Hughston Allied and ProAct

ALLIED & PROACT Medical & Pharmacy

TABLE OF CONTENTS

Allied

Member Guide

Smart Connect

ProAct

Your Prescription Drug Benefit

Check the Formulary Status of Your Medication

Prior Authorization Chart

Mail Order Program

HEALTH INSURANCE 101

Before you enroll, here are some common terms you need to know and understand:

1. CO-INSURANCE

The percentage of a covered healthcare service cost you pay after you've paid your deductible.

CO-PAYMENT A fixed dollar amount you pay for healthcare services, such as doctor’s visits, urgent care or emergency room services. Co-payments track towards your Out-of-Pocket Maximum, but do not apply towards the Deductible.

WHO PAYS FOR YOUR HEALTHCARE

Your Deductible, Co-Pays, and Coinsurance track toward your Out-of-Pocket Maximum Once you have reached your OOP Max, your Plan will pay for any charged services covered by Your Plan

All Other Covered Expenses

3. DEDUCTIBLE

The amount you pay for certain covered healthcare services before your insurance plan starts to pay on your behalf.

Out-of-Pocket Maximum

OUT-OF-POCKET MAXIMUM The most you will pay for healthcare services in one year. After you spend this amount on deductibles, co-payments, and coinsurance, your health plan pays 100% of the costs for covered benefits (with some exceptions). PREMIUM This is the cost you will pay to participate in the employer health plan. Your Premium is separate from your Deductible and Out-of-Pocket Maximum.

You and Your Plan each pay a % after your Deductible has been met

Coinsurance

Deductible and Co-Pays

You Pay

Your Plan Pays

Preventive Care

PREVENTIVE CARE Routine healthcare services like check-ups, immunizations, and screenings for adults, women, and children.

Premium

You Pay

How to Find an Aetna PPO Network Provider

Your plan offers enhanced benefits for covered services when you visit providers and

hospitals in the Aetna network. Start your search by visiting AlliedBenefit.com to locate a

network provider near you.

On AlliedBenefit.com, hover over the “ Network Partners ” tab and select “ Aetna ”.

Step 1

In the PPO box, click “ Connect ” to access Aetna’s provider database.

Step 2

Specify the location you would like to find a network provider near, then click “ Search ”.

Step 3

Type or click the type of provider you would like to use

How to Find an Aetna PPO Network Provider

Your plan offers enhanced benefits for covered services when you visit providers and

hospitals in the Aetna network. Start your search by visiting AlliedBenefit.com to locate a

network provider near you.

Use the search bar or select the provider category you would like to view from the list.

Step 4

Narrow your search by selecting the type of care and provider service offering.

Step 5

Review and compare the provider matches. Once you have selected your preferred provider, use the contact information to reach that provider.

Step 6

MANAGE YOUR BENEFITS ONLINE WITH ALLIED

Allied is committed to helping you and your family make the most of your benefits and feel confident in getting the care you need when you need it. With access to on-demand tools and one-on-one customer service support, Allied makes it easy to manage your healthcare on your own time. Once you are enrolled in an Allied health plan, you will have access to your own personalized member portal via AlliedBenefit.com. Allied’s online member portal allows you to navigate your benefits and proactively manage your healthcare at any time from any device.

With Allied’s Member Portal, you can: • Check your plan details

Ready to get started? Go to alliedbenefit.com/Members to set up your personalized account. Need more help? Contact our Member Services Team at the number listed on your ID card.

• Track your spending

• Review your claims

• View your Personal Health Record (PHR)

• Access your ID card

Mon-Thu, 7:30 am to 7 pm CT Fri 8 am to 5 pm CT Sat 9 am to 12 pm CT

Allied-Member-Portal (8/2021)

Get Started With My Allied Portal

On January 1st, visit the Allied website and follow the steps below.

STEP 1 Navigate to Allied’s website

STEP 2 Create your account

Go to alliedbenefit.com/Members and click “Sign In or Create an Account.” Then click “Sign Up” on the login page.

Enter your name, email address, and create a password. Note, your email address will be used for your login.

STEP 3 Verify your information

STEP 4 Complete your account

Enter your Date of Birth, followed by your Social Security Number (SSN), OR your Member ID and Group Number. Then click “Continue . ”

Last, confirm your EOB delivery preference, accept terms and conditions, and you’re all set! Begin accessing your benefits right away.

