine ER Nitro-BID
bumetanide candesartan candesartan/
Tiadylt timolol
hydrochlorothiazide captoprilcaptopril/ hydrochlorothiazide Cardura XL
torsemide trandolapril
* Note: Diabetic supplies (i.e., blood glucose meters, test strips, lancets, syringes) are covered under Preventive Drug Benefit with prescription. This Preventive Drug List is not all-inclusive and is subject to change to comply with IRS guidance and as formulary updates are made. For the current Harvard Pilgrim Health Care formulary please see harvardpilgrim.org/rx . Flyer Last Updated October 8, 2024; effective 1/1/25.
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trandolapril/verapamil triamterene triamterene/ hydrochlorothiazide valsartan valsartan/ hydrochlorothiazide verapamil verapamil ER Verquvo Dyslipidemics for HIGH CHOLESTEROL amlodipine/atorvastatin atorvastatin cholestyramine colesevelam
omega 3 acid pravastatin
Theo 24 theophylline tiotropium bromide Trelegy Ellipta zafirlukast zileuton ER SMOKING CESSATION bupropion, smoking cessation nicotine gum, lozenge Nicotrol Inhaler
Anoro Ellipta arformoterol, neb
Prevalite Repatha
Arnuity Ellipta Atrovent HFA Breo Ellipta Breztri budesonide ampule-neb Combivent cromolyn sodium Dupixent epinephrine injection Fasenra Pen fluticasone/salmeterol Diskus Formoterol, neb Incruse Ellipta ipratropium/albuterol (nebulizer solution) ipratropium bromide
rosuvastatin simvastatin
Hormonal agents (Parathyroid/Metabolic
bone disease) for OSTEOPOROSIS
alendronate calcitonin-salmon nasal spray Duavee ibandronate sodium raloxifene
Nicotrol NS varenicline
Selective Serotonin reuptake inhibitors for DEPRESSION
risedronate teriparatide Tymlos
colestipol ezetimibe ezetimibe/ simvastatin fenofibrate fenofibric acid fluvastatin fluvastatin ER gemfibrozil
citalopram escitalopram fluoxetine fluoxetine DR fluvoxamine fluvoxamine ER paroxetine paroxetine ER sertraline
Platelet-stimulating agents for HEMATOLOGICAL DISORDERS
levalbuterol montelukast Nucala Pulmicort Flexhaler QVAR roflumilast Serevent Diskus Stiolto Symjepi terbutaline
Doptelet Promacta PRENATAL VITAMINS Generic Rx (only) Respiratory agents for ASTHMA/COPD Advair HFA albuterol sulfate albuterol HFA
lovastatin midodrine Nexletol Nexlizet niacin ER Niacor
› For more information go to harvardpilgrim.org or call 800-848-9995
* Note: Diabetic supplies (i.e., blood glucose meters, test strips, lancets, syringes) are covered under Preventive Drug Benefit with prescription. This Preventive Drug List is not all-inclusive and is subject to change to comply with IRS guidance and as formulary updates are made. For the current Harvard Pilgrim Health Care formulary please see harvardpilgrim.org/rx . Flyer Last Updated October 8, 2024; effective 1/1/25. Harvard Pilgrim Health Care includes Harvard Pilgrim Health Care, Harvard Pilgrim Health Care of New England and HPHC Insurance Company
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Coverage for Over-the-Counter Medications
Your health plan includes coverage for certain generic over-the-counter (OTC) medications. This means cost savings on the essentials in your medicine cabinet.
Here’s how it works: › Use the online lookup tool at harvardpilgrim.org/rx to see which OTC medications you take are covered. › Ask your provider to write a prescription for the covered medication, for up to a 90-day supply. › Bring the prescription to any in-network pharmacy* so that the pharmacist can give you the proper medication. › You pay Tier 1 cost sharing instead of the retail price. If you have an HSA plan, you pay either our discounted rate or the retail cost, whichever is lower, until you meet your deductible, and then Tier 1 cost sharing applies. There’s another advantage: because your provider will be giving you a prescription for the OTC medications you take, your medical records will have a more complete medication history. Below are the types of OTC medications that are covered along with a complete listing by medication:
Type of Therapy
Purpose
› Antitussive (cough suppressant) › Expectorant › Nasal decongestant › Antihistamine › Nasal spray
Cough, cold, allergy
› Anti-fungal › Poison ivy
Dermatology
› Dry eye › Allergy
Eyes (ophthalmic)
› Anti-parasite › H2 blocker (antacid) › Laxative › Anti-inflammatory
Gastrointestinal
Pain
*Visit harvardpilgrim.org/rx to find in-network pharmacy locations near you.
