Medical
Elmet Technologies offers three medical plans administered by Health Plans, Inc. (HPI). HPI offers excellent customer care and utilizes
- The Harvard Pilgrim Health Care (HPHC) network of providers - Inside New England
- The United Healthcare (UHC) Choice Plus network of providers - Outside New England
You may choose between the HSA Plan, PPO Silver Plan, and PPO Gold Plan.
This will be different for union members hired before April 15th, 2013. If you are enrolled in the union-contracted Allegiant Care plan, you are not eligible to elect these plans.
The HSA plan is a High Deductible Health Plan (HDHP), which qualifies participants to contribute to a Health Savings Account (HSA). If you elect the HSA plan, you are not required to open or contribute to a Health Savings Account (HSA). However, those who do contribute to an HSA will reduce their taxable income and be able to pay for medical, dental, vision, and prescription expenses federal income tax-free. See the Health Savings Account (HSA) page for more information. Preventive care is always covered at 100% before the deductible, as long as it is coded as preventive.
The PPO plans offer copays for services like office visits, ER visits, and prescription drugs. For most other services, you are responsible for your deductible and coinsurance until you meet your out-of-pocket maximum. Please be aware that copays do not count towards your deductible, only your out-of-pocket maximum. Copay services are covered at 100% after a copay, as long as you stay in-network. For out-of-network services, you will be responsible for a separate out-of-network deductible and coinsurance until you meet your out-of-network out-of-pocket maximum.
Preventive care is always covered 100% before the deductible. However, for preventive care to be covered in full, the service must be coded as preventive. If the service is coded as diagnostic, a member out-of-pocket (deductible, copay, or coinsurance, depending on the service) will be associated with the claim.
Medicare
For active employees with HPI-enrolled spouses who are enrolled in Medicare and not disabled, the HPI medical plan is primary. The spouse is not required to elect Part B (medically necessary services such as outpatient care and preventive care) until the active employee retires. However, the spouse will automatically receive Part A (hospital insurance).
HPI Online Access
With HPI's My Plan Portal, you can access your Medical ID Card online and manage your account 24/7.
Register in Minutes!
- Go to https://hpitpa.com/.
- Visit the Members section and click the link to register.
- Enter your information to create your username and password.
Access all of your account details* in one secure location anytime, anywhere!
- Review your claims
- Check your benefits
- Access your prescription drug plan
- Search your provider network
- Download a report of your claims
- Request claim reimbursements
- View, print, or order your member ID card
- View or print applicable tax forms
- Find a Primary Care Provider (PCP)
- View your health spending account details
Healthcare Centers of Excellence
We believe that distance and cost should never get in the way of you receiving the best possible medical care. Elmet employees have full access to top hospitals in New England, Ohio, and Michigan at zero out-of-pocket costs for complex medical conditions and procedures. As you explore these options, we want you to know that all possible barriers have been removed, and travel expenses will be covered for you and a companion. All employees, spouses, and dependent children who are enrolled in an Elmet health plan are eligible.
The Healthcare Centers of Excellence Program covers the following procedures:
- Cancer Treatment
- Joint Replacement
- Back Surgery
- Heart Procedures
- Organ Transplant
Additional medical procedures may be included on a case-by-case basis. To learn more, contact the Elmet Benefits Service Center or HPI's Pathways Concierge team.
HPI's Pathways Concierge - HPI Plans Only
Healthcare can be confusing—we’re here to help!
The concierge team knows all about your benefits and can help you with anything related to healthcare. These services are part of your benefit plan, so they will never charge you for their help.
Your Personal Healthcare Concierge—Whenever You Need It
- What is Pathways Concierge?
- With Pathways Concierge, you have direct access to an experienced, compassionate Member Advocate who will serve as your personal healthcare concierge whenever you have a question about your health plan, claims, or how to use your benefits.
- What will Pathways Concierge do for me?
- Pathways Concierge is here to help with all things healthcare-related, ensuring you and your family members receive the right care at the right time.
- Pathways Concierge:
- They can help with things like coordinating prescriptions or calling a provider about a bill
- They are trained to know everything about your health plan benefits.
