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Find the answers to some common member questions. If you have a question that is not answered below, please call Member Services at 413-787-4004 or 800-310-2835, 8 a.m.-5 p.m., Monday-Friday. We would be happy to help.
Q.: If I have questions, who should I contact?
If you are an employer group interested in obtaining a quote for HNE coverage or would like additional information about our plans, please contact the Sales Department at 413-787-4000 or ktrotta@hne.com.
If you currently offer HNE coverage to your employees and have questions, please contact Michelle McBride at 413-233-3387 or mmcbride@hne.com
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Q.: How do I enroll a new employee or terminate coverage for an employee?
You may submit an Enrollment/Add/ Termination form to enroll or cancel employees or their dependents. You may also administer your enrollment and termination activity electronically via HNE Direct, our secure website. You may also terminate employee coverage via telephone by contacting Member Services at 413-787-4004 or
800-310-2835.
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Q.: What is the difference between HMO and PPO plans?
Members enrolled in an HMO product must select a PCP and may see specialists and other providers in the HNE provider network without a referral.
Members enrolled in a PPO do not have to choose a PCP and have the option of using in-network providers for the lowest out-of-pocket cost OR using non-network providers and paying a deductible and coinsurance.
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Q.: How do I change my Primary Care Physician?
It’s simple and convenient. You can:
You may select any PCP, except those who have notified HNE that they no longer accept new patients. Member Services representatives can provide up-to-date information on PCPs in your area. We’ll make sure the change takes effect the next business day after you contact us, and we’ll also send a revised HNE ID card listing the new PCP. You can also call us to change your address and phone number.
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Q.: I received a bill that I didn’t expect. What should I do?
First check to see if the bill lists copayments or charges for non-covered services, which you pay. If you are still unable to determine why you received a bill, call Member Services at 413-787-4004 or 800-310-2835, 8 a.m.-5 p.m., Monday-Friday. A representative will investigate to correct any errors and inform you of the result as soon as possible.
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Q.: Do I need a referral from my PCP for specialty care?
HNE does not require referrals for any in-plan specialty services. Prior Approval is required for certain services and for out-of-plan care.
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Q.: Can I see a specialist who does not participate with Health New England?
Our HMO members may visit an out-of-plan specialist only if HNE approves in advance. If plan providers offer the services, we usually will deny the request. When you use plan providers, you know they have been credentialed by Health New England and that they will work with our medical staff to help ensure you get the care you need.
If you seek medical care from an out-of-plan specialist:
- Before scheduling an appointment, ask your Primary Care Physician or treating doctor to send an Authorization Request form.
- After reviewing the request, we will notify you and your doctor of our decision in writing.
If you are enrolled in a PPO or point of service plan, you have the freedom to visit any provider, although your costs are lower and coverage levels higher when you visit plan providers.
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Q.: What happens if my children attend college? Are they still covered?
Under the MA Healthcare Reform regulations, dependents covered under a fully insured plan will be eligible for coverage for two years after losing dependent status under the IRS rules, or until they reach age 26, whichever occurs first. Thus, if your child was last claimed as a dependent for tax year 2006, that child would still be eligible for coverage under your plan until December 31, 2008, unless the child turns 26 before that date.
Students who attend college outside the HNE service area are covered for urgent or emergency care under an HMO plan. Under a PPO plan, services may be obtained from non-plan providers subject to deductible and coinsurance.
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Q.: Are newborn children automatically enrolled in my plan?
No. To obtain coverage for newborn children, you must enroll them within 31 days of the birth. Depending on your plan, you will enroll your child through your employer or HNE. To learn the enrollment process for your plan, please call Member Services at 413-787-4004 or 800-310-2835, 8 a.m.-5 p.m., Monday-Friday.
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