In compliance with the Affordable Care Act, preventive care is covered at 100% with no member cost share.  There are no pre-existing limitations, and the plan includes unlimited coverage for covered services.

The health plan includes benefits and resource to help you manage your diabetes at a competitive cost.

• Diabetic equipment and supplies are covered on the pharmacy portion of your health plan, rather than the medical portion. Your equipment will be obtained from a local in-network pharmacy or ProAct, one of the mail-order pharmacies. 
  • To fill through ProAct

    • Members need to call ProAct Pharmacy and set up their account (see mail order tip sheet on the resources page of the benefits website).

    • Have your physician submit a new 90-day script for any needed supplies.

    • Once the script is reviewed, approved, and processed, the equipment will be mailed directly to your home.

    • NOTE: Members will need to wait until after 1/1/23 to contact ProAct. If you call now, you will not show as eligible in the system.

•  If the specific supplies are included on the formulary, the applicable tier copay applies.   
• Members may receive a free blood glucose meter and unlimited strips and lancets through the Livongo program.  Access the program through the HealthJoy app and refer to the Chronic Condition Management programs described below.
• For members who do not participate in Livongo, test strips and lancets, if covered on the formulary, are typically covered at the Tier 2 $60 copay. 
• Continuous Glucose Monitors (CGMs) and Insulin Pumps are subject to the Tier 2 copay of $60 for all medical plan members. This copay applies for this equipment for members who do and do not participate in the Livongo diabetes management program.   Note:  The Freestyle Libre is the formulary CGM, available at the $60 copay.   

Address Back and Joint Pain with Free Virtual Exercise Therapy

HealthJoy’s Virtual Exercise Therapy is an effective program for individuals struggling with back, neck, shoulder, knee, hip, hand, wrist, elbow, ankle, and/or foot pain. With guidance and support from a personal coach, you can significantly reduce pain and improve functional abilities in just 15 minutes per day. The MSK program is integrated with HealthJoy for non-complex aches and pains. This program is a supplement to the medical plan and available at no cost to members. 

• 100% virtual program for common minor injuries.
• Most commonly used for back, hip, knee injuries and minor pain.
• Daily 15-minute exercises to help manage non-complex musculoskeletal issues plus weekly virtual meetings with a physical therapist.
• No equipment needed.
• A convenient approach to traditional physical therapy.
• Program consists of a 15 minute questionnaire and a virtual interview with a physical therapist.
• Accessible through HealthJoy.

Note: This is not designed to replace Edison (the required Centers of Excellence program for complex illnesses).  This is designed to help with non-complex aches and pains.

MSK Virtual Therapy Brochure

MSK Virtual Therapy Flyer

Distance and cost should never get in the way of you receiving the best possible medical care. Our employees who are enrolled in medical will have full access to Edison’s Smart Care Network.  All possible barriers have been removed for the best care and all travel expenses will be covered for you and a companion. All employees, spouses, and dependent children who are enrolled in the medical plan are eligible.  This is ZERO COST HEALTHCARE at AMERICA’S BEST MEDICAL CENTERS for the certain conditions.

Edison specializes in delivering excellent and appropriate care to individuals facing spine, joint & orthopedic, heart/valve, and cancer surgeries for adult and pediatric patients.

A mandatory program for cancer, orthopedic, spine, and non-acute cardiac procedures.  To receive coverage for one of these procedures, members are required to access the Edison Smart Care Centers network.  The medical plan also includes access to Edison’s Smart Care Centers for additional conditions on a voluntary basis.

Second Opinions

A thorough medical review is provided before traveling to an Edison’s Smart Care Center.

Travel with Ease

Edison will coordinate all of your travel, cover all costs, and provide you a prepaid card for your food and incidentals. Traveling for care has never been this easy!

Why are Edison’s medical centers considered the best of the best?

Medical centers that are recognized as the top in the world based on risk-adjusted quality outcomes.

Multi-disciplinary teams who deliver a fully vetted diagnosis, the best possible treatment, and extraordinary surgical outcomes.

Team-based diagnosis / treatment plan for all and doctors who are paid a salary rather than procedure based compensation.

Get to know Edison
We encourage you to reach out and learn how Edison can help you and your family today. We understand how frightening a new diagnosis can be, which is why we have partnered with Edison to give you the best resources and care possible!

Phone: (866) 982-7988
Email: ehc@edisonhealthcare.com

Patient Process: https://edisonhealthcare.com/patientprocessvideo

• Employees covering new spouses on the health plan for 2023 will be required to provide proof of current marriage (marriage certificate and joint marital document, i.e. mortgage / bank statement, utility bill, etc.).
• Spouses with other employer-sponsored health coverage are not eligible for the Jim Ellis health plan.  An affidavit acknowledging no other employer-sponsored health coverage will be required.
• If you are covering a spouse for health coverage, you will receive an email from the Benefits Service Center following Open Enrollment explaining the documentation needed.

For employment separations, the medical plan coverage end date is the date of separation.  In certain cases, medical plan premiums may be paid by employees through the end of the pay period, but the medical plan coverage end date could be prior to the end of the pay period. 

The Machine Readable Files (MRF's) for the Jim Ellis Nova Health Plan can be found at the below link:

https://jimellis.mrfcentral.com

This link is not expected to change. Applicable in-network and allowed amount files will be updated monthly, as required by the regulation, and any future changes needed to the Table of Contents file will be made as well. 

Make the Most of Your Health Care Dollars:

• Nova’s online Price Comparison Tool, hosted by Green Light, makes it possible to obtain a cost estimate before a service or procedure takes place. You can also compare costs and quality ratings across different providers to help you make the best decisions for your health and budget.

 Get To Know The Price Comparison Tool

• When you search for a medical service or procedure, you’ll see a list of providers who provide that service. You can choose a geographical area to search or look for a specific provider by name. Cost estimates will show how much you can expect to pay (based on your benefit plan, network, deductibles, and copays, if applicable).

How To Register

• Log in to the Consumer Information Center and choose Price Comparison Tool from the Member Resources menu.
• Click on Use the Price Comparison Tool.
• Click Register to create an account. You will need the member ID number from your ID card.
• Once registered, your Price Comparison Tool homepage will include plan-specific information (network, deductibles, and copays, if applicable). Using this information, you can search for care based on a medical service or procedure, geographical area, or provider name and receive a cost estimate of what you can expect to pay.

Questions? Nova can help! Whether you have questions or you would like to get a price estimate by phone, just call the Customer Service phone number found on your ID card.