2016 Massachusetts Small Group (1-50) Health Plan Portfolio

Transcription

1 2016 Massachusetts 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 complex health care system, we can help make it simpler. is committed to finding solutions to fit the health care needs of Massachusetts small group (1-50) employers. You want to offer benefits that 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 wise health care choices to help control costs. Our portfolio includes a variety of products with a wide range of affordable and flexible health plan solutions. Choose from traditional open access plans, account-based, tiered benefit, limited network and higher cost share plans. We also 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 Massachusetts 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. Member Role / Level of Member Involvement Low Moderate Products Choice Plus Choice EPO HSA Network Coverage Non-Network Coverage Account-based Plan Primary Care Physician (PCP) Referrals Required Online Tools and Mobile Apps Member Support Programs Health & Wellness Programs No Fee Benefit Services SM (FSA, Pre-Tax, COBRA for 2-99) Metallic Tier Silver, Gold and Platinum Bronze, Silver, Gold and Platinum Bronze, Silver and Gold Relative Premium $$$$ $$$ $$$ KEY Best, Most Better, More Good Basic Not available Included 2

3 Massachusetts Small Group Plan descriptions Below are more detailed plan descriptions as depicted in the chart on the opposite page. Products with Low Level of Member Involvement Choice Plus This is a traditional health plan with co-payments, co-insurance 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 Choice EPO HSA This plan offers in-network coverage only with co-payments, co-insurance and deductibles. Members have access to our nationwide network, and referrals are not required for specialists. 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 pay for eligible medical and pharmacy expenses, including their deductible, or save it for future expenses. 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. 3

4 Delivering on what employers value most You ll be surprised to learn how many tools offers to help make your job easier. You Value: Comprehensive Benefit Plans Offers: A variety of plan designs ranging from open access to primary care providercentric 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. Integrated Medical and Pharmacy Benefits All products come with our easy-to-use pharmacy benefit. This includes 64,000 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. Specialty Benefits Attract and retain the best employees by offering more options. is able to offer you a full suite of dental, vision, life and disability products in addition to our medical products. Innovative Employer Tools 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. 4

5 Delivering 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 address behavior change. Your Employees Value: Cost Comparison Tools Mobile Access to Health Care Information Online Health and Wellness Tools 24/7 Access to Health Care Guidance Reliable Member Support Health Discount Program* Offers: Our myhealthcare Cost Estimator tool provides information on procedures, providers, even estimated prices to encourage choices that increase savings and improve health. The Health4Me mobile app allows 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 TM is a fun, 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. 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. 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. Helping employees save money. 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, Any Time Fitness, Jazzercise and others. *Components are subject to change. 5

6 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. Premiere Local Network: Massachusetts employers enrolled in our plans have access to 25,042 providers and 94 hospitals in the state.* Broad National Network: Our national network provides seamless access to 99 percent of the U.S. population in 96 percent of all U.S. counties. 800,000 doctors 5,700 hospitals UnitedHealth Premium designation program: This program recognizes doctors who meet standards for quality and cost-efficiency. We use evidence-based 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. 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 64,000 pharmacies *As of 6/30/2015 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 timeconsuming. With virtual visits, employees can see and speak to a doctor 24 hours a day/7 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. 6

7 Awards and recognition At we strive to deliver consistent performance, solid fundamental execution and an innovative approach to health care. 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 2015 World s Most Admired Companies list. This is the fifth straight year UnitedHealth Group ranked No. 1 overall in its sector and the sixth consecutive year the company ranked No. 1 in its sector for innovation. (February 19, 2015) UnitedHealth Group was recognized as one of America s 50 most community-minded companies for 2014 in the Civic 50, and ranked first in the health care industry for the second consecutive year. UnitedHealth Group received the 2014 Best Corporate Steward Large Business award from the U.S. Chamber of Commerce Foundation s Corporate Citizenship Center. For the fourth 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 (2014). Ranked Highest in Customer Satisfaction with Vision and Dental Plans according to the J.D. Power 2014 Vision and Dental Plan Satisfaction Reports. This is the second year in a row has received an award in the Vision Plan Report. 7

8 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-bylocation 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. 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. Insurance coverage provided by or through Insurance Company or its affiliates. Health Plan coverage provided by or through of New England, Inc. MT /15 UHC MASG 1-50 Product Capabilities Brochure 2015 United HealthCare Services, Inc rev. 2