Visit alliedbenefit.com/Members on January 1st to set up your Allied Member account.

Questions? Call Allied Member Services at the number listed on your ID card.

Setting up your Allied Member account

Getting started On January 1st, head to your device’s app store to download the My Allied Portal app, and then follow the steps below.

STEP 2 Create your account

STEP 1 Open the My Allied Portal app Open the app from your mobile device and click “Sign Up.”

Enter your email address, desired password, and your name. Note, your email address will be used for your login.

STEP 3 Verify your information

STEP 4 Complete your account Last, confirm your EOB delivery preference, accept terms and conditions, and you’re all set! Begin accessing your benefits right away.

Enter in your Date of Birth, followed by your Social Security Number (SSN), OR your Member ID and Group Number. Then click “Continue.”

Visit alliedbenefit.com/Members on January 1st to set up your Allied Member account.

(833) 644-2474 | TTY: 711 Mon - Fri, 7:30 a.m. - 5 p.m. CT

Explore your options: gps.smartmatch.com/allied

(833) 644-2474 | TTY: 711 Mon - Fri, 7:30 a.m. - 5 p.m. CT

Introducing SmartConnect ™

SmartConnect is an exclusive program created specifically for working or retiring adults (and family members) who are Medicare-eligible and may not have fully explored the benefits of Medicare coverage.

About SmartMatch Insurance Agency

Staying on your employer’s coverage may be easy, but it’s not always the best option. In fact, Medicare plans could provide more coverage at a lower cost than your employer’s plan. SmartConnect puts your specific needs first and matches you with the education and the experienced advisor you need to make the best decision for you. SmartConnect gives you access to plans from national insurance carriers. Whether you’re planning to continue working or looking to retire, we are expert listeners who can guide you to a tailored solution. We know this is a big decision. Our mission is to inspire confidence and help you find your balance in Medicare.

SmartMatch Insurance Agency is an independent Medicare insurance agency that helps consumers research, compare, and purchase Medicare insurance plans. We provide an unfiltered view of the entire range of options and prices available to you. To get a head start, visit SmartConnect’s Benefits GPS: gps.smartmatch.com/allied Comparing Medicare and employer health insurance offerings can be frustrating. We do the work for you, all you need to decide is how much you’d like to save.

SmartMatch Insurance Agency, LLC

• Explore your options: gps.smartmatch.com/allied •

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(833) 644-2474 | TTY: 711 Mon - Fri, 7:30 a.m. - 5 p.m. CT

The Medicare Roadmap

Medicare can pull you in different directions. Our licensed insurance agents provide the full range of options available, along with strategies and information to help you see the complete picture.

Starting Medicare SmartMatch makes Medicare easy, allowing you to confidently choose between Medicare Advantage and Medicare Supplement insurance plans.

Part A & B Covers 80% of doctor visits and hospital costs

Medicare Supplement Helps cover the remaining 20% of doctor visits and hospital costs

Part D Covers prescription costs

Medicare Supplement

Medicare Advantage

Part C Replaces Part A & B, generally an HMO or PPO-type of plan

Nice to meet you Let’s SmartMatch a plan tailored to your needs

Part D Most Medicare Advantage plans include prescription coverage

SmartMatch Insurance Agency, LLC

• Explore your options: gps.smartmatch.com/allied •

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(833) 644-2474 | TTY: 711 Mon - Fri, 7:30 a.m. - 5 p.m. CT

Key considerations when choosing a plan type

One of the primary decisions with Medicare is determining whether a Medicare Advantage plan or Medicare Supplement insurance policy is right for you. Let’s take a look at some of the key points our team considers when working with you or a family member.

Existing conditions or pending treatments Medicare generally covers pre-existing conditions and disabilities. However, there are exceptions. This is an area where working with an advisor can be especially helpful. Prescriptions Medicare offers a few different options for prescription coverage.

Location Networks and plan offerings vary by region.

Travel The amount of travel (and type of travel) you do can impact out-of-pocket costs. Out-of-pocket cost structure Some plan types require a monthly premium while others only need payment when you use the plan.

No matter your need, no matter your situation, our licensed insurance agents are your personal guide to Medicare.

