Getting Started With Hometown Health
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- Darrell Watkins
- 5 years ago
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1 1 Getting Started With Hometown Health
2 Know Your Benefits In-network- Health care providers that have contracted with your insurance company to accept certain negotiated (i.e., discounted) rates. Out-of-Network- Out-of-network providers have not agreed to the discounted rates. Copay- Amount paid by you directly to the In-network provider at the time the services are received. Deductibles- The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. Coinsurance- The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible. Out of Pocket Maximum-The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits. 2
3 Know Your Benefits Exclusions- Services, supplies, and treatments not covered by the plan and charges in excess of the customary and reasonable amount or negotiated rate. PCP- Your Primary Care Provider, a health care practitioner who sees people that have common medical problems. Your PCP is often involved in your care for a long time. 3
4 Be Your Own Advocate By being here, you re already educating yourself to better understand your benefits. Use Renown Facilities, whenever possible, for better rates. Find contracted facilities and providers if Renown Facilities are not right for you. Make sure healthcare facilities you go to are In-Network. Use mail order for maintenance drugs 4
5 Hometown Health Customer Service Local customer Service Answers claims and/or billing questions Provides assistance finding or changing a PCP, finding specialist, guiding you through In/Out Network Assist you in ordering new ID cards Explain your benefits to you Answer any questions you have Open Monday-Friday, 8:00 am - 5:00 pm
6 Hometownhealth.com Your one-stop shop to answer your questions 6
7 Finding a Doctor or Healthcare Facility 7
8 Finding a Doctor or Healthcare Facility 8
9 Finding a Doctor or Healthcare Facility 9
10 Why use the computer to find a doctor? You want to ensure that your doctor/facility is In-Network, meaning they are contracted with us. Going Out-of-Network could result in you paying much more for your services. Hometown Health has a selective process to ensure our contracted doctors are licensed and have a clean record. 10
11 MyBenefitsCoverage Order ID Cards View your claims Look at your benefits Look at your Rx benefits Change PCPs Look at your referrals 11
12 Navigate to Member support and MyBenefitsCoverage 12
13 In Member Support 13
14 Navigate to MyBenefits Coverage 14
15 Login/ Register For an Account 15
16 Membership Forms 16
17 Membership Forms 17
18 Telemedicine and Virtual Visits Allows you to talk to a doctor anywhere, by phone or video. Available Mon-Fri 9 a.m. 4 p.m. No Appointments Necessary Affordable option for treating common conditions. Saves you a trip to the doctor s office 18
19 Easily find a pharmacy near you Look up cheaper drug options on our Preferred Drug List. View 90-day Prescription Pharmacies.. Nation Wide 19
20 Diplomat Pharmacy Specialty Pharmacy Care The Nation s Largest Independent Specialty Pharmacy Providing personalized, high-touch care to patients with chronic and complex conditions. Contact: Phone: Fax:
21 Preventative services Colorectal Cancer Screening, Colonoscopy, Sigmoidoscopy, or fecal occult blood test Mammograms- baseline and annual Pap and pelvic exams Periodic health assessments for hearing and vision BRCA genetic counseling Prenatal well visits Prostate screening Well baby and child visits, wellness physicals, immunizations/vaccinations for children through age 17 Screening- Alcohol, blood pressure, cholesterol, depression, osteoporosis, HIV, obesity, tobacco use. 21
22 Women s Preventative Health Services As part of the Affordable Care Act, Women s Preventative Services will be covered without cost sharing Well-Woman visits- Pap, Mammograms, HPV DNA Testing Gestational Diabetes Screening STI Counseling, and HIV Screening and Counseling Domestic Violence Screening Contraception and Contraception Counseling Sterilizations- Vasectomy (for men only), Essure, Bilateral Tubal Ligation. 22
23 Health and Wellness Coaching with Healthy Tracks Healthy Tracks health and wellness program from Hometown Health is a web-based wellness portal that provides many useful tools to help you take control of your health, reduce health risks and help you live a longer, happier life. Health Assessment Food Log & Meal Planner Exercise Logs Progress Report Wellness Workshops Wellness Challenges 23
24 THANK YOU! Questions? Comments? 24
25 25
OUT-OF-NETWORK MEMBER PAYS IN-NETWORK MEMBER PAYS. Contract Year Plan Deductibles. services and prescription drugs) Out-of-Pocket Maximum
FlexPOS-CNT-HSA-6000I/12000F-01 Open Access Contract Year Benefit Summary (E) Point-Of-Service Open Access High Deductible Health Plan (HDHP) for use with a Health Savings Account (HSA) This is a brief
$11,000 Family. $6,600 Individual $13,200 Family
PLAN DESIGN AND BENEFITS - CA Bronze Basic HMO Deductible 5500 (01/15)(2015) CA Group Business 1-50 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Required Not
$4,000 Family. $7,150 Individual $14,300 Family
PLAN DESIGN AND BENEFITS - CA Silver Basic HMO 2000 (01/17) (2017) CA Group Business 1-100 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Required Not applicable
$250 per member. All covered expenses accumulate separately toward the Network and Out-of-network Coinsurance Maximum.
