CARING FOR YOUR SMALL BUSINESS. Off-Exchange 2018 Plans and Services for Groups With Up to 100 Employees

Transcription

1 CARING FOR YOUR SMALL BUSINESS Off-Exchange 2018 Plans and Services for Groups With Up to 100 Employees

2 SMALL GROUP PLANS AT A GLANCE EmblemHealth offers small group plans with the needs and budgets of small businesses in mind. Each plan offers quality coverage with costs to fit your needs. EmblemHealth HMO 40/60 (Gold) offers a small yearly deductible and higher copays. EmblemHealth HMO 15/35 (Platinum) offers low copays, no yearly deductibles, but a high monthly premium for our members. EmblemHealth Gold Open Access offers a low yearly deductible and three free visits to a primary care doctor. Generic drugs only have a $10 copay. No referrals are needed to visit a specialist. Adult and pediatric dental and vision benefits are included. EmblemHealth Silver Value offers a low premium, high yearly deductible, and three free visits to a primary care doctor. Generic drugs only have a $10 copay. Adult and pediatric dental and vision benefits are included. EmblemHealth Bronze Value offers a low premium, a high yearly deductible, and two free visits to a primary care doctor. Adult and pediatric dental and vision benefits are included. EmblemHealth Bronze HSA offers a Health Savings Account (HSA) that lets members save pretax dollars for medical costs. There is a high deductible followed by a 50% coinsurance. IN OUR PRIME Starting January 1, 2018 EmblemHealth s small group plans will include access to our larger Prime network in the New York service area. Groups already with EmblemHealth will have access to the larger network when they renew. With this network, members can choose from 51,000 more health care professionals and 39 more hospitals. With our Prime Network, members can choose from over 90,000 private and group practice health professionals, facilities and 144 hospitals in 28 New York State counties all five boroughs of New York City (the Bronx, Brooklyn, Manhattan, Queens and Staten Island), plus Nassau, Suffolk, Orange, Rockland, and Westchester counties and upstate areas that stretch north of Albany. Unless it s an emergency, members may have to pay for medical services if they get treatment outside of our Prime network. FIND A DOCTOR It s easy to find a doctor in our network. Simply go to emblemhealth.com/find-adoctor and choose from our Prime network. ADVANTAGECARE PHYSICIANS EmblemHealth, one of the nation s largest nonprofit health insurers, and AdvantageCare Physicians, a leading New York medical group, are partners in providing quality, personalized care to New Yorkers. Through AdvantageCare Physicians 36 medical offices, EmblemHealth members have access to top primary care doctors, specialists and a personal care team. For more information, visit emblemhealth.com and acpny.com or call us at With AdvantageCare Physicians, you have access to more than 100 primary care physicians and specialists, 150 nurses, and 65 advanced practice clinicians. Plus, all AdvantageCare Physicians are preferred doctors in our network, so you don t have to worry about out of network costs.

3 HELPING MEMBERS STAY HEALTHY, GET WELL AND LIVE BETTER Helping our members stay healthy is one of our top priorities. Our preventive care and wellness programs help us do that. With our small group plans, members get access to: Discount programs on health-related products such as weight-loss programs and acupuncture. Payment towards a gym membership. Education and support in managing certain health conditions. ACCESS TO DOCTORS 24/7 THROUGH YOUR PHONE, COMPUTER, OR MOBILE DEVICE* With Telemedicine, members can get non-urgent medical care. It s convenient, immediate and available 24 hours a day, 365 days a year. Talk to doctors who practice primary care, family care, and more. Telemedicine doctors can even prescribe certain medicines.* Members can also talk to a registered dietician. Telemedicine is in-network care and there are no copays. Remember: Telemedicine does not replace the care of a regular doctor. IN THE NEIGHBORHOOD EmblemHealth Neighborhood Care provides in-person customer service, sales and health and wellness support at eight locations across New York City. From enrollment seminars to assistance with translating paperwork, Neighborhood Care helps EmblemHealth members make the most of their benefits. For more information on Neighborhood Care s programs and community partnerships, visit emblemhealth.com/community. KEEP EVERYONE SMILING Complete your benefit package with dental coverage. Each plan offers quality coverage with costs to fit your business needs. Pediatric Dental: Benefits are offered in all small group products. Adult Dental: Benefits are offered in EmblemHealth s Silver and Bronze Value plans as well as our Gold Open Access plan. EmblemHealth Preferred Dental: 100% coverage for all in-network preventive, basic, and major services. EmblemHealth s Preferred Network includes over 8,000 dentists and specialists in New York and New Jersey, plus access to a nationwide network. EmblemHealth Dental Access Program: 100% coverage for all preventive and diagnostic services when members visit a dentist in our network. The Dental Access Program also provides discounted fees on many complex and costly dental services. * Only applicable in US states where Telemedicine prescriptions are allowed. New York State permits Telemedicine prescriptions, but others may not. Members without computer access can take advantage of this benefit by using their phone or mobile device to speak with a doctor who is in network.

