Transcript Employee Health Benefits 2012 Open-Enrollment Today’s Agenda • Welcome & Introduction • HealthAmerica Overview • Network Accessibility • Medical Benefits Overview • Pharmacy Benefits/Administration • • • • Additional Member Benefits Enrollment.

Employee Health Benefits
2012 Open-Enrollment
Today’s Agenda
• Welcome & Introduction
• HealthAmerica Overview
• Network Accessibility
• Medical Benefits Overview
• Pharmacy Benefits/Administration
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Additional Member Benefits
Enrollment Process
Customer Service/Claims Administration
Questions?
HealthAmerica
Overview
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HealthAmerica at a Glance
• Subsidiary of Coventry Health Care, Inc.
• Deeply rooted in Pennsylvania since 1975
• Regional offices in Pittsburgh, Erie, Harrisburg &
Plymouth Meeting
• Approximately 465,000 members
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Only carrier in PA with a statewide, seamless PPO network
Access to national PPO network
Strong financials
Commitment to quality
– NCQA – Excellent Accreditation
– HEDIS – Leader in PA
– US News & World Report Rankings
Hallmarks
• One of the top health plans in the nation. Current commercial
health plan ranking: 14 — the top six percent*
• Our Medicare plan is ranked 28 out of 183 Medicare plans
evaluated nationwide**
• Excellent NCQA Accreditation for HMO, POS, and Medicare
HMO
• HEDIS scores outperform statewide competitors and national
averages in most categories
*NCQA’s Health Insurance Plan Rankings 2010-11 - Private
**NCQA’s Health Insurance Plan Rankings 2010-11 - Medicare
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Major Accounts - Statewide
• Dickinson College
• Carnegie Mellon University
• Delta Dental of PA
• Lancaster Schools Consortium
• Verizon Wireless
• Lycoming College
• Hanover Foods Corporation
• Ward Trucking
• General Electric
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Network
Accessibility
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Best in Class Network Solution
• Pennsylvania provider network
– Statewide network is directly contracted & proprietary
– More than 250 hospitals and 49,000 providers*
• National network
– More than 5,600 hospitals and
550,000 providers
*January 2011
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Strong Local and Regional Network
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PPO Nationwide Coverage
(Coventry National Network)
Coventry Health Plans
Coventry National Network
Over 5,600 Hospitals and 550,000 Professional Providers
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Transplant Centers of Excellence
Coventry Transplant Network (Adult)
(Adult)
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Allegheny General Hospital (Pittsburgh, PA)
Cleveland Clinic (Cleveland, OH)
Johns Hopkins Hospital (Baltimore, MD)
Loyola University Medical Center (Maywood, IL)
Medical College of Virginia Hospitals (Richmond, VA)
Milton S. Hershey Medical Center (Hershey, PA)
Northside
(Atlanta,
GA)
1. Hospital
Cleveland Clinic
(Cleveland,
OH)
9.
2.
Johns
Hopkins
Hospital
(Baltimore,
MD) MO)
10.
St. Louis University Hospital (St. Louis,
3. Loyola University Medical Center (Maywood, IL)
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Stanford4. University
Hospital (Stanford, CA)
Medical College of Virginia Hospitals (Richmond, Va)
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CHC
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5. Milton S. Hershey Medical Center (Hershey, PA)
6. Northside Hospital (Atlanta, Georgia)
Plan7.Location
Ohio State University (Columbus, OH)
8. St. Louis University Hospital (St. Louis, MO)
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St. Louis University Hospital (St. Louis, MO)
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14.
15.
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10. Tulane University Medical Center (New Orleans, LA)
11. Tenet Health System-Memorial Medical Center & Lindy
Boggs Medical Center (New Orleans, LA)
12. University of Alabama Health System (Birmingham, AL)
13. University of Iowa Medical Center (Iowa City, IA)
14. University of Kansas Medical Center (Westwood, KS)
15. University of Pennsylvania (Philadelphia, PA)
Stanford University Hospital (Stanford, CA)
Tulane16.
