Carrum Health Benefit

Participants in the Plan have access to the Carrum Health Benefit, which provides enhanced coverage for certain planned procedures at participating Centers of Excellence. Through the Carrum Health Benefit, participants have access to specialized providers and facilities selected for their expertise in certain high-risk or high-cost procedures.

Participants may use the Carrum Health Benefit for the following procedures:

• Spinal fusion surgery
• Bariatric (weight loss) surgery
• Other orthopedic and spine procedures (e.g., hand, wrist, elbow, shoulder, ankle, foot) • Cardiac (heart) surgery
• Oncology

This section describes the Carrum Health Benefit, including important conditions and restrictions. The Summary of Benefits Coverage table below summarizes coverage of the medical services available through the Carrum Health Benefit. Individuals enrolled in a high-deductible plan must first meet their full deductible and coinsurance. Individuals enrolled in the J1 PPO plan must first meet their full deductible and coinsurance. Per IRS rules, a portion of any covered travel expenses will be reported as taxable income.

Summary of Benefits Coverage

About Carrum Health

Carrum Health provides access to hospitals and surgeons for planned medical care and coordinates the delivery of care with travel, communication and other non-medical aspects of the program. Carrum Health itself does not render any medical care or advice, and does not recommend any particular medical providers or course of treatment.

To learn more about the program or determine eligibility for the Carrum Health Benefit, please contact Carrum Health at 888-855-7806, Monday to Friday 9 a.m. to 8 p.m. ET or visit carrum.me/purdue. The ‘Carrum Health’ app is available to download on both iPhone and Android devices.

How It Works

Plan participants can contact Carrum Health at 888-855-7806, Monday-Friday 9 a.m. to 8 p.m. ET, online at carrum.me/purdue or by downloading the ‘Carrum Health’ app on iPhone and Android devices to search for and compare participating hospitals and physicians.

After contacting Carrum Health, a participant is assigned a Care Specialist to determine if the participant is eligible for the Carrum Health Benefit and provide non-medical coordination throughout the entire episode of care. Care Specialist services can include assistance with hospital and physician selection, medical records collection, appointment scheduling, and travel reservations and logistics management.

Participants must agree to provide their medical records and any other relevant information to their selected hospital and physicians in order to facilitate a consultative evaluation to determine if the procedure is appropriate and medically necessary. Medical records and images are collected on behalf of participants by their assigned Care Specialists. Receiving this evaluation does not commit a participant to proceed with the procedure or to use the Carrum Health Benefit.

Covered Expenses

Medical costs: The Carrum Health Benefit covers all medical costs charged by the Center of Excellence that are related to the covered procedure.

Travel costs: In addition, the following expenses incurred for transportation, lodging, meals, and incidentals are covered for the participant and one adult companion as long as travel arrangements are scheduled and reserved through Carrum Health. The daily allowance will be paid to the participant prior to travel to the Center of Excellence location and is to be used at the discretion of the participant and companion. Health. The daily allowance will be paid to the participant prior to travel to the Center of Excellence location and is to be used at the discretion of the participant and companion.

• Participants traveling for inpatient (overnight stay) surgeries that live within 60 miles of the Center of Excellence where the procedure is to be performed, or for outpatient (same day) surgeries, will receive a stipend to cover gas, parking, and meals.
• Participants that travel over 60 miles for any inpatient surgery or for outpatient total joint replacement/spine surgery will receive the full travel coverage, which includes:
  • The main mode of round trip transportation, e.g. flight or rental car, for the participant and one adult companion between the participant’s home location and the location of the Center of Excellence where the procedure is to be performed,
  • Hotel accommodations near the Center of Excellence, limited to one room with two queen beds, to be shared by the participant and one adult companion, and
  • A daily allowance for the participant and companion intended to cover meals, incidentals, and all other out-of- pocket expenses related to the procedure. The daily allowance for the participant will be provided for days before and after, but not during, the inpatient stay.
  • If an in-person consultation is required by the Center of Excellence physician, a round trip solely for the participant will be arranged and covered.

Coverage Limitations and Disclosures

• A Center of Excellence may decline to treat a participant as it determines in its discretion, including for failure to:
  1. identify a designated adult companion who is willing and able to meet caregiver requirements;
  2. be safe to travel to the Center of Excellence for medical care and not requiring emergency care at the time of travel;
  3. follow preoperative and postoperative instructions;
  4. provide all required medical history, labs, and diagnostic tests;
  5. make lifestyle changes required by the Center of Excellence as a condition of obtaining the covered procedure (e.g., stop smoking or lose weight); or
  6. refrain from committing an act of physical or verbal abuse or other threatening behavior to the staff of the Center of Excellence.
• To receive coverage under the Carrum Health Benefit, services MUST be scheduled and authorized by Carrum Health. If the participant does not use the Carrum Health Benefit, their care will be covered as outlined in the Summary of Benefits Coverage table above under “In-Network” and “Out-of-Network”, as applicable.
• Although a procedure may be provided through the Carrum Health Benefit, it is only covered under the Plan as long as it is deemed to be medically necessary and not otherwise excluded under the terms of the Plan. In order to receive coverage under the Carrum Health Benefit, a Center of Excellence must determine that the covered procedure is medically necessary.
• If the participant changes plans after travel arrangements have been made to receive a covered procedure at a Center of Excellence, the participant will still be responsible for any standard Plan cost-sharing and travel costs applicable to services received prior to the change in plans.
• Emergency or lifesaving medical services that occur as the result of the planned procedures under the Carrum Health Benefit are not covered under the Carrum Health Benefit and are subject to the coverage limits, cost-sharing, and other terms of the Plan.
• Certain examinations, tests, or other medical services may be required before or after the participant visits the chosen Center of Excellence under the Carrum Health Benefit. Any medical services not performed by a participating Center of Excellence facility or physician, including necessary pre-and post-acute care, are not covered under the Carrum Health Benefit and are subject to the coverage limits, cost-sharing, and other terms of the Plan.
• The Carrum Health Benefit applies toward any benefit maximums on the covered procedures under the Plan. Any cost- sharing paid by the participant will count towards the Plan’s annual deductible and out-of-pocket maximum.
• Carrum Health will provide appropriate documentation for any non-medical benefits paid under the program, which may be subject to taxation as income to the participant – in particular, the allowance paid for meals and incidentals.
• Coverage under the Carrum Health Benefit may be denied by Carrum Health if:
  1. The participant does not provide a local provider recommendation or any other documentation required to approve a referral to a Center of Excellence;
  2. Two Centers of Excellence have both declined to treat the participant due to a medical condition that will not change; or
  3. The participant commits an act of physical or verbal abuse or other threatening behavior to the staff of Carrum Health or a Center of Excellence.
• If coverage under the Carrum Health Benefit is denied by Carrum Health, the participant may appeal the denial in accordance with the Claims and Appeals section of this Summary Plan Description.
• If the Plan would pay secondary in accordance with its coordination of benefits provisions, such secondary coverage will be determined in accordance with the Plan’s standard terms and cost-sharing provisions and not under this Carrum Health Benefits.

Carrum Health’s Register to Enter Monthly Giveaway

Carrum Health is giving away prizes (Yeti Coolers, Amazon gift cards and Apple gift cards) each month through December 14, 2023.

The Entry Periods for the Giveaway are as follows:

See the OFFICIAL RULES of the giveaway https://info.carrumhealth.com/prizes/.

Frequently Asked Questions (FAQs)