Nation s Best Individual and Family Customer Guide

Transcription

1 One of the Nation s Best health plans* 2017 Individual and Family Customer Guide

2 High-quality coverage at an affordable price What do you expect from high quality health coverage? You want to be confident you made the right choice for yourself and your family. You want to know you didn t spend too much. Moreover, you want to have the confidence that your coverage will come through for you when you need it not cutting corners or pinching you on what s covered. With Security Health Plan, you get what you expect. From easy-to-understand benefit statements, to accurate and on-time claims payments, to friendly and knowledgeable customer service, you will be glad you selected Security Health Plan. As a member you ll have access to My Security Health Plan, our member-only portal where you ll be able to review claims, arrange payments, take your health assessment and more. We re Security Health Plan. Wisconsin is our home and your home. When we say high-quality coverage, affordable prices, we mean it. Promises kept, plain and simple How do I get started? Whether you call, click or visit, you ll be able to easily compare plans and apply for Security Health Plan coverage. Call: Click: Visit: Our Sales Department at We help you over the phone or arrange a meeting with a Benefit Specialist. Go online to You also can request a quote by at shp.new.quotes@securityhealth.org One of our 13 conveniently located Answer Centers, stop by our main office at 1515 North Saint Joseph Avenue in Marshfield, or see your local independent insurance agent. Generally, to qualify for enrollment with Security Health Plan, an individual must reside in our service area and be a U.S. citizen or a resident legal alien.

3 What types of coverage does Security Health Plan offer? Security Health Plan offers individual and family coverage through two base plans with multiple options Security Health Plan Select and Security Health Plan Classic. Both base plans are available through the Health Insurance Marketplace as well as on the open market. Security Health Plan Select: If you re looking for great coverage at a lower price, our Select options are for you. You can save money and get the same covered services as our Classic plan. Select is available throughout our service area, with the exception of Waushara and Monroe counties. With Select, you ll be able to choose from a special set of high quality providers, including: Marshfield Clinic Essentia Health Ministry Providers and Facilities Sacred Heart Hospital, Eau Claire Bayfield Douglas Iron Ashland Vilas Burnett Washburn Sawyer Florence Price Oneida Forest Marinette Rusk Polk Barron Lincoln Langlade Taylor Chippewa St Croix Menomimee Oconto Dunn Marathon Shawano Door Pierce Eau Claire Clark Pepin Kewaunee Portage Wood Waupaca Outagamie Brown Buffalo Trempealeau Jackson Manitowoc Winnebago Waushara Calumet Adams La Crosse Monroe Juneau Marquette Green Lake Fond Du Lac Sheboygan Security Health Plan Main Office Marshfield Vernon Columbia Ozaukee Dodge Sauk Richland Washington Crawford Milwaukee Dane Waukesha Iowa Jefferson Grant Racine Green Rock Walworth Lafayette Kenosha Douglas Bayfield 2017 Individual and Family plans Select service area Classic service area Ashland Iron Vilas Burnett Washburn Sawyer Florence Security Health Plan Classic: With a larger choice of providers, Classic could be the right coverage choice for you. With Classic, you ll have access to more than 5,000 doctors and other health care specialists, including: Marshfield Clinic Ministry Providers and Facilities Aspirus Sacred Heart Hospital, Black River Falls Medical Center Eau Claire Essentia Health Saint Joseph Hospital, Krohn Clinic, Black River Falls Chippewa Falls Memorial Medical Center Hospital and Allied Health Chiropractic and Clinics of Greenwood, Loyal and Neillsville many pharmacies Price Oneida Forest Marinette Rusk Polk Barron Lincoln Langlade Taylor Chippewa St Croix Menomimee Oconto Dunn Marathon Shawano Door Pierce Eau Claire Clark Pepin Kewaunee Portage Wood Waupaca Outagamie Brown Buffalo Trempealeau Jackson Manitowoc Winnebago Waushara Calumet Adams La Crosse Monroe Juneau Marquette Green Lake Fond Du Lac Sheboygan Security Health Plan Main Office Marshfield Vernon Columbia Ozaukee Dodge Sauk Richland Washington Crawford Milwaukee Dane Waukesha Iowa Jefferson Grant Racine Green Rock Walworth Lafayette Kenosha Key preventive benefits Whether you choose Select or Classic, you will appreciate these preventive benefits that are offered at no additional cost: Screening: Blood Pressure Cholesterol Hepatitis B & C HIV Immunization Vaccines Services for pregnant women & well-woman visits Children s screening & services: Cancer: Breast, Cervical, Colorectal, Lung Depression Diabetes (Type 2) Lung Cancer Obesity Osteoporosis Autism Developmental Hearing Lead Vision Fluoride supplements Iron supplements