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› When using the lookup tool for your plan’s formulary, search by the generic name shown here. › Only the generic versions of the product names are covered. › Keep in mind that multiple store brands are available as generic drugs. Covered Over-the-Counter Generic Medications
Type of Therapy
Medication Brand Name
Generic Name
Benadryl tabs, liquid
Diphenhydramine
Cough, cold, allergy
Claritin tabs, syrup
Loratadine
Dextromethorphan liquid, syrup
Guaifenesin
Nasalcrom nasal spray
Cromolyn
Ocean 0.65% nasal spray
Saline
Robitussin syrup, liquid
Phenylephrine tablet
Sudafed tabs, liquid
Pseudoephedrine
Zyrtec tabs, solution
Cetirizine
Clotrimazole cream, vaginal cream Clotrimazole Hydrocortisone cream, gel, lotion, ointment, solution (various name brands) Hydrocortisone Miconazole cream, vaginal cream and suppository Miconazole Tolnaftate cream, solution, aerosol Tolnaftate
Dermatology
Artificial tears (various name brands)
Artificial tears
Eyes (ophthalmic)
Zaditor OTC 0.025%
Ketotifen
Citrate of Magnesium solution
Magnesium citrate
Gastrointestinal
Dulcolax tabs, suppositories
Bisacodyl
Fleet Enema
Sodium phosphate
Metamucil powder
Psyllium
Miralax powder
Polyethylene glycol 3350
Pepcid tabs
Famotidine
Senna 8.6mg tabs
Senna, sennosides
Tagamet tabs
Cimetidine
Ibuprofen 100mg/5mL suspension
Ibuprofen
Pain
Harvard Pilgrim Health Care includes Harvard Pilgrim Health Care, Harvard Pilgrim Health Care of New England and HPHC Insurance Company.
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Reduce My Costs Shop, Save, and Earn
• Lower costs and more savings: For services such as a colonoscopy or an MRI, the average savings is more than $1,000. And, if you’re already seeing a cost-effective provider, you’ll receive a reward just for using the Reduce My Costs program. 2 • Quick and easy access: Get exclusive access to an experienced nurse who will help you compare costs and shop for cost-effective providers near you. The nurse can assist with appointment scheduling or required paperwork, if needed. • What members are saying: “The Reduce My Costs Service is an outstanding program of Harvard Pilgrim. Heidi was just phenomenal. I cannot thank her enough for helping me to navigate the options and cut through the red tape.” — Roxi J. Rose, Harvard Pilgrim member near you. The nurse can assist with appointment scheduling or required paperwork, if needed. Did you know that the cost of a common MRI can range from $680 to over $3,000 depending on where you choose to go? 1 Reduce My Costs is a personalized health care concierge service that connects you with a nurse via phone, email, or live chat to help you find cost-effective, high-quality providers near you. Depending on the service and the associated cost savings with your selected provider, you could earn a Visa® gift card and reduce your out of pocket costs. 2 The Reduce My Costs program includes most outpatient tests and procedures that are ordered by your provider such as lab work, MRIs, colonoscopy, mammograms and more. 3 Reduce My Costs Shop, Save, and Earn Did you know that the cost of a common MRI can range from $780 to $2,230 depending on where you go? 1 Reduce My Costs is a personalized health care concierge service, you can connect with a nurse, via phone or chat, who can help you find high-quality, cost-effective providers near you. Depending on the service and the associated cost savings, you could earn a Visa® gift card. 2 The Reduce My Costs program includes most outpatient services and tests that are ordered by your provider such as lab work, MRIs and mammograms and more. 3 On average, you can save more than $1,000 for services such as a colonos- copy or an MRI. And, if you’re already seeing a cost-effective provider, you’ll receive a reward just for using the Reduce My Costs program. 4 “Janine at Reduce My Costs helped me get the MRI I needed for $254 instead of $1200. This was tremendous savings!” – Mr. Cox, Harvard Pilgrim member Get exclusive access to an experienced nurse who will help you compare costs and shop for cost-effective providers Lower costs and more savings Quick and easy access What members are saying:
› Make the call and get rewarded. Connect with a nurse at 855-772-8366 or scan the QR code to chat Monday through Friday from 8 a.m. to 6 p.m. ET Make the call and get rewarded Connect with a nurse at (855) 772-8366 or scan the QR code to chat. Monday through Friday from 8 a.m. to 6 p.m. ET.
