SERFF Tracking #: Inc., Project Name/Number: Filing At A .
SERFF Tracking #: THPC-129022561State Tracking #:Company Tracking #: 2013-RI-130State:Rhode IslandFirst Filing Company:TOI/Sub-TOI:H16G Group Health - Major Medical/H16G.002A Large Group Only - PPOProduct Name:RI 2014 Rate Review Process - TAHMO & TIC LGTufts Associated Health Maintenance Organization,Inc., .Project Name/Number: RI 2013 Rate Review Process - TAHMO & TIC LG/2013-RI-130Filing at a GlanceCompanies:Product Name:State:TOI:Sub-TOI:Filing Type:Date Submitted:SERFF Tr Num:SERFF Status:State Tr Num:State Status:Co Tr Num:ImplementationDate Requested:Author(s):Reviewer(s):Disposition Date:Disposition Status:Implementation Date:Tufts Associated Health Maintenance Organization, Inc.Tufts Insurance CompanyRI 2014 Rate Review Process - TAHMO & TIC LGRhode IslandH16G Group Health - Major MedicalH16G.002A Large Group Only - g Actuary Review2013-RI-13001/01/2014Paul Hatch, Haiyun Guo, Colin Woodworth, Michael Kulikowski, Jen Stevenson, Emily MulliganPatrick Tigue (primary), Charles DeWeese, Herbert Olson, Maria Casale, Bela GormanPDF Pipeline for SERFF Tracking Number THPC-129022561 Generated 05/16/2013 10:51 AM
SERFF Tracking #: THPC-129022561State Tracking #:Company Tracking #: 2013-RI-130State:Rhode IslandFirst Filing Company:TOI/Sub-TOI:H16G Group Health - Major Medical/H16G.002A Large Group Only - PPOProduct Name:RI 2014 Rate Review Process - TAHMO & TIC LGTufts Associated Health Maintenance Organization,Inc., .Project Name/Number: RI 2013 Rate Review Process - TAHMO & TIC LG/2013-RI-130General InformationProject Name: RI 2013 Rate Review Process - TAHMO & TICLGProject Number: 2013-RI-130Requested Filing Mode: Review & ApprovalExplanation for Combination/Other:Submission Type: New SubmissionGroup Market Type: EmployerFiling Status Changed: 05/15/2013State Status Changed: 05/15/2013Created By: Paul HatchCorresponding Filing Tracking Number: 2013-RI-130Status of Filing in Domicile: AuthorizedDate Approved in Domicile:Domicile Status Comments:Market Type: GroupGroup Market Size: LargeOverall Rate Impact:Deemer Date:Submitted By: Jen StevensonPPACA: Non-Grandfathered Immed Mkt Reforms, Grandfathered Immed Mkt ReformsPPACA Notes: nullNoInclude Exchange Intentions:Filing Description:Attached are the Tufts Associated Health Maintenance Organization Inc. (TAHMO) and Tufts Insurance Company (TIC) LargeGroup Rate Review Process filings for 1/1/13. For any questions about this submission, please contact Jen Stevenson,Analytic Manager, at 617-972-9400, ext. 3748.Company and ContactFiling Contact InformationJen Stevenson, Analytic Manager705 Mt. Auburn StreetWatertown, MA 02472jen stevenson@tufts-health.com617-972-9400 [Phone] 3748 [Ext]617-972-9078 [FAX]Filing Company InformationTufts Associated HealthMaintenance Organization, Inc.705 Mount Auburn StreetWatertown, MA 02472-1508(617) 972-9400 ext. [Phone]CoCode: 95688Group Code:Group Name:FEIN Number: 04-2674079State of Domicile:MassachusettsCompany Type:State ID Number:Tufts Insurance Company705 Mount Auburn StreetWatertown, MA 02472-1508(617) 972-9400 ext. [Phone]CoCode: 60117Group Code:Group Name:FEIN Number: 04-3319729State of Domicile:MassachusettsCompany Type:State ID Number:Filing FeesFee Required?YesFee Amount: 80.00PDF Pipeline for SERFF Tracking Number THPC-129022561 Generated 05/16/2013 10:51 AM
SERFF Tracking #: THPC-129022561State Tracking #:Company Tracking #: 2013-RI-130State:Rhode IslandFirst Filing Company:TOI/Sub-TOI:H16G Group Health - Major Medical/H16G.002A Large Group Only - PPOProduct Name:RI 2014 Rate Review Process - TAHMO & TIC LGTufts Associated Health Maintenance Organization,Inc., .Project Name/Number: RI 2013 Rate Review Process - TAHMO & TIC LG/2013-RI-130NoRetaliatory?Fee Explanation:YesPer Company:CompanyAmountDate ProcessedTransaction #Tufts Insurance Company 40.0005/15/201370315943Tufts Associated Health MaintenanceOrganization, Inc. 40.0005/15/201370315944PDF Pipeline for SERFF Tracking Number THPC-129022561 Generated 05/16/2013 10:51 AM