SmartMatch Insurance Agency, LLC

• Explore your options: gps.smartmatch.com/allied •

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(833) 644-2474 | TTY: 711 Mon - Fri, 7:30 a.m. - 5 p.m. CT

The SmartConnect Process

Here’s what concierge service from SmartMatch looks like:

Educate The first step is to understand the details that could impact your enrollment, costs, and coverage. To get started, visit SmartConnect’s Benefits GPS: gps.smartmatch.com/allied Connect Next, we get to know you. We’ll ask you some questions about your health insurance needs and preferences so we can head down the right path.

Evaluate Then, a licensed insurance agent will provide you with the plan and carrier options available to you

Enroll While our services are obligation-free, if you find something you like and you’re ready to take action, we can enroll you on the spot.

Support We have a team who is dedicated to your Medicare experience. They’re available to answer questions, conduct policy reviews, and even help you work with the carrier when necessary.

Whether you’re familiar with Medicare or just starting out, we’re here to guide you confidently through your options.

Explore your options: gps.smartmatch.com/allied

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Welcome to your prescription drug benefit plan!

Health insurance plan changes can create uncertainty. ProAct is here to ensure that your pharmacy benefits are easily accessible, when you need them most. Here are 5 ways to prepare before walking in the pharmacy door.

Have you considered mail order?

How does the pharmacy get your new insurance information? To fill a prescription, the first thing the pharmacy will need is your new insurance information. It’s important to provide the pharmacist with your new ID card so they can verify your prescription benefit and copays. If you’re enrolled in your new plan, but your card hasn’t arrived in the mail yet, it might be possible to print off a temporary card through ProAct’s member portal. To access this feature* and many more tools, complete the registration process online at proactrx.com/accounts/ register/ *Please note that this feature is only available after your pharmacy benefit officially transitions to ProAct. What is a “tier” and how does it work? Drug lists are typically divided into different categories or “tiers” . Usually these include: generic (tier one), preferred brand (tier two), non-preferred brand (tier three), and specialty medications (often referred to as tier four). The copay you are responsible for paying at the pharmacy is determined by what tier level your medication falls into.

What is prior authorization and why is it important to me? There will be some drugs on the ProAct drug list that require a prior authorization. This helps ensure that you are getting the most cost effective drug for your condition. You may need to meet certain requirements or try a preferred drug before ProAct will approve the drug you are requesting. Your drug list is available on ProAct’s member portal. This will help you to identify if your drug will require a prior authorization. To access this feature and many more tools, complete the registration process online atproactrx.com/accounts/ register/ If you experience a rejection at the pharmacy because your drug is requiring a prior authorization, DO NOT LEAVE THE PHARMACY. Contact ProAct right away, and we can assist in an immediate resolution. How do I know if I can still utilize my pharmacy? ProAct’s pharmacy network includes over 64,000 pharmacies nationwide. To confirm if your local pharmacy is a part of our network, please use the “Network Pharmacies” tool online at proactrx.com/pharmacy-finder/

If you take a daily maintenance medication, you may want to consider getting your prescriptions through mail order. Most plans will allow for a 90-day fill of your prescription medication at a reduced copay or coinsurance. ProAct’s mail order pharmacy is a reliable, cost effective way to securely receive maintenance medications at the convenience of your doorstep.

Enrolling in ProAct’s mail order program is easy!

1. Set up your Mail Order Profile online atproactrx.com/mail- order/1/#register or by calling 866 – 287 – 9885.

2. Submit

your

prescription(s) proactrx.com/

request here:

programs/rtm/enroll/

ProAct will coordinate with your physician(s) to gather your prescription(s) on your behalf. Refills are easy, as you can order online or via phone. You can even enroll in Auto-Refills!

Or simply call our member support center at any time to confirm.

Caring people are never more than a phone call away, any time of day. We’re always here when you need us.

24/7/365 MEMBER SUPPORT: 877 – 635 – 9545

MEMB

ide

YOUR PHARMACY BENEFITS MADE EASY

Helping you get and remain healthy. We’re here to ensure that your pharmacy benefits are accessible, with ease, when you need them most.

Customer Service The ProAct Help Desk is available to serve you 24 hours a day, 7 days a week. Our knowledgeable

customer service representatives can assist you with; Benefit Overview, Eligibility, Prior

Authorization, and much more .

