Welcome to Starmark. Group Installation. for Employers with a PPO Plan Design

Transcription

1 Welcome to Starmark Group Installation for Employers with a PPO Plan Design

2 Why Starmark /Trustmark? Starmark A Trustmark company founded in 1985 Provides self-funded healthcare benefits administration for small to mid-size businesses Stop-loss insurance is provided by Trustmark Life Insurance Company Trustmark Companies Providing employee benefits for more than 100 years More than 2 million covered lives or plan participants Trustmark Life Insurance Company is rated A- (Excellent) by A.M. Best 2

3 Starmark : Personal. Flexible. Trusted. Experience Starmark s unparalleled personal service. Starmark offers flexible self-funded health plan designs to meet your needs and budget. Employers have trusted Starmark to serve the healthcare benefit needs of their employees since

4 PPO Plan Design Overview Preferred provider organization Network of doctors, hospitals and healthcare providers Discounted services when using innetwork providers Out-of-network providers usually charge a higher amount for the same services Plus, pair a higher-deductible selffunded health plan with the Starmark HRA (health reimbursement arrangement) for lower health plan costs and cash-flow control 4

5 HRA Overview The Starmark HRA is available only if selected by the employer. A health reimbursement arrangement, or HRA, is set up and funded by you to help your employees pay for expenses eligible for reimbursement, meet their deductible and/or coinsurance and get them more engaged in their healthcare decisions. 5

6 Key Features of the Starmark Website For Employers provides easy, online access to key information about your self-funded health plan and administration, including: Manage My Group A summary of your benefits The Document Center Online Bill Payment A personalized Administration Kit Healthcare Reform information Pharmacy Services 6

7 Key Features of the Starmark Website For Members The Starmark website provides: My Starmark Cost-savings tips and educational information tailored to their health benefit plan Benefits and Claims information An online summary of benefits Current- and prior-year claims View or print their Starmark ID Card* The Document Center Important healthcare benefit documents online A comprehensive suite of health and wellness management services * ID cards are available approximately 48 business hours after the group has enrolled. 7

8 How to Register on the Starmark Website For Employers New users: Go to select Employer from the drop-down menu and complete the online registration process. When registering, you ll need to: Enter your Group Number, month of original effective date and ZIP code Read and accept the Terms And Conditions Complete the registration form Provide answers to three security questions Click the link provided in the you will receive 8

9 How to Register on the Starmark Website For Members Members can register following the instructions provided on the website registration flyer available on the login screen at GO GREEN! Members can opt-in to the Starmark Document Center to access their important healthcare benefit plan documents online. 9

10 Manage My Group Log in to the Starmark website > Administration > Manage My Group to securely administer your health benefit plan: Add coverage for an employee s newborn dependent Waive coverage for an employee or dependent Order replacement ID Cards Enroll a new employee Update your business or mailing address Update an employee s or mailing address Remove coverage for a terminated employee Add or update Social Security numbers for employee dependents 10

11 Document Center For Employers The Document Center provides around-the-clock access to your group s important health benefit plan documents, including your: Plan Document Stop-Loss Insurance Contract Administrative Services Agreement Application for Stop-Loss Insurance Coverage Monthly Billing Statement Monthly Aggregate Claim Liability Summaries 11

12 Document Center For Members The Document Center* provides members with around-the-clock access to key healthcare benefit plan documents, including their: Plan Document, which provides the details of their plan Summary of Benefits and Coverage (SBC), which provides an overview of their plan *Available only to members with a Starmark self-funded health plan design. 12

13 Accessing Benefits and Claims From the Benefits and Claims page on the Starmark website, members can: Conveniently review an online summary of their benefits Obtain their current- and prior-year claims Access resources, including: Their Starmark ID Card Informative materials to assist with understanding their ID card and explanation of benefits (EOBs) Their CVS/caremark TM account via single sign-on Educational materials to help them learn about their pharmacy benefits 13

14 Claims Lookup From the Claims Lookup section, members can access current- and prior-year claims, detailed by: Deductible Satisfied Out-of-Pocket Satisfied To view the status of a claim and an online Explanation of Benefits, users should click on the participant s name. 14

15 How to File a Medical Claim Provider Claim Filing In-network providers will file claims electronically. Be sure the provider submits claims to the address on the Starmark ID card to avoid delays in claim processing. Member Claim Filing When needed, members can submit a paper claim by following the steps outlined in the flyer, Filing a Medical Claim, available on the Starmark website. 15

16 Healthy Foundations Healthy Foundations is a suite of resources to help members get and stay healthy: YourCare*: Health and wellness outreach program MyNurse 24/7 : Access to a registered nurse 24 hours a day, seven days a week MaternaLink : Maternity wellness program HealthCenter**: Online health risk assessment, personal health records and more Wellness Education E-Newsletter: Provides wellness information, such as diet and nutrition tips, health and exercise articles, home safety tips and more * Available if selected by the employer. ** Members can access the HealthCenter via the Starmark website. 16

17 CareChampion 24/7 Navigate the healthcare system Educate about healthcare options Support and advisory services CareChampion 24/7 is available if selected by the employer. 17

18 Network Provider Lookup Visit Go to Network Availability > select your state Choose the network listed on your benefits schedule to access their website Follow the instructions to determine if a provider is in the network 18

19 Outpatient Prescription Drug Benefit Administered by CVS/caremark TM Outpatient Prescription Drug Benefit Choices: Prescription Drug Card: Covered prescriptions are subject to the prescription deductible, coinsurance and copays selected, when the prescription is filled at a participating pharmacy. -or- Price Assurance Program: Covered prescriptions are subject to the in-network plan deductible and coinsurance when the prescription is filled at a participating pharmacy. Two convenient ways to fill prescriptions: Local pharmacy Mail service pharmacy Prescription safeguards Specialty Guideline Management 19

20 Caremark.com Members can: Find health information Find a participating local pharmacy Order refills Access to Tools and Resources View prescription history Check pharmacy benefit coverage Check drug costs Log in from the Starmark website to access the single sign-on link to caremark.com for personalized plan information. Communicate with CVS/caremark TM based on personal preferences: phone, or text. Download the CVS/caremark mobile app 20

21 Contact Us Account Management and New Plan Years Phone: , ext Fax: Administration and Premium Phone: , ext Fax: For more information, contact your Starmark representative, or visit Plan design availability and/or coverage may vary by state. Plans are administered by Starmark, and stop-loss insurance and ancillary coverage are provided by Trustmark Life Insurance Company. Starmark 400 Field Drive Lake Forest, Illinois 21 T er-PPO ( )