Welcome to the Tyoga CareNet network. This web page is provided to help you better understand and easily use the benefits provided to you under the Laurel Health System Medical Plan. The information listed below will address most of your needs most of the time. For any issues not covered here, please find the section on customer service for further instructions on where to go and who to call for more specific assistance.

Health Plan Changes for July 2007

Effective July 1, 2007, the changes are: the Enhanced Plan option individual deductible is now $300 and Family is $600. The Basic Plan option Deductible did not change from $1,000 individual and $2,000 family. The HSA Plan option deductible saw a small increase in deductibles of $1050 individual and $2100 Family.

Vision Plan Changes for July 2007

The Laurel Health System vision plan changed to National Vision Administrators, L.L.C (NVA) effective July 1, 2007. You may utilize in and out-of-network benefits. If you use an out-of-network provider, you will need to submit a claim form for reimbursement to NVA. If you would like to locate a participating provider go to www.e-nva.com or call Human Resources at (570) 723-0107.

Radiological Rules For All Tioga County LHS Employees

Effective July 1, 2005 to current the following radiological procedures are required to be performed at Soldiers + Sailors Memorial Hospital for individuals that live in Tioga County. This rule applies even if you have been referred to providers outside the county:

MRI, CT, Nuclear Medicine, Mammography, Dexa Scan(Bone Densitometry)

This does not apply to emergency situations. For further information or questions, please contact Tyoga CareNet 723-0560.

Benefit Information

You can access various documents that will be useful in answering questions you may have about your Laurel Health System Medical Plan by clicking on the document buttons provided below.

Remember your Tier

The Laurel Health System Medical Plan utilizes a set of networks designed to meet the needs of each employee. Your individaul primary network is identified based upon your residence. A combination of "wrap" networks is then provided to assure access to services.

To review the Laurel Health System Medical Plan Tiers and to identify your primary network, click below.

Searching for Providers

To obtain detailed instructions on how to search for a provider, click on the document button below.

To search for a provider or for more information, just click on the web site logo below to go directly to that site.

Greensburg Employees Only Can Utilize The InterGroup Network

Travel Network

The Beech Street network has been identified by your plan as a travel network. Access to providers through this network is generally limited to times of travel outside your primary tier or for college students living outside the area on a temporary basis.

If you are out of town and still unable to locate a provider, call Healthy Directions at 800.858.8769.

Pharmacy Benefits

Your pharmacy benefits are obtained through PharmaCare local participating pharmacies or through Soldiers + Sailors Memorial Hospital Pharmacy. Soldiers + Sailors Memorial Hospital Pharmacy is used for all mail order prescriptions.

PharmaCare Help Desk: 1.800.837.9600

SSMH Pharmacy: 570.723.0150

Your pharmacy program utilizes a three tier program; generic, preferred brand, and non-preferred brand. The national formulary is used for the program and can be found below. Your pharmacy program is a "mandatory generics" plan. A mandatory generic plan means that all prescriptions covered by the Laurel Health System Medical Plan that have a generic equivalent available must be filled with the generic drug. When filled with the generic drug, you pay the lowest of your prescription co-pays. If you choose to fill your prescription with the name brand drug, you must pay the higher co-pay, plus the difference between the cost of the generic and the name brand.

When a generic drug is Not available, you will receive a $5.00 discount off your co-pay amount when you use the Soldiers + Sailors Memorial Hospital Pharmacy. The discount is for a 30-day (or less) supply only, and does not apply to generic drugs or mail order prescriptions.

Notice: Pharmacare joined Caremark in 2007. You can access your formulary by logging into pharmacare or caremark website.

The PharmaCare/Caremark formulary is updated two times a year, in April and in October. When the formulary changes, any individual taking a medication that is becoming non-preferred will be notified via letter by PharmaCare. The next updated formulary will be available October 1, 2006.

Pre-Certification and Medical Management

PPHN is contracted by Laurel Health System to provide pre-certification services and must be contacted prior to such services being rendered. Covered services provided after pre-certification has been obtained will be covered within the limits of the Laurel Health System Medical Plan. If pre-certification is NOT obtained prior to the services being rendered, any expenses incurred will NOT BE COVERED.

The following services must be pre-certified by PPHN at 866.384.7746 as medically necessary before any treatment can be obtained. Services that require pre-certification are: hospital confinement, inpatient surgical operation, home health care, home infusion therapy, inpatient mental health and/or substance abuse treatment, partial confinement in a psychiatric facility, skilled nursing facility confinement, hospice care and private duty nursing.

Referral

The Laurel Health System Medical Plan uses four networks: Tyoga CareNet, PPHN, Beech Street and Devon. Beneficiaries are assigned a primary tier (Tier 1) of approved providers based on where the beneficiary resides. Services must be obtained within your primary tier in order for benefits to be paid at the highest level.

There are times however, when the primary tier is unable to provide the service the beneficiary requires. In this circumstance, the primary tier physician must provide a written referral. For Tioga County residents, the referral must be to a PPHN participating provider. Individuals residing outside Tioga County, require a referral to either Beech Street or Devon participating providers. The referral must be to a provider who paricipates in one of the other approved networks (Tyoga CareNet, PPHN, Beech Street and Devon). If you or your physician have any trouble finding an in-network provider please call Tyoga CareNet at 570.723.0560.

Remember, a completed referral does not constitute approval of the physician as in-network nor approval of coverage/payment.

Claims and Covered Services

For any claims and covered services questions, please call The Loomis Company. You can access The Loomis Company web site information by clicking on the logo below.

Review Your Claims History

The Loomis Company offers an on-line claims review service to Laurel Health System employees called Group Web. Group Web allows individuals to look up personal eligibility information, claims history and review explanation of benefit forms. The site is secure and you set up your own password. You can only review your own information. To enroll in the Group Web service, please click on the button provided below.

Changes

You can modify your health plan choices at any time during the year if you experience a "Life Event". It is important that you make any qualifying change within 31 days of the life event. Changes after 31 days cannot take place until the next open enrollment. It is your responsibility to complete a change form in a timely fashion, Human Resources cannot do this for you.

For a full listing of appropriate life events, please click on the button below.

Remember: a newborn baby will be covered under the mother's health plan for the first 30 days only. You must complete paperwork to add the child for coverage to continue beyond 30 days.

Customer Service Issues

For any additional customer service questions not specified above, please click on the summary contact guide below to locate who you need to contact.