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How to Maximize your Benefits through Coordinated Healthcare

The benefit design under the TICUA health benefit plan includes the TICUA Coordinated Health/CareTM program. This Program is designed for the specific purpose of providing a more satisfying patient experience while creating savings for both you and your employer. The following are answers to some frequently asked questions concerning this program.

What is the Coordinated Health/Care program?

Think of it as a patient assistance program in which you, your family, your physicians and a staff of Care Coordinators all work together to help ensure your healthcare is provided in the most efficient and medically effective manner. The aim is to remove the chronic confusion, misinformation, duplication and delays that plague healthcare so you can enjoy better health outcomes – not to mention, potential cost savings.

How do I know which physicians and facilities are In-network?

Your in-network provider panel is shown on your ID card. You can also look up providers on this site by clicking "Find In-Network Providers" or by calling your Care Coordinators at the number below.

Do I have to choose a Family Doctor for myself and each family member?

No. You are not required to choose a Family Doctor. However, selecting a Family Doctor as a “coordinating physician” is highly recommended. Doing so helps ensure you get the most efficient healthcare at the best cost.

What are the benefits of getting a referral before seeing a specialist?

You have lower co-pay for office visits with specialists to whom you have received a PCP referral. If you choose to visit specialists on your own without such a referral, you pay your higher co-insurance. In addition to helping you avoid visits to the wrong specialist, a referral from a Family Doctor is also communicated to the Care Coordinators. If you are being referred to an out-of-network physician (which is surprisingly common) or the service you seek has a limited benefit, the Care Coordinators will call you and notify you in advance -before you incur an out-of-pocket expense.

Am I required to get a PCP referral before seeing a specialist?

The coordinated healthcare program strongly encourages you to follow this approach, and you receive an enhanced benefit when you do so. However, you may also visit specialists without a referral and receive the standard benefit.

What if I require medical care while on vacation or traveling?

In the event of an emergency, go to the nearest medical provider. For a non-emergency, check your ID card or call the Care Coordinators for assistance in finding the most appropriate provider.
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