SERFF Tracking #:THPC-129022561State Tracking #:Company Tracking #:State:Rhode IslandTOI/Sub-TOI:H16G Group Health - Major Medical/H16G.002A Large Group Only - PPOFirst Filing Company:Product Name:RI 2014 Rate Review Process - TAHMO & TIC LGProject Name/Number:RI 2013 Rate Review Process - TAHMO & TIC LG/2013-RI-1302013-RI-130Tufts Associated Health Maintenance Organization, Inc., .Rate InformationRate data applies to filing.SERFFFiling Method:Rate Change Type:Overall Percentage of Last Rate Revision:Effective Date of Last Rate Revision:Filing Method of Last Filing:Increase%01/01/2013SERFFCompany Rate InformationCompanyName:Tufts AssociatedHealth MaintenanceOrganization, Inc.CompanyRateChange:Overall %IndicatedChange:Overall %RateImpact:WrittenPremiumChange forthis Program:# of PolicyWrittenHolders Affected Premium forfor this Program: this Program:Maximum % Minimum %ChangeChange(where req'd): (where req'd):Increase9.500%9.500% 1,177,155469.600%Product Type:HMOCovered Lives:2,18481Policy Holders:442Tufts InsuranceCompanyIncreaseProduct Type:PPO10.100%HMOEPO10.100%PPOPOS 4,119,499EPOPOSHSA 12,397,135HDHP47HSAFFSOther 40,704,22810.200%HDHPCovered Lives:6,569356Policy Holders:425PDF Pipeline for SERFF Tracking Number THPC-129022561 Generated 05/16/2013 10:51 AMFFSOther9.100%9.700%
SERFF Tracking #: THPC-129022561State Tracking #:Company Tracking #: 2013-RI-130State:Rhode IslandFirst Filing Company:TOI/Sub-TOI:H16G Group Health - Major Medical/H16G.002A Large Group Only - PPOProduct Name:RI 2014 Rate Review Process - TAHMO & TIC LGTufts Associated Health Maintenance Organization,Inc., .Project Name/Number: RI 2013 Rate Review Process - TAHMO & TIC LG/2013-RI-130Rate Review DetailCOMPANY:Company Name:HHS Issuer Id:Product Names:Trend Factors:Tufts Associated Health Maintenance Organization, Inc.90010Tufts Health Plan (TAHMO) HMOThe projected overall combined Medical and Rx trend is 6.2%. Pleasesee the details in the OHIC template.FORMS:New Policy Forms:Affected Forms:Other Affected Forms:For HMO - EC-RIHMO-001n/an/aREQUESTED RATE CHANGE INFORMATION:Change Period:AnnualMember Months:22,302Benefit Change:NonePercent Change Requested: Min: 9.1 Max: 9.6 Avg: 9.5PRIOR RATE:Total Earned Premium:Total Incurred Claims:Annual :12,397,135.0010,855,788.00Min: 323.47 Max: 510.52 Avg: 402.46REQUESTED RATE:Projected Earned Premium:Projected Incurred Claims:Annual :13,574,289.0011,624,379.00Min: 354.24 Max: 559.32 Avg: 440.68PDF Pipeline for SERFF Tracking Number THPC-129022561 Generated 05/16/2013 10:51 AM
SERFF Tracking #: THPC-129022561State Tracking #:Company Tracking #: 2013-RI-130State:Rhode IslandFirst Filing Company:TOI/Sub-TOI:H16G Group Health - Major Medical/H16G.002A Large Group Only - PPOProduct Name:RI 2014 Rate Review Process - TAHMO & TIC LGTufts Associated Health Maintenance Organization,Inc., .Project Name/Number: RI 2013 Rate Review Process - TAHMO & TIC LG/2013-RI-130COMPANY:Company Name:HHS Issuer Id:Product Names:Trend Factors:Tufts Insurance Company38712Standard (non-CareLink) PPO; CareLink PPOThe projected overall combined Medical and Rx trend is 6.2%. Pleasesee the details in the OHIC template.FORMS:New Policy Forms:Standard PPO - Form RI-PPO-001; CareLink PPO - Form RI-PPO002.Affected Forms:Other Affected Forms:REQUESTED RATE CHANGE INFORMATION:Change Period:AnnualMember Months:56,285Benefit Change:NonePercent Change Requested: Min: 9.7 Max: 10.2 Avg: 10.1PRIOR RATE:Total Earned Premium:Total Incurred Claims:Annual :40,704,228.0035,643,436.00Min: 340.93 Max: 541.68 Avg: 432.21REQUESTED RATE:Projected Earned Premium:Projected Incurred Claims:Annual :44,823,727.0038,170,663.00Min: 375.50 Max: 596.85 Avg: 475.95PDF Pipeline for SERFF Tracking Number THPC-129022561 Generated 05/16/2013 10:51 AM