4 LET S BE CLEAR! Insurance speak can sometimes be a little confusing. Here are some words you ll see throughout this brochure: Copay The amount your pay for health services. Coverage The benefits and services available to you from your health insurance plan. Deductible The amount you pay each year before your plan starts to pay for health services. Coinsurance- The percentage you pay for health services after the deductible, when your insurance plan begins to pay. Network A group of health care professionals or facilities that contract with EmblemHealth. They provide covered products and services to members. You ll usually pay less when you use this network. Premium The amount you pay for insurance every month. Preventive services Routine health care services, like annual visits, shots, screenings, and tests. These services can prevent illnesses or find conditions before they become serious. BENEFITS HIGHLIGHTS Service HMO 40/60 (Gold) HMO 15/35 (Platinum) Gold Open Access Silver Value Bronze Value Bronze HSA Yearly Deductible (Individual/ Family) $250/$500 Pharmacy: $100/$200 $0 $700/$1,400 Pharmacy: $100/$200 $5,800/$11,600 $7,150/$14,300 $5,500/$11,000 Primary Care Visit (Individual/ Family) $40 copay $15 copay 3 free visits, after free visits $10 copay* 3 free visits, after free visits $35 copay* 2 free visits, after free visits 0% coinsurance 50% coinsurance Specialist Visit $60 copay $35 copay $50 copay $55 copay* 0% coinsurance 50% coinsurance Emergency Room Visit $200 copay $100 copay $150 copay $0 copay 0% coinsurance 50% coinsurance Urgent Care Visit $60 copay $55 copay $50 copay $75 copay* 0% coinsurance 50% coinsurance Pediatric Vision exams, lenses, frames $40, 10%, 10% $15, 10%, 10% $10, 10%, 10%* $0, 0%, 0%* 0% coinsurance* 50% coinsurance Generic prescription drugs $15 copay $10 copay $10 copay* $10 copay* $30 copay* 10 copay Prescription drugs: Mail Order (Generic, Preferred, Non-Preferred) $37.50, $87.50, $ copay $25, $75, $150 copay $25 copaygeneric*, $75, $175 copay 25 copaygeneric*, $0, $0 copay 75 copaygeneric*, $0, $0 copay $25, $87.50, $175 copay *These services are not subject to the deductible. This means that the amount you pay doesn t count toward meeting your deductible amount. An extended dependent coverage rider is available for purchase, extending the age limit to 29 for all eligible dependents. All prescription drug program options include voluntary home delivery, clinical prior authorization and specialty pharmacy programs. Certain services must be approved in advance by EmblemHealth. The benefits described here are only brief highlights of the covered services and benefits available. Some covered services and/or benefits may have ANNUAL DAY OR VISIT limits and/or maximums. The terms, limitations, conditions and exclusions of the insurance contract and certificate will govern.

5 Caring for Your Small Business To learn more about our small group plans, call us at Our hours are 8 a.m. to 8 p.m., Monday to Friday. A sales representative will be happy to help. You can also find more information at emblemhealth.com/smallgroupplans.

6 55 Water Street, New York, New York emblemhealth.com All plans are underwritten by HIP Health Plan of New York. Refer to the following HIP policy form numbers: EmblemHealth Silver Value NSSGOFFHIXSSchedule (04/17), et al.; EmblemHealth Bronze Value NSSGOFFHIXBSchedule(04/17), et al.; EmblemHealth HMO 40/60 (Gold) NSSGOFFHIXGSchedule (04/17), et al.; EmblemHealth Gold Open Access 155-OA-SGOFFHIXCERT(04/17), et al,; EmblemHealth Bronze HSA SGOFFHIXBHSASchedule (04/17), et al.; EmblemHealth HMO 15/35 (Platinum) SGOFFHIXPSchedule(04/17), et al. Group Health Incorporated (GHI), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies /17