for Individuals and Families 2017

Transcription

1 for Individuals and Families 2017 LIVE LIFE ASSURED

2 A great health plan that s all yours The plans in this brochure are for people who aren t on an employer plan, covered by a parent s policy, are self-employed or just want a reliable plan they can keep no matter where they work. We offer many affordable choices and the peace of mind that comes with convenient access to Mayo Clinic care. How to choose your health plan Start with the care you expect to use and the expenses you want the plan to cover if the unexpected happens. Choose from two types of plans:» Standard HMO plans These include a choice of deductible, copayment and coinsurance options. For plans with an office visit copay, the copay applies whether or not deductible has been met. Copays count toward maximum out-of-pocket.» HMO qualified high-deductible plans These plans have lower premiums than standard HMO plans. However, deductibles are higher, so they are usually paired with a health savings account (HSA) to pay for qualified out-of-pocket medical costs such as a deductible or copayment. The money you contribute to your HSA is pretax, so your health care dollars go further. Another Health Tradition innovation The 4000 plan has a drug deductible that works like a medical deductible. Once it, your covered prescriptions require only a copay. Get help, at no charge Go to HealthTradition.com to find a licensed insurance agent in your community to help you find the right plan. A family with children may have different needs from a young, single person with no health issues. Reducing your cost You may qualify for a cost reduction based on annual income and family size. There are two ways to reduce cost:» A tax credit that reduces your monthly premium Most people qualify. One of our agents can get you qualified and enrolled in one step, or you can do it on your own at HealthCare.gov.» Reduced payment when you receive care Some people qualify for a special Reduced Cost Sharing plan. Ask an agent or call us to see these plans, or apply at HealthCare.gov. URAC accredited, Health Plan and Health Plan for Health Insurance Exchange (HIX) The Summary of Benefits and Coverage for each plan is available at HealthTradition.com. It describes benefits in greater detail. Complete benefits are contained in the Certificate of Coverage, the official plan document. If there are any inconsistencies between this brochure and the Certificate of Coverage, the Certificate of Coverage will govern. Go to HealthTradition.com to» Get the Summary of Benefits and Coverage (SBC) for plan details (each plan has its own)» See which prescription drugs are covered» Choose the provider you want to lead your care team» Learn about copays, coinsurance and deductibles Now enroll in your new plan! Go to HealthTradition.com/enroll Compare plans and monthly premiums and enroll in one visit. If you qualify for reduced cost, an agent can help you claim it. Get help from an agent A list of local insurance agencies is at HealthTradition.com, or contact us for a referral. Go to HealthCare.gov You can enroll yourself in a Health Tradition plan in the Health Insurance Marketplace. Call for enrollment support. Call us directly We re here to answer any questions and connect you with an agent to help you enroll (toll-free)

3 Standard HMO Plans Covered Services Gold 1000/80 Gold 2000/80 w/copay 2500/ /70 w/copay /80 w/copay 6000/80 Annual Deductible Indiv/Family $1,000/ $2,000 $2,000/ $4,000 $2,500/ $5,000 $3,000/ $6,000 $4,000/ $8,000 $4,000/ $8,000 $6,000/ $12,000 Annual Out-of-Pocket Maximum Indiv/Family $4,750/ $9,500 $3,750/ $7,500 $5,000/ $10,000 $5,400/ $10,800 $5,000/ $10,000 $6,500/ $13,000 $6,850/ $13,700 Preventive Care* Routine Eye Exam One per member per year. Limits apply. Routine Hearing Exam One per member per year. Limits apply. Lifetime Maximum Unlimited After meeting your deductible, you pay (copays do not apply to deductible) Office Visits 2 $30 primary/ $60 specialist 2 $75 primary/ $125 specialist $50 primary/ $100 specialist $30 primary/ $60 specialist 2 Chiropractic Services 2 $30 copay 2 $75 copay $50 copay $30 copay 2 Urgent Care** 2 $30 copay 2 $75 copay $50 copay $30 copay 2 Emergency Room Services** Ambulance Hospitalization Inpatient and outpatient Outpatient Diagnostic Lab and Radiology Durable Medical Equipment Skilled Nursing Facilities With prior authorization Home Health Care Rehabilitation Services Prenatal/Postnatal Care Delivery and All Inpatient Services Mental/Behavioral Health, Outpatient Mental/Behavioral Health, Inpatient 2 $30 copay 2 $75 copay $50 copay $30 copay 2 Prescription Drugs Health Tradition Formulary G=Generic B=Brand N=Non-formulary S=Specialty $40 B $75 N 2 S $40 B $75 N 2 S $70 B $150 N $10 G $50 B $145 N After $250 drug deductible $20 G $40 B $60 N $80 S $70 B $155 N $30 G $100 B $150 N * This Benefit Plan provides for preventive health services. Coverage may be subject to reasonable medical management techniques to determine the frequency, method, treatment, or setting for receipt of preventive health services and as defined in Section 1001 of the Patient Protection and Affordable Care Act, with no cost sharing. ** Out-of-network medical emergencies, urgent care and plan prior-approved referrals are covered as in-network benefit. See Certificate of Coverage for plan detail.