PLAN FEATURES Network Managed Choice POS (Open Access) OUT-OF- Not Applicable Primary Care Physician Selection Deductible (per calendar year) Not Applicable $250 per member Not Applicable $250 per member
IN-NETWORK MEMBER PAYS OUT-OF-NETWORK MEMBER PAYS. Calendar Year Plan Deductible. services and prescription drugs) Out-of-Pocket Maximum
POS HDHP $3,000/$6,000 Deductible-F Point-of-Service Open Access High Deductible Health Plan for use with a Health Savings Account (HSA) Benefit Summary This is a brief summary of benefits. Refer to your
NETWORK CARE. $3,500 Individual $7,000 Family
PLAN FEATURES Network Primary Care Physician Selection Deductible (per calendar year) Managed Choice POS (Open Access) OUT-OF- $2,000 Individual $4,000 Family Unless otherwise indicated, the Deductible
$10,000 Family. $7,000 Individual $14,000 Family
PLAN DESIGN AND BENEFITS - NV Silver AWH Las Vegas HMO 5000 $30 (2018) NV Group Business 1-50 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Required Not applicable
$14,000 Family. $7,000 Individual. $14,000 Family
PLAN DESIGN AND BENEFITS - NV Bronze PPO 7000 100/70 (2017) NV Group Business 1-50 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Not applicable Not applicable
$8,000 Family. $6,000 Individual $12,000 Family
PLAN DESIGN AND BENEFITS - FL Silver HNOnly 4000 100 (2016) FL Group Business 2-50 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Not required Not applicable
$7,000 Family. $7,150 Individual $14,300 Family
PLAN DESIGN AND BENEFITS - MD Silver HNOnly SJ 3500 100% (2017) MD Group Business 1-50 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Not required Not applicable
$7,000 Individual $14,000 Family
PLAN DESIGN AND BENEFITS - CA Gold AVN HMO 20 (01/17) (2017) CA Group Business 1-100 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Required Not applicable Deductible
$8,000 Family. $6,600 Individual $13,200 Family
PLAN DESIGN AND BENEFITS - GA OAMC 4000 100/70 (2018) GA Group Business 51-100 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Not Required Not Required Deductible
$7,000 Family. $7,500 Individual $15,000 Family
PLAN DESIGN AND BENEFITS - NV Silver AWH Las Vegas HMO 3500 80% $40 (2019) NV Group Business 1-50 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Required Not
$3,000 Individual $6,000 Family All covered expenses accumulate separately toward the Network and Out-of-Network Coinsurance Maximum.
PLAN FEATURES Network Managed Choice POS (Open Access) OUT-OF- Primary Care Physician Selection Deductible (per calendar year) $3,000 Individual $6,000 Family Unless otherwise indicated, the Deductible
NETWORK CARE. $1,000 Individual $2,000 Family
PLAN FEATURES Network Managed Choice POS (Open Access) Primary Care Physician Selection Not Applicable Deductible (per calendar year) $3,500 Individual $7,000 Family Unless otherwise indicated, the Deductible
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PLAN DESIGN AND BENEFITS - PA Silver PPO 2000 100/50 (2015) PA Group Business 1-50 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Not applicable Not applicable
WA Bronze PPO Saver /50 (1/14)
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Summary of Benefits Prominence HealthFirst Small Group Health Plan
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PLAN DESIGN AND BENEFITS - CT OA MC 3000 HD 25/40 90/70 / 3000 HD 25/40 90/70 A 51+
PLAN DESIGN AND BENEFITS - PLAN FEATURES Deductible (per calendar year) $3,000 Individual $5,000 Individual $6,000 Family $10,000 Family Unless otherwise indicated, the Deductible must be met prior to
Not Applicable. $5,000 Individual. All covered expenses accumulate separately toward the Network and Out-of-Network Coinsurance Maximum.
PLAN FEATURES Network Managed Choice POS (Open Access) Primary Care Physician Selection Deductible (per calendar year) Not Applicable $2,000 per member Not Applicable $2,000 per member (2-member maximum)
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PLAN DESIGN AND BENEFITS - CA Gold MC 0 80/50 (2018) (2018) CA Group Business 1-100 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Not required Not required Deductible
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$5,000 Family. $6,800 Individual $13,600 Family
PLAN DESIGN AND BENEFITS - NV Silver PPO 2500 70/50 (2018) NV Group Business 1-50 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Not applicable Not applicable
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$5,400 Family. $6,650 Individual $13,300 Family
PLAN DESIGN AND BENEFITS - WA Silver PPO 2700 80/50 HSA-E (2019) WA Group Business 1-50 Employees PLAN FEATURES NETWORK CARE OUT-OF-NETWORK CARE Primary Care Physician Selection Not applicable Not applicable
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PLAN FEATURES IN-NETWORK OUT-OF-NETWORK Deductible $2,500 Individual $5,000 Individual (per calendar year) $5,000 Family $10,000 Family Unless otherwise indicated, the deductible must be met prior to benefits
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PLAN FEATURES Network Managed Choice POS (Open Access) Primary Care Physician Selection Not Applicable Deductible (per calendar year) $250 per member (2-member maximum) Unless otherwise indicated, the
NETWORK CARE. $4,500 Individual. (2-member maximum)
PLAN FEATURES Network Open Choice PPO Primary Care Physician Selection Deductible (per calendar year) Not Applicable $750 per member Not Applicable $750 per member (2-member maximum) (2-member maximum)
PPO HSA HDHP $2,500 90/50
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