Note: due to an editing error this article did not appear in the newsletter. It was, however, e-mailed to the department in late May.

Commonwealth Care Open Enrollment

Commonwealth Care Open Enrollment begins May 25th and ends on June 25th, 2009 with plan changes effective July 1.

Commonwealth Care Plan Choices:

• This year, there are five plans that are offering Commonwealth Care - NHP, Network Health, BMC HealthNet, Fallon and a new plan "CeltiCare" (CeltiCare is the new plan offered by Centene Corporation in partnership with the Caritas system).
• Monthly premiums for the lowest cost plans will not increase. They remain at:

  Plan Type I & II a (Less than 150% FPL): $0

  Plan Type II b (150.1 FPL – 200% FPL): $39

  Plan Type III a (200.1 FPL – 250% FPL): $77

  Plan Type III b (250.1 FPL – 300% FPL): $116

• Not all Commonwealth Care plans are available in all geographic areas. Also, monthly premium amounts differ by plan and geography. See exact premium amounts by towns for different income levels.
• In each geographic area, there may be a mix of lowest cost plans and higher cost plans.

Open Enrollment Process:

• Members may switch plans for any reason during open enrollment. They can do this by visiting the Connector's website at www.macommonwealthcare.com and completing the "Open Enrollment Health Plan Change Request Form", or by calling the Connector Customer Service at 1-877-MA-ENROLL.
• Members who are satisfied with their current plan don’t have to do anything.

Open Enrollment Materials:

• The Connector should have sent customized open enrollment materials by the end of May. The materials include - health plan choices for the member's geographic area and plan type; list of covered benefits and co-pays; and monthly premium amounts for available health plans.
• Materials will be in English and Spanish.

Commonwealth Care Plans that Partners Accepts:

• Network Health: Partners is contracted with Network Health for primary care, and specialty and hospital services.
• NHP: Partners is contracted with NHP for primary care, and specialty and hospital services, with the exception of NWH and the IMA practice at MGH. MGH patients on NHP Commonwealth Care would need to go to one of the MGH health centers for primary care.
• BMC HealthNet : Partners is not contracted with BMC HealthNet, with the exception of NSMC.
• Fallon : Partners is not contracted with Fallon, although in some cases Fallon members may come to us for inpatient or outpatient services if a prior authorization is in place.
• CeltiCare : Partners is not contracted with CeltiCare, with the exception of MGH and BWH for quaternary services. Quaternary services include procedures such as transplants that may not be offered at hospitals in the regular CeltiCare network.

-Adapted from “ Commonwealth Care Open Enrollment Update” e-mail, Pragya Rizal, Assistant manager, Public Payer Policy and Operations, Parters HealthCare, May 22, 2009.

 

5/09