MMC Benefits Handbook
How the Program Works
Health Advocate serves as a liaison for you with health care (medical, vision and dental) providers, insurance plans and other health-related community resources. This program covers a broad menu of services and can address nearly any clinical and insurance-related question and issue.
Health Advocate's program is NOT health insurance and is not a replacement for health care coverage. Rather, the service is designed to help you navigate the health care and insurance systems. Health Advocate does this by providing you with access to a Personal Health Advocate. Health Advocate's goal is to improve your health care experience by helping to eliminate hassles and frustrations.
When you call Health Advocate, you will speak with a Personal Health Advocate (PHA), typically a registered nurse supported by medical directors and benefits and claims specialists. The PHA will personally help you with your issue, problem or other need for assistance. After obtaining the necessary background information, the PHA will work to resolve the issue and establish a time frame and method for responding to you.
Who are the Personal Health Advocates?
The Personal Health Advocate team consists of registered nurses, medical directors, and benefits and claims specialists that have years of experience working in health care-related jobs. These professionals are carefully screened to ensure that they have both the necessary professional credentials and excellent personal communications skills to handle the problems members present to them.
Will I be able to speak with the same Personal Health Advocate each time I call with an issue?
When you call Health Advocate for the first time, you will speak with a Personal Health Advocate (PHA) who will listen to your issue and either help you or put you in touch with a nurse, benefits, claim or other professional who is specifically trained in that area. The PHA will stay with you for the duration of your issue. If you call about a new concern, you may work with the same PHA or you may be matched with a different PHA for your new issue. You may also speak with a different PHA if you call outside of their regular business hours of 8:00 a.m. – 10:00 p.m. Eastern time or on weekends. In these circumstances, you may receive a return call from another PHA who is on-duty to handle after-hours calls.
When calling Health Advocate, what information will my family member or I need to provide?
You or your eligible family member will need to provide the company name and your name. You or your eligible family member should also have available any information regarding the issue, including contact information for your doctor and/or health plan provider. In addition, an authorization or release may be required. Health Advocate will help facilitate any necessary authorizations.
Can I access Health Advocate in other ways besides via phone?
Yes. You can go online (www.healthadvocate.com/members) or download the mobile app (available on the App Store or Google Play). The member website and mobile app will allow you to see, learn and interact in real time with Health Advocate, no matter where you are. You will be able to:
- Conveniently and instantly upload documents and forms and view the status of your case
- Save money and make smarter choices by viewing tips on important consumer topics like ways to save money on your healthcare expenses or how to make the most of your medical visits
- Become more informed: Access trusted information on virtually any health topic like weight loss, pregnancy, first aid, chronic conditions and much more
Can I call Health Advocate to answer treatment questions?
No. Health Advocate does not provide medical care, advice or treatment, but rather can help you understand your condition and treatment that your physician recommends, as well as help arrange second opinions, or help you prepare for your doctor's visits. Health Advocate does not function as a nurseline.
Will Health Advocate be talking to anyone at my health plan provider?
If you request and authorize information to be shared, Health Advocate will release your consent to the appropriate individuals (e.g. health plan provider case manager) involved with your care.
Do I have to follow the recommendation of Health Advocate?
No. You remain in full control of your health care decisions. The information you and your treating physician receive from Health Advocate is intended to help you make informed decisions regarding your treatment.
If I have an authorized unpaid leave of absence, can I still participate in the program?
If Marsh McLennan grants you an authorized unpaid leave of absence, coverage for you and your family members continues for the duration of your authorized period of leave.
If I become disabled, does the Plan still provide a benefit?
During a period of approved disability, you and your covered family members remain eligible for coverage.
If I die
If you die while you are an active employee, your eligible family members may be eligible for coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). For information on COBRA, see "Continuing Coverage" in the Participating in Healthcare Benefits section.
If I no longer satisfy the Plan's eligibility requirements
Your coverage ends on the date you no longer satisfy the Plan's eligibility requirements. Coverage for eligible family members ends when yours does.
When coverage ends, COBRA coverage may be available, as described under "Continuing Coverage" in the Participating in Healthcare Benefits section.
If my family member loses eligibility status
If your family member no longer meets the eligibility requirements, his or her coverage ends.
Family members who lose coverage may be eligible for coverage under COBRA provisions described under "Continuing Coverage" in the Participating in Healthcare Benefits section.