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Health Benefits: 3 Must-know details about provider networking, tiering

As we end our Open Enrollment period, we want to make sure you know this important information as you make your choices:

1. Go to nhp.org/partners for your provider info needs. You’ll find a link to our all-inclusive online provider directory, which lists participating providers from the AllWays Health Partners network, behavioral health network and Aetna providers from across the country.

2. Outside of Massachusetts, both Partners Select and Partners Plus offer access to the nationwide Aetna network. Aetna’s network gives you access to 2 million health care professionals.

3. Partners plans have differentiated between “preferred providers” and “non-preferred providers” for many years. Both Partners Plus and Partners Select continue to offer employees the choice between two tiers of network providers. However, the use of the terms “Tier 1” and “Tier 2” are new in 2019.

Tier 1 - Preferred Doctors and Hospitals (Includes Partners Providers)

Tier 2 - Non-Preferred Doctors and Hospitals

Tiering does not apply for employees who live out-of-area, so Tier 1 cost-sharing for employees enrolled in an out-of-area plan applies to all services delivered by a network provider (Tier 1 or Tier 2).

Some services have no tiering, which means you will pay the Tier 1 cost-sharing as long as you see a network provider. They include Acupuncture, Chiropractic Care, Physical Therapy/Occupational Therapy, Speech Therapy, and Mental Health Care or Substance Use Care.

Help is available

As you enroll in your benefits for 2019, it is important that you review your medical plan choices and understand which plan will work best for you and your family. Ask myHR has tools to help, including Partners Select vs. Partners Plus: Which plan is right for you in 2019? If you have any questions, call AllWays Health Partners Customer Service at 1-800-432-9449 (TTY 711).

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