P1450919113-0724 1 Ranges are based on Harvard Pilgrim’s data, actual service prices vary by provider type and location. The figures represent Q1 2022. 2 Cash rewards comes in an e-gift card format that is emailed directly to the member. Rewards are offered on services that meet minimum savings threshold. Rewards are considered taxable income; please consult with your tax advisor. Rewards vary based on plan and state. 3 Your health plan may require a referral and/or prior authorization before you receive services from a cost-effective provider. To ensure the services will be covered, please refer to your plan documents or contact Harvard Pilgrim at (888) 333-4742. 4 Reduce My Costs program is included with all fully insured plans except Littleton Options HMO. Buy up options are available to self insured employers. Ask your employer if your plan includes the Reduce My Costs program. 17 1 Ranges are based on Harvard Pilgrim’s data, actual service prices vary by provider type and location. The figures represent 1Q2024. 2 Cash rewards comes in an e-gift card format that is emailed directly to the member. Rewards are offered on services that meet minimum savings threshold. Rewards are considered taxable income; please consult with your tax advisor. Rewards vary based on plan and state. 3 Your health plan may require a referral and/or prior authorization before you receive services. To ensure the services will be covered, please refer to your plan documents or contact Harvard Pilgrim at 888-333-4742. Reduce My Costs program is included with all fully insured plans except Littleton Options HMO. Buy up options are available to self insured employers. Ask your employer if your plan includes the Reduce My Costs program.
Living Well Program — Enhanced Earn up to $120 in rewards
How it works: 1 Enroll in the Living Well sm program and earn rewards for participating in a variety of informative, fun and interactive activities including topics such as:
Well-being as you define it. A community, at your fingertips. Our program is packed with tools that let you define your own vision of well-being. Here are some of the features: • Customize to suit your goals • Sync to your wearable device • Connect with others for tips and advice Our digital engagement platform is easily accessible from most devices so you can stay on top of your goals wherever you are.
• Stress management • Healthy eating • Financial literacy • Environmental wellness
• Self-care • Volunteerism • Physical activity • Health plan literacy
Subscriber rewards — Earn up to $120 in gift cards.
You’ll earn rewards incrementally, so the more you participate in the program, the more rewards you earn. Subscribers can achieve up to eight levels, at $15 each, for a total of $120 in gift cards each year. Covered dependents or employees who are not Harvard Pilgrim members can participate in a separate program where they can earn points towards monthly gift card drawings.
› Get started at harvardpilgrim.org/livingwellportal
1 Rewards are available for fully-insured commercial accounts rated as large group, with 51-999 eligible employees. Effective January 1, 2025, rewards will also be available to fully-insured small group and individual members across all of the states in which we operate: MA, NH, ME and RI. Rewards may be taxable, please consult with your tax adviser.
