Alaska Plan 190

This page covers information about your benefits
that will begin on January 1, 2020.

Learn about your current benefits

Questions about your benefits?

Call UNITE HERE HEALTH

(844) 427-8501

Phone hours:

Monday to Friday

8:30am to 4:30pm AKDT
 

Find a doctor

Choose a provider in your plan's network. It saves you money. Here are your in network options:

  1. Find a MultiPlan network provider by state
    State MultiPlan PPO Network
    Alaska Beech Street
    Washington First Choice Health Network
    Idaho First Choice Health Network
    Montana First Choice Health Network
    All other states PHCS
  2. Visit a PPO provider in Anchorage, Alaska
    If you’re in Anchorage, you can only go to a Coalition provider on the list below for these services:
    Hospital services
    Alaska Regional Hospital
    2801 Debarr Rd
    Anchorage, AK 99508
    907-276-1131
    Emergency medicine
    Denali Emergency Medicine
    Associates
    2801 Debarr Rd #505
    Anchorage, AK 99508
    907-258-9272
    Physical therapy
    Ascension Physical Therapy
    6200 Lake Otis Pkwy #104
    Anchorage, AK 99507
    907-770-6693
    Hand therapy
    Alaska Hand Rehabilitation
    4015 Lake Otis Pkwy #200
    Anchorage, AK 99508
    907-563-8318
    Chugach Physical Therapy
    2740 Lake Otis Pkwy
    Anchorage, AK 99508
    907-272-8615
     

    For all other services in Anchorage, you can go to any provider you want.

  3. Visit a Coalition Health Center
    There is no copay.
      Anchorage Fairbanks
    Address 2741 DeBarr Road
    Suite C210
    Anchorage, AK 99508
    575 Riverstone Way
    Unit 1
    Fairbanks, AK 99709
    Hours Appointments:
    Monday to Friday
    7:30am to 6:30pm
    Saturday
    8am to 2pm
    Walk-ins:
    Monday to Friday
    8:30am to 4:30pm
    Appointments:
    Monday to Friday
    7:30am to 6:30pm
    Saturday
    8am to 2pm
    Walk-ins:
    Monday to Friday
    8:30am to 4:30pm
    Phone number (907) 264-1370 (907) 450-3300
    Ages 5 years and older 2 years and older
  4. Go to a Primary Care Associates facility
    You have a Wellness and Minor Care Program available to you. It is
    provided by Primary Care Associates. Services are for ages 1 and up.
    Your costs:
    • $20 copay for most services
    • No copay for preventive services like physicals (annual exams)

    Locations:

    Appointments Only
    4100 Lake Otis Parkway
    Suite 322
    Anchorage, AK 99508
    907-562-1234

    Walk-ins Only
    4100 Lake Otis Pkwy.
    Suite 100
    Anchorage, AK 99508
    907-563-4006

    12350 Industry Way
    Suite 160
    Anchorage, AK 99515
    (on the corner of Huffman & Old Seward)
    907-345-4343

    17101 Snowmobile Lane
    Suite 102
    Eagle River, AK 99577
    907-694-7223

  5. Use Teladoc
    You can get care 24 hours a day, 7 days a week. Use your computer, cell phone, or mobile device to see a doctor. Visit www.teladoc.com to set up your account.

Learn about your benefits

Get to know your benefits. It will help you know what is available to you. To find out about your benefits:

Call us at (844) 427-8501

Participant guide

Download a copy of your participant guide

English: Bronze | Silver | Gold

Spanish: Bronze | Silver | Gold

Summary of Benefits and Coverage (SBC)

Download a copy of your Summary of Benefits and Coverage (SBC). It
gives you a quick outline of some of your benefits and costs.

English: Bronze | Silver | Gold

Spanish: Bronze | Silver | Gold

Benefits at a Glance

View your Benefits at a Glance:

English: Bronze | Silver | Gold

Spanish: Bronze | Silver | Gold

Summary Plan Description (SPD)

View your Summary Plan Description (SPD). It explains all your benefits.

English | Spanish (Coming in 2020)

Where to get your medicine

You can go to any pharmacy in the CVS/Caremark network. Some of your network pharmacies are:

Carrs/Safeway Fred Meyer
Costco Target
CVS Walgreens

Visit www.caremark.com or call (866) 818-6911 to find a pharmacy near you. See the chart below to see how much you will pay for medicine.

Your pharmacy costs

Prescription drug feature Bronze Silver Gold
Preventive
prescriptions
or supplies
No charge
Prescriptions at a
retail pharmacy
50%
coinsurance
($5 minimum)
40%
coinsurance
($5 minimum)
30%
coinsurance
($5 minimum)
Diabetic oral
medicine, insulin
and supplies
$5 copay at a retail pharmacy;
$10 copay by mail order
Prescriptions by mail 50%
coinsurance
($10 minimum)
40%
coinsurance
($10 minimum)
30%
coinsurance
($10 minimum)
Out-of-pocket
maximum

$2,350 per person;
$4,700 per family

For compound medications that cost $500 or more, you must get prior authorization.
Please call CVS at (866) 818-6911.

Important: If you get a brand drug when a generic drug is available, you will have to pay the full cost of the difference between the brand drug and generic drug.

How to make payments for dependents

If you enroll your spouse and/or children as dependents, you will pay a
dependent premium each month.

Here are important details for you to remember:

  • Your payment is due on the 20th of the month. The payment is for next month’s coverage.
  • You can only pay for the month that is due. We do not accept advance payments.

Make your payments:

  • By mailing us a check
    Make checks payable to: UNITE HERE HEALTH
    Mail checks to:
    UNITE HERE HEALTH
    P.O. Box 809328
    Chicago, IL 60680-9328
  • Online through the member portal starting in December 2019.
  • By phone using a credit card starting December 2019.

Find a dentist

You can go to any dentist you want. Dental benefits are only for employees.
Your dependents don’t have dental coverage.

Dental plan feature Details
Deductible $50
Annual maximum $1,000 per calendar year
Picking your dentist You can go to any dentist you want.
What you pay You pay your deductible and
50% coinsurance*
Who's covered? Employees only
Specialists You can see specialists
without referrals.
*Services received will be covered up to the Usual & Customary Charge (UCC). Any
amounts above the UCC will not be covered. You may receive a balance bill from
the provider.

Prior authorization

You must get prior authorization before you get certain services. That’s
approval before you get care. For prior authorization, contact Medical
Rehabilitation Consultants (MRC) at (800) 827-5058.

Download a list see to what services need prior authorization.

English | Spanish

Important forms

Call us at (844) 427-8501 if you need help with these forms.

Life insurance beneficiary: English | Spanish

Mail order pharmacy form

Prescription reimbursement claim form