SMALL BUSINESS HEALTH PLANS that live up to New York s tough standards. You want more: Plans. Access. Value.

Transcription

1 SMALL BUSINESS HEALTH PLANS that live up to New York s tough standards You want more: Plans. Access. Value.

2 Empire Advantages Empire has the largest networks in New York, which allows them to leverage their size to get deeper provider discounts and savings for you and your employees NETWORK DISCOUNTS LARGE NETWORKS + + GREAT SAVINGS = HIGH MEMBER SATISFACTION RATINGS 2

3 Three distinct network options Providing a great balance of choice, access and value Empire s strong networks have got you covered: PPO/EPO BLUE PRIORITY PATHWAY Comprehensive coverage 1 and a broad network within the Empire service area. 2 An EPO network with comprehensive coverage and access to in-network doctors. It s personalized care and strong benefits at a lower price. An EPO network with comprehensive coverage through Empire s 28-county service area. Members get lower or no copays. It s good care at a competitive cost. 1 Blue Cross and Blue Shield Association PPO/EPO network comparison data from websites of other national carriers as of Network data include the BlueCard program s extensive networks of doctors, hospitals and other providers that participate in independent Blue Cross and Blue Shield plans across the country. 2 Empire s 28-county service area: Albany, Bronx, Clinton, Columbia, Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery, Nassau, New York, Orange, Putnam, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Schoharie, Suffolk, Sullivan, Ulster, Warren, Washington and Westchester. 3

4 And a variety of plan options PPO A preferred provider organization gives members the most flexibility with both in-network and out-of-network coverage. EPO An exclusive provider organization covering in-network providers only. No referrals are needed to see a specialist. CDHP Consumer-driven health plans feature higher deductibles than traditional insurance plans. They can be paired with a health savings account allowing members to pay for qualified out-of-pocket medical expenses. CDHPs are available as an HMO, EPO or PPO. HSA HRA A health savings account is a member-owned savings account that you and your employees can fund with pre-tax dollars to help pay for qualified health care expenses, including prescriptions. A health savings account is a member-owned, employer-funded savings account that helps pay for employees costs when they need care. Employees decide how to pay for care either out of pocket or with their HRA debit card, plus they can earn rewards by taking certain steps to improve their health. And, for all plans, preventive care visits are covered 100% with in-network providers. 4

5 Medical plans at a glance 5

6 ONE Encompassing network With BlueCard, members benefit from a seamless, consistent experience no matter where they are. Coast-to-coast in-network access to 96% of U.S. hospitals and 93% of U.S. doctors Cost savings no-balance billing No claims forms The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies. The Association owns and manages the Blue Cross and Blue Shield trademarks and names in more than 170 countries and territories around the world. The Association grants licenses to independent companies to use the trademarks and names in exclusive geographic areas.

7 Enhanced Personal Health Care Personalized care, empowering doctors Empire is changing the way they work with doctors Paying doctors for value over volume when they improve patient health, meet quality standards and lower costs Giving doctors added support with the right tools and strategies to help strengthen the doctor-patient relationship so they can spend more time with patients and coordinate their care with other doctors Improving the patient experience with better access to a primary care physician (PCP) who cares for the whole person, becomes their health care champion and helps them navigate the health care system 7

8 Enhanced Personal Health Care Empire believes a strong patient-provider relationship is at the center of a high-performing health care system Members with a primary care physician are: 40% 33% 30% more likely to have had their cholesterol checked more likely to have been tested for diabetes more likely to have received a flu shot It all adds up to real results. DELIVERED. Anthem, Inc. composite states data, % decrease in E.R. visits 3.5% decrease in overall E.R. costs 7.8% fewer acute inpatient admissions 8

