Welcome to Dean Health Plan! Dane County. Find this presentation and much more at deancare.com/danecounty September 2016

Transcription

1 Welcome to Dean Health Plan! Dane County Find this presentation and much more at deancare.com/danecounty September 2016

2 About Us Local Company, Local Focus Headquartered in Madison, WI Employees 30 Years of Excellence Established in 1983 Full-service health insurance Integrated System Integrated network of clinics, hospitals and health care partners Dean Health Plan is part of SSM Health SSM Health and Dean have been partners for over 100 years Benefits of Our Integrated System Focus on a proactive, preventive approach to care Decreases duplication of services & provides better health care value 1

3 The Dean Difference Recognized High-Quality Care Dean Health Plan is proud to be accredited by the National Committee for Quality Assurance. Access to Providers We have more than 2,300 providers, 28 hospitals and 184 primary care sites in 20 counties throughout southern Wisconsin. Technology & Innovation Get online access to your personal health information with View and manage insurance benefit information with Complex Case Management If you ve been diagnosed with a chronic health condition or have a complex health care need, we ll provide you with the resources you need. Wellness & Rewards Helping members achieve their goals on their own terms with our user-friendly Living Healthy program, powered by WebMD. 2

4 Learn more and activate your Living Healthy portal today! deancare.com/livinghealthy 3

5 Dean HMO Overview 4

6 Dean HMO: Highlights One of the Largest HMOs in the Midwest The Dean Health Maintenance Organization (HMO) network focuses on integrated care from trusted providers in 20 counties. Our exceptional network includes more than two dozen local Dean Medical Group locations and hundreds of additional providers in network. By the Numbers Numbers as of July 11,

7 Dean HMO Network: Service Area Search for a clinic or primary care provider near you. deancare.com/doctors 6

8 Dean HMO: Benefits Table 1 Table 2 Plan At-a-Glance You Pay Medical Services You Pay Deductible $100 single $200 family Office Visit Primary Care & PCP $5 copay* Deductible & Coinsurance Limit $100 single $200 family Office Visit Specialist $5 copay* Annual Maximum Outof-Pocket Includes: & coinsurance and copays for office visits & prescriptions $250 single $500 family Preventive Care Services Urgent Care Emergency Room $0 copay $10 copay* and/or 0% coinsurance after $50 copay and/or 0% coinsurance after Diagnostic Services Lab & X-Ray 0% coinsurance after Hospitalization 0% coinsurance after * Copays waived for dependents through age 18 Visit deancare.com for a complete listing of benefits, found in Member Certificate documents. 7

9 Dean HMO: Prescriptions (Rx) Drug Formulary A list of approved medications that are covered by your insurance plan. Drugs are reviewed routinely for effectiveness, safety and cost. Check the list from time to time to find out if drugs have been added or removed. Convenient Mail Order Services Available! We work with WellDyne Rx for mail order services. Rx Benefit Categories You Pay View drug formularies and reference guides, learn about mail order services and more. Tier 1 Tier 2 Tier 3 Mail Order 102 Day Supply Tier 1 & 2 Only $10 copay $20 copay $40 copay 2 copay(s) deancare.com/pharmacy Visit deancare.com for a complete listing of benefits, found in Member Certificate documents. 8

10 Dean Point of Service (POS) Overview 9

11 Dean POS: Highlights Point of Service (POS) Highlights Offers the benefits of an HMO, with the option to see out-of-network providers if necessary. When you receive care from a Dean network provider, you will enjoy lower out-of-pocket costs than when going out-of-network. Same Benefits of Managed Care High-quality health care Wellness and preventive programs Lower out-of-pocket costs No paperwork when using Dean network providers It s a good choice if You want to take advantage of the higher benefit level. If you wish to see Dean providers for routine care, with the comfort of knowing you have coverage if you ever need to see a specialist outside of the Dean network. 10

12 Dean POS Network: Service Area Search online for a clinic or primary care provider. deancare.com/doctors Plan & Non-Plan Providers The in-plan network is the same as the HMO network. You may see any provider under the POS plan. 11

13 Dean POS: Benefits Deductible Plan At-a-Glance Deductible & Coinsurance Limit Annual Maximum Out-of-Pocket Includes: & coinsurance and copays for office visits & prescriptions You Pay Plan Providers $100 single $200 family $100 single $200 family $250 single $500 family You Pay Non-plan Providers $200 single $400 family $200 single $400 family $500 single $1,000 family Visit deancare.com for a complete listing of benefits, found in Member Certificate documents. 12

14 Dean POS: Benefits Medical Services You Pay Plan Providers You Pay Non-plan Providers Office Visit Primary Care & PCP Office Visit Specialist $5 copay* $10 copay* $5 copay* $10 copay* Preventive Care Services Urgent Care Emergency Room Diagnostic Services Lab & X-Ray Hospitalization $0 copay $10 copay* and/or 0% coinsurance after $50 copay and/or 0% coinsurance after 0% coinsurance after 0% coinsurance after 0% coinsurance after $10 copay* and/or 0% coinsurance after $50 copay and/or 0% coinsurance after 0% coinsurance after 0% coinsurance after * Copays waived for dependents through age 18 Visit deancare.com for a complete listing of benefits, found in Member Certificate documents. 13

