Harvard Pilgrim is honored to partner with North Country Healthcare to offer you and your family quality, comprehensive medical care coverage. We want to make your transition to us as simple and seamless as possible. Please take a few minutes to read this document which answers both general and transitional questions that many members like yourself may have when joining a new health plan. We are also including contact information to connect you with our team for any additional information you may need.

From everyone at Harvard Pilgrim Health Care, welcome!

Transition support for you and your family Leading up to the plan’s effective date of January 1, 2018, the TotalAssist team, comprised of Harvard Pilgrim professionals, will be available through a toll-free number designed to answer any questions you may have.

We know that changing medical plans may be stressful, especially if you are amid ongoing treatment. The TotalAssist team can help you by:

• Answering questions about your benefits or helping you to find a provider

• Helping with clinical transition if you are pregnant, have an upcoming surgery or a complex medical condition

• Empowering you to make the best decisions about your own health care by showing you how to use our extensive online tools at www.harvardpilgrim.org/nch.

NCH Members:Your partner in health care is here to help!

Support during your transition to Harvard Pilgrim

Call TotalAssist toll-free at (866) 874-0817, Monday, Tuesday and Thursday 8 a.m. to 6 p.m., Wednesday 10 a.m. to 6 p.m. and Friday 8 a.m. to 5:30 p.m.

• When prompted, state that you are an employee of “North Country Healthcare.”

• For TTY service, call 711.

Please Note: From 1/1/2018 forward, please call the phone number on the back of your Harvard Pilgrim member ID card.

Open up for answers to common questions when transitioning to Harvard Pilgrim.

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How can I find out if my doctor participates in Harvard Pilgrim’s network?It’s easy! Visit www.harvardpilgrim.org/nch. There you will find information about the networks for each of the plans available to you. Depending on the medical plan(s) offered by your employer, the network of participating providers may vary.

Will I need to select a PCP for my 2018 coverage?If you select an HMO plan, you will be required to designate a primary care provider (PCP). You may write your selection on your member enrollment form, and you can change your PCP any time by creating a secure online account at www.harvardpilgrim.org. You can create an account on or after your effective date of January 1, 2018. PPO plans do not require members to select a PCP.

I am undergoing treatment for a medical condition and am concerned about how my transition to Harvard Pilgrim will affect my care. Do you have any support in place to help me?You will be able to confidentially discuss specific issues or concerns about specialized medical care with Harvard Pilgrim staff by calling the TotalAssist line at (866) 874-0817.

You can talk about your specific situation, and find out about resources available to meet your individual medical needs. And if appropriate, we can have a plan for your continuing care already in place by the time you enroll.

Do I need to take action during North Country Healthcare’s Open Enrollment Period? Yes, you will need to choose your medical plan. You can read about plan details at www.harvard pilgrim.org/nch. We recommend that you take the time to become familiar with your new plan and confirm that your doctors are part of its network. If you do not make an election during open enrollment then you will not have medical coverage beginning January 1, 2018.

Whom can I call with questions?If you have additional questions during the transition period, call the toll-free TotalAssist line at (866) 874-0817.

Note: Please state that you are an employee of “North Country Healthcare.” For TTY service, call 711.

For support beginning the effective date of January 1, 2018, please call the phone number on the back of your Harvard Pilgrim member ID card.

Answers to common questions when transitioning to Harvard PilgrimInformation to help make your transition to Harvard Pilgrim easier

Q & A about your behavioral health benefits

How do I receive authorization for care?Call Harvard Pilgrim’s Behavioral Health Access Center at (888) 777-4742. A clinical coordinator will assist you by:

• Determining the type of care you need

• Finding an appropriate behavioral health provider located within or near your community

• Authorizing the services

If you already know the name of a provider you’d like to visit, a clinical coordinator will let you know whether he or she treats Harvard Pilgrim members. The coordinator will also answer questions you may have about your benefits and applicable cost sharing (e.g., copayment, deductible and coinsurance) amounts.

Do I need a referral from a primary care provider (PCP) to visit a behavioral health provider? You do not need a referral. If your PCP is suggesting treatment, he or she may call for authorization on your behalf.

I’m having trouble finding a provider or obtaining a timely appointment. What can I do? If you are having difficulty finding a provider or getting an appointment that meets your needs, please call the Behavioral Health Access Center for help. A coordinator can provide additional referrals, assist with getting you an appointment, and help you if you’re experiencing an urgent transition situation.

I am joining Harvard Pilgrim from another medical plan and I’m in the middle of treatment with a behavioral health provider. What should I do?

If your provider accepts Harvard Pilgrim coverage - You can continue treatment, provided it is a covered benefit. You can confirm whether your provider participates in the network by visiting www.harvardpilgrim.org/nch and using the online directory. Please note that your cost-sharing amounts may change depending on the plan you enroll in for 2018.

If your provider does not accept Harvard Pilgrim coverage - Call the Behavioral Health Access Center at (888) 777-4742 to ask for transitional benefits. Transitional benefits allow you to continue ongoing treatment for a limited time with providers who do not accept Harvard Pilgrim coverage, as described below.

You must call the Behavioral Health Access Center to request transitional coverage within 30 days of the effective date of your coverage with Harvard Pilgrim to be eligible for transitional benefits.

To be eligible for transitional benefits:

• You must be in active treatment with your current provider at the time you enroll with Harvard Pilgrim

• Your provider must agree to accept our usual authorization, review and claims procedures, and in-network fees

• The services provided must be a covered benefit under our plan

If you receive approval for transitional benefits, you will be covered for medically necessary services at the in-network level of coverage for 90 days. During that time, you and your provider can either conclude treatment, or arrange for a coordinated transition to a provider who accepts Harvard Pilgrim coverage, or you can continue to see your provider at the out-of-network benefit level.

During your transition to Harvard Pilgrim

Looking ahead to your 2018 behavioral health coverage

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Harvard Pilgrim Health Care includes Harvard Pilgrim Health Care, Harvard Pilgrim Health Care of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company.

Contact UsWe’re here to help you during your transition

to Harvard Pilgrim.

TotalAssist

(866) 874-0817

Call toll-free for support during the transition period ending 12/31/2017

Monday, Tuesday and Thursday 8 a.m. to 6 p.m., Wednesday 10 a.m. to 6 p.m. and Friday 8 a.m. to 5:30 p.m.

When prompted, state that you are an employee of “North Country Healthcare.”

For TTY service, call 711.

Behavioral Health Access Center

(888) 777-4742

Call toll-free for support with your behavioral health needs and to request transitional coverage if your

behavioral health provider is not covered.

Member Services

For member support beginning the effective date of January 1, 2018, please call the number on the back

of your Harvard Pilgrim member ID card.

Want more information?

Visit www.harvardpilgrim.org/nch to learn more about your benefits, wellness resources and member discounts.