Visit HCPSS’ Staff Help Site for answers to frequently asked questions about benefits.
2021 Active Employee Benefits
Annual Medical Costs
Medical (prescriptions included), Dental, and Vision Plan Breakdowns
Medical Plans – CareFirst and Aetna
CareFirst BlueChoice HMO Open Access
With CareFirst BlueChoice HMO Open Access, you can select your doctor from a regional network of physicians, specialists and hospitals located throughout Maryland, Washington, D.C. and Northern Virginia. CareFirst aims to keep you healthy by emphasizing prevention, early detection and early treatment.
- 2021 BlueChoice HMO Open Access – Your Health Benefits Booklet
- 2021 CareFirst BlueChoice HMO Open Access Benefits Summary
- 2021 CareFirst BlueChoice HMO Summary of Benefits and Coverage (SBC)
- CareFirst Video Visit
- Affordable Care Act (ACA) Summary of Preventive Services
- CareFirst HMO – Away from Home Care
- CareFirst Blue Vision
- Blue365 – Wellness Discount
- CareFirst HCPSS Web Site
- Regional Vaccine Network
Open Access Aetna Select HMO
There’s no requirement to select a PCP, or obtain referrals for specialty care. The network of medical providers and facilities is nationwide, offering a full range of primary care doctors and specialists. When you visit a network provider, you will pay a flat copay for your care. Network providers will handle all of the claims paperwork for you. In order to receive benefits from this plan, you must see network providers.
- 2021 Open Access Aetna Select HMO Benefits Summary
- 2021 Open Access Aetna Select HMO – Summary of Benefits and Coverage (SBC)
Aetna Open Choice PPO
You can receive care within the network and pay less for your care. Or, you can choose to receive care outside the network and still receive benefits, but at a higher cost. There are no referral requirements.
Aetna’s nationwide Open Choice PPO network includes 934,260 health care providers; 159,100 of whom are Primary Care Providers (PCPs). This makes it easy to find a network doctor or a hospital, whether you are at home, work or traveling.
- 2021 Aetna Open Choice PPO Benefits Summary
- 2021 Aetna Open Choice PPO – Summary of Benefits and Coverage (SBC)
Other Member Resources (Open Access Aetna Select HMO and Open Choice PPO)
- ACA Preventive Care
- Informed Health Line
- Aetna Travel
- Aetna Health App
- Aetna Maternity Program
- Blood Pressure and Cholesterol
- Breast Cancer Support Center
- Men’s Health Flyer
- Aetna Discount Program
- Aetna website
Prescriptions Plan – Express Scripts
Included in employee benefits packages, express scripts handles services related to prescriptions. They are supported by a national network of over 50,000 pharmacies and a 24-hour, 365-day-a-year Patient Care Contact Center. Home delivery is available for employee medications from express.
On or after 01/01/2020, please call Express Scripts member services at (877) 866-5859 to verify if your pharmacy will allow a 90-day fill, or for assistance in locating a SMART90 participating pharmacy. You may also log in or register at www.Express-Scripts.com/90day to locate SMART90 participating pharmacies in your area.
- Express Scripts SMART90 Drug List (Drug Class Level)
- Express Scripts SMART90 Drug List
- Express Scripts SMART90 Participating Pharmacy Listing – MD and PA
- Express Scripts SMART90 FAQs
- Drug Quantity Management Member Flyer
- Drug Quantity Management – Drug List
- Prior Authorization FAQs
- Step Therapy FAQs
- Vaccine Program
- 2020 National Preferred Formulary Exclusion List Changes
- Pharmacy Web Site
For Plan Year 2021, the new Dental PPO plan will be offered through Cigna PPO and new Dental Maintenance Organization (DMO) plan will be offered through Aetna. Employees who are currently enrolled in the Delta Dental PPO plan will be automatically moved to the new Dental PPO plan through Cigna. Similarly, employees who are currently enrolled in the Cigna DHMO plan will automatically be moved into the new Aetna DMO plan for the Plan Year 2021.
New Dental Plans for Plan Year (beginning 01/01/2021)
The Cigna PPO has a national network of dentists with no need to select a primary care dentists. Employees will have the freedom to visit any licensed dentist you wish, but selecting an “in-network” Cigna PPO provider will result in the lowest out-of-pocket costs to the employee.