9 Empire Whole Health Connection Medical, pharmacy and specialty working together MEDICAL PHARMACY The most widely used benefit, even more than medical Medical DENTAL One of the nation s largest networks, great pricing, flexibility DISABILITY Superior service and personalized support, quick and accurate payments, enhanced clinical coordination LIFE Caring one-on-one support, reliable service, a full suite of valuable extras *Excludes Healthy New York Small Group plans Pharmacy Life and Disability Vision Dental VISION Market-changing integration, deep discounts, superior customer service Pediatric dental and vision benefits are included in all medical plans. Basic adult vision is also included in plans at no additional cost.* 9

10 Empire Whole Health Connection Connecting medical, pharmacy, dental, vision, life and disability data to total population health management MORE data, insights and member engagement opportunities BIGGER and more complete picture of a member s health VALUE-ADDED BENEFIT at no cost and with no vendor fees 41.6M annual average of care gaps closed with integrated pharmacy, specialty, wellness and medical 40% lower medical costs with integrated dental and medical 1 25% lower medical costs with integrated disability and medical 2 1 American Journal of Preventive Medicine's Impact of Periodontal Therapy on General Health Study, June Empire Productivity Solutions Quantifying Value Study,

11 Empire offers 2 Formularies and 1 best-in-class Pharmacy network Employees use their pharmacy benefit more frequently than any other health benefit. The average person: Fills 12 prescriptions per year Only goes to the doctor three times a year Empire s pharmacy benefits include: Traditional Open Drug List A broad, open drug list that includes most generic and brand-name drugs. Select Drug List Cost-effective prescription drugs that meet or exceed the Affordable Care Act (ACA) requirements. Home delivery pharmacy savings : NEW! Save on up to a 30-day supply through either a local or home delivery pharmacy. NEW! All plans with drug copays have a money-saving discount for 90-day supplies of maintenance drugs. When purchased through the home delivery pharmacy, a 90- day supply is just 2.5X the 30-day retail copay. Includes tier 2 and 3 drugs.

12 Strongest Rx in New York 9 of Empire s Top-32 most utilized drugs aren t covered under Oxford s formulary Drug Empire Oxford Traditional Traditional HARVONI HUMIRA PEN COPAXONE CRESTOR TRUVADA ENBREL NUTROPIN AQ NUSPIN ATRIPLA ORKAMBI Not covered REVLIMID TECFIDERA METFORMIN HCL ER JANUVIA ARIPIPRAZOLE ADVAIR DISKUS FOLLISTIM AQ Not covered VICTOZA 3-PAK SOVALDI GLUMETZA Not covered LANTUS SOLOSTAR GILENYA TAGRISSO Not covered BETASERON HUMATROPE Not covered STELARA GLEEVEC XALKORI Not covered TRIUMEQ AVONEX NEULASTA Not covered APOKYN Not covered AFINITOR Not covered

13 Vision plan A bottom line you can clearly read BLUE VIEW SM VISION Big discounts The industry s best discounts and incentives, including 35% 40% off extra glasses IN-NETWORK PROVIDERS Lots of doctors Over 37,000 doctors at more than 27,000 locations nationwide Less hassle Simplified administration from enrollment through claims processing 13

14 Empire s dental network Coverage from sea to shining sea. And then some. One of the largest in the nation with 124,000+ unique dentists (3,655 in New York) 33% average savings on covered services 370,000 access points (10,125 in New York) 14

15 Anthem Life Quality service from a caring staff providing support to employees and their families during times of need MEMBER ASSISTANCE PROGRAMS Resource Advisor offers emotional, legal and financial support, including grief counseling and identify-theft recovery Travel Assistance gives support for employees and their families if an emergency arises while they re more than 100 miles from home Beneficiary Companion program assists family members with death certificates, notifying third parties, creditors and more 15

16 Disability Back-to-work strategies that really work 35% of claims received before absence 36% of claims received before end of first week 21% of employees return to work early 9% lower disability costs SOURCE: Empire Life pilot results,

