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Transitioning to a new year – information for members

As we get ready to begin a new year, your clients may have questions about where to find information regarding their plan. These are some of the topics members may have questions about:

Wallet Benefit reimbursement

  • The reimbursement form for Wallet benefit 2022 eligible costs needs to be received by Harvard Pilgrim Health Care by March 31, 2023.
  • The 2023 Wallet Benefit reimbursement form (for 2023 eligible costs) is available here.

Over-the-Counter (OTC) benefit

  • StrideSM (HMO) Plan members get an annual allowance to use to purchase health-related drugs and supplies, including cough, cold and allergy medicines, vitamins, first aid supplies and much more
  • Over-the-counter amounts by plan:
    • Basic Rx (HMO) $170
    • Value Rx (HMO) $100
    • Value Rx Plus (HMO) $100
    • Choice Rx (HMO-POS) $150
  • Members select items from the 2023 Over-the-Counter Brochure then call 1-888-609-0692 (TTY: 711) to place the order.

Formulary change

  • The 2022 formulary had 5 tiers and the 2023 formulary will have 6 tiers.
  • New – Tier 6 provides $0 for tier 6 vaccines used to treat the flu, shingles, pneumonia, and more
  • Because of the additional tier, some drugs may be on a different tier in 2023. It is important that Brokers review the pharmacy benefit and look up each medication to identify any changes.
  • As a reminder Tiers 3, 4, and 5 have a deductible.

New members

  • New members will receive their new member kits in early 2023
  • New members should receive their Harvard Pilgrim Healthcare ID cards before their coverage begins on January, 1, 2023.

Questions