- 2021 Cigna Dental PPO Benefits Summary
- How to find a Dentist
- Orthodontics in Progress Flyer
- Transition of Care FAQ Flyer
- Dental Only MyCigna Mobile App
- Information Regarding Healthy Rewards
Aetna DMO is a dental maintenance organization (DMO). Aetna DMO offers a list of participating dentists for your care. It is important that you review your choices of Primary Care Dentist (PCD) in your area to make sure that this is the right plan for your dental needs. A PCD selection will not be mandatory during enrollment process. However, in order to use your DMO benefits a PCD is required. Once you enroll, Aetna will send you a “Welcome Kit” in the mail The Welcome Kit will include a reminder of the mandatory PCD election and a sample ID card. Once the Welcome Kit is received, employees should call the Aetna Customer Service line at 877-238-6200 Monday through Friday 8:00am to 6:00pm or login to the member website at https://www.aetnaresource.com/p/HCPSS-Open-Enrollment-2020 to select your PCD and/or for additional assistance. Once a PCD is elected from the Aetna network, employees can set-up a dentist appointment to see their provider. There is no deductible to meet, no annual dollar maximums, and no claim forms for you to file.
Your selection of PCD must be made prior to the 15th of the month, in order to take effect the first of the next month.
- 2021 Aetna DMO Dental Benefits Summary
- Aetna Dental DMO – Pre-enrollment Member Flyer
- Aetna Dental Discounts
Vision Plan- Vision Service Plan (VSP)
- Vision Service Plan Benefits Summary
- VSP.com at Your Fingertips
- Combat Digital Eye Strain
- VSP TruHearing
- VSP Benefits Web Site – view your vision benefit information, register as a member.
- 1-800-877-7195 – Member Benefit Services.
- The Ultimate Provider Playlist
- Eyeconic – Browse with Benefits
Flexible Spending Accounts (FSA) – Navia Benefit Solutions (formerly Flex Plan Services, Inc.)
- Health Care FSA Flyer
- Dependent Care FSA Flyer
- FlexConnect Fact Sheet
- Health Care FSA Eligible and Ineligible Expenses
- Navia Estimation Worksheet
- Navia Mobile App
- Online Claim Submission Participant Portal
- Navia Benefits Solutions Website Company ID: HWC
HCPSS Benefits Help Desk representatives are available to help with online enrollment and questions: Monday–Friday 8:30 a.m.–4:30 p.m. Phone: (410) 313-7333. Inquires may always be sent to the Benefits Office via email at firstname.lastname@example.org.
Employee Well-Being Program
HCPSS employees have access to professional, free and confidential counseling and support services to manage their needs. Consider this program as your very own personal assistant who can connect you to resources to improve your finances, schedule counseling sessions, develop strategies for navigating stress, and much more.
Employees and family members can receive up to six free counseling sessions (including assessment, follow-up and referral services) per person, per episode, per year. Listed below is information regarding the program and a link to EAP Orientation video.
- HCPSS Staff Counseling and Support Services Program – Overview
- Online Will Preparation
- Employee Engagement and Well-Being
- Counseling and Support Services – Staff Hub
Women’s Health and Cancer Rights Act
The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires group health plans to make certain benefits available to participants who have undergone a mastectomy. In particular, a plan must offer mastectomy patients benefits for:
- All stages of reconstruction of the breast on which the mastectomy was performed
- Surgery and reconstruction of the other breast to produce a symmetrical appearance
- Treatment of physical complications of the mastectomy, including lymphedema
Our plans comply with these requirements. Benefits for these items generally are comparable to those provided under our plans for similar types of medical services and supplies. Of course, the extent to which any of the items is appropriate following mastectomy is a matter to be determined by the patient and her physician.
Our plans neither impose penalties (for example, reducing or limiting reimbursements) nor do they provide incentives to induce attending providers to provide care inconsistent with these requirements. For more information about WHCRA coverage, contact your health plan administrator.
Newborns’ and Mothers’ Health Protection Act
The Newborns’ and Mothers’ Health Protection Act (NMHPA) of 1996 is a federal law that addresses the length of time a mother and newborn child are covered for a hospital stay in connection with childbirth. In general, benefits for a hospital stay in connection with childbirth cannot restrict benefits:
- to less than 48 hours for a normal vaginal delivery
- to less than 96 hours following a delivery by cesarean section
The 48 and 96 hour period starts at the time of delivery. It is important to note that coverage subject to NMHPA guidelines is the mother’s coverage. Newborns must be added to the Employee’s health plan within 30 days of the date of birth.