SERFF Tracking #:THPC-129022561State Tracking #:Company Tracking #:State:Rhode IslandTOI/Sub-TOI:H16G Group Health - Major Medical/H16G.002A Large Group Only - PPOFirst Filing Company:Product Name:RI 2014 Rate Review Process - TAHMO & TIC LGProject Name/Number:RI 2013 Rate Review Process - TAHMO & TIC LG/2013-RI-1302013-RI-130Tufts Associated Health Maintenance Organization, Inc., .Rate/Rule ScheduleItemNo.ScheduleItemStatusDocument NameAffected Form Numbers(Separated with commas)Rate Action1TAHMO HMO EOCEC-RIHMO-001 Ed. 7-2012New7-2012 RI HMO EOC Clean Version.pdf,2TIC Standard PPO CertficateRI-PPO-001 Ed. 7-2012New7-2012 RI TICStandard PPO Cert Clean Version.pdf,3TIC CareLink PPO CertficateRI-PPO-002 Ed. 7-2012New7-2012 RI TICCareLink PPO Cert Clean Version.pdf,Rate Action InformationPDF Pipeline for SERFF Tracking Number THPC-129022561 Generated 05/16/2013 10:51 AMAttachments
REVISED Rhode Island HMO Evidence of Coverage (EOC) forTufts Associated Health Maintenance Organization, Inc. (TAHMO)REVISED CLEAN COPY(submitted to Rhode Island Dept. of Business Regulation – 2-22-13)Rhode Island[ [Premium] [Value] [Basic] Benefit]Evidence of CoverageTufts Health Plan705 Mount Auburn StreetWatertown, MA 02472-1508 2010 Tufts Health Plan, Watertown, MA 02472-1508 USA. All rights reserved. Theinformation contained in this document may not be reproduced in whole or in part without writtenpermission by Tufts Health Plan.EC-RIHMO-001Ed. 7-2012
Tufts Health Plan Address And Telephone DirectoryTUFTS HEALTH PLAN705 Mount Auburn StreetWatertown, Massachusetts 02472-1508Hours:Hours: Monday through Thursday 8:00 a.m.-7:00 p.m.Friday 8:00 a.m - 5:00 p.m.IMPORTANT PHONE NUMBERS:Emergency CareFor routine care, always call your Primary Care Provider (PCP). Do this before seeking care. Ifyou have an urgent medical need and cannot reach your PCP or your PCP’s Covering Provider,seek care at the nearest emergency room.Important Note: If needed, call 911 for emergency medical assistance. If 911 services arenot available in your area, call the local number for emergency medical services.Liability RecoveryCall the Liability and Recovery Department at 1-888-880-8699, x. 1098 for questions aboutcoordination of benefits and workers compensation. For example, call that Department withquestions about how Tufts Health Plan coordinates coverage with other health care coverageyou may have. This Department is available from 8:30 a.m. – 5:00 p.m. Monday throughThursday, and 10:00 a.m. – 5:00 p.m. on Friday.You may have questions about subrogation. If so, call a Member Specialist at 1-800-682-8059.You may not be sure about which department to call with your questions. If so, call MemberServices.Member Services DepartmentCall our Member Services Department at 1-800-682-8059 for: general questions; assistance inchoosing a Primary Care Provider (PCP); benefit questions; and information regarding eligibilityfor enrollment and billing.[Mental Health ServicesYou may need information regarding mental health professionals in your area. If so, callthe Mental Health Department at 1-800-208-9565.]Services for Hearing Impaired MembersYou may be hearing impaired. If so, these services are provided:Telecommunications Device for the Deaf (TDD)If you have access to a TDD phone, call 1-800-868-5850. You will reach our MemberServices Department.Rhode Island Relay1-800-745-5555Italicized words are defined in Appendix A.iTo contact Member Services, call 1-800-682-8059.Or, see our Web site at www.tuftshealthplan.com.
