Five things for employers to know about care navigation

February 08, 2022

Starting April 1, care navigation will provide a guided, personalized healthcare experience for members in the Medical Plan.

Today’s healthcare experience is growing more complicated. That’s why The Board of Pensions of the Presbyterian Church (U.S.A.), in partnership with Quantum Health, is providing the next level of support for Medical Plan members. Here’s what employers need to know about care navigation.

  1. It’s a new value-added feature of the Medical Plan. Care navigation helps members and their covered family members navigate their healthcare and use their medical benefits.
  2. It starts April 1, 2022. Beginning April 1, Quantum Health is the primary point of contact when members in the PPO, EPO, or HDHP have questions about medical or prescription drug benefits or need help with a healthcare issue.* 
  3. It complements medical coverage through the Board of Pensions. The medical coverage features employees rely on continue to work seamlessly. 
    • They still have access to the same Blue Cross Blue Shield (BCBS) national provider network.
    • Highmark BCBS continues to process medical claims.
    • Express Scripts continues to administer prescription drug benefits.
    • Medical Plan benefits, including deductible, coinsurance, copay, and out-of-pocket maximum amounts, remain the same.
  4. It provides a guided, personalized healthcare experience for members. Highly trained Care Coordinators at Quantum Health are nurses, clinicians, and benefits specialists who bring personalized healthcare solutions to members. Care Coordinators can help with everything from everyday issues to more complex issues, such as
    • verifying covered services and benefits;
    • answering claims and billing questions;
    • replacing ID cards;
    • finding network providers; and
    • handling precertification of medical services when needed.
  5. It’s another way we demonstrate value to employers. A significant step in the Board’s healthcare evolution, care navigation aims to provide employers with peace of mind that employees will be cared for throughout their healthcare journey.

Have questions? Call the Board of Pensions at 800-773-7752 (800-PRESPLAN) Monday through Friday, 8:30 a.m. to 7 p.m. ET. We are always here to serve!

*Members enrolled in Triple-S and GeoBlue should refer to their plan provisions for details about their benefits and continue to contact those plans as before. Similarly, Medicare is the primary coverage for members enrolled in the Medicare Supplement Plan; therefore, Medicare Supplement Plan members will continue to contact Highmark Blue Cross Blue Shield.