Transcript Kevin Lewis, Maine Community Health Options

“To be a leader in transforming the health of Maine
people and positively affecting the Maine economy”
Local, Nonprofit, Maine-Based,
Statewide
Located in the Bates Mill in Lewiston, MCHO is
committed to offering local services with a local
presence, and at the highest quality.
 Member Services Center
 Provider Relations
 Care Management
 Behavioral Health Integration
 Members have a voice: Member-led Board
 Nonprofit and Transparent
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Extensive Network and Preferred
Provider Organization (PPO) Plan
 Maine Community Health Options offers an
extensive network of Medical and Behavioral Health
Providers.
 All Maine Hospitals
 Border Facilities and Providers
 National network of in-network providers
 Providers include doctors, nurse practitioners,
specialists, mental health and substance abuse
providers, pharmacies, clinics, hospitals, and others.
 No referral needed for a specialist.
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Small Group Plans on & off SHOP
MCHO Individual Plan Summary
Plan Name
Community Community
Advantage Preferred
Community
Choice
Community Community Community Community
Value
Option
Option HSA Safe Harbor
Plan
Description
Comprehensive
Coverage with
Lowest Out-ofPocket Costs
Comprehensive
Coverage with
Low Office Visit
Co-pay
Comprehensive
Coverage with
Low Coinsurance
Percentage
Comprehensive
Coverage with
Low Out-ofPocket Costs
Low Monthly
Low Monthly
Premium;
Premium; HSA
Chronic Illness
compatible
Support Program
Low Monthly
Premium with
a Higher
Deductible;
No Coinsurance
Metal Level
Gold
Silver
Silver
Silver
Bronze
Catastrophic
In-Network $650 Individual
Deductible $1300 Family
$2000 Individual
$4000 Family
$2000 Individual
$4000 Family
$2350 Individual $5000 Individual $5000 Individual $6350 Individual
$4700 Family
$10000 Family $10000 Family $12700 Family
In-Network
20%
Coinsurance
30%
30%
50%
50%
50%
In-Network
Primary Care $25
Visit
$20
$30
$20
$45
10% Coinsurance
after deductible
0% Coinsurance
after deductible
In-Network
Specialist
$75
Visit
$75
$80
$50
$140
50% Coinsurance
after deductible
0% Coinsurance
after deductible
In-Network
Out of
Pocket
Maximum
$5500 Individual
$11000 Family
$6350 Individual
$12700 Family
$6350 Individual
$12700 Family
$6350 Individual
$12700 Family
$2500 Individual
$5000 Family
Bronze
$6350 Individual
$12700 Family
0%
$6350 Individual
$12700 Family
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MCHO Approach – Benefit Design
Attributes
 Integrated Behavioral and Medical Health
 Member Engagement
 PT/ST/OT at primary care level cost sharing
 Value Based Insurance Design
 Chronic Illness Support Program
 Tobacco Cessation
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Your Wellness Counts
24/7 Access to
Health Coaches

Registered Nurses,
Dieticians, Respiratory
Therapists

May call you to talk about
your condition

Provide information

Help you make important
medical decisions
Make
informed
decisions
Healthy Options Online
with
Health and Wellness Portal
guidance
from skilled
coaches and
 Get facts on over 6,000 health
get useful
topics
information  Use decision support tools and
videos
from our
online portal.  Complete your wellbeing
assessment

Join challenges to earn points
and get rewards. Create
personal goals and track
progress
Tobacco Cessation Treatment
Maine Community Health Options will cover:
 Plan Provider prescribed nicotine replacement products or
any products approved by the FDA to quit tobacco use
 Medications covered at no Out-Of-Pocket cost when
prescribed by a Plan Provider
 Generic Nicotine Replacement Therapy (NRT): Gum,
Patch, Lozenge
 Chantix (up to a 90 day supply)
 Tobacco cessation education and counseling
NOTE: MCHO does not use the new “tobacco rating band” or
charge higher premiums for smokers
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Chronic Illness Support Program
MCHO offers additional help to members with
certain chronic medical conditions that can be
managed for better health:
 High blood pressure/Hypertension
 Diabetes
 Asthma
 COPD (Chronic Obstructive Pulmonary
Disease)/Emphysema.
This program can save members money through
lower Out-of-Pocket costs when they get medically
necessary services from a Plan Provider.
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Supporting You to Manage Your Chronic Condition
Lower out-of-pocket costs for meds and services
Diabetes
Asthma & COPD
Medications

$0 costing sharing for
Specific medications used
to treat diabetes-Generics,
50% cost-sharing for
preferred brand
Services -
$0 cost sharing
when done by Plan Provider

Offices Visits to PCP for
routine management

Endocrinology consultation

Podiatry Consultation

Nutritional Counseling,
diabetes education,
modification counseling

Diabetic Eye Exam (1/yr.)

1 Glucometer/yr., up to 100
test strips every 90 days

Lab services linked to
diabetes primary
diagnosis code.
Medications

$0 costing sharing for Specific
medications used to treat asthma
& COPD-Generics, 50% costsharing for preferred brand
Services - $0 cost sharing
when done by Plan Provider

Offices Visits to PCP for routine
management asthma, COPD,
emphysema

Pulmonologist consultation;
Pulmonary function test (1/yr.),
Home oxygen therapy assessment

Lab services linked to
asthma/COPD primary diagnosis
code

Inhaler adjuncts; Peak flow meter
(1/yr.); Asthma education

Pulmonary rehab., ongoing
exercise program for COPD

Home assessment (asthma
only) up to $75/yr.
Hypertension
Medications

$0 costing sharing for
Specific medications used to
treat hypertension and
hyperlipidemia-Generics,
50% cost-sharing for
preferred brand
Services -
$0 cost sharing
when done by Plan Provider

Offices Visits to PCP for
routine management

Cardiology or nephrology
consultation and
management of hypertension

Lab services linked to
hypertension primary
diagnosis code.
Impact of CISP as Seen Through SBC
(Silver Plan example)
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Maine Community Health Options
MCHO Website
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Business Development
MCHO Website
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Business Development
Group Plans – easy to access
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Business Development
1 Step Employer/Employee Contributions
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Business Development
Choices at your finger tips
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Business Development
All the information you need to make a decision
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Business Development
Ongoing administration made easy
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Business Development
Automated process keeps you in the know
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Business Development
Maine Community Health Options
Mission
“To partner with Maine people,
businesses and health professionals
to provide affordable, high quality
benefits that promote health and
well-being”
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Thank you for your time and interest in
Maine Community Health Options.
Toll Free: 1-855-624-6463
www.maineoptions.org
Business Development
207-402-3353
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