Last month, it was announced that Partners HealthCare will move the administration of its 2019 employee health benefit plans from Blue Cross Blue Shield to Neighborhood Health Plan (NHP).

Below are the three most frequently asked questions about the 2019 health plans answered by Human Resources:

Does the move to NHP change who is considered “in-area” versus “out-of-area?”

The move to NHP will have no impact on who is considered in- and out-of-area for health benefit purposes. However, HR will review these definitions and provide any updates for 2019 later this summer. As with the current plan, employees who live out-of-area will be able to see any provider in the NHP network and will pay the Partners Preferred Network copay when they receive care. All plan design features will remain the same, except primary care office visit copays, which will reduce by $5.

Will I have to find new medical providers for me and my dependents? What about behavioral health?

As of June 1, more than 95 percent of all providers seen by Partners HealthCare employees are already part of the NHP network. NHP is growing and investing in its future and is actively working to increase its provider network. An interim online Provider Directory has been created allowing staff to see providers currently part of the NHP network. The tool also allows requests that NHP contact care providers about joining the network for 2019. HR will be actively working to grow the network in time for Jan. 1, 2019.

NHP also is building a custom network of mental health and substance use disorder providers for Partners employee health plans. As part of this process we are actively recruiting providers and establishing
Partners’ specific reimbursement and claim management processes.

What happens if I live in a state that does not accept NHP, am traveling and need medical care, or have a child who lives outside Massachusetts?

As with the current plans, Partners Select and Partners Plus cover participants no matter where they are. Outside of Massachusetts, the plans use Aetna’s national network, one the largest commercial health plans in the country. All cards will have the Aetna logo on the back so that if a cardholder or college-aged child live out of state or travel, they will have access to all 1.2 million health care professionals, more than 690,000 primary care doctors and specialists, and more than 5,700 hospitals. Emergency care is always covered regardless of whether there is an in-network provider.



Read more articles from the 07/27/18 Hotline issue.