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Grow Therapy: Comprehensive Mental Health Support The Grow Therapy program provides virtual and in-person outpatient therapy and medication management for a wide range of behavioral health needs. This program helps to ensure timely and personalized care for members ages 6+. Access to Comprehensive and Continuous Care • Therapy and medication: Access a full suite of services, including therapy and medication management. • Ongoing support: Benefit from continuous care and crisis support services, with regular follow-ups to help ensure effective treatment. • Ability to customize search results by: race, ethnicity, language, sexual orientation, gender identity, religious/ spiritual beliefs and treatment specialty (e.g., trauma-informed, depression, anxiety, ADHD, youth). How it Works 1. Visit growtherapy.com and enter your state of residence. If you live in New England, select Harvard Pilgrim . If outside of New England, select Harvard Pilgrim/United Healthcare/Optum . 2. View provider search results and filter based on your preference. 3. Select an appointment date and time for the provider of your choice. Have your insurance card available, you will need to enter the 9-digit member ID to complete the booking. Benefits of Grow Therapy • Quick access: An average wait time of just 2-4 days for appointments.* • Culturally inclusive: 43% of our providers are Black, Indigenous, and people of color (BIPOC), and 14% are bilingual. • Quality focused: Grow Therapy program uses evidence-based assessment tools to track progress and share insights with you. › Get started at growtherapy.com Member cost share may apply. Members should refer to their member benefit documents for details regarding benefits and coverage. * Average wait time provided by Grow Therapy. Grow Therapy Services are available across the country. Services in Rhode Island will be added soon.
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AbleTo Mental health support at your fingertips
As part of our “whole-person” approach to care, Harvard Pilgrim members have access to mental health support from AbleTo . 1 These programs aim to seamlessly combine on-demand self-care tools and personalized virtual therapy sessions, helping to ensure access to a range of options from enhancing mental resilience with self-care techniques to connecting with licensed therapists for structured guidance. AbleTo Virtual Therapy — Start feeling and living better Need help managing stress, changing unhealthy habits, improving your mood or managing your time? As a Harvard Pilgrim member, you have access to a personalized virtual therapy program. You can connect with an AbleTo licensed therapist, who will guide you through a customized 8-week program proven by AbleTo to help reduce depression, stress and anxiety. 2,3,4
AbleTo virtual therapy is: • Confidential and personalized: program tailored to your schedule and specific needs • Convenient: connect anytime, anywhere over phone or video • Proven with real results among AbleTo users to reduce depression, stress and anxiety
Get started in 3 easy steps: • Grab your member ID card and confirm your insurance coverage • Schedule your consultation with the therapist of your choice • Receive a customized program and start your personal program
› Visit AbleTo.com/HarvardPilgrim and click on the 1:1 virtual therapy link to get started
What members are saying… “The eight-week program was a life-changer for me. It helped me recognize how my thoughts and actions were impacting my health.” – Tiffany, AbleTo Graduate
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Self Care from AbleTo — 24/7 on-demand mental health support at no cost Access Self Care from AbleTo — available anytime, anywhere. This digital program is designed to help adults improve coping skills, resilience and overall mental health. Whether you’re exploring mental health for the first time or you’re not ready for a structured care plan, Self Care offers tools and strategies to enhance your daily well-being, from self-care activities and coping mechanisms to meditation tools. Navigate your mental health journey with ease: • Use Self Care on your mobile device or computer. • Engage with curated content based on your needs. • Leverage strategies such as cognitive behavioral therapy tools, mindfulness techniques and mood and habit trackers to foster emotional growth. Emotional support at your fingertips: • Mood & habit tracking: get to know yourself, your moods and what makes you feel good. Understand the “why” behind your actions and how they relate to your emotions, thoughts and mood. 5 • Meditations: combat feelings of anxiety, improve your mood and practice being more present. • Collections: explore therapist-designed guides that walk you step-by-step through activities designed to help you achieve a specific goal. Get Started with Self Care digital tool — Your access code is your member ID card number
• Visit AbleTo.com/HarvardPilgrim and click on the 24/7 self care link to get started • Choose Harvard Pilgrim as your sponsor and enter your member ID card number • Answer a few questions and access curated content based on your needs
Scan QR code to download the AbleTo mobile app and get access to virtual therapy and 24/7 Self Care digital tool
1 AbleTo is available to Harvard Pilgrim commercial members. Member cost sharing may apply. Members should refer to their plan documents for specific details regarding their coverage and benefits. 2 Internal AbleTo book of business analysis to evaluate change in depression symptoms (DASS-21) among 3934 Therapy+ program graduates who completed an initial consultation 1/1/22-9/30/22 with depression symptoms at baseline. February 2023. 3 Internal AbleTo book of business analysis to evaluate change in anxiety symptoms (DASS-21) among 3339 Therapy+ program graduates with an initial consultation between Jan 1 - Sept 30 2022 with anxiety symptoms at baseline. February 2023. 4 Internal AbleTo book of business analysis to evaluate change in stress symptoms (DASS-21) among 3374 Therapy+ program graduates with an initial consultation between Jan 1 - Sept 30 2022 with stress symptoms at baseline. February 2023. 5 Daily assessments are available for 18+
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Improve Your Health Through Better Nutrition
Looking to lose weight, prevent or manage a health condition, or make better food choices? Harvard Pilgrim has partnered with Good Measures to offer their Healthy Weight program to help you manage weight in a nutrition-focused way to help you reach your goals.
