2019 Additional Benefits

2019 Additional Benefits, Allowances and Programs

We are committed to meeting your health care needs.

In addition to providing coverage if you ever need medical services, we want to help you stay healthy and improve your overall well-being. Health New England Medicare Advantage also offers various tools and clinical programs designed to help our members stay healthy, seek care, manage complex health conditions and manage medications.*

For more details, download our Additional Benefits booklet.

*Medication management for members enrolled in a Health New England Medicare Advantage plan with prescription benefits.

EyeMed

TruHearing

Teladoc

WebMD

Increased Dental Allowance

In 2019, Health New England has increased your dental allowance from $150 to $250 per calendar year.*

Use your $250 annual dental allowance towards:

Dental exams
Cleanings
Fluoride treatments
Dental x-rays

*Preventive dental services are not covered by Original Medicare. Health New England offers its Medicare Advantage member this as an additional benefit. You may receive dental services from any dentist. You must fill out a reimbursement form and then submit receipts to Health New England for reimbursement. The service must be provided by a business established to provide dental services. There is not a dental network or limits on the type of service. The service must be used toward the promotion of oral health or oral improvement.

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Reimbursement requests for a prior year must be received by Health New England no later than March 31 of the following year.

Allowances and Reimbursements

We want to help make it a little easier for you to make important lifestyle choices. That’s why your Health New England Medicare Advantage plan provides several allowances and reimbursements to help you stay healthy.

Each allowance is subject to the limits described in the Allowances Chart below and is provided as a reimbursement. You will pay for the items or services first, then you will submit appropriate receipts and documentation for reimbursement from Health New England. Click here to download the Reimbursement Form.

The prescription eyewear allowance is offered at point of service and is not a reimbursement.

Allowance Chart

Dental $250
Reimbursement per calendar year

*Fitness Center, Weight Watchers®, Acupuncture,
Over-the-Counter Items and Activity/Fitness Tracker Combined total of $150
Reimbursement per calendar year

Prescription Eyewear
(Benefit must be obtained from an in-network
EyeMed^® provider.) $100
Allowance at point of service every
two calendar years

Wig
(Applies if you are on or have recently undergone
chemotherapy.) $350
Reimbursement per calendar year

Note:
Each allowance is paid on a calendar year basis. A calendar year is the twelve month period from
January to December. Any unused portion of an allowance cannot be carried over from the one or
two calendar year period to the next.

*The Fitness Center, Weight Watchers®, Acupuncture, Over-the-Counter Items and Activity/Fitness Tracker Allowance is a combined benefit total of up to $150 per calendar year. Over-the-counter items include shower chairs, grab bars, raised toilet seats, automatic blood pressure cuffs, bathtub benches/stools and compression stockings.

Support for Managing Complex Conditions

Care Management

Our Care Management programs are available to help members with long-term health challenges. Experienced care managers and care coordinators will help manage your care and your relationships with physicians and health care providers. If you are going through a period of illness or managing a chronic health condition, we encourage you to take advantage of this special program to manage your health and help reduce your health care costs. Once enrolled into a program, a nurse or social worker will work with you to help you manage your health condition and risk factors through regular phone calls and check-ins.

We offer the following Care Management programs:

Behavioral Health (including depression, mental health, substance use disorder and social case management)
Complex Care Management
Care Coordination
Disease Management (including asthma, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, diabetes and hypertension)
New Diabetes and Congestive Heart Failure Care Management Program For members who have been diagnosed with both Diabetes and Congestive Heart Failure (CHF), you may be eligible to enroll in our Diabetes/CHF Care Management Program. Upon enrollment and successful completion of the Diabetes/CHF Care Management Program, you will be eligible for copayment reimbursement for visits with your primary care provider, endocrinologist, cardiologist, certified diabetic educator, and nutritional counselor.
New Falls Prevention Program For members who have been diagnosed with gait and mobility difficulties, you may be eligible to enroll in our Falls Prevention Program. The goals of this program are to decrease falls, thereby preventing injuries and hospital or rehab stays, and maintain your independence. Upon enrollment and successful completion of the Falls Prevention Program, you will be eligible for copayment reimbursement for your physical and occupational therapy.
- Do you think you are at risk for falling? Use this resource to evaluate your risk for falling and bring with you to your next
  PCP visit.

Transitions of Care Program

This program is available to help Medicare Advantage members plan a smooth transition after a hospital stay. We offer one-on-one support from a certified nurse at no additional cost. The nurse offers coaching that will help guide you before and during your transition to home or a rehabilitation facility.