THE PROGRAM

What is the Edison Healthcare COE Program?

Edison Healthcare is a medical benefits program offered to you by your employer. We manage a network of SmartCare Medical Centers that have achieved outstanding success in treating patients. Through our program, patients travel to one of these carefully chosen medical centers to be treated for their complex healthcare needs free of charge*.

What types of diagnoses does the Edison Program cover?

You can get second opinions, treatment plans, or surgeries through the Edison program for the following:

· Cancer – All Cancers for accurate diagnosis, surgery, and appropriate treatment plan.

· Spine – Discectomy, microdiscectomy, disc replacement, laminectomy, decompression, fusion, scoliosis, etc.

· Heart – Bypass, ablation, stent, valve, pacemaker, angioplasty, chronic angina, etc.

· Orthopedic – Knee, hip, and shoulder replacement repair or replacement; arthroscopy, etc.

· Transplant – Heart, liver, kidney, lung, pancreas, blood & marrow, etc.

· Women’s Health – Endometriosis, pelvic inflammatory disease, hysterectomy, menopause, etc.

· Complex Care – Multiple sclerosis, inflammatory bowel disease, neurological conditions, etc.

· Pediatric Complex Care – Cardiology, gastroenterology, hematology, oncology, pulmonology, neurology, etc.

Other medical conditions and procedures may also be eligible through the Edison Program. If you need assistance or have questions about coverage reach out to Edison today at ehc@edisonhealthcare.com or 866-982-7988.

Why should I utilize Edison Healthcare?

NO COST or REDUCED COST • PROPER DIAGNOSIS • SUPERIOR CARE

Edison is FREE for members, and our SmartCare Network includes some of the best specialty hospitals and medical centers in America (Mayo Clinic, Cleveland Clinic, Beverly Hills Cancer Center, and other award-winning facilities).  The specialists we work with are chosen for their expertise in the complex conditions we cover; thus, they deliver the highest quality patient outcomes. The surgeons we utilize are paid for optimal patient results, not patient volume; thus, unnecessary surgeries are avoided. Our centers use a multi-disciplinary physician approach that delivers a meticulous analysis and superior diagnosis.  What this means for our members: accurate diagnosis, avoiding unnecessary surgeries, appropriate treatment plans, proper medication, lowered risks, superior surgical results (when necessary), and faster return to a healthier and better life.

How does Edison Healthcare work?

The patient (and a companion) will travel to a SmartCare Center based on their specific needs. All medical costs (co-pays, coinsurance, deductibles) and travel expenses (flight, hotel, food, transportation) for the patient and companion will be paid for by Edison*. Our Care Coordinator will walk the patient through all necessary forms, coordinate travel & accommodations, and help ensure the SmartCare Center’s surgical team has received all the required documentation. In addition, a Nurse Navigator from the SmartCare Center will be engaged with the patient throughout their journey.

PARTICIPATION

Who can participate in the program?

Any eligible enrolled plan member (employee, spouse, dependent) of an employer’s health plan (if the employer is contracted with Edison) who is facing one of our covered diagnosis types: Spine, Orthopedic, Heart, Cancer, Bariatric, and Transplant.

Am I required to use Edison for any diagnosis types?

That depends on your employer’s health plan design; some are set up as voluntary, while others require certain diagnosis types to utilize Edison. Please call us to learn more about how your employer is set up with Edison.

How can a member participate in the program?

The eligible member (employee or dependent) calls Edison at 1-866-982-7988, and the Care Coordinators will verify eligibility to determine if the member qualifies.

What does a member provide to Edison to obtain services?

The member needs to complete and return the Edison Patient Authorization Form.

What does a patient provide the SmartCare Center?

Medical Release forms and all forms from the SmartCare Center (each center has unique forms based on the patient's diagnosis).

Why are medical records required?

Medical records are necessary for the SmartCare Center and its medical teams to properly evaluate the patient’s current diagnosis, scans, labs, health history, etc., to develop a proper treatment plan.

Is there an ID card provided?

Yes, the Edison Care Coordinator will send a Patient ID Card in the travel packet.

TRAVEL

Who handles the travel plans?

Edison provides a concierge Travel Team who will schedule and pay for all necessary travel (flight, hotel, transportation), including a prepaid debit card for meals, gas,  and incidentals.

Who qualifies as a travel companion?

The travel companion can be a family member, friend, or caregiver to be chosen by the patient.  The plan covers one travel companion and their travel costs.

Can the patient choose the hotel or airline that is used?

Edison will make all travel arrangements based on the needs of the patient and SmartCare Center. All airline and hotel reservation changes must be made through Edison as well. Patients can add their frequent flyer numbers or hotel loyalty numbers during their travel process so that they get reward points.

AFTER SERVICES ARE COMPLETED

What happens if the patient experiences health issues once discharged?

If there are any medical issues once the patient has returned home, the local physician and/or 911 should be called immediately.  Patients and local providers should communicate with their SmartCare team throughout their post-op period to coordinate any necessary care.

What type of follow-up care is required?

The SmartCare Center will coordinate any transfer of care to local physicians (e.g. if physical therapy or chemotherapy are needed, the Center will facilitate with the patient and/or local providers).  Patients should keep their Care Coordinator updated and reach out if they have any questions or concerns along the way.

COVERAGE

What medical services are paid for under the Edison Healthcare program?

All medical services associated with a second opinion, treatment, or surgery are covered - including coinsurance, co-pays, and deductibles*. In addition, medically necessary services will be covered during the SmartCare Center stay, including physical therapy, treatment, consults, or additional procedures.  Services back in the local market are covered under the member’s regular health plan with the employer.  When allowed by law and subject to plan provisions, deductibles associated with the use of this program will be waived or reduced contingent on the medical plan that you are enrolled in, as described below. 

• Non-HSA PPO & HMO Plans: All deductibles, co-pays, and coinsurance are waived. 

• HSA Plans: Federal guidelines require a minimum deductible to be met before employers can cover costs. Edison and the employer will work diligently to limit any financial responsibility for members who are on HSA plans and still have responsibility.

What services/benefits are not covered under this program?

Elective outpatient services not related to the covered program services; convenience items (i.e. telephone, movies, hotel room mini-bar, laundry services, etc.); costs associated with unapproved flight changes.

Can a patient choose which SmartCare Center to utilize?

The SmartCare Medical Center will be selected by Edison Healthcare based on the patient’s medical need(s) and the SmartCare Medical Center’s area of expertise.

What kinds of travel expenses are covered?

• Airfare or travel allowance for the patient and a companion

• Rental cars and/or fuel charges

• Lodging for the member and companion

• A daily food allowance for the member and companion (via prepaid debit card)

• Transportation between the airport, hotel, and the SmartCare Center