Medical Benefits
Medical insurance is one of the most important components of Tishman's Employee Benefits Program. Tishman offers medical benefits through Oxford Health Plans (UnitedHealthcare's small group provider). Oxford Health Plans Employees can select from three medical plan options: ⮞ Core Oxford EPO 20/40 (Medical and RX) ⮞ Oxford HDHP $1,500/90% with Health Savings Account (Medicaland RX) ⮞ Buy-Up Oxford PPO 20/40 (Medical and RX) While all of the options cover the same types of medical services and provide prescription benefits, each provides coverage at a different level. The Core EPO and the HDHP are offered at the same cost, however the plans work differently. The Buy-Up option provides a higher level of coverage when compared against the two options, but also requires a higher contribution per pay. Core Oxford EPO 20/40 (Medical/RX) The core plan provides its members with medical coverage through a specified network of doctors.The plan provides you with access to primary care and specialty care physicians within the plan's network. All services must be provided by in-network providers in order to be covered; emergency services, however, are covered at any licensed provider. EPOs do not offer out-of-network benefits. If you choose to go out-of-network, you’ll have to pay 100% of the provider’s charge. Oxford HDHP $1,500/90% with Health Savings Account (Medical and RX) This typeof plan puts you, the consumer, in the driver’s seat. You have affordable coverage, protection from catastrophic expenses, and the flexibility to choose how to spend – or save – your money along the way. Paired with a tax-free Health Savings Account (HSA), this plan can offer many long-term financial benefits for those who are willing to take an active role in managing their health care experience. See page 7 for more information on the HSA. Similar to a traditional PPO plan, the Oxford HDHP $1500/90% Health Savings Account Plan provides the flexibilityof both in andout-of-networkcoverage. However, the HSA Plan works differently from the PPO option in that you pay the full cost for all services (with the exceptionof in-network preventivemedical services) until you have met thedeductible. Buy-Up Oxford PPO 20/40 (Medical and RX) The Buy-Up Oxford PPO 20/40 Plan is a comprehensive, high-end medical plan. This plan provides participants the freedom of choice by allowing you to choose your own doctors and hospitals. You do not need to enroll with a primary care physician and you never need a referral. Tishman offers this plan as an option to those who are interested in a more comprehensive coverage and willing to “buy up” to a premium plan. While the PPO 20/40 Plan allows you to receive care from both in-network and out-of-network providers, it is important to note that if you use out-of-network providers, you will be subject to a higher deductible and higher out-of-pocket costs.
Network An insurance company's group or list of approved or contracted providers from which you can obtain services at the plan's highest benefit level.
If you have any questions about
network availability, you can call Oxford Health Plans at 1-800- 444-6222 or visit www. oxhp.com for an up-to- date listing of providers.
IMPORTANT! You must obtain
precertification before receiving the services and procedures outlined on the next page. To precertify treatment, please call UnitedHealthcare for Oxford. Inpatient Mental Health Care must be precertified by calling 1-800-444-6222. Be sure to identify yourself as a Oxford member and provide your ID number.
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