University
Medical Center
(New Orleans,
LA) Sciences (Charlottesville, VA)
University
of Virginia
Health
University of Alabama (Birmingham, AL)
University of California, Los Angeles (Los Angeles, CA)
University of Chicago (Chicago, IL)
University of Iowa Medical Center (Iowa City, IA)
University of Kansas Medical Center (Westwood, Kansas)
University of Virginia Health Sciences (Charlottesville, VA)
Transplant Centers of Excellence
Coventry Transplant Network (Pediatric)
(Pediatric)
1. Children’s Hospital Medical Center (Cincinnati, OH)
2. Children’s Hospital (Pittsburgh, PA)
3. Cleveland Clinic Foundation (Cleveland, OH)
4. Johns Hopkins Hospital (Baltimore, MD)
5. Lucile Salter Packard Children’s Hospital (Stanford, CA)
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1.
2.
Children’s Hospital Medical Center (Cincinnati, OH)
Children’s Hospital (Pittsburgh, PA)
6. Medical College of Virginia Hospitals (Richmond, VA)
7. Milton S. Hershey Medical Center (Hershey, PA)
8. Tulane University Medical Center (New Orleans, LA)
9. University of Alabama Health System (Birmingham, AL)
10. University of Virginia Health Sciences (Charlottesville, VA)
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Medical College of Virginia Hospitals (Richmond, VA)
Milton S. Hershey Medical Center (Hershey, PA)
Medical Benefits
Overview
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Benefit Plan Additions/Changes - 2012
• Increased mh/sa benefits.
• Enhanced benefits for autism spectrum disorders.
• Out-of-pocket maximum excludes deductible
• Benefits limits/maximums reset on 6/1; continued on
a calendar year basis on 1/1/13.
• $25 inpatient copay included on mh/sa & SNF
• Addition of a $3.00 Tier 1A Rx copay
• Increased outpatient rehabilitation therapy visits
• Continuation of deductible carry over benefit
• Open access mh/sa benefits – no out-of-network
PPO Benefits Overview
PARTICIPATING
Choice 1
Benefit Category
NON-PARTICIPATING Outof-Network
Annual Deductible
$0 Single
$0 Family
$300 Single
$600 Family
OOP Maximum
(excludes Deductible and Copays)
$0
$0
$2,000 Single
$4,000 Family
Coinsurance
(after Deductible is met)
100%
80%
PCP/Specialist Office Visit
$10 Copay
80% Eligible Charges
(after annual deductible)
Preventive Care
Well Child, Adult Physical, Annual
GYN Exam
100% or $10 Copay
80% Eligible Charges
(after annual ded. or waived)
Emergency Room Copay
$25 Copay
(waived if admitted
$25 Copay
(waived if admitted
Inpatient Hospital Care
$25 copay (per admission )
80% Eligible Charges
(after annual deductible)
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Emergency Care
• Worldwide ‘Emergency Care’ Coverage - $25 Copay
(waived if admitted)
• Non-emergent use of the emergency room
Exercise Good Judgment
• a medical emergency is defined as a sudden accident
or medical condition that poses a significant jeopardy to
your health, impairment to bodily functions, or serious
dysfunction of any bodily organ or part if you do not seek
immediate medical care.
• call your physician or HealthAmerica’s NurseLine
if you are uncertain whether your symptoms warrant
a visit to the emergency room.
• Ambulance Services – covered @ 100%
(medically necessary)
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Pharmacy Benefits
Overview
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Prescription Drug Benefits
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“Freedom” Formulary –
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Generic Substitution – (Restrictive Generic)
Refer to insert in
your O/E packet – (take to your doctor’s office)
If you elect a brand-name drug when your physician
authorized a generic drug is available; you pay the
Tier 2 cost PLUS ancillary charge (difference in price).
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Quantity limits may apply (QLL)
Tier 1A $3.00 Copay (select generics) 90-day supply of maintenance meds. @ retail level
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Over-The-Counter drugs: Claritin, Prilosec
OTC, Zaditor eye drops, Zyrtec, Allegra, etc. –
$3 Copay with script from doctor.
• Copay per container at pharmacy
• Lifestyle Drugs (discounted) -
weight loss and
certain non-covered smoking cessation drugs.
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available at “no cost”
(LifeScan Brand - J & J program)
Diabetic meters 18
Retail:
• $3 - Tier 1A Generic
• $10 – Tier 1 Generic
• 10% coinsurance
(min. $20; max. $100) Brand-Name
• 10% coinsurance
(min. $40; max. $100 Non-formulary
Mail Order:
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$6 – Tier 1A Generic
$20 - Tier 1 Generic
$40 – Brand-Name
$80 – Non-formulary
(Limit of 90-day supply)
Drug Formulary
• Drugs are removed generally only 1x time per year
(effective January 1).
• Drugs can be added throughout the year (generally
quarterly).
• Communication of changes:
 Members adversely impacted are sent notification
60 days in advance of changes.
 Notify physicians annually during the month of December.
 Annual changes posted on HealthAmerica website.
Note: Not all generic medications are covered at Tier 1 (lowest copay).
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What Makes Us Different?
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Manage our own Formulary
Medco is our pharmacy benefits administrator
Promote select OTCs to lower costs
Targeted $0 “copay waiver” program
$3 Tier 1A
Freedom formulary
Flexible benefit packages
Member Education Resources
•Take formulary to every doctor visit
– Ask for the evidence behind the choice
– Ask for the lowest copay drug that is safe &
effective
– Use INDEPENDENT sources for information
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Consumer Reports at www.CRBestBuyDrugs.org
MedlinePlus at www.medlineplus.gov
How to take drugs at www.safemedication.com
Summary comparisons of drugs by disease state at
www.effectivehealthcare.ahrq.gov
Additional Member
Benefits
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NurseLine – 24/7
•Registered Nurses
•24 / 7
•Sick or Injured
•Health care questions
•800# on all ID cards
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Health Education Reimbursements
(Learn & Earn Program)
• Group class format / behavior change
• 100% Reimbursement (80% completion)
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Back Care
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Cardiovascular Disease Prevention
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Diabetes Education
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Nutrition Education
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Prenatal Education
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Safety Education
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Smoking Cessation
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Stress Management
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General Wellness
• $350/member/calendar year
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Weight Management
Digital Online Coaching
•Balance - weight management
•Breathe - smoking cessation
•Relax - stress management
•Nourish – nutrition improvement
•Move - physical activity
•Achieve - cholesterol management
•Control - blood pressure management
•Overcoming Depression - depression
management
•Overcoming Insomnia - sleep
improvement
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WellBeing Member Discounts
• WellBeing
– Fitness Facilities
• International Fitness Club
Network
– Acupuncture
– Massage Therapy
•Weight Watchers Online
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•VisionOne Vision Discounts
•Lasik Vision Correction
– EyeMed
– QualSight
Living Well - Member Magazine
• Up-to-date health information
• Updated health plan information
• Listing of resources and tools
• Articles available online for your
employee newsletter
• Important contact information
• Distributed bi-annually
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Enrollment Process
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Timeline
 Completed Enrollment Forms due by:
Monday, April 23rd!
■ Forms must be completed accurately with all
required data.
■ Must provide real social security numbers and
street addresses, no P.O. boxes
 ID Cards will be mailed directly to your home.
 Each member of the family receives own ID card.
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Enrollment Form
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Sample ID Card
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Customer Service &
Website Resources
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Dedicated Customer Service Team
Strategic Customer Service
• 1-800-252-5742
• www.healthamerica.cvty.com
MHNET (Behavioral Health)
• 1-866-369-8362
Hours of operation:
Monday -- Friday: 8:00 a.m. - 6:00 p.m.
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Our Website –www.healthamerica.cvty.com
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My Online Services Features
My Online Services
• View benefit information
• Check claim and referral status
• Print ID cards
• Manage HSA thru HealthEquity
• Review and print “EOB’s”
• View medical claims history
• View prescription claims history
• Access Medco to order prescriptions
• Review out of pocket and deductible accumulators
• Access Wellbeing to participate in online coaching programs or take HRA
• Establish a personal health record to print and share with providers
• Set and track personal health goals
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Online Customer Service
-- Available 24/7 -Web access via My Online Services
• Order an ID card
• View & print temporary card
• Locate a network provider
• Change address
• Request literature
• View contact numbers
• Review plan documents &
benefit usage
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• Check claim status & lab tests
• Check eligibility
• Update your COB information
• Send and receive secure
messages from customer
service within 24 hours
• Manage your personal
health with our wellness tools
Questions?
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