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UNITE HERE HEALTH Offers Tiered Benefit Plan

Posted January 6, 2015

Effective Nov. 1, 2014, members enrolled through the group plan of UNITE HERE HEALTH moved to a tiered benefit plan. Updated ID cards issued to these UNITE HERE HEALTH members include a new group number – 0M7506. The alpha prefix is EIU.  There were no changes to the customer service number, which appears on the back of the card.

The UNITE HERE HEALTH member’s use of the independently contracted provider network for each tier, or not using any contracted provider, will determine the level of the member’s financial liability as outlined below. Members that receive covered services from a Tier 1 provider will have the highest benefit levels with the lowest copay under the benefit plan.

  • Tier 1 – Members will receive the highest level of benefits for covered services with the lowest out-of-pocket expense when they utilize contracted providers in a network defined by this employer as Tier 1. The following three facilities and their respective physician groups are considered in-network for Tier 1: Presence Health System, St. Joseph Hospital and Little Company of Mary. Members can find out which health care providers are affiliated with these institutions by calling the UNITE HERE office at the number listed on their ID card
  • Tier 2 A member may choose to use any contracted provider from the broader Blue Choice PPOSM network. However, at this level, the member’s out-of-pocket expense will be slightly higher. If you are a Blue Choice PPO provider you are considered as in-network for UNITE HERE HEALTH members, but at the Tier 2 level.
  • Tier 3 – Members who decide to receive health care services from a provider other than those defined above for Tiers 1 and 2 have been advised by UNITE HERE HEALTH that there are no benefits and the member is responsible for the entire cost of care, except in emergency situations.

While informational materials are typically provided by employer groups to their members, some members may not be aware of higher out-of-pocket costs that may be incurred for tiered product options. As always, if members have any questions or concerns, they should contact the number on the back of their member ID card.

NETWORK STATUS CHECK:  As a reminder, it is important to confirm your network status for each member’s plan in addition to checking eligibility and benefits for each patient prior to rendering services. UNITE HERE HEALTH member ID cards indicate Blue Choice PPO on the front of the card. The BCS network code will appear in our online Provider Finder® to help when members are searching for independently contracted network providers.

Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered.