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Insights

benefits bulletin

Our New Health, Dental, and Dependent Care Plan Service Providers

March 06, 2018

By Benefits-Firmwide

We are nearly 90 days into 2018 and you’ve likely noticed that our benefit service providers have changed.  We know it’s difficult to change benefit programs and there are resources that can help.  To get the most from your benefit plans, you need to understand how the plans are structured and get familiar with the resources and tools available to help you fully navigate with our new service providers.  Below is a high level overview and we have attached a

that summarizes many of the questions that have come into the Benefits-Firmwide over the past several weeks.

Last year, Aetna provided the following services:

  • Medical claims administration

  • A PPO preferred list of doctors and facilities

  • Prescription drug oversight (approvals and preferred list of pharmacies)

  • Dental claims administration

This year, we now have new service providers providing the same services:

maxorplusfaa8576a23346428811cff00004cbded

HealthSCOPE Benefits is responsible for:

  • Medical claims administration (paying medical claims according to Paul Hastings

  • Providing access to the Anthem PPO network of doctors and facilities

  • Dental claims administration with access to the Guardian PPO network of dentists

  • FSA Dependent Care claims processing

  • Providing member service support for any inquiries about your medical, dental, and dependent care claims

MaxorPlus is responsible for:

  • Prescription Drug oversight (including paying Rx claims according to Paul Hastings

    and reviewing drugs needing prior approval)

  • Providing member service support for any inquiries regarding Rx drug claims

HealthSCOPE and MaxorPlus are two separate companies but they coordinate with each other behind the scenes to make sure that your deductible and out of pocket maximums are updated nightly within both systems.  Each company has its own web portal for you to view claims.  Both companies are committed to providing a seamless experience so if you call HealthSCOPE Benefits with a pharmacy question, the member service representative will transfer you to MaxorPlus.  This is similar to Aetna, when you called with a pharmacy question and were transferred to Aetna’s pharmacy department.

There are also two new network service providers that are operating behind the scenes:

  • Anthem Blue Cross is the network being used for PPO medical providers

  • Guardian is the network being used for PPO dental providers

The Firm is using these networks in order to provide discounted, negotiated pricing for services provided to you by contracted physicians and facilities.   This arrangement stays behind the scenes.  The only access will be to use their portals to find providers.  Anthem and Guardian do not have access to your Paul Hastings’ U.S. Health Plan and cannot answer any of your questions regarding claims or benefit coverage.
Remember, your medical and dental plans are managed by HealthSCOPE so you will always contact HealthSCOPE Benefits for all medical and dental inquiries.

In limited circumstances, if you have a chronic condition, Anthem may reach out to you to enroll you in a voluntary disease management program.  Additionally, there will be times when your provider will work with Anthem to obtain authorization for the medical necessity of a procedure.
Change is hard and we expect some bumps in the road as we all adjust to a new process.  Our new service providers bring more flexibility and better control over our health plan and we appreciate your patience as we work through any transition issues.
How to contact your benefit resources:

benefit-contact