2017 Rhode Island Small Group (1-50) Health Plan Portfolio.

Transcription

1 2017 Rhode Island Small Group (1-50) Health Plan Portfolio.

2 What do you value in a health plan? Businesses today are faced with a lot of difficult decisions. Finding the right health care benefits plan should not be one of them. No matter how you get into the health care system, we can help make it simpler. is committed to finding solutions to fit the health care needs of Rhode Island small group (1-50) employers. You want to offer benefits that help attract employees and keep them healthy. provides a variety of health plans that help you achieve your goals while educating and engaging employees in making informed health care choices to help control costs. Our portfolio includes a variety of products designed to be affordable and provide flexible health plan solutions. Choose from traditional open access plans, account-based, tiered benefit, limited network and higher cost share plans. We also Member Role/Level of Member Involvement Low Moderate Products Choice Plus HRA HSA Edge Network Coverage Out-of-Network Coverage Cost-Efficient Network Account-Based Plan UnitedHealth Premium Designation Program Tiering Place of Service Benefits Hospital Tiering Primary Care Physician (PCP) Referrals Required Online Tools and Mobile Apps Member Support Programs Health and Wellness Programs No-Fee Benefit Services (FSA, Pre-Tax, COBRA, for 2 99) Metallic Tier Silver, Gold, Platinum Bronze, Silver, Gold, Platinum Relative Premium $$$$ $$$ $$$ $$$ KEY Our Best, Largest Better, Plus Better, More Good Basic Not Available Included 2

3 integrate pharmacy benefits with our medical plans and offer a variety of specialty benefit options so you have the ability to offer your employees a comprehensive benefit package. In accordance with the Affordable Care Act (ACA), all of our Rhode Island small group plans can also be identified by metallic benefit coverage levels: Bronze, Silver, Gold and Platinum. These designations indicate the relative value of the covered benefits, from Bronze (lowest) to Platinum (highest). All plans must meet standard requirements for affordability, essential health benefits and consumer protections. Each metallic level includes choices of benefits, plan types and price. Think about what you value most in a health plan and use the chart below to help you determine which product has the features and benefits you are looking for. High Edge HSA Choice HMO Edge HMO Edge HMO HSA Choice Advanced Navigate Silver Silver, Gold Gold Bronze, Silver Silver, Gold Silver, Gold, Platinum $$ $$ $$ $$ $$ $$ 3

4 Rhode Island Small Group Plan descriptions. Below are more detailed plan descriptions as depicted in the chart on the previous page. Products with low level of member involvement Choice Plus This is a traditional health plan with copayments, coinsurance and deductibles. Members have the freedom to see any doctor and visit any facility in our nationwide network, including specialists, without a referral and without choosing a primary care doctor. Members can choose services outside our network, but their payments will be higher. Products with moderate level of member involvement Edge These plans feature lower office visit copayments and greater plan coinsurance coverage when members receive care provided by UnitedHealth Premium designation program quality and costefficiency designated specialty doctors. These doctors designations are displayed on the member website, myuhc.com. Referrals are not required for specialists. HRA This consumer-driven health (CDH) plan includes a deductible and a health reimbursement account (HRA) that is funded by the employer. The HRA is used to help the member help pay a portion of his or her deductible. Members will be responsible for paying the remaining deductible, which requires them to pay the actual cost of eligible health care expenses. This also helps encourage smarter spending. Referrals are not required for specialists. HSA This consumer-driven health plan is made up of two parts: a high-deductible health plan and a Health Savings Account (HSA). With this plan, members can open and deposit money, before taxes, into an HSA, which is their own personal savings account. Members can use the money to help pay for eligible medical and pharmacy expenses, including their deductible, or save it for future expenses. Some plans offer office and facility copayments after the deductible. Referrals are not required for specialists. Products with high level of member involvement Choice HMO This plan offers network coverage only with copayments, coinsurance and deductibles. Members have access to our nationwide network, and referrals are not required for specialists. Edge HSA Edge HMO Edge HMO HSA Choice Advanced Navigate We also offer a Edge plan with a Health Savings Account (HSA). All other benefits and features are the same as our Edge plan. Some plans offer office and facility copayments after the deductible. This plan offers network coverage only and features lower office visit copayments and greater plan coinsurance coverage when members receive care provided by UnitedHealth Premium designation program quality and cost-efficiency designated specialty doctors. These doctors designations are displayed on the member website, myuhc.com. Referrals are not required for specialists. We also offer an Edge HMO plan with a Health Savings Account (HSA). All other benefits and features are the same as our Edge HMO plan. These are open access plans that encourage members to seek care from certain providers and facilities to get the highest level of coverage. By making informed decisions about the physicians and service providers they choose, members can save money by going to certain network providers, facilities and hospitals that are less expensive and still deliver the same quality care as other network providers. Since Choice Advanced is a network-based product, members must seek care from Choice network providers to receive benefits. This is a gated product, designed to deliver traditional benefits at a lower price-point while still providing the plan design flexibility. In the Navigate product, members choose a primary care physician, who will provide care for the majority of the member s health care needs, including preventive and routine care, and care for sickness or injury. Because the primary care physician will understand the member s health needs thoroughly, they can best refer the member to other network physicians when additional care is needed. Out-of-network coverage is not available, except in the case of emergency care. 4

