You can count on us to deliver the benefits you expect
Transparency regulations require health insurers and group health plans to provide negotiated rates and allowed amounts for in-network and out-of-network providers, respectively, in the form of machine-readable files (MRF). Effective July 1, 2022, public access to these files may be found on this page. The presentation of MRFs follow the Centers for Medicare & Medicaid Services (CMS) defined layout and format and will be compiled monthly by UST, our claims processing partner. Machine-readable files are not meant to be consumer-friendly—they are a digital representation of data or information in a file that can be imported or read by a computer system. To understand Member benefits and cost sharing, please contact Member Services at (855) 624-6463.
Employers may choose multiple plan options. PioneerASO will work with you on selecting the plan(s) that best fit your population to meet the goals of your benefits strategy. We have a large variety of plans including PPO and HDHP HSA plans that are available for our self-insured groups.
An employer may choose to contract separately for vision and dental benefits. The PioneerASO plans include a vision exam for adults and pediatrics once each 12-month period. Coverage for frames, lenses or contacts would require separate coverage. As for dental, Health Options partners with Delta Dental to offer our clients the opportunity to purchase contracted dental coverage.
Our Business Development Team can work with you or your broker to develop quotes for both fully funded large group options and our self-funded administrative service option. If you find you are not ready to make the move to self-funding, we can help you make an easy to transition from Health Options fully funded to PioneerASO with our PioneerASO Step-Up Program.
We offer the PioneerASO Step-Up Program. This program helps employers get started on the path to self-funding beginning with a fully funded large group plan that includes cost-saving wellness and healthcare programs. The goal is to develop cost-savings through these programs while supporting development of the necessary employee population data to migrate to self-funding through PioneerASO.
PioneerASO is powered by Community Health Options which has a robust network of providers designed to make it easy and convenient for your employees and their dependents to receive care. Our network includes 48,000 providers in New England. This includes 100% of the hospitals in Maine, most in New Hampshire and a number of premier institutions within New England. Members spending time outside of Maine and New Hampshire can count on national coverage through First Health Network®
Your employees can utilize our convenient 24/7 Member portal, where they will find all the information they need to stay on top of their health plan’s benefits and services, including checking claim status, downloading forms and documents, and learning more about their benefits. Group administrators will have access to our convenient Online Insight tool, where they can handle employee census data.
All our self-insured plans and documents fall within the guidelines of ERISA.
Our Business Development Team can work with you to develop quotes for your client for both fully funded large group options and our self-funded administrative service option. If your client is not ready to make the move to self-funding but would like to in the future, we can help them make an easy to transition from Health Options fully funded to PioneerASO with our PioneerASO Step-Up Program.
PioneerASO is powered by Community Health Options. The Health Options’ Cornerstone Large Group Plans provide the foundation for PioneerASO plans. However, the pharmacy benefit manager may be contracted for separately as well as dental coverage and vision coverage for lenses, frames and contacts.
PioneerASO has strategically partnered with a select group of stop loss carriers that have evaluated our hands-on medical management model and provider network to ensure they can provide the most comprehensive and competitive proposals. We are happy to work directly with you on any question you may have about a specific stop loss carrier.
PioneerASO provides the option of separate contracting for a pharmacy benefit manager, dental and vision benefits. The PioneerASO plans include Express Scripts as the pharmacy benefit manager. All PioneerASO plans include coverage for pediatric and adult vision exams once every 12-month period. The plans do not provide benefits for lenses, frames or contacts and there is no dental coverage. PioneerASO clients are encouraged to contract separately for these benefits.
To assist with a transition phase, we offer the PioneerASO Step-Up Program. This program helps employers get started on the path to self-funding beginning with a Health Options fully funded large group plan that includes cost-saving wellness and healthcare programs. The goal is to develop cost-savings through these programs while supporting development of the necessary employee population data to migrate to self-funding through PioneerASO.