4 With 3 no-cost primary care office visits HMO Qualified High-Deductible Plans 7150/ /100 Rx Essential HDHP 85 HDHP 100 HDHP 50 HDHP 100 $3,000/ $6,000 $4,400/ $8,800 $4,500/ $9,000 $6,550/ $13,100 $5,000/ $10,000 $4,400/ $8,800 $6,550/ $13,100 $6,550/ $13,100 Unlimited After meeting your deductible, you pay (copays do not apply to deductible) Unlimited In addition to meeting your deductible, you pay is met $30 G $100 B $150 N 1 G 2 B 5 N 5 Once a member of a family plan meets the individual deductible or maximum out-of-pocket, Health Tradition begins paying for covered services for that person, regardless of whether the family deductible or out-of-pocket maximum has been met. Catastrophic plans are available only to people under 30 and to some with low incomes. Not HSA compatible.

5 Affordable health plans from Health Tradition and Mayo Clinic Health System, so you can live life assured Included in all plans Mayo Clinic care A relationship with the doctor who knows you best With Health Tradition, you ll choose a Mayo Clinic Health System primary care provider (PCP) in your community to lead your care team. This provider will get to know you, your medical history, preferences, challenges and goals. Through Patient Online Services, you can your doctor, see test results and make appointments. Choose your PCP at HealthTradition.com/fi ndadoc Local customer service Health Tradition is there for you when it counts We are a local, physician-led organization owned by Mayo Clinic, one of the most respected names in health care. We re helpful people right here in western Wisconsin who can answer your questions. Information to step you through using your new benefi ts is at HealthTradition.com. Our award-winning website and online resources begin with a new member checklist so busy people like you can take care of things quickly. Family-friendly embedded deductibles Because not everyone needs the same level of care If someone on a family plan meets their individual deductible (or outof-pocket maximum), the plan starts paying for covered services for that person even if the family deductible (or out-of-pocket maximum) hasn t been met. These provisions provide extra protection for families in which one person requires quite a bit more care than others in the family. Preventive care benefits covered, with no copay and no deductible» Annual preventive physical exam» Annual hearing exam» Annual eye exam, with no copay or deductible» Immunizations» Other recommended preventive screenings by age and gender, such as screenings for depression, high blood pressure and high cholesterol, mammograms and tests for colorectal cancer Wellness benefits Supporting your health Mayo Clinic Tobacco Quitline This is the national model program that combines counseling with nicotine replacement therapies, available to you with no out-of-pocket cost. Mayo Clinic 24/7 Nurse Line An experienced RN is always available for reliable answers when you have questions about symptoms or care, even in the middle of the night. Make smarter health care decisions An information-packed member website helps you get the most for your health care dollars.

6 Excellent, compassionate care by Mayo Clinic Health System physicians in your own community Your Mayo Clinic Health System care team works closely with Health Tradition to ensure you receive the most appropriate care at the appropriate facility. Eau Claire When you need a specialist, your primary care provider may refer you to a Mayo Clinic specialist practicing locally, or you may be referred to Mayo Clinic in Rochester or another outof-network provider when medically indicated. These referrals require written plan approval before services are received. Health Tradition will keep you informed, by letter, of out-ofnetwork services being considered and those that are approved. La Crosse A large provider network Health Tradition Health Plan insures people all over western Wisconsin. Members know they have simple access to excellent care, and that s there when they need it. Use the provider search at HealthTradition.com/fi ndadoc to choose a primary care provider in your community. Rochester Hospital/Clinic Site Clinic Site Specialty Referral Center More than 70 locations Service Area Communities listed in bold type indicate a Mayo Clinic Health System site Get covered. Enroll today! To learn more or to enroll, contact us at or East Main Street, Onalaska, Wisconsin Health Tradition Health Plan. HTHP-V624 (10/16)