Berks Member Guide

Contents Personal help and support when you need it Health Care Concierge. ...................................................................4 Health coaches and personal care managers….........................4 UPMC Health Plan app.................................................................... 5 My Health OnLine……………………………………………………............... 5 Find a doctor…………………………..………………………………...............6 How to get care………..………….………………………………..................9 Coverage when you travel………………………………………............. 10 Access to care when you need it……………………………............... 11 Understanding your health care costs Paying for your health care coverage......................................... 14 Explanation of Benefits.................................................................. 15 Your prescription drug coverage Covered prescription drugs………………………….......................... 18 Understanding your drug costs……………………….……............... 19 Save money when filling your prescriptions……..................... 20 Lower copays for diabetic medications…………........................ 21 Living healthier with diabetes..……………………………................. 21 Extra benefits and programs to help you stay healthy Preventive care services................................................................24 Vision benefits.................................................................................26 Dental benefits................................................................................26 Hearing benefits..............................................................................27 Over-the-counter (OTC) allowance………………………..............27 SilverSneakers ® fitness program................................................. 28 Bathroom safety products............................................................29 In-home safety assessment.........................................................29 Counseling and extra support..................................................... 30 Behavioral health coverage............................................................31 Additional information Important plan documents.......................................................... 34 How we assess new medical technology................................ 34 Our utilization management policy........................................... 34 Your rights and responsibilities.................................................. 34 Resolving problems………………………........................................... 34 Information available upon request...........................................35 Quality comes first.........................................................................35 We honor your privacy..................................................................35 1