- They will take the time to get to know you and your family
- A Few Ways Pathways Concierge Can Help You
- They can help you understand your benefits coverage and claims
- Find in-network specialty providers
- Recognize when support from other resources may be needed
- Leverage available resources
- Coordinate time with a care manager or health coach
Just one more thing to know:
- MedWatch is the name of the company that provides these services. They’re part of the Health Plans, Inc. (HPI) family of companies, and they may reach out to you to help you with your healthcare needs.
Help is just a phone call away.
To get in touch with a Member Advocate, call (888) 340-5487 (M-F, 8 am-8 pm, ET)
***Don’t worry, your information is completely confidential and secure, which means they'll never share it with anyone without your permission first.***
Fairos Rx Pharmacy Benefits - HPI Medical Plans
- For the PPO Plan
- Generic, Preferred Brand, and Non-Preferred Brand Drugs are covered in full, after the applicable tier copay.
- Specialty Drugs are covered at 75% coinsurance
- For the HSA Plan (High Deductible Health Plan)
- Prescription drugs are subject to the deductible and then coinsurance, similar to other medical services.
Fairos Rx Navigator Program
Are you or a dependent taking a high-cost medication? You may be eligible for programs to
reduce your medication costs. The FairosRx Navigator program is focused on simplifying the process of obtaining your medication at a lower cost to you and Elmet Technologies.
What should you expect from FairosRx Navigator if you are taking an eligible medication?
- You will receive a call from a member of the Navigator team to provide program education and an overview of the next steps.
- Based on eligibility criteria, the FairosRx Navigator program determines the appropriate program for you and will provide enrollment assistance.
- The Navigator team will communicate with your prescriber about your program and request a new prescription.
- You are provided with tracking information for your medication, and your package is tracked to ensure delivery.
Examples of the Top 9 Medications (by volume) that are eligible for the FairosRx Navigator Program. This is not intended to be a complete list of the covered medications.
- Jardiance
- Trulicity
- Eliquis
- Nurtec
- Farxiga
- Mounjaro
- Xarelto
- Trelegy Ellipta
- Humalog Kwikpen
Questions? Please call the FairosRx Navigator program at 833-464-9600. You can also email Fairos at: ContactUs@FairosRx.com.
AchieveHealth Tobacco Cessation Program
A tobacco-free life is within reach!
Your health goals are unique to you; your tobacco cessation program should be, too. With AchieveHealth, you’ll get a coaching approach tailored to you, your life, and your health, to help you quit smoking for good.
The program is:
- Free to you
- Individualized
- Convenient—you’ll talk with your coach over the phone when it works best for you.
How can they help?
- Together, you and your health coach will:
- Create your customized quit plan
- Identify barriers to quitting
- Explore new ways to cope with triggers and cravings
How it works
- Appointments range from 15-30 minutes.
- Your coach will call you at your scheduled appointment time, anytime Monday through Thursday, 8:00 a.m. to 10:00 p.m. (EST), or Friday, 8:00 a.m. to 6:00 p.m. (EST).
- Outside of scheduled appointments, you’ll be able to contact your coach through a toll-free number.
Not quite ready to quit?
That’s okay. Give them a call, and they'll discuss when and how you'll be able to quit.
Transparency in Coverage - Machine-Readable Files (MRFs) - HPI Medical Plans
As part of the Transparency in Coverage Final Rule issued by the U.S. Department of the Treasury, the U.S. Department of Labor, and the U.S. Department of Health and Human Services, health insurers and self-funded health benefit plans must post machine-readable files (MRFs) on a public internet website that includes:
- Negotiated rates for all covered items with in-network providers, and
- Historical payments to and billed charges from out-of-network providers.
These files will permit the public access to health plan payment information to help understand pricing and costs for health care services. The MRFs are accessible free of charge, without establishing a user account, password, or other credentials, and without submitting identifying information such as a name, email address, or telephone number. The machine-readable files are formatted to allow researchers, regulators, and application developers to access and analyze data more easily.
Download machine-readable files (MRFs) here
For more information, please visit the HPI Transparency in Coverage - Machine Readable Files page
Dependent Eligibility Verification
If you choose to cover dependent(s) on your medical, dental, or vision plan(s), you will receive an email from the Benefits Service Center following enrollment requesting dependent verification documents. Please be sure to provide the dependent(s) verification by the deadline so that your dependents remain covered.
- Only legal spouses and registered domestic partners are eligible for coverage.
- Children are eligible until their 26th birthday.
You will receive detailed information on the required documentation after your enrollment, if applicable.
