For existing members, everything that you were used to on our old site is still here – just take a look around.  We hope the changes are to your liking, and make it easier for you to get the information you need.

Please let us know your thoughts, and anything that we can do to make your web experience at www.celticarehealthplan.com better.

Kind Regards,

CeltiCare Team

If you need help finding a doctor near you, call CeltiCare member services department, Monday – Friday, 8am – 5 pm at (866)895-1786.

The following problems are a real emergency:

• Difficulty breathing, shortness of breath.
• Chest or upper abdominal (stomach) pain or pressure.
• Fainting, sudden dizziness, weakness.
• Changes in vision.
• Confusion or changes in mental status.
• Any sudden or severe pain.
• Uncontrolled bleeding.
• Severe or persistent vomiting or diarrhea.
• Coughing or vomiting blood.
• Thoughts of suicide.
• Difficulty speaking.

If you aren’t sure where to go for treatment, call your doctor’s office for advice, or call NurseWise^® 24 hours a day, seven days a week at (866)895-1786.

NurseWise is ready to answer your health questions 24 hours a day – everyday of the year. NurseWise is staffed with Registered Nurses. These nurses have spent lots of time caring for people. Now they are ready and eager to help you.

Remember, in cases of real emergency, please go to the nearest hospital immediately to seek medical attention.

During the year, CeltiCare will review our pharmacy program to ensure appropriate and improved services for our members.  Please note the below changes to your Preferred Drug List (PDL) that is available at www.celticarehealthplan.com under the members tab.

Commonwealth Care Type I PDL:

The following drugs have been added to list of covered drugs: 

Commonwealth Care Type II & III and Commonwealth Care Bridge PDLs:

The following drugs have been added to list of covered drugs:

Tier 1:

Lansoprazole

Tier 2:

Aricept ODT

Exforge HCT

Prevacid SoluTab

Zenpep

Tier 3:

Prevacid Capsule

If you have additional questions regarding the copayment amounts please contact CeltiCare Member Services at 1-866-895-1786.

We apologize for the inconvenience.

• The co-pay for the following diabetic supplies has been moved from Tier 2 to Tier 1 effective October 24^th, 2009.  The copayments for these supplies will now be $0.
  • Blood Glucose Monitoring Strips
  • Lancets
  • Insulin Syringes

Please refer to the Preferred Drug List for the Commonwealth Care Bridge Program for a complete list of supplies and the related copayments.

• Several brand name prescription drugs currently do not have a generic equivalent.  As a result, certain brand name drugs have been moved from Tier 2 to Tier 1 effective December 4^th, 2009.  The copayments for these drugs will now be $0.  Please refer to the Preferred Drug List for the Commonwealth Care Bridge Program for a complete list of prescription drugs and the related copayments.

If you have additional questions regarding the copayment amounts please contact CeltiCare Member Services at 1-866-895-1786.

The program will be available to members in three phases:

October 1, 2009: Greater Boston

November 1, 2009: Northern and Southern Regions of the State and;

December 1, 2009: Central and Western Region of the State

We look forward to working with you and assisting you with your healthcare needs.  

Sincerely,

Richard Lynch

President & CEO, CeltiCare Healthplan of Massachusetts

• The co-pay for OTCs listed as part of the Over the Counter Pharmacy Program for Plan Type II members is $10.00 per 30 day supply.
• The co-pay for OTCs listed as part of the Over the Counter Pharmacy Program for Plan Type III members is $12.50 per 30 day supply.

If you have additional questions regarding the co-pay amount correction please contact the CeltiCare staff at 1-866-614-1949.

BOSTON, MA (July 1, 2009) – CeltiCare Health Plan of Massachusetts (CeltiCare) today announced that it has received the “Seal of Approval” from the Commonwealth Health Insurance Connector Authority (Connector Authority) for entry into the State’s Commonwealth Choice (CommChoice) program. CeltiCare’s application was unanimously approved by the Connector Authority’s Board at its June meeting.

CommChoice offers affordable, commercial health insurance products to individuals, families, and small employer groups. CommChoice is one of a variety of health insurance programs offered by the Connector Authority under the 2006 Massachusetts Health Care Reform Act.

“We are pleased to receive the Connector Authority’s seal of approval for this important healthcare program,” said Richard Lynch, president and CEO of CeltiCare. “Not only does our participation in the program allow us to extend our reach to cover more individuals and small businesses throughout Massachusetts, but it also reinforces CeltiCare’s long-term commitment to bringing superior value to Massachusetts healthcare consumers.”

Subject to regulatory approval, CeltiCare hopes to begin serving CommChoice members on January 1, 2010. CeltiCare will offer the full spectrum of CommChoice benefit plans, including Gold, Silver, Bronze and Young Adults health plans to individuals and families throughout central and eastern Massachusetts.

This is CeltiCare’s second major healthcare initiative with the Connector Authority to provide quality, affordable health options to underserved residents of Massachusetts. CeltiCare was unanimously approved by the Connector Authority’s Board in March for inclusion in the Commonwealth Care program and began serving members on July 1, 2009.