5 Network access. We know how important it is to find the right doctor. That s why we offer both a local and a large nationwide network and the UnitedHealth Premium designation program to help you find one. Local Network: Rhode Island employers enrolled in our plans have access to 5,939 providers and 16 hospitals in the state*. Broad National Network: Our national network provides access to 99 percent of the U.S. population in 96 percent of all U.S. counties. UnitedHealth Premium designation program: This program recognizes doctors who meet standards for quality and cost-efficiency. We use evidencebased medicine and national industry guidelines to evaluate quality. The cost-efficiency standards rely on local market benchmarks for the efficient use of resources in providing care. 859,000 doctors 5,650 hospitals This program applies to certain specialists and not to all providers. You can search for Premium designated providers within our doctor search tool located at myuhc.com. 67,000 pharmacies *As of 9/30/2016. Virtual visits No driving. No crowded waiting rooms. See a doctor when you need a doctor. When employees are sick they often miss work. If they are unable to see their own doctor, they may visit an urgent care or emergency department, which can be costly and time-consuming. With virtual visits, employees can see and speak to a doctor 24 hours a day/seven days a week using a mobile device or computer, all from the convenience of their home or office. If needed, a prescription* can be sent to their local pharmacy. Virtual visits are integrated into their medical benefits. The virtual visit provider groups we contract with deliver care using live audio and video technology based on quality standards aligned with American Medical Association (AMA) and Federation of State Medical Boards (FSMB) guidelines. *Prescription services may not be available in all states. 5

6 Helping deliver on what employers value most. You ll be surprised to learn how many tools offers to help make your job easier. You Value: Benefit Plans Integrated Medical and Pharmacy Benefits Specialty Benefits Innovative Employer Tools Offers: A variety of plan designs ranging from open access to primary care provider-centric to consumer-driven and more which can be sold as a package, allowing you to select the options that might work best with your employee population. All products come with our integrated pharmacy benefit. This includes 67,000 network retail pharmacies that are available to you across the country and Mail Order services that can give your employees up to a 90-day supply of their medication(s), often at a lower price than retail and it s delivered to their home with free shipping. Help attract and retain employees by offering more options. is able to offer you a selection of dental, vision, life and disability products in addition to our medical products. Employer eservices is designed to save time and money by streamlining online eligibility, enrollment, billing and reporting. Manage virtually every aspect of benefits administration online. 6

7 Helping deliver on what employees value most. What if you could help improve your employees health and well-being, increase productivity and job performance, and increase employee satisfaction and retention all at no additional cost to you? Understanding and identifying the health risks of your employees is the first step in creating a comprehensive wellness strategy that can help address behavior change. Your Employees Value: Cost Comparison Tools Offers: Our myhealthcare Cost Estimator tool provides information on procedures, providers, even estimated prices to encourage choices that help increase savings and improve health. Mobile Access to Health Care Information Online Health and Wellness Tools Consumer Wellness Program 24/7 Access to Health Care Guidance Reliable Member Support The Health4Me mobile app helps employees to find nearby providers, check the status of a claim, see an account balance or speak directly with a nurse. Our myclaims Manager helps your employees better understand their health care benefits, what their plan paid, and what they owe and why. And the Smart Patient app lets employees log health information such as blood pressure, cholesterol and body mass index (BMI), set reminders for medical appointments, use checklists to help them determine what to ask doctors and pharmacists, and more. Rally is an interactive health and wellness component of myuhc.com. By harnessing the power of data, social connections and rewards, consumers receive personal lifestyle plans that focus on goals, competition, tracking progress and healthy living all while earning Rally coins. Rally offers a personalized interaction experience with: step-based Challenges, discussion Communities, individual action plans called Missions, health information and more. SimplyEngaged is an incentive program designed to help improve the health of consumers and will offer incentives for consumer health and wellness improvement actions. Covered consumers can earn rewards when they complete the following: Health Survey, Biometric Screening, online action plans (Missions), telephone-based health coaching program and use myhealthcare Cost Estimator tool. SimplyEngaged offers money back to consumers who go to a participating fitness center on a regular basis. It s a fun way to encourage healthy behavior. Speak with knowledgeable registered nurses 365 days a year 24/7 by phone or online chat to help manage illness or injury as well as maternity education support. provides tools to help your employees stay healthy at uhcpreventivecare.com to find out which immunizations and screenings are recommended for all family members at different stages of their lives. We send special mailings HealtheNote Reminders on the topics of women s health, child and adolescent immunizations, coronary artery disease and diabetes to the homes of your employees who we think can benefit from this information. We also offer condition management programs to help members with chronic health issues, such as chronic kidney disease and heart failure enhance self-care, identify warning signs and access resources for assistance, reducing the need for urgent or emergency services. By developing trusted relationships we can reinforce and support physician treatment plans, and help members get the most out of their care encounters. And, all members (not just those in crisis) are able to tap into our Employee Assistance Program (EAP), 24 hours a day, seven days a week, for information to help them make informed decisions about their health and well-being. Health Discount Program* Our health discount program helps employees and their families typically save 10 to 25 percent on a wide range of health- and wellness-related programs, products and services. Discounts are available for the member, spouse and dependents and include access to a robust network of 150,000 health care professionals, facilities and retailers including popular brands such as Jenny Craig, Nutrisystem, Anytime Fitness, Jazzercise and others. *Components are subject to change. 7

