Once you have completed your benefit election you will be directed to a confirmation page. Please review the confirmation page and click "Please confirm" to verify your new election. Email or print the confirmation page for your personal records.
Also, email a copy of the Secova confirmation to Dora Blair at blairtl si. The SECOVA technical support team is available for assistance with logging into the iElect platform, password resets and basic system navigation. The SBC document provides a summary of the coverage in each health plan and includes summaries of covered and excluded services, plan deductibles, out-of-pocket limits, annual limits, and network and referral provisions. The plan choices are listed below with a brief description.
For additional details regarding each plan and directories of participating providers are available on the websites listed or by calling the plan carrier using the telephone numbers listed below.
The most flexible of all the CareFirst plans, the PPO has a network of doctors that you may use, but you also have the freedom to go outside the network. If you use a physician in the network, you will receive a higher benefit than if you go outside of the network. You are not required to select a primary care physician, nor do you need a referral to see a specialist.
You choose who you would like to see as service is needed. Providers under the PPO network can be located on www. To locate a provider out of the service area, go to www. This is a Point of Service plan that offers flexibility in choosing your health care provider. You are required to choose a Primary Care Physician upon enrollment, but you do not need a referral in order to see a specialist or another physician within the network.
Choosing a provider or a specialist within the network will result in a lower out-of-pocket expense. Seeing a physician who is out-of-network will result in a higher out-of-pocket expense, and you may have to file your own claim. Providers under the POS network can be located on www. This is an HMO plan with a private network of doctors and service providers that you must use in order to receive a benefit.
You must choose a primary care physician from the directory who will coordinate your health care needs. You do not need a referral from the primary care physician to see a specialist within the network. Pharmacy card drug benefits are included. Providers under the HMO network can be located on www. However, fellows must self-enroll via the Secova System which is designed for staff so the health insurance premiums reflect the cost to staff per pay period, but fellows should only refer to the monthly premiums identified below.
The Smithsonian and its benefits consultant, Mercer worked with our insurance carriers to negotiate the premiums for the benefit year. Below is a summary of the renewal information for each plan. The premiums can be located on the chart below. The overall CareFirst premium decreased by 1. The decrease is based on a review and analysis of the claims paid on behalf of Smithsonian plan participants during the previous year which is used to determine the overall premium for As part of the Patient Protection and Affordable Care Act ACA , insurance carriers are required to rebate part of the premiums received if they did not spend at least 85 percent of the premiums on health care services e.
The Smithsonian must use a portion of this rebate to reduce premium rates for the upcoming plan year and have done so by reducing the premium for the active participant population for the plan year. If you have a specific transition of care issue, please contact the Carriers directly at the numbers provided below.
Questions regarding plan benefits may also be addressed by contacting the Member Services numbers below. If you are currently not enrolled in a Smithsonian Health Insurance Plan, prior to Wednesday, November 24, , you must notify the Office of Fellowships OF of your intent to submit an election.
OF will need a full name, local address, social security number, and full date of birth mmddyyyy. Updates to Secova are only done on Tuesday of each week so if information provided by COB Monday you will be able to make an election on the Wednesday after your information is provided to OF.
The site will be active beginning November 8, for Open Enrollment actions. NOTE: If you do not confirm your election, your changes will not be processed. If you have any questions regarding the online system navigation, please call the SECOVA technical support call center The system will not accept any Open Enrollment elections after December 13, pm. However, fellows must self-enroll via the Secova System which is designed for Smithsonian employees.
The health insurance premiums reflect the cost to employees on a per pay period basis. Other Benefits. Back to top. CareFirst BlueChoice Advantage offers you the flexibility and freedom to choose from both in- and out-of-network providers.
CareFirst BlueChoice Advantage does not require you to designate a primary care provider PCP or to obtain a referral to see a specialist. However, if you select a patient centered medical home PCMH PCP , they can help you to better manage your health care needs and overall well-being by providing comprehensive care coordination. Your portion of the cost of the medical coverage is deducted from your pay on a pre-tax basis. Express Scripts drug coverage is included with your cost for the CareFirst medical coverage.
The Plan Allowance for covered services is determined by the contracted rate or fee schedule that participating providers have agreed to accept for that service or the rate or fee that is established by law. The in-network annual deductible applies to non-preventive care services. Preventive care such as annual physicals and mammograms are not subject to the deductible, however, copayments still apply.
The BlueChoice plan does not cover any portion of your medical bills until you first meet your annual deductible; copayments still apply and do not count toward the deductible. After the deductible is met for the year, you pay the copayment for certain covered services.
The out-of-network plan does not cover any portion of your medical bills until you first meet your annual deductible. If your provider participates with BCBS through another plan, they are required to submit your claims on your behalf and BCBS will reimburse them directly. You are responsible for arranging your own hospital certifications.
There is a financial penalty if pre-certification is not arranged. Please call the provider's office directly to confirm that they still participate in the CareFirst network, even if they are listed as a provider on the CareFirst site.
To find an in-network provider, visit www. If your provider is not listed in the online directory, they are considered out-of-network. You will still have coverage, but your out-of-pocket costs will be greater. Please call the provider's office directly to confirm that they still participate in the CareFirst network, even if they are listed as a provider on the BCBS site.
In addition, you can schedule visits for other needs such as behavioral health support from a therapist or psychiatrist, guidance from a certified nutritionist or breastfeeding support from a lactation consultant.
Visit www. Patient centered medical home PCMH doctors provide coordination of care for patients with serious and chronic health conditions. If your physician participates, they will get streamlined access to specialist reports, test results, and hospitalization information. A nurse in your physician's office is designated to be available to answer questions, support the treatment process, and be proactive in providing care.
The program is confidential, voluntary, and provided at no additional cost to you. If you are contacted by your doctor, we strongly encourage you to enroll in the program so that you can get personalized care and support for you and your family. To find out if your physician participates in the program, go to www.
CareEssentials is a personalized, confidential, and voluntary health coaching program to help people with chronic conditions, like diabetes or asthma, to manage their overall health. Highly trained nurses provide one-on-one telephone support and health information, help you prepare questions for doctor visits, answer questions about new diagnoses and medications; and assist with other health issues.
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A new patient-centric, virtual-first primary care practice. Compassionate care for over conditions through an easy-to-use app. 24/7/ CloseKnit's care teams offer preventative . Make a Referral Ė CareFirst Itís Easy to Make a Referral to CareFirst! CareFirst has made it easy to refer patients to our hospice, palliative care, and grief service programs. We . CareFirst offers a variety of plan types (HMO, POS, PPO). Plan types refer to how plans provide coverage and from which network of providers you receive care. Review the information below .