PEIA offers a healthcare program that allows you to receive primary care services while paying less. This program, called the Comprehensive Care Partnership (CCP) program, is designed to promote quality of care, preventive services and appropriate use of health services to identify health problems early and maintain control of chronic conditions. This benefit option is available to PEIA PPB Plan A, B and D insureds.
CCP members have reduced or no copayments for office visits, and some CCPs waive deductible or coinsurance for specified covered services. Check with the CCP for details of their waived/reduced cost-sharing.
Office visits to a provider other than your CCP provider have a $40 copay and urgent care visits have a $50 copay.
CCP providers are expected to provide primary care services, coordination of care, and some CCP locations also provide specialty care services and/or laboratory services. If a CCP member uses a primary care provider outside the CCP, they may pay a higher copay. The purpose of the CCP is to promote the use of health services to keep the patient well, identify health problems early, maintain control of chronic conditions and to promote efficient utilization of healthcare resources.
As such, the following is required of the CCP provider: • Remind you when services are due; • Perform an initial evaluation to include an assessment of your preventive health care services and overall health status; • Provide the information you need to care for yourself; • Maintain an electronic medical record, which includes a summary of key health and preventive care history, medicines, and a provision for delivering such information to you as needed; • Provide 24-hour telephone access to a medical provider; • Coordinate with specialists to ensure that all information and treatment plans are consistent; • Notify you of any changes to covered services; • Notify PEIA of non-compliant members who should be removed from the program.
Members enrolled in the CCP program agree to receive their primary healthcare from the CCP provider. Enrolled members pay less for specified services provided at their CCP location. Please note, each plan member must enroll individually for the CCP program. A separate enrollment form must be completed for each individual plan member or the information for the specific member’s provider must be updated on Manage My Benefits. The success of the program requires a working partnership between the CCP provider and the patient/member.
Participating members agree to:
• Use their chosen CCP provider for all health care available at their designed CCP. • Contact their CCP provider before receiving medical care from providers with the exception of emergency cases. • Participate in initial and regular health assessment at least every two years. The purpose of the assessment is to collect the health history and clinical data needed to identify the preventive services needed, plan the patient’s care, and address all healthcare questions. • Members who do not comply with the requirements of the program may be dis-enrolled.NOTE: If you want to continue using other primary care providers and/or specialists for much of your health care, the CCP may not be for you. To enroll in the CCP program, simply: • Review the Provider Directory on UMR’s website at umr.com and choose the provider location to serve as your CCP provider; • Click on the green “Manage My Benefits” button in the upper right corner, register on the site or use your existing credentials to log-in and choose your CCP provider; • Or complete the CCP program enrollment form below, note the CCP location of choice and the seven-digit provider ID number, then sign it and return it to PEIA at the address provided, or you may give it to a receptionist at one of the health centers; Your CCP will be effective the first day of the month following receipt of your completed enrollment form, if it is received no later than the 25th. If the form is received after the 25th, then enrollment may be delayed a month.