Get personalized support to: • Learn how different foods and nutrients affect your health • Build new habits that help you sustain better health • Fit healthy eating into your schedule and budget • Help prevent or better manage conditions such as high blood pressure, type 2 diabetes and heart disease and avoid disease related complications • Find easy ways to incorporate physical activity into your daily routine What’s included: • Coaching by your own registered dietitian — check in by phone or app messaging • Access to the Good Measures app with personalized food recommendations, online classes, articles and tips, goal and food tracking • Fun challenges with prizes
The Good Measures Healthy Weight program is available to eligible Harvard Pilgrim Health Care members including all fully insured members (group and individual commercial plans). For self-insured accounts, program eligibility and benefits may vary by employer, plan and state. An annual medical claim for nutritional counseling services will be submitted by Good Measures for engagement in the program. Under federal and state law, many preventive services and tests are covered with no member cost sharing; please see the Preventive Services Notice at harvardpilgrim.org for a complete list of preventive services. Your engagement in the Good Measures Healthy Weight program with registered dietitian coaches is designated as preventive services. › Learn more and sign up at harvardpilgrim.goodmeasures.com or call 800-407-0399
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Get Reimbursed for Childbirth Education Classes in 2025
Congratulations! Having a baby is an exciting time in your life, but it can also be overwhelming. Taking a class or course is a great way to build your confidence and prepare for childbirth and early parenthood. If you’re a Harvard Pilgrim member, you can get reimbursed up to $150 for completing a childbirth education class or course. 1 Reimbursement is available to fully insured large group plans and ASO plans that opt in for childbirth class reimbursement.
Your questions answered
Take the class or course, get a receipt and send it in — it’s that simple.
What’s considered a qualifying class or course? Qualifying classes are offered through your local hospital, birthing center, physician’s office or childbirth education organization. They may consist of a one-day course or a series of weekly sessions. Led by a trained childbirth educator, classes typically address labor and birth, pain relief and coping management, birthing options, postpartum care, and the basics of caring for your newborn baby. This includes the virtual class option available through Tinyhood. Visit tinyhood.com/partner/harvardpilgrim for details. What do I need to prove that I took the class? Be sure to get a paid receipt verifying class enrollment. The receipt must show your name, the name and location of the class, the amount paid, and the date of payment. What if the class costs less or more than $150? Harvard Pilgrim will reimburse up to $150, 2 but not more than the cost of the class or course. For example, if the class fee is $225, we will only reimburse $150. If the class costs $120, we will reimburse $120. I took my class a year ago. Can I still get reimbursed? You have until March 31 of the next calendar year to submit your form and receipt. For example, if you took your class in 2025, you must submit your request by March 31, 2026. I took a childbirth class during my last pregnancy. If I take another class in preparation for the birth of my next child, can I be reimbursed? Yes. You’re eligible to be reimbursed for one childbirth class or course per pregnancy, per calendar year.
Select the qualifying childbirth class or course that meets your needs. Fill out the form at harvardpilgrim.org/ reimbursement . Remember, only the subscriber can request the reimbursement. If the dependent is enrolled in the class, the subscriber must complete and submit the form. Mail your form and receipt to the address listed on the form.
