Broker Bonus ProgramWe are proud to inform you that the broker bonus program will remain in effect through December 31, 2006. To be eligible for the quarterly bonus, each broker must have at least four employer groups or 25+ subscribers that have a renewal/new effective date within the quarter. Bonuses will be paid out within 45 days of the end of each quarter. What's changed? Since Advantage is now part of the standard benefit plan, the Advantage bonus program will no longer be applicable. For more information regarding the Broker Bonus Program, please contact Kim Christen at 517-782-7154 ext 6720.Telesage InstructionsPHPSM has a new automated survey tool to help us in assessing new member understanding of our written and verbal communications. New members will be sent a free PHPSM t-shirt for completing the survey.
New Group DeadlinesPaperwork for new groups must be received by PHPSM a minimum of 15 days prior to the effective date. Required documentation includes:
Need Help?For questions regarding current member benefits, eligibility, physicians, member ID cards, pharmacy, claims, and conversion, please contact the Customer Service Department at 517-787-6865 or 1-800-394-7569. Since we are local, you may also stop by Monday through Friday between 8 a.m. and 5 p.m. One of our service representatives will be happy to help you.Sales Department Contact Information
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iSave
We are proud to offer you iSave - our six affordable high deductible health plans (HDHP's). iSave features low premiums and first dollar coverage for preventive care. The following are some of the more common preventive care services that if provided by an in-network provider, will not be subject to the annual deductible and are offered without a co-payment:- Routine infant and child check ups
- Routine general medical exam
- Annual eye and vision exam
- Prenatal and postnatal care visits
- Immunizations
- Screening mammograms
- Cholesterol testing
In addition to the standard preventive services covered without co-payment under iSave, members can also take advantage of the following services. These services are offered to the member without additional co-payments or office charges.
- It's Your Life health management program
- Nutritional counseling (3 sessions per calendar year)
- Weight Reduction Program (13-week program)
- Smoking Cessation Program (RX subject to deductible)
The Smoking Cessation Program managed by our Smoking Cessation nurses is included as a preventive service under iSave. The Smoking Cessation medication, however, is subject to the annual deductible before the prescription co-payment is applied. For questions about iSave or for a complete list of covered preventive health services, please contact the Sales Department at 517-782-7154.
PHPSM Ranks 36 out of the Top 257 Health Plans
Sales Staff Changes
iSave Coverage Outside of the Service Area
Groups with members who reside outside the service area will need to be quoted and installed with the Plus HDHP coverage as opposed to the HMO HDHP coverage due to our HDHP product filings with the State. iSave does not include an Out-of-Area product, therefore, groups with out-of-area members will need to use the Plus HDHP to receive benefits. Groups must also be aware that the following services are only available when provided by a Network provider: Preventive Health Services (as described above), Infertility, Mental Health Inpatient/Intermediate, Morbid Obesity Surgery, Nutritional Counseling, Smoking Cessation, Pain Management, Weight Reduction and Wellness Program, and Transplants.These groups can take advantage of Options providers (when available), but PHPSM does not have Options providers available for Chiropractic, Mental Health or Transplant services. If Options providers are not available, members who reside outside the Service Area will have coverage under the "Plus" benefits; however, will be subject to significantly higher deductibles, out-of-pocket maximums, and coinsurance amounts. Please contact the Sales Department if you have any questions about Out-of-Area coverage under iSave.
2006 Prescription Drug List Changes
Effective January 1, 2006, the medications listed in the chart below were moved from Tier 2 to Tier 3 pharmacy benefits. Members of PHPSM were sent notification of these changes by United Health Care. If you have any questions about the below tier changes, please contact our Pharmacy Department at 517-782-7154.| Category | Product Name |
| Oral Contraceptives | Ortho Cyclen |
| Ortho Evra (patch) | |
| Ortho Micronor | |
| Ortho-Cept | |
| Ortho Novum | |
| Ortho TriCyclen | |
| Ortho TriCyclen Lo | |
| Modicon | |
| Overactive Bladder | Ditropan XL |
| Fertility | Novarel |
| Erectile Dysfunction | Viagra |
| Acne Treatment | Tazorac |
| Oral & Inhaled Steroids | Beconase AQ |
| Hormone Replacement | FemHRT |
| Insulin Products | Humulin (vials) |
| Humalog (vials) | |
| Eye Drops | Xalatan |
| Diabetic Test Strips | ACCU-CHEK |