8 Awards and recognition. s parent company, UnitedHealth Group, strives to deliver consistent performance, solid fundamental execution and an innovative approach to health insurance. We are privileged to be recognized with awards for our work. UnitedHealth Group was the top-ranking company in the insurance and managed care sector on Fortune s 2016 World s Most Admired Companies list. This is the sixth straight year UnitedHealth Group ranked No. 1 overall in its sector and the seventh consecutive year the company ranked No. 1 in its sector for innovation. (February 2016) UnitedHealth Group was recognized as one of America s 50 most community-minded companies for 2016 in the Civic 50, and ranked first in the health care industry for the third consecutive year. For the sixth consecutive year, the National Business Group on Health honored UnitedHealth Group with a Platinum award for being named one of the Best Employers for Healthy Lifestyles (2016). For more information, please contact your broker or sales representative. For a complete description of the UnitedHealth Premium designation program, including details on the methodology used, geographic availability, program limitations and medical specialties participating, please visit myuhc.com. Rally Health provides health and well-being information and support as part of your health plan. It does not provide medical advice or other health services, and is not a substitute for your doctor s care. If you have specific health care needs, consult an appropriate health care professional. Participation in the health survey is voluntary. Your responses will be kept confidential in accordance with the law and will only be used to provide health and wellness recommendations or conduct other plan activities. Disease Management programs and services may vary on a location-by-location basis and are subject to change with written notice. does not guarantee availability of programs in all service areas and provider participation may vary. Certain items may be excluded from coverage and other requirements or restrictions may apply. If you select a new provider or are assigned to a provider who does not participate in the Disease Management program, your participation in the program will be terminated. Self-Funded or Self-Insured Plans (ASO) covered persons may have an additional premium cost. Please check with your employer. Virtual visits are not an insurance product, health care provider or a health plan. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times or in all locations. FORTUNE is a registered trademark of Time, Inc. FORTUNE and Time Inc. are not affiliated with, and do not endorse products or services of UnitedHealth Group. The plan with Health Savings Account (HSA) is a high-deductible health plan (HDHP) that is designed to comply with IRS requirements so eligible enrollees may open a Health Savings Account (HSA) with a bank of their choice or through Optum Bank, Member of FDIC. The HSA refers only and specifically to the Health Savings Account that is provided in conjunction with a particular bank, such as Optum Bank, and not to the associated HDHP. Specialty benefits and programs may not be available in all states or for all group sizes. The plan with Health Reimbursement Account (HRA) combines the flexibility of a medical benefit plan with an employer-funded reimbursement account. Components subject to change. All members can access a cost estimator online tool at myuhc.com. Depending on your specific benefit plan and the ZIP code that is entered, either the myhealthcare Cost Estimator or the Treatment Cost Estimator will be available. A mobile version of myhealthcare Cost Estimator is available in the Health4Me mobile app, and additional ZIP codes and procedures will be added soon. This tool is not intended to be a guarantee of your costs or benefits. Your actual costs and/or benefits may vary. When accessing the tool, please refer to the Terms and Conditions of Use and Why Your Costs May Vary sections for further information regarding cost estimates. Refer to your health plan coverage document for information regarding your specific benefits. Disclosure: The Health Discount Program is administered by HealthAllies, Inc., a discount medical plan organization. The Health Discount Program is NOT insurance. The discount program provides discounts at certain health care providers for medical services. The discount program does not make payments directly to the providers of medical services. The discount program member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. HealthAllies, Inc., is located at P.O. Box 10340, Glendale, CA 91209, , ohacustomercare@optumhealth.com. The health discount program is offered to existing members of certain products underwritten or provided by Insurance Company or its affiliates to provide specific discounts and to encourage participation in wellness programs. Health care professional availability for certain services may be dependent on licensure, scope of practice restrictions or other requirements in the state. does not endorse or guarantee health products/services available through the discount program. This program may not be available in all states or for all groups. Components subject to change. SimplyEngaged is a voluntary program. The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical advice. You should consult with an appropriate health care professional to determine what may be right for you. Rewards may be taxable. You should consult with an appropriate tax professional to determine if you have any tax obligations from receiving rewards under this program. If you are unable to meet a standard related to a health factor to obtain a reward under this program, you might qualify for an opportunity to earn the same reward by different means. Contact us at and we will work with you (and, if necessary, your doctor) to find another way for you to earn the same reward. Insurance coverage provided by or through Insurance Company or its affiliates. Health Plan coverage provided by or through of New England, Inc MT / United HealthCare Services, Inc UHC RISG 1-50 Product Capabilities Brochure