Tel: Fax:

Email: Support@ProActRx.com Mail: 1230 US Highway 11

877 – 635 – 9545

315 – 287 – 7864

Web:

www.ProActRx.com

Gouverneur, New York 13642

Mail Order Pharmacy ProAct Pharmacy Services will deliver maintenance prescriptions, up to a 90 day supply, directly

to your door for the cost of your mail order pharmacy copay. You will need a new prescription

from your doctor to begin using the mail service. Your doctor can e-scribe, call in, or fax your

prescription to “ProAct Pharmacy Services” . You may also mail a prescription along with a

completed profile form. To get started, call a Customer Services Representative to set up your

home delivery profile and method of payment.

Tel: Fax:

Email: MailOrder@ProActPharmacyServices.com Mail: 1226 US Highway 11 Gouverneur, New York 13642

866 – 287 – 9885

315 – 287 – 3330

Web:

www.ProActPharmacyServices.com

Specialty Pharmacy Noble Health Services is ProAct’s specialty pharmacy and is available to dispense medications

used to treat complex and chronic conditions. Our experts at Noble strive to support patients

in all aspects of therapy and always provide the utmost care, from prescription needs and

medication therapy management to financial guidance. Emergency on-call support is available

at all times via our toll-free number. Your doctor may mail, fax, call, or e-scribe to “Noble Health

Services” . Packages will ship next day delivery to your home, physician’s office, or place of

business. Same day delivery is available in some areas of Upstate New York. Local members

may pick up specialty medications at our facility in Syracuse, New York.

Tel: Fax:

Email: ContactUs@NobleHealthServices.com Mail: 6040 Tarbell Road Syracuse, New York 13206

888 – 843 – 2040

888 – 842 – 3977

Web:

www.NobleHealthServices.com

Check the formulary H s o t w at t u o s : of your medication

ProAct makes it easy to check the formulary status of a medication. Our Advantage and Core formularies can be found on our website. You have the option of viewing them without logging in, if you know which formulary you are covered under. For best results, if you are unsure, you can log into the member portal at www.proactrx.com to view that information.

Step-by-Step Guide — Viewing Your Formulary

TO BEGIN THE PROCESS:

Visit www.proactrx.com and log into your account by entering your username and password in the large blue login box.

Once logged in, you will be brought to your DASHBOARD.

STEP 1: OVERVIEW

Under the BENEFITS section, click on OVERVIEW.

Member

QUESTIONS? The ProAct Help Desk is available to serve you 24 hours a day, 7 days a week. Our knowledgeable customer service representatives can assist you with account creation and much more . Call 877 – 635 – 9545

STEP 2: FORMULARY

In the right hand menu, click on the link to open any of the formulary documents.

The Covered Drug Search tool offers you another way to view your whether your drug is covered on your formulary, view your medication tier, and if your medication is a brand or generic.

Step-by-Step Guide — Covered Drug Search

TO BEGIN THE PROCESS:

Visit www.proactrx.com and log into your account by entering your username and password in the large blue login box.

Once logged in, you will be brought to your DASHBOARD.

STEP 1: OVERVIEW

Under the BENEFITS section, click on OVERVIEW.

Member

STEP 2: COVERED DRUGS

In the right hand menu, click on SEARCH COVERED DRUGS.

STEP 3: DRUG COVERAGE SEARCH

Type the name of your drug in the box under Drug Name. A list of suggested drugs will start to populate. Make your selection from the list and then click CHECK COVERAGE. You may narrow searches further, if needed, by selecting an option from the TIER list before clicking CHECK COVERAGE.

ProAct also offers a Drug Pricing Tool that allows you to compare the price of your prescriptions at nearby pharmacies. The results are presented in real-time and are based on your unique member benefits. Results may vary by pharmacy used, as well as drug dispensed, including strength, quantity, manufacturer, and days supply.

Step-by-Step Guide — ProAct’s Drug Pricing Tool

TO BEGIN THE PROCESS:

Visit www.proactrx.com and log into your account by entering your username and password in the large blue login box.

Once logged in, you will be brought to your DASHBOARD.

STEP 1: GO TO DRUG PRICING TOOL

Under the BENEFITS section, click on DRUG PRICING.

Member

STEP 2: GET PRICING

Type the name of your drug in the box under Drug Name. A list of suggested drugs will start to populate. Make your selection from the list and enter a days supply, quantity, zip code, radius, and then click GET PRICING.

