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last update | 4.26.19

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+ Do I still need to select a PCP (Primary Care Provider)?

Yes. We encourage you to seek services from your selected PCP whenever possible. If your selected PCP is not available you can now see any other PCP in the THT network.

+ What if I want to change my PCP?

You can change your PCP at any time by calling Allegiance at 855-999-1050.

+ Do I need a referral to see a specialist?

No. A referral is not required by the plan at this time. However, please understand that some specialists may require a referral from a referring provider to ensure appropriate scheduling.

+ What if I have a procedure coming up in 2019 that was already approved?

Allegiance will honor all prior authorizations for services that will occur in 2019. Please contact Allegiance to make sure they have a record of your prior authorization. Allegiance may request that you provide a copy of the prior authorization letter that you received from TriStar.

+ Who do I call if I have questions about claims submitted in 2018?

TriStar will be processing all claims for dates of service on or before 12/31/2018. Please call TriStar at 702-216-1622 if you have any questions.

+ How much will my premium be in 2019?

Your premium will remain the same as 2018

+ What is the difference between Tier 1 & Tier 2? Can I choose between benefits between them?

Tier 1 is the preferred network in Clark County. Tier 2 is Cigna's Open Access Plus National network. If you choose to see a provider who is not in the preferred Tier 1, your out-of-pocket costs may be significantly higher for all services.

+ On that note, can you share information about the different deductible between tiers? And do I need to meet both deductibles each year?

You may because the deductibles for each tier are separate. If you receive services from providers in Tier 1 and Tier 2, you may be required to meet both deductibles. In other words, Tier 1 benefits have a $500 Individual/$1,500 Family deductible. Tier 2 benefits have a $1,500 Individual/$4,500 Family deductible.

+ My child is covered by THT and is attending college out-of-state. Can he/she see doctors?

Your child can see doctors in Cigna's Open Access Plus National network. If your child does not see a doctor in the Cigna network, he or she will not receive benefits.

+ What if my doctor is not a member of the THT network?

If your doctor is not a member of THT but is a member of the Cigna Open Access Plus network, you will receive Tier 2 level benefits. If your doctor is not a member of either THT or Cigna, you will not receive benefits.

+ What if I am traveling outside of Clark County and I need to see a doctor? What about coverage outside of the United States?

The most affordable level of care outside of Clark Country will be through the Cigna Open Access Plus National network. If you do not see a doctor in the Cigna network, you will not receive benefits unless your condition is determined to be an emergency. Regarding coverage outside of the United States, THT does not extend to international coverage.

+ If I am a retiree, what are my benefits?

• Pre-65 retirees living in Southern Nevada have the same benefits as active employees. Pre-65 retirees living outside Southern Nevada have access to the Cigna Open Access Plus National network benefits; however the deductible will be $250. Post-65 employees have the option to elect Medicare or Senior Dimensions.

+ Where can I find the latest formulary information?

Please click right here to access.

+ I was sent an email in early April about login in to a portal and reviewing my info. Is there an update to this?

Yes. As you may have experienced, the portal is not working right now, and we have taken it offline to make all of the necessary changes for a successful member experience. These fixes will be made over the coming weeks, and the portal will be reopened upon completion. We drafted this letter to share with you, our members, about this experience. We hope you have a moment to read it and please email us here with any further questions.

+ Speaking of cards, can I get a new card sent to me?

Yes, please click here to request a card to be mailed to you.

+ You used to have a searchable provider directory. Is this something that we will have again?

Yes, we are working on creating a brand new interactive directory for you. In the meantime, you can access our Medical, Dental, Facilities, and Vision directories right here. We will be updating these evey two weeks and you can always email us with any questions • serviceteam@teachershealthtrust.org


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