Transcript 2014_15 Aetna Presentation
TRS-ActiveCare Member Website
Welcome to Aetna
Just a little about what we will do for you . . .
Not your average service!
Concierge Customer Service
Enhanced Clinical Services
Dedicated Care Advocate Team Disease Management Program Beginning Right Maternity Management Program 24-Hour Nurse Information Line
We are here for you!
Learn about our providers
Transition of Care needs
What to expect How to reach us
It’s all about the extras!
Aetna Navigator member portal
Aetna mobile app My iTriage Personal health record Simple Steps to a Healthier Life Discount programs
TRS-ActiveCare Customer Service
Aetna Health Concierge
Aetna Concierge is a high-touch member service model delivering a simple, more personalized and seamless experience for members. Every Concierge not only takes member calls — they take member calls personally.
Dedicated member service team trained on TRS-ActiveCare culture and goals First Impression Treatment offers first time callers an opportunity to review plan benefits, programs, resources and even a guided tour of our online system Warm transfers to Aetna programs Clinical and other health-action alerts Appointment scheduling
Whether you need a quick answer, help to untangle a difficult issue, or someone to explain your benefits - you have an advocate dedicated to your needs.
Enhanced Clinical Programs
Care Advocate Team
A dedicated care advocate team supports everything from clinical precertification and concurrent review - to acute care management. Through our predictive modeling tools, expanded triggers, and monitoring of inpatient admissions on a daily basis, we find the individuals who need our help and support them through a single-nurse approach. We help employees and their families take advantage of the benefits available to them. This team also includes a social worker to ensure we can help members with all of their needs.
The Aetna Health Connections program identifies and continually monitors members who have chronic conditions. This team supports members while they reach their optimal health goals by using evidence based clinical tools and delivering individualized actions. This is strictly a voluntary program and is available both online and telephonically.
Beginning Right Maternity Management Program
The Beginning Right Maternity program is voluntary and designed to assist eligible female members achieve a healthy term delivery. The program provides education and outreach focused on identified risk factors including but not limited to: diabetes, hypertension, hyperemesis, smoking, a history of preterm labor or delivery, and the timing of elective deliveries.
24-Hour Nurse Information Line
A 24/7 toll-free number that provides members with immediate access to a registered nurse for health information. Member’s can also e-mail a nurse through a secure e-mail using Aetna Navigator.
Teladoc is an affordable alternative to emergency room and urgent care. Many common medical issues can be resolved through the convenience of just a phone call – 24/7/365
• • • • • • •
Copays waived for ActiveCare 2 and ActiveCare Select plans; only $40 for ActiveCare 1-HD plan.
Board certified providers specializing in family practice, internal medicine, emergency medicine and pediatrics. Common diagnosis and treatment of sinusitis, upper respiratory infection, urinary tract infection, bronchitis, otitis media, influenza and the common cold. Consults available wherever the patient is - at home, at work, or travelling within the United States. Guaranteed member call back within 60 minutes! The average call back time is 20-30 minutes.
Diagnosis, recommended treatment and prescriptions ordered when appropriate. A copy of the consult record will be sent to the member's PCP upon request.
Added Savings and Value with Quest Diagnostics
Take advantage of extra savings when you need a lab test. Quest Diagnostics has agreed to lower rates for Aetna members. That helps save on out of pocket costs. • TRS-ActiveCare 2 and TRS-Active Select Plans will have Quest lab services paid at 100%.
• TRS-ActiveCare HD-1 members will save on out of pocket costs for services from Quest lab by having reduced rates.
• Request use of Quest Diagnostics to get these great savings!
New Plan Option - TRS-ActiveCare Select
ActiveCare Select is an affordable health plan option made available for the 2014 2015 plan year. With ActiveCare Select, you are free to see any network provider without a referral. However, there is no coverage if you see a provider who is not in the plan network. The only exception is for a true medical emergency. There are two networks that make up the ActiveCare Select plan. Benefits are the same regardless of where the employee lives.
Aetna Whole Health is an Accountable Care Organization (ACO) network. With Aetna Whole Health, available to you is a health care team of doctors, nurses, therapists and other providers whose goal is to work together with you to meet your unique needs and keep you healthy.