Tufts Health Plan Address And Telephone Directory, continuedIMPORTANT ADDRESSES:Appeals and Grievances DepartmentYou may need to call us about a concern or appeal. If so, call a Specialist at 1-800-6828059. To submit your appeal or grievance in writing, send your letter to:Tufts Health PlanAttn: Appeals and Grievances Department705 Mt. Auburn St.P.O. Box 9193Watertown MA 02471-9193Web siteYou may want more information about Tufts Health Plan or to learn about the self-serviceoptions available to you. If so, see the Tufts Health Plan Web site atwww.tuftshealthplan.com.Italicized words are defined in Appendix A.iiTo contact Member Services, call 1-800-682-8059.Or, see our Web site at www.tuftshealthplan.com.
Translating services for 140 languagesInterpreter and translator services related to administrative procedures are available to assistMembers upon request. For information, please call the Member Services Department.1-800-682-8059Telecommunications Device for the Deaf (TDD)Call 1-800-868-5850Italicized words are defined in Appendix A.iiiTo contact Member Services, call 1-800-682-8059.Or, see our Web site at www.tuftshealthplan.com.
OverviewWelcome to Tufts Health Plan. We are pleased you have chosen us. We look forward toworking with you to help you meet your health care needs. We are a health maintenanceorganization. We arrange for your health care through a network of health care professionalsand hospitals. When you join Tufts Health Plan, you will need to choose a Primary CareProvider (PCP). Your PCP will manage your care. Your PCP is a physician or nursepractitioner in private practice. He or she personally cares for your health needs. If the needarises, your PCP will refer you to a specialist in our network.[ IMPORTANT NOTE: For Outpatient care: You may receive services from your PCP, a mentalhealth/substance abuse Provider, or an obstetrician/gynecologist (“Ob/Gyn”). If thishappens, your Copayment may be lower than for services from other Providers. [For Inpatient care or Day Surgery: Your Copayment may be lower when you receivecare at a Community Hospital [or at your Designated Facility] than when you receivecare at a Tertiary Hospital (. See Appendix A for definitions of these facilities.]For more information, see “Covered Services” in Chapter 3. ]This book will help you find answers to your questions about Tufts Health Plan benefits.Italicized words are defined in the Glossary in Appendix A.Your satisfaction with Tufts Health Plan is important to us. If you have any questions, call aMember Specialist. We will be happy to help you.Tufts Associated Health Maintenance Organization, Inc. is licensed as a health maintenanceorganization in Massachusetts and Rhode Island. This company does business under thename Tufts Health Plan.Eligibility for BenefitsWhen you join Tufts Health Plan, you agree to receive your care from Tufts Health PlanProviders. We cover only the services and supplies described as Covered Services in Chapter3. [There are no pre-existing condition limitations under this plan.] You are eligible to use yourbenefits on your Effective Date.IMPORTANT NOTE FOR MEMBERS IN GROUP CONTRACTS ONLY: You may live inMassachusetts or New Hampshire. If so, your benefits under this plan may include benefitsrequired under applicable Massachusetts or New Hampshire law. For more information, callMember Services.Calls to Member ServicesOur Member Services Department is committed to excellent service. Calls to our MemberServices Department may be monitored. This is done to assure quality service.Italicized words are defined in Appendix A.ivTo contact Member Services, call 1-800-682-8059.Or, see our Web site at www.tuftshealthplan.com.
