for Employer Groups 2018

Transcription

1 for Employer Groups 2018 LIVE LIFE ASSURED 1

2 Excellent coverage with Mayo Clinic care. That s the Health Tradition difference. A powerful partnership creates a valuable benefit for your workforce We understand the value of health care benefits Health benefits are a key factor in attracting and retaining your employees. With Health Tradition, you re not only offering great coverage, you re providing access to worldclass care from Mayo Clinic Health System. Mayo Clinic-owned and physician-led Health and well-being has always been our priority, and it s something we understand like few other health plan providers. As part of the Mayo Clinic family, Health Tradition is committed to quality and dedicated to meeting the needs of those who put their trust in us. The greatest benefit is staying well The value of can t be overstated. It helps contain costs, but more importantly it helps keep your employees healthy. We collaborate with providers at Mayo Clinic Health System to provide medical, referral, condition and case management, concurrent review and discharge planning to optimize outcomes. More choices ensure the right fit One size never fits all. That s why we have 32 options that include HMOs, PPOS and consumer-directed qualified highdeductible plans that can be paired with tax-advantaged accounts and pharmacy benefit management. These proven Mayo Clinic programs are included in all group plans Wellness feels good. It s also part of the value equation. Wellness at Work» Quarterly wellness challenge kits» Easy to implement» Reinforces healthy habits» Boosts office morale Mayo Clinic 24/7 Nurse Line» Expert advice anytime day or night» Helps members make informed decisions to get appropriate care Eat Well Move More rebate» Up to $200 per member household» Rewards healthy choices, including fitness club memberships, Community Supported Agriculture, Weight Watchers dues, A New Me and Camp Wabi Consumer education resources» Award-winning health education and web-based resources» Members become informed health care consumers Our operational standards are developed to meet or exceed Healthcare Effectiveness Data and Information Set (HEDIS) benchmarks, National Committee for Quality Assurance (NCQA) and URAC accreditation standards. URAC accredited, Health Plan and Health Plan for Health Insurance Exchange (HIX) 2

3 It s personal. The relationship at the center of excellent care Health Tradition members choose a primary care provider (PCP) to lead their health care team. It can be a physician, nurse practitioner or physician assistant who will take the time to get to know the member and their families, including health history, preferences, goals and challenges. This relationship is key to building trust and providing continuity. Convenient access Health Tradition s provider network gives members access to the care they need close to home. Providers in small communities and large in western Wisconsin, southeastern Minnesota and northeastern Iowa that are part of the Mayo Clinic Health System deliver a high standard of care and can provide referrals to specialists, the Mayo Clinic in Rochester or even an out-of-network provider when medically indicated. Through managed, medically indicated referrals, each member s care team works closely with Health Tradition to ensure appropriate and effective care. Talk with a Health Tradition broker or call us We ll help you design a costeffective plan that your group will value and appreciate or You can also locate a broker in your community at HealthTradition.com World-class care Collaboration. It s a pillar of the Mayo Clinic model of care, exemplified by the high level of integration between the specialty practices of Mayo Clinic, Rochester and Mayo Clinic Health System. Telemedicine, specialty outreach, residency programs and other initiatives bring remarkable expertise into even the smallest communities. New options fill a need Mayo Clinic Express Care online: Not every health concern requires an office visit. In fact, there are many conditions that can be addressed by communicating with a provider online. With Mayo Clinic Express Care Online, employees can get answers and get on with their lives within an hour for just $49 and they don t have to leave work or home. It s available every day of the year between 8 am and 7 pm. For employees and their families, Express Care Online provides a convenient and inexpensive way to address common ailments, with a minimal time commitment. The Belle Square clinic Conveniently located in downtown La Crosse, Mayo Clinic Health System - Franciscan Healthcare clinic at Belle Square provides a wide range of services usually found in larger facilities. Employees don t have to take half a day off to treat an illness or injury, get a lab test or receive counseling. Walk-in and same-day appointments are available. See back cover for a map of the Health Tradition provider network. 3