If you live in or around San Antonio, Dallas, Austin, or Houston (counties listed below) and elect ActiveCare Select as your 2014-2015 plan option, you will be required to use providers who belong to the
Aetna Whole Health network
. If you do not live in one of the counties listed, you will be required to use providers listed 7 in the
Aetna Select (Open Access) network .
The go-to resource for managing health
Members access a secure, personalized website to: Find a doctor or facility View claims and Explanation of Benefits (EOBs) Compare costs for office visits, tests and procedures Complete a health risk assessment and participate in online wellness programs Store and share personal health history and access a Personal Health Record Track health goals Find forms and order ID cards Access information on discounts: Fitness memberships and equipment Vision services and products Natural products and services Hearing exams, hearing aids and batteries Weight-management programs 9
Helpful On-line Tools and Resources
stores health information including insurance, medications and dosages, conditions and more, securely and conveniently online. Assists with treatment options and decision support.
Personal Health Record (PHR)
a secure, online tool that connects people to their health information, helping them take a more active role in managing their health. It offers an easy, convenient, and organized way to store health history and information. When members share PHR information with their health care providers, it can help decision making with better access to patient data.
this smartphone app can check symptoms, find a doctor, get a cost estimate or make an appointment.
Simple Steps to A Healthier Life
an online health risk assessment and online coaching tool that provides new and simple ways to manage health and set goals. The online coaching sessions help members meet health goals, at their own pace, with their specific health and wellness needs in mind.
Transition of Care
For employees in an active course of treatment with a non-par provider
Examples of an active course of treatment include, but are not limited to:
3 rd trimester pregnancy Ongoing treatment plan such as chemotherapy or radiation therapy Terminal illness Conditions requiring multiple surgeries Recent surgery Outpatient treatment for mental illness or substance abuse Ongoing or disabling condition that worsens Organ or bone marrow transplant
Members should contact the TRS Customer Service team to obtain a form Impacted members should submit their request to continue treatment with a non par provider 90 days before your effective date of coverage
FirstCare Health Plans
Why Choose FirstCare?
Local offices; Texas-based customer service
Comprehensive network of quality physicians
No referral to network specialists
Coverage for dependents living outside service area
Worldwide emergency care
New wellness program & improved provider search
In TRS-ActiveCare since 2003
Now serving 10 new counties
ID Card Timing
• • •
All covered employees will receive cards beginning in mid-August Annual Enrollment changes received by Aetna by August 15 will result in cards reflecting coverage updates being issued by end of August Those making changes later will receive replacement cards as processed
Important Information For Mail Service Pharmacy Users Caremark is your new mail service prescription provider.
Starting 9/1/2014, Caremark will become your new prescription drug provider. Feel free to register at www.caremark.com
or call TRS-ActiveCare Customer Service toll-free at for more information after 9/1/2014.
Existing refills with Express Scripts
Caremark will not have access to your mail service refill information until 9/1/2104. To avoid any delay in processing during this transition, we recommend you choose one of the following: •Ask your doctor or other prescriber to write a new prescription for up to a 90-day supply, plus refills when appropriate. Mail this prescription to Caremark using the enclosed mail service order form.
•Send your refill request after 9/1/2014.
Ordering a new prescription through mail service
Ask your doctor or other prescriber to write two prescriptions: one for immediate short-term use to be filled at a local network pharmacy, and one for a 90-day supply plus refills to be filled through Caremark Mail Service Pharmacy. You can send in a mail order form www.caremark.com, use the FastStart tool at ww.caremark.com, or call FastStart at 1-800-875 0867.
How to order refills from Caremark in the future:
Once you have received your first prescription from Caremark Mail Service Pharmacy, you can choose one of the following ways to request a refill: •Online: Log on to www.caremark.com
and register if you haven’t already done so. Then click on “Refill a Prescription”.
•Mail: Simply complete the enclosed mail service order form or find one online at www.caremark.com.
•Phone: Call TRS-ActiveCare Customer Service and speak to a Customer Care representative toll-free at 1-800-222-9205.