Table of ContentsAddress and Telephone Directory . iTranslating Services for 140 Languages . iiOverview . iiiBenefit Overview . viiBenefit Limits. xxiiiChapter 1 -- How Your HMO Plan WorksHow the Plan Works . 1-1[Continuity of Care . 1-2]Emergency Care and Urgent Care . 1-3Inpatient Hospital Services . 1-3Mental Health/Substance Abuse Services . 1-4About Your Primary Care Provider . 1-5Financial Arrangements between Tufts Health Plan and Tufts Health Plan Providers. 1-8Member Identification Card. 1-9Utilization Management . 1-9Chapter 2 -- Eligibility, Enrollment and Continuing EligibilityEligibility.Enrollment .Adding Dependents under Family Coverage .Newborn Children and Adoptive Children .Student Dependents .Disabled Dependents .Former Spouses .[Domestic Partners .Keeping Our Records Current .2-12-12-22-22-32-42-42-4]2-5Chapter 3 -- Covered ServicesCovered Services .Emergency care .Emergency room or Provider’s office .Outpatient care .[Acupuncture services .[Autism spectrum disorders – diagnosis and treatment for Children under age 15Cardiac rehabilitation services .[Chiropractic care .[Chiropractic Medicine .Diabetes services and supplies .Early intervention services for a Dependent Child .Family planning .Procedures .Services .Contraceptives .Hemodialysis .[House calls to diagnose and treat illness or injury .Infertility services .
May 15, 2013 · Filing at a Glance Companies: Tufts Associated Health Maintenance Organization, Inc. Tufts Insurance Company Product Name: RI 2014 Rate Review Process - TAHMO & TIC LG . Tufts Insurance Company 40.00 05/15/2013 70315943 Tufts Associated Health Maintenance Organization, Inc. 40.00 05/15/2013
SERFF Health and Disability Rate Filing General Instructions . WAOIC HD RATE GFI Page 5 of 32 12-18-2018 . 2. Attach in PDF format, Part II Written Description Justifying the Rate Increase. 2.1 You must name the Part II PDF file “Part II Written Description Justifying the Rate Increase” 3. Attach in PDF format,
Filing at a Glance Company: Providence Health Plan Product Name: 90-day Discontinuance Filing_Providence_Portability_123113 State: Oregon TOI: H06 Health - Conversion Sub-TOI: H06.000 Health - Conversion Filing Type: Form Date Submitted: 08/16/2013 SERFF Tr Num: PROV-129121711 SERFF Status: Closed-Filed
Company: United Security Assurance Company of Pennsylvania Product Name: PA 2020 TQLTC-97 Rate Increase State: Pennsylvania TOI: LTC03I Individual Long Term Care Sub-TOI: LTC03I.001 Qualified Filing Type: Rate - Other (Not M.U. or G.I. Product) Date Submitted: 09/25/2020 SERFF Tr Num: USPA-132537056 SERFF Status: Closed-Approved
Individual Accident/Accidental Death & Dismemberment Insurance Checklist for SERFF Filings (As of 9.20.19) Instructions for SERFF Checklist A. For ALL filings, the “General Requirements for All Filings” section in this checklist MUST be completed. B. For a FORM filing, completion of additional sections of this checklist may be required as .
PENNSYLVANIA BULLETIN, VOL. 49, NO. 40, OCTOBER 5, 2019. Metropolitan Life Insurance Company (SERFF . United Security Assurance Company of Pennsylva-nia; rate increase filing for individual LTC form TQLTC-97 (SERFF # USPA-132078586) .5771 PENNSYLVANIA PUBLIC UTILITY COMMISSION
State: Delaware TOI: 16.0 Workers Compensation Sub-TOI: 16.0004 Standard WC Filing Type: Rate/Rule Date Submitted: 08/04/2017 SERFF Tr Num: DCRB-131144956 SERFF Status: Closed-Filed . The corresponding manual residual market rate level change is -4.01%. The manual voluntary market loss cost change is -1.01%. These
Object tracking is the process of nding any object of interest in the video to get the useful information by keeping tracking track of its orientation, motion and occlusion etc. Detail description of object tracking methods which are discussed below. Commonly used object tracking methods are point tracking, kernel tracking and silhouette .
2nd Grade . ELA Priority Standards Grade 2 CCSS PA Core Foundational Skills RF.2.3 CC.1.1.2.D Know and apply grade level phonics and word analysis skills in decoding words. Distinguish long and short vowels when reading regularly spelled one- syllable words. Decode two-syllable words with long vowels and words with common prefixes and suffixes. Read grade level high-frequency .
