Help for Serious Conditions
Nurse Outreach When You Are Hospitalized
If you or a covered dependent is hospitalized, a registered nurse from your medical plan administrator will call you to provide information regarding treatment or next steps and help connect you with other Pfizer resources so you can be confident you’re getting the right care and have the support you need.
Cancer Support
The Cancer Support Program, available through your medical plan administrator, provides a dedicated oncology nurse for ongoing support throughout your diagnosis and treatment, including helping you manage side effects, guiding you to quality providers and appropriate, cost-effective care, and connecting you with other Pfizer-sponsored resources that can help. All nurses are supported by board-certified oncologists, hematologists, or medical directors.
You can also join Pfizer’s Butterfly Community SharePoint or the Butterfly Community on Viva Engage, which seeks to provide care, comfort, and community to support colleagues through a life-changing cancer diagnosis, whether it is their personal journey or that of a loved one. Access one-on-one peer support services for all cancer types and connect with a community of cancer fighters, survivors, previvors and caregivers through Pfizer’s partner, Imerman Angels.
Medical Plan Administrators
HORIZON
For medical and mental health/substance use services:
1-888-340-5001
UHC
For medical services:
1-800-638-8010
OPTUM
For mental health/substance use services:
1-866-834-7603
Kidney Services
Kidney Resource Services, available through your medical plan administrator, offers the tools you need to manage the effects of advanced chronic kidney disease. A registered nurse will offer individualized care management, help you manage multiple health conditions, and provide information and assistance with transplant coordination or dialysis, if needed.
Neonatal Services
If your newborn requires care in the neonatal intensive care unit (NICU) after delivery, you can get the education and support you need during this emotional time. The Neonatal Resource Services program, available through your medical plan administrator, offers personalized support from a registered neonatal nurse from birth through your baby’s first year. These nurses will provide information to help you make the best decisions for your baby, prepare you to bring your baby home, and connect you with local resources and services.
Congenital Heart Disease Services
Through this resource, you have access to a registered nurse who can help you make informed decisions about your child’s heart condition – from birth to adulthood — including treatment options and access to nationally recognized treatment centers. Contact your medical plan administrator for information.
Bariatric Services through Optum (for Horizon and UHC members)
These services provide support before and after weight-loss surgery. Get direct access to online weight-loss services, health coaches, exercise and nutritional experts, and referrals to highly-rated doctors and facilities for bariatric services. For bariatric surgery to be covered under the Pfizer Medical Plan, you must participate in this program before your surgery is scheduled; contact Optum for details.
Transplant Services
This program is available through your medical plan administrator and offers access to leading transplant programs where you’ll receive treatment from health care providers with extensive, specialized expertise. With this program, you will have a dedicated nurse case manager who can help you understand your benefits, coordinate with your doctors and the transplant facility, and even keep your family up-to-date on your care.
Specialty Pharmacy Care Management through Accordant (for Horizon and UHC members)
For certain conditions requiring a specialty medication including Rheumatoid Arthritis, Multiple Sclerosis, or Ulcerative Colitis — work with a nurse who can provide personalized support such as guidance on coping with medication side effects, and resources to help you manage your condition.
Visit the Prescription Drug page for details about specialty medication coverage.
Medical Plan Administrators
Horizon:
1-888-340-5001
(For medical and mental/substance use services)
UHC:
1-800-638-8010
(For medical services)
Optum:
1-866-834-7603
(Follow the prompts for the applicable support program.)
Specialty Pharmacy Care Management
1-844-342-4033
(available 24/7)
accordant.com
Specialty Pharmacy Care Management Conditions
The CVS Specialty Pharmacy can help you manage certain conditions, including:
- Amyotrophic Lateral Sclerosis
- Chronic Inflammatory Demyelinating Polyradiculoneuropathy
- Chrohn’s Disease
- Cystic Fibrosis
- Dermatomyositis
- Epilepsy (seizures)
- Gaucher Disease
- Hemophilia
- Heredity Angioedema
- Multiple Sclerosis
- Myasthenia Gravis
- Parkinson’s Disease
- Polymyositis
- Rheumatoid Arthritis
- Scleroderma
- Sickle Cell Disease
- Systematic Lupus Erythematosus
- Ulcerative Colitis
Deductible
Amount you pay for non-preventive covered services before your plan begins to pay.
Out-of-Pocket Maximum
The most you will pay out-of-pocket for eligible expenses in any given calendar year for covered services, including all deductibles, copays, and coinsurance. After you reach the out-of-pocket maximum, all remaining covered services will be paid by the plan at 100 percent for the remainder of the plan year. Note that different out-of-pocket maximums may apply for in-network and out-of-network care. Additionally, the out-of-pocket maximum for medical expenses is separate from the out-of-pocket maximum for prescription medications dispensed through a pharmacy, except under the HSA Copay, where the out-of-pocket maximum for medical and prescription medication expenses is combined.
Allowed Amount
The Allowed Amount for out-of-network services is determined by your medical claims administrator. It’s generally defined as 250 percent of the Medicare reimbursement rate. For certain other supplies and services, including those for which Medicare doesn’t provide a reimbursement rate, the Allowed Amount will be determined based on the method utilized by your medical claims administrator. Contact your medical claims administrator for details before receiving out-of-network services.
(monthly)
(monthly)
(monthly)
(monthly)
(As of Sept. 1, 2021 or hire date if later)
Includes One-Time HealthEquity $50 Contribution
(individual/family)