15 Dean POS: Prescriptions (Rx) Drug Formulary A list of approved medications that are covered by your insurance plan. Drugs are reviewed routinely for effectiveness, safety and cost. Check the list from time to time to find out if drugs have been added or removed. Convenient Mail Order Services Available! We work with WellDyne Rx for mail order services. Rx Benefit Categories You Pay Plan Provider View drug formularies and reference guides, learn about mail order services and more. deancare.com/pharmacy You Pay Non-plan Provider Tier 1 $10 copay 50% coinsurance Tier 2 $20 copay 50% coinsurance Tier 3 $40 copay Not Covered Mail Order 102 Day Supply Tier 1 & 2 Only 2 copay(s) Not Available Visit deancare.com for a complete listing of benefits, found in Member Certificate documents. 14

16 Save Time & Money with evisits available through: Convenience There s no need to leave your home or work when you aren t feeling well. evisits may replace a visit to the clinic or urgent care and it s free of charge! When Should I Use evisits? When your schedule doesn t allow you to travel to a clinic or urgent care site. evisit are available between 7am and 8pm Monday through Friday and 8am to 5pm on Saturdays. Please Remember There may be times when care cannot be delivered in an evisit and you will be required to see a physician in person. If you are newly enrolled with Dean Health Plan your option for an evisit will become available after you register and establish care with a primary care provider. No Copay for evisits! Sign up for MyChart at deancare.com/mychart Visit deancare.com for a complete listing of benefits, found in Member Certificate documents. 15

17 Additional Benefits for Dane County Acupuncture Acupuncture is covered with a Dean network provider for up 10 visits per year and is subject to your office visit copay. Weight Loss Management / Bariatric Surgery Dean s Comprehensive Weight Management program is being offered to Dane County employees and families. Authorization is required and any approved bariatric surgery is performed at St. Mary s Hospital. Gender Dysphoria / Sex Transformation Many gender dysphoria services are included in the base medical benefits of your plan, including counseling and hormone therapy. Authorization is required for sex transformation benefits and the policy has a $25,000 lifetime limit. Call with Questions Customer Care Specialists are ready to answer your questions at (800) (TTY: 711) Mon Thr, 7:30 am 5 pm Fri, 8 am 4:30 pm Visit deancare.com for a complete listing of benefits, found in Member Certificate documents. 16

18 Health Care Coverage For Your Out-of-area Dependents Dean Health Plan is committed to helping your dependents get the health care coverage they need when they need it. Students who attend college outside of the area and children living in another community are common examples of out-of-area dependents. NOTIFY US If you have an out-of-area dependent, please complete the Out-of- Area form as part of your health plan enrollment. You may also contact the Dean Health Plan Customer Care Center at (800) New Insurance Card After Notification Dean Health Plan will send a new ID card, which the dependent should carry at all times. It will have a sticker that gives access to a national network of providers. Out-of-area members will use the networks listed on the back of their ID card to access care and receive in-network benefits. 17

19 We Make Change Easy We re committed to offering the. transition possible into the Dean Health Plan network. Care Transition Our transition of care process is designed to assist employees who are in an active course of treatment with an out-of-network specialty provider. An employee who has a scheduled appointment within the first 90 days of the plan s effective date may be eligible for transition of care assistance. A transition of care form must be submitted no later than 14 days after the plan s effective date Member Guide New members will receive a printed Member Guide upon enrollment. The guide contains helpful tips and information so you can begin your experience with Dean Health Plan the exceptional way. Watch Your Mail! ID cards will be mailed directly to your home in a plain white envelope (for privacy reasons) 18

20 Here When You Need Us Call Customer Care Specialists are ready to answer your questions at (800) (TTY: 711) Mon Thr, 7:30 am 5 pm Fri, 8 am 4:30 pm Dean Medical Group has opened a phone line to welcome Dane County employees and assist with scheduling family medicine, internal medicine and pediatric care appointments. Call (608) Click Visit deancare.com/contact-us and click on the Dean Health Plan button. Come In Our Insurance Desk is open M F, 8 am 4:30 pm. Come by our corporate office of one of our SSM Health Dean Medical Group locations: Business Office: 1277 Deming Way, Madison East : 1821 S. Stoughton Road, Madison West : 752 N. High Point Road, Madison Fish Hatchery : 1313 Fish Hatchery Road, Madison Janesville East: 3200 E. Racine Street, Janesville Not sure where to go for care or need health advice? Call Dean On Call 24/7/365. (800) 57-NURSE ( ) 19

21 Thank You!! Questions? Find this presentation and much more at deancare.com/danecounty 20