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For more details, see the Childbirth Class Reimbursement Form at harvardpilgrim.org/reimbursement 1 MassBio and Milennial plans eligible for full class reimbursement. 2 Maximum reimbursement per Harvard Pilgrim policy in a calendar year (individual or family contract). Some employers may offer a different reimbursement amount. Must be currently enrolled in Harvard Pilgrim at time of reimbursement. For tax information, consult your employer or tax advisor. Childbirth reimbursement details vary for small or individual group. Reimbursable classes must be taken on or after January 1, 2025.
Questions? Call Member Services at 888-333-4742
Harvard Pilgrim Health Care includes Harvard Pilgrim Health Care, Harvard Pilgrim Health Care of New England and HPHC Insurance Company.
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Ovia Health
Support to help you and your family through some of life’s biggest transitions.
Ovia offers support for reproductive health, starting a family, having a healthy pregnancy, balancing life as a working parent and managing menopause.
Ovia Health features three mobile apps: Ovia (formerly Ovia Fertility), Ovia Pregnancy , and Ovia Parenting .
Each app offers access to daily, personalized articles and tips, instant analysis and feedback on your health data, and unlimited in-app messaging with Ovia Health’s team of experts including registered nurses, nurse practitioners, social workers, mental health counselors, nurse midwives, lactation consultants, and infant and child sleep consultants.*
Ovia Ovia offers support for overall reproductive health including pre-conception, looking to conceive, conception, and perimenopause or menopause. Ovia Pregnancy Watch baby grow, track a pregnant woman’s health and progress, and talk to a health coach for support through every pregnancy milestone.
Ovia Parenting Track newborn and infant health, find answers to parenting questions, and receive personalized, age-specific guidance from Ovia’s in-house experts. Parenting supports single parents, co-parents, and multiple caregivers with shared accounts so that everyone can stay involved.
*Harvard Pilgrim Health Care does not specifically endorse or recommend, and makes no warranties expressed or implied, that communication with Ovia Health is a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or qualified health provider with any questions concerning your medical or mental health condition.
Harvard Pilgrim Health Care includes Harvard Pilgrim Health Care, Harvard Pilgrim Health Care of New England and HPHC Insurance Company.
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Ovia apps are a great daily support system if you are: › Interested in tracking and understanding your reproductive health and fertility › Trying to start or grow your family, whether that’s through pregnancy, adoption or surrogacy › Already pregnant › The parent of a newborn, baby and/or toddler, or school-aged child to adolescent › Preparing for or returning from parental leave › About to start the menopause journey
Download the Ovia app(s) right for you and activate your account
If you don’t have an Ovia Health account yet: › Download Ovia (formerly Ovia Fertility), Ovia
If you have an Ovia consumer account already: › Tap “More” and tap “Update my health care information.” › Select health plan and employer. › Enter first name and last name (as listed with your health plan), date of birth and zip code. › Accept the terms and conditions. › Press the Save button at the top right and get started. › Explore Ovia Health!
Pregnancy or Ovia Parenting on your mobile device through the App Store or Google Play, or the landing page at connect.oviahealth.com/harvardpilgrim . › Select “Try it now” and then at the Welcome screen, customize your profile and create a new account. › After entering your email address and creating a password, select the toggle for “I have Ovia Health as a benefit.” › Select “Sign up.” › Select health plan and employer. › Enter first name and last name (as listed with your health plan), date of birth and zip code. › Accept the terms and conditions. › Explore Ovia Health!
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Menopause Support Harvard Pilgrim has partnered with Ovia Health to offer perimenopause, menopause and postmenopause support. Perimenopause can start as early as mid-30s and last as long as 8 to 10 years before menopause. Menopause can happen between the ages of 40 to 50. Ovia’s digital solution can help support and guide a woman through these changes. Expert Advice and Resources • Distinct perimenopausal and postmenopausal symptom tracking • Identification of trends to help members understand how their cycle, moods or symptoms may be changing • A personalized member experience, based on health and life stage • Actionable insights and alerts each day • Unlimited support from Ovia’s Care Team through in app messaging Access To Certified Menopause Practitioners Ovia Health’s Care Team has certified menopause practitioners, who have specific training and expertise in perimenopause and menopause symptoms and health coaching.
Harvard Pilgrim commercial members are eligible for Ovia and can download the Ovia app or visit harvardpilgrim.org/public/ovia-health for more information.
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