About CeltiCare Health Plan of Massachusetts

Founded in 2009, Boston-based CeltiCare Health Plan of Massachusetts is a managed care organization that provides high-quality, cost-effective health insurance to Massachusetts residents enrolled in the Commonwealth Care and Commonwealth Choice programs. CeltiCare is committed to helping its members achieve better health outcomes by providing high-quality benefits, services and wellness education. Backed by parent company Celtic Group, Inc., CeltiCare offers a new form of local managed care that is tailored to the needs of Massachusetts’ progressive healthcare system.

Originally projected to rise by two percent, the premium rates paid to the health plans and approved by the Commonwealth Health Insurance Connector Authority board of directors will actually decline slightly from the current year. The new rates take effect July 1 for one year.

“Governor Patrick has made health care cost containment a priority for the Administration,” said Administration and Finance Secretary Leslie A. Kirwan, who chairs the Health Connector board of directors. “Controlling costs helps us not only maintain, but also improve on the strong progress that health care reform has made in Massachusetts by ensuring that residents can continue to receive quality care they can afford.”

The Connector covers the entire cost of the premium for about 70 percent of the 165,000 Commonwealth Care members. The remaining members receive partial subsidies based on their income, which cannot exceed $32,508 for an individual and $66,168 for a family of four. Those who choose the lowest-priced plans next year will see no increase in their monthly premiums, and most of those who choose higher-priced options will actually pay less. 

Since the inception of the program in 2006, the average annual rate of increase in premiums per covered person has been held under 4.5 percent, well below most benchmarks for health insurance.

“With more than 97 percent of Massachusetts residents insured, the Commonwealth must focus on controlling health care costs now more than ever,” said Secretary of Health and Human Services Dr. JudyAnn Bigby.  “The Connector’s unanimous decision today to hold premium rates and base enrollee contributions steady is part of a statewide commitment to a multi-pronged strategy for ensuring the continued success of health care reform in Massachusetts.”

The Connector today also announced that a new insurance carrier has been added to the Commonwealth Care program, expanding the pool of doctors available to residents covered by Commonwealth Care.

Commonwealth Family Health Plan (CFHP) is a partnership between Centene Corporation and Caritas Christi Health Care. Centene is a national, multi-line health care organization with more than 1.2 million members in nine states. Caritas Christi Health Care is a local not-for-profit health care system with over 2,300 physicians and six acute care hospitals.

Through this new plan, Caritas will significantly add to the pool of primary care doctors now available to Commonwealth Care members.  In addition to the Caritas network, CFHP will also be contracting with other providers for hospital, physician and ancillary services.

“As a result of an innovative procurement process, the commitment of local providers, and national interest in our landmark healthcare reform programs, we have succeeded in simultaneously lowering costs and increasing access,” said Health Connector Executive Director Jon Kingsdale. “This is a home run.”

The procurement process was headed by Health Connector Chief Financial Officer Patrick Holland. He noted that most service areas of the state that currently have only one plan to choose from will now have at least two, and that options will expand in other regions, as well.

“We are pleased with the results,” said Holland. “Not only have we increased the number of health plan options for our members, but just as importantly, we have lowered the expected cost of the program. In bringing together cost control incentives, strong financial oversight and high-quality, cost-effective health plans, we collectively have proven the value of such a powerful model, evidenced in the program’s annual expense trend over the last three years.”

The four original carriers will continue in the program. They are Boston Medical Center HealthNet Plan, Fallon Community Health Plan, Neighborhood Health Plan and Network Health.
 

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The Massachusetts Commonwealth Care program is a health insurance program for low-income, working adults (up to 300% of the Federal Poverty Level) who are not eligible for Medicaid or employer-sponsored insurance. There are currently approximately 165,000 Commonwealth Care members.

Commonwealth Family Health Plan is a new, innovative managed care solution that leverages local provider relationships, national managed care experience and Celtic’s expertise in the individual health insurance market. The health plan offers a greater pool of primary care physicians available to Commonwealth Care members, as well as a full spectrum of providers and managed care services to ensure comprehensive access to all benefits required under the Commonwealth Care program. 

Frederick J. Manning, Executive Vice President for Centene and Chief Executive Officer for Celtic, stated, “We are committed to provide a managed care solution for the underserved communities in Massachusetts. By promoting the medical home and preventive care, our new health plan will successfully deliver better health outcomes for the citizens of Massachusetts. Consistent with our philosophy that quality healthcare is best delivered locally, our health plan will hire local staff to meet the needs of the members and communities we will serve.”

Ralph de la Torre, M.D., President and Chief Executive Officer for Caritas, stated, “This plan confirms Caritas Christi’s commitment to bring the highest quality healthcare to patients in their communities.  This commitment coupled with Celtic’s national experience and financial backing, effectively position this new health plan to deliver world-class healthcare to Commonwealth Care enrollees while maintaining the fiscal responsibility owed to the citizens of the commonwealth.”

About Commonwealth Family Health Plan

Commonwealth Family Health Plan, Inc. is a managed care organization that will provide health insurance to Massachusetts residents enrolled in the Commonwealth Care Program. A partnership between Celtic Group and Caritas Christi Health Care, Commonwealth Family Health Plan offers a new form of local managed care that is tailored to meet the needs of Massachusetts’ progressive healthcare system. Effective July 1, 2009, the plan will contract with the Commonwealth Care Health Insurance Connector Authority (Authority) to serve low-income, working adults who are not eligible for Medicaid.

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