Health Insurance - HMO Plan

Health Insurance - HMO Plan

Open Enrollment will take place on the CES Intranet this year. All process details, as well as plan descriptions and costs, can be found there. If you are unsure how to access the intranet, please contact HR directly.

Is the HMO Plan right for me?

All members must choose a primary care physician — from among thousands that accept Harvard Pilgrim (HPHC) — to provide or coordinate your care. To find a doctor, please visit the Harvard Pilgrim website.

Preventive care services are covered free of charge; some services require a copayment and others are not covered until the deductible is met. Certain tests and screenings are covered at no charge, while others are subject to the deductible.

New Enrollment:

  1. Go to www.harvardpilgrim.org
  2. Select “Member Login” -  Enroll in Harvard Pilgrim
  3. Enter Employer ID: 0000288568
  4. Effective date: 07/01/2020
  5. Reason for Enrollment: Open Enrollment
  6. Select the plan you would like to enroll in, add Member Information then click “submit”

New Enrollment Instructions

Make changes:

  1. Go to www.harvardpilgrim.org
  2. Select “Member Login” -  Enter your HP Connect username/password
  3. Select “Update my Information”
  4. Select “Edit Plan Options”
  5. FOLLOW THE INSTRUCTIONS!

Existing Employee Instructions

NOTE:  Changes to your plan, can ONLY be made during Open Enrollment, or if you have a qualifying event (birth, marriage, divorce, death).

 

Learn more about the HMO Plan

View all coverage-related documents, including plan description, Rx information and information on additional benefits. The Summary of Benefits below provides plan details, if you have questions please call HPHC (800) 708-4414.

HMO Plan Summary of Benefits

HPHC's HMO "How It Works"

"Four Facts about the HMO"

 

Learn more about the HRA

You are automatically enrolled in the HRA if you have the HMO Plan.

RSI HRA Summary of Benefits

RSI Sample Explanation of Benefits

RSI HRA Plan Claim Process

 

HMO Cost Information

Chart Comparing All Three Plans

Chart of Biweekly Employee Health Insurance Costs 20 pays

Chart of Biweekly Employee Health Insurance Costs 24 pays

*School Year - 20 Pay Employees: see 20 pay rates

**Union Employees: Union members selecting the year-round lump sum payment in the last payday of the school year will have deductions taken based on the 24 Pay Schedule until the last payday when 2 months of employee payments will be taken.

Flexible Spending Accounts

Now is the time to take advantage of an FSA (Flexible Spending Account) to help with deductible expenses.

Learn more about FSAs

FSA (Flexible Spending Account) Enrollment Form

FSA (Flexible Spending Account) Claim Form

 

What about Prescriptions?

Prescription Plan Details

Would you like to save time and money? Obtain your prescriptions by mail!

Log in to your harvardpilgrim.org member account or download and open the OptumRx app to: 

  • Manage your OptumRx mail order prescriptions
  • Get updates on prior authorization status 
  • Set up reminders for when it’s time to take your medications 
  • Get email and text alerts for mail order prescription refill reminders and order status updates If you have any questions about your coverage

Call Harvard Pilgrim’s Member Services department at (888) 333-4742. Representatives are available Monday, Tuesday and Thursday from 8 a.m. to 6 p.m., Wednesday from 10 a.m. to 6 p.m. and Friday from 8 a.m. to 5:30 p.m. 

Fill your prescriptions with home delivery: 

  • Order a 3-month supply of your maintenance medications — ones you take regularly. 
  • OptumRx® home delivery fills your order, mails it to you and lets you know when to expect your delivery. 
  • Your medication arrives within 4 to 7 days of placing the order. 
  • OptumRx home delivery will notify you if there will be a delay in your order. Your medication is delivered right to your mailbox, saving you a trip to the pharmacy.
    • Your maintenance medication could cost less. 
    • Pay nothing for standard shipping. 
    • Phone, text and email reminders help you remember every dose and every refill.

OptumRx Home Delivery Brochure

OptumRX Home Delivery Tips

For more information, contact: 
Phone: 
413.586.4900 x5923, x5922 or x5932
Email: 
hr@collaborative.org