PEACEPlan Health FAQs

FAQs

Frequently Asked Questions

The PEACEPlan – Benefits at Your Fingertips

Your employer has chosen the PEACEPlan for your employee benefits health plan. This Plan is very different than the traditional plans you may be used to. We put you in control of your healthcare with the use of technology and your own live Patient Advocate. The following is a summary of services in the Plan that will help you better understand your benefits and how to most effectively manage the healthcare of you and your loved ones.

PEACEPlan APP — Your Access To The Right Kind Of Care

  • Every member and dependent will receive a free APP for either iOS or Android phones.
  • At the touch of a button, this APP will assist you to directly communicate with your personal Healthcare Advocate, Plan services and information regarding your individual Plan, you will have

Personal Healthcare Advocate Services — Know Where To Get The Best Care
For You And Your Family

  • Each member in the health plan will have their own personal live Health Advocate. This Advocate will assist you in obtaining access to: Preventative Services, Primary Care, understanding what is and is not covered in your health plan benefits, obtaining specialist coverage, In/Out of Network Coverage, Prescriptions, Telemedicine, Behavioral Health, Vision services.
  • This is your FIRST POINT of contact with the healthcare system. This is VERY different than what you are used to with other health plans—we are here to help you navigate this very complex system. Free Preventative Services — Contact Your Advocate

Free Preventative Services — Contact Your Advocate For Detail

  • All Services deemed “Preventative” are covered at 100% and NO COST to you or your family.
  • This includes pediatric inoculations, flu shots, annual physicals, well visits, mammograms and colonoscopies.
  • Reach out to your Advocate for more details on the services covered free to you.

Access Your Primary Care Providers — Your Advocate Can Help You

  • Except for the High Deductible Plans, all Primary Care is covered at 100%, with no out of pocket copays, deductible or coinsurance.
  • Your Advocate with help you choose a Primary care doctor if you do not already have one.
  • Your Advocate will assist you with any ongoing questions.
  • Depending on your Plan, you will have a deductible which is the amount that you pay first before any coinsurance is applied.
  • All out of pocket expenses apply to your deductible including copays, pharmacy (except Discount Card purchases), lab and hospitalizations.
  • Depending on your Plan, you may have some level of coinsurance which applies when you see a specialist, have an inpatient or outpatient procedure.
  • Contact your Advocate for help in accessing and better understanding the financial impact of your Plan.
  • Depending on your Plan, you and your family will have an Annual Maximum Out of Pocket. This amount is calculated on a calendar year basis—from
  • January 1st to December 31st of each year. Contact your Advocate to understand how this applies to your personal needs and expenses.

Specialists & Specialty Care — Your Advocate Will Help You Access These Services

  • Your Advocate will assist you in finding an In-Network provider for any lab work, imaging, specialty providers, needs and services.
  • Your Advocate will help you understand how to choose the highest quality provider at the lowest cost to you and your family.
  • Pre-certification/authorization is required for most elective procedures in your Plan—your Advocate will be there to assist you in obtaining your authorization and insuring access to the care you need.

Aetna/First Health National Network — Your Advocate Will Help
You Stay In-Network With Providers

  • Your network is the Aetna First Health National Network, this means you have access to over 93% of the healthcare providers in the U.S.
  • This network provides discounts for services you may need and your Advocate can assist you in making sure that your provider is in the Network and that you are informed on the quality and cost of the service being provided before you obtain those services.

Pharmacy Benefits — You Have Options For Your Prescription Needs, Contact Your Advocate For More Information

  • You have access to over 65,000 pharmacies across the U.S.
  • Contact your Advocate if you have any questions on where and how to obtain your prescriptions at the lowest possible cost to you.
  • You will also have access to a pharmacy discount card option, which means you can shop for the best price for your pharmacy needs before you buy them.

Telemedicine Benefit — Contact Your Advocate For Use Of These Services

  • This is a free 24/7 service for any Non-Emergency healthcare needs, so you may not need to go to the Emergency Room or Clinic, there is NO co-pay, deductible or coinsurance on your part for this service.
  • A doctor will be able to prescribe medications over the phone and send them to your local pharmacy of choice.

Behavioral Health Benefit — Contact Your Advocate To Understand
The Kind Of Care You May Need

  • This is a free 24/7 service for any mental or stress related concern or needs.
  • This benefit is COMPLETELY confidential and there are virtually no restrictions when accessing this benefit.

Vision Benefit — Contact Your Advocate To Help Find A Provider Near You

  • This is a completely free benefit (no premium) for you and your family, you will have access to eye exams once a year for a $10 copay and
    additional benefits for eyeglasses and contacts. You can review your benefits book for more details or contact your Advocate for help in accessing and maximizing this benefit.
  • This benefit is highly recommended even if your eyesight is currently good.
  • Eye exams can detect diabetes, MS, high cholesterol, thyroid, lupus and many cancers before they present any symptoms.

Exclusions to Your Plan

  • There are some services not available in your Plan—contact your Advocate for more specific details that may directly affect you.