STEP 3: COMPARE THE RESULTS

The pricing displayed is reflective of the member logged in. Results may vary by pharmacy used, as well as drug dispensed, including strength, quantity, manufacturer, and days supplied. Not all plan designs will generate drug pricing information. For assistance with drug pricing, please contact the ProAct Help Desk at 1-877-635-9545.

Affordable Care Act (ACA), Consumer Directed Healthcare (CDH) Preventative medication list, prior authorization, step therapy, and quantity limit program listings can be found along with formulary documents in the member portal under the resources, drug lists link. These documents represent the standard offerings associated with these programs. There may be other medications subject to one or more of these edits based on a member’s specific plan design, or due to a change in the prescription drug market.

YourFully Integrated Pharmacy Benefit Manager

Here is what you should know if your prescription rejects for Prior Authorization:

PHARMA C Y

S TO P

APPROVED Get Healthy and Stay Healthy!

DENIED (for Prior Authorization requirement)

DO NOT LEAVE THE PHARMACY

HAVE YOU BEEN ON THE MEDICATION BEFORE? ?

YES

If ProAct can verify that you’ve been on the medication previously, and it is covered through your plan . . .

CALL THE PROACT HELP DESK 1 – 877 – 635 – 9545

CONTACTYOUR DOCTOR (Notify them your prescription has been denied due to a Prior Authorization requirement.)

PROACTWILL GRANT A ONE-TIME OVERRIDE (up to a 30 day supply)

YOU WILL STILL NEED TO CONTACTYOUR DOCTOR to initiate the Prior Authorization process

YourFully Integrated Pharmacy Benefit Manager

Mail Order Program: As part of your prescription drug benefit plan you have the option to use ProAct’s mail order pharmacy, ProAct Pharmacy Services, for maintenance medications. Maintenance prescriptions are medications you take every day for an indefinite period of time. Each mail order maintenance medication can be filled up to a 90 day supply. Learn more below:

24 7

Free standard shipping

Lower out-of-pocket costs

Access to a Customer Service Representative any time of day or night

State-of-the-art dispensing with 3x quality control

FREQUENTLY ASKED QUESTIONS

■ What if I am not home to receive my medication(s)? If your medication(s) are being sent USPS (non-refrigerated medication), they will be delivered to your mailbox just like normal mail. If you are receiving a controlled substance, a signature will be required in order for the medication to be left at your home. You may provide us with an alternate address in which to ship the medication, where you know someone is present to sign for it. If you are leaving your residence for an extended period of time, simply provide us with an alternate address or a one- time-use address in which to ship your medications. ■ Do I need to call every 90 days to make sure my prescription is filled and being mailed? You have the option of utilizing our Automatic Refill Program. This will push maintenance prescription(s) with remaining refills into process when approximately 15% of your current prescription is remaining.

■ How do I get started? To enroll in ProAct’s mail order program, set up your Mail Order Profile online at proactrx.com/mail-order/1/#register or call 866 – 287 – 9885 to speak to a Customer Service Representative. They will assist you in setting up a patient profile including a payment method. You may set up automatic billing to a credit card of your choice. ■ What if my medication needs to be refrigerated? If your medication requires refrigeration, our team will call you to schedule the delivery at a time when you will be home. Your medication is packaged with special ice packs and ventilation that can last up to 48 hours. All refrigerated medication is delivered UPS Overnight to ensure the integrity of the medication. ■ How long will it take for me to receive my medication(s)? You can expect to receive your medication(s) within 7 – 10 days after we have received the order.

If you have a prescription that is enrolled on the program, but there are no refills remaining, the system will automatically send a refill renewal request to your doctor. We strongly encourage you to reach out to your doctor as well to inform them you are out of refills in order to avoid any possible interruptions. You can also utilize our website, www.proactrx.com, or automated phone system to call in your prescription(s) up to 21 days in advance to ensure timely delivery of your medications.

Prescriptions controlled substances are excluded from the auto refill program and doctor renewal requests. for

Your exclusive provider

of mail order prescriptions!

1226 US Highway 11 Gouverneur, New York 13642

More Frequently Asked Questions can be found on our website! www.proactrx.com/help-center/

866 – 287 – 9885 tel | 315 – 287 – 3330 fax MailOrder@ProActPharmacyServices.com

For additional information or to enroll, please call 866-287-9885.

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