17 Voluntary portfolio For Dental, Vision, Life and Disability Voluntary plans offer groups a way to strengthen the value of their benefits plans and improve satisfaction, at no extra cost. LOW MINIMUM PARTICIPATION REQUIREMENTS Groups pick the plan designs. Employees choose the coverage at affordable group rates. Employees pay 100% of the costs. DENTAL 5 enrollees VISION 5 enrollees LIFE & DISABILITY 10 enrollees 17

18 Member resources

19 Empire delivers member solutions so that no one falls through the cracks CLINICAL PROGRAMS WELLNESS PROGRAMS ONLINE RESOURCES Medical management Health coaching/advocacy Disease management Behavioral health Maternity Gaps in care Lifestyle improvement programs Preventive alerts 24/7 NurseLine Health and wellness incentives Health assessment Discounts Provider cost/quality information Online wellness coaching Communication campaigns The Weight Center 19

20 Health and wellness incentives Simple health steps can lead to big rewards. Sometimes a little incentive is all we need to take that extra healthy step. And that s why we re offering employees and their spouse or partner financial incentives for taking simple steps to live well. Your employees can earn up to $700 per year 1 : Preventive wellness exam and flu shot Tobacco-free certification $100 Employees must complete both the wellness exam ($50) and the flu shot ($50) to receive the $100 reward. Activities can be completed in any order. Once the second of the two activities is complete, two separate rewards will be given. $50 Employees complete the online tobacco-free certification after they register and log in at empireblue.com. Online wellness toolkit Gym reimbursement Up to $150 Up to $400 Employees earn rewards by using online wellness tools that help them achieve nutrition, exercise, stress and other personal health goals. Employees who meet reimbursement qualifications (complete 50 visits every six months within the benefit plan year) can earn up to $200 every six months. Employees covered spouses or partners can earn $100 every six months. Employees and their covered spouses or partners must be 18 or older to earn rewards. 1 Employees can earn up to $700 per year. Employees covered spouses or partners can earn up to $500 per year. Up to $1,200 annual benefit per family. 20

21 This is the definition of increased access. LiveHealth Online Members can easily and conveniently connect to a board-certified doctor any time, anywhere. 92% reasonable wait time 89% easy to use 89% doctors were professional and helpful 92% given enough time for visit $201 Per-episode savings 2 ER 6.35X Higher cost than LHO DOCTOR S OFFICE 1.6X Higher cost than LHO 1 LiveHealth Online Consumer Post-Visit Survey Results 2 Results based on internal LIveHealth Online study during 2014 and Q1 of 2015 for the most common conditions URGENT CARE 1.45X Higher cost than LHO RETAIL HEALTH 1.14X Higher cost than LHO 21

22 empireblue.com No hassle. No jargon. Just super-useful information. Personalized member website experience 22

23 Download the Empire app You re on the go and so are we! Find a doctor Search for a doctor, specialist, urgent care or hospital close by. Get your ID card Share, fax, or your ID card right from your smartphone. Check your claims Find out what your doctor billed, how much was paid and if you owe anything. Estimate your costs See what nearby doctors and facilities charge for a procedure. You can compare providers on cost and quality. View your medical benefits See your copays, deductibles, your percentage of the costs, and other important plan benefit information. Manage prescription benefits Check the cost of drugs, find a participating pharmacy, get refills, check order status, or switch to our home delivery program. Access your mobile Health Record View your Health Record and share with your doctors whenever you go. Empire Anywhere Download the Empire Anywhere app today! 23 23

24 Exceptional service Through strong customer service and innovative tools, Empire helps employers and their employees get the most from their plan and focus on what s important keeping people healthy while reducing costs. 91.5% CUSTOMER SATISFACTION RATING 1 and near-perfect record for claims processing speed and accuracy. 2 Our Results % 2 CLAIMS Claims Timeliness in 30 Days Claims Processing Accuracy Claims Financial Accuracy Total Claims TOTAL , Member Satisfaction survey performed by Convergys , Empire internal data.

25 YOU DEMAND MORE. EMPIRE DELIVERS. 25