4 Standard HMO Small Group Plans Covered Services Platinum /80 w/copay 1500/ / /70 w/copay 2000/ /80 w/copay Annual Deductible Indiv/Family $1,000/ $2,000 $1,000/ $2,000 $1,500/ $3,000 $2,000/ $4,000 $1,500/ $3,000 $2,000/ $4,000 $2,500/ $5,000 Annual Out-of-Pocket Maximum Indiv/Family $1,900/ $3,800 $4,000/ $8,000 $3,000/ $6,000 $3,500/ $7,000 $6,500/ $13,000 Preventive Care* 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage Routine Eye Exam One per member per coverage year. Limits apply. Routine Hearing Exam Annual. Limits apply. After meeting the deductible, member pays (copays do not apply to deductible) Office Visits $50 primary/ $75 specialist $50 primary/ $75 specialist 2 1 $75 primary/ $125 specialist 3 $75 primary/ $125 specialist Chiropractic $50 copay $50 copay 2 1 $75 copay 3 $75 copay Urgent Care** $50 copay $50 copay 2 1 $75 copay 3 $75 copay Emergency Room Services ** and 2 and 2 and 1 and 3 and 3 $250 copay and 2 Ambulance Hospitalization Inpatient/outpatient Outpatient Lab/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 $50 copay $50 copay 2 1 $75 copay 3 $75 copay Prescription Drugs Health Tradition Formulary G=Generic B=Brand N=Non-formulary S=Specialty $25 G $60 B $80 N $70 B $150 N $70 B * This Benefit Plan provides 10 coverage 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

5 HMO Qualified High-Deductible Plans Compatible with Health Savings Accounts 6500/60 NEW! 7350/100 HDHP 100 HDHP 90 HDHP 100 HDHP 50 HDHP 60 HDHP 80 $6,500/ $13,000 $2,800/ $5,600 $3,500/ $7,000 $4,500/ $9,000 $6,000/ $12,000 $2,800/ $5, coverage 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage After meeting the deductible, member pays (copays do not apply to deductible) In addition to meeting the deductible, member pays $75 B $150 N 1 G 1 B 3 N 1 S 5 4 G 4 B 6 N 2 G 2 B 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. 5

6 Standard Point of Service Small Group Plans There is coverage for both in-network and out-of-network provider services. Please see plan documents for out-of-network coverage. Covered Services Platinum 1000 POS 1000/80 w/copay POS 1500/80 POS 2000/90 POS 1500/70 w/copay POS 2000/70 POS 2500/80 w/copay POS Annual Deductible Indiv/Family $1,000/ $2,000 $1,000/ $2,000 $1,500/ $3,000 $2,000/ $4,000 $1,500/ $3,000 $2,000/ $4,000 $2,500/ $5,000 Annual Out-of-Pocket Maximum Indiv/Family $1,900/ $3,800 $4,000/ $8,000 $3,000/ $6,000 $3,500/ $7,000 $6,500/ $13,000 Preventive Care* 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage Routine Eye Exam One per member per coverage year. Limits apply. Routine Hearing Exam Annual. Limits apply. After meeting the deductible, member pays (copays do not apply to deductible) Office Visits $50 primary/ $75 specialist $50 primary/ $75 specialist 2 1 $75 primary/ $125 specialist 3 $75 primary/ $125 specialist Chiropractic $50 copay $50 copay 2 1 $75 copay 3 $75 copay Urgent Care** $50 copay $50 copay 2 1 $75 copay 3 $75 copay Emergency Room Services ** and 2 and 2 and 1 and 3 and 3 $250 copay and 2 Ambulance Hospitalization Inpatient/outpatient Outpatient Lab/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 $50 copay $50 copay 2 1 $75 copay 3 $75 copay Prescription Drugs Health Tradition Formulary G=Generic B=Brand N=Non-formulary S=Specialty $25 G $60 B $80 N $70 B $150 N $70 B * This Benefit Plan provides 10 coverage 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. 6

7 Point of Service High-Deductible Plans Compatible with Health Savings Accounts 6500/60 POS 7350/100 POS NEW! HDHP 100 HDHP 90 POS HDHP 100 POS HDHP 50 POS HDHP 60 POS HDHP 80 POS $6,500/ $13,000 $2,800/ $5,600 $3,500/ $7,000 $4,500/ $9,000 $6,000/ $12,000 $2,800/ $5, coverage 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage 10 coverage After meeting the deductible, member pays (copays do not apply to deductible) In addition to meeting the deductible, member pays $75 B $150 N 1 G 1 B 3 N 1 S 5 4 G 4 B 6 N 2 G 2 B 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. 7

8 Mayo Clinic Health System primary and specialty care Community-based provider network The provider network includes leading clinics and hospitals across western Wisconsin, northeastern Iowa and southeastern Minnesota. Primary care providers may refer patients to a Mayo Clinic specialist practicing locally or, when medically indicated, to Mayo Clinic in Rochester or another out-of-network provider. Eau Claire Service area Hospital/Clinic Site Clinic Site Specialty Referral Center Service Area Communities listed in bold type indicate a Mayo Clinic Health System site La Crosse Rochester More than 70 locations HealthTradition.com 1808 East Main Street, Onalaska, Wisconsin Health Tradition Health Plan. HTHP-V625 (10/17) 8