4 How do I know what s best for me? You can compare plans and apply online at We ve included a plan-by-plan comparison in this guide that will allow you to compare benefits easily. A more detailed listing of each plan and benefits can be found online. How does a health savings account (HSA) work? Some of our high-deductible plans can be matched with a health savings account that allows you to set aside pre-tax dollars you can use to pay deductibles and non-covered medical expenses. You pay no taxes on the money you set aside in the HSA, nor when you withdraw the money for eligible expenses. If you choose one of these HSA plans, you ll be eligible to open a health savings account through your bank. Any money left in the account at the end of the year remains in your HSA for the next year. Can I choose my own doctor? Yes, you may use any doctor or other health care professional in the provider network associated with your plan option. One of the ways the Security Health Plan helps keeps your premiums down is by negotiating lower rates with providers. So please keep in mind, you need to see a provider in your plan s network to receive coverage. You will have a choice of the high quality providers, whether you choose the smaller set of providers offered through our Select option, or the broader network of providers in our Classic coverage. You can find a list of network providers at: What about emergency or urgent care? You have worldwide coverage for emergency and urgent care regardless of your network. If you receive emergency or urgent care from a nonaffiliated provider, call Security Health Plan as soon as possible after your care is complete. What about dental coverage for children? This policy does not include pediatric dental service as required under the Federal Patient and Protection and Affordable Care Act. The coverage is available in the insurance market and can be purchased as a stand-alone product. Please contact your insurance carrier, agent or the Health Insurance Marketplace if you wish to purchase pediatric dental coverage. What about purchasing on the Health Insurance Marketplace? You can find Security Health Plan Select and Classic at healthcare.gov. Answer a few simple questions about your address and income and you ll see the plans available to you. You ll also be able to find out if you qualify for tax credits and cost-sharing reductions. Can I get financial assistance? More than 90 percent of people who purchased Security Health Plan coverage through the Health Insurance Marketplace received some tax subsidy. And 60 percent of those people received some other cost sharing. Through securityhealth.org/myplans you can discover whether you qualify for a subsidy that can lower your monthly health insurance premium and help pay for the services you use. Call our sales professionals at to discuss subsidy and coverage options. How will billing work? We offer many convenient ways you can pay your premium. We ll send you a bill with the amount of your monthly premium. You can write a check to Security Health Plan or can easily arrange for your monthly premium to be paid directly from your bank account. NEW for 2017: Security Health Plan members can now pay their monthly premium with their debit or credit card. What about coverage for my family? One reason we offer many options for our Select and Classic plans is that we know every family is unique, with its own medical and financial needs. We have maternity benefits for those who are pregnant to reduce the risk of complicated births. And our well-child program helps ensure that youngsters get the appropriate care they need as they grow.

5 Prescription drug benefits that fit your needs Security Health Plan can help you save money on your prescription drugs. Regardless of which Security Health Plan option you choose, your prescription drug coverage includes: Coverage for certain mental health and alcohol and drug abuse medications Coverage for certain prescribed over-the-counter drugs Coverage for Food and Drug Administration-approved tobacco-cessation medications Thousands of network pharmacies nationwide Discounts on any prescription drugs not covered by your plan through the Security Value Pharmacy Program Security Health Plan can help you save money on your prescription drugs. Our team of physicians and pharmacists reviews information on new and existing drugs to regularly update Security Health Plan s list of covered drugs that are safe and effective. Our goal is to ensure you have access to high-quality, cost-effective prescriptions. For Select members we have changed the pharmacy network to keep out-of-pocket cost for your health care as low as possible. Beginning January 1, 2017, some pharmacies that were previously in-network will now be out-of-network pharmacies. You can find Security Health Plan-affiliated pharmacies through our Pharmacy locator at You may also call our Pharmacy Department for a list of affiliated pharmacies Notice of Nondiscrimination and Limited English Proficiency Services Security Health Plan of Wisconsin, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Security Health Plan of Wisconsin, Inc., does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Security Health Plan of Wisconsin, Inc.: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact Customer Service at If you believe that Security Health Plan of Wisconsin, Inc., has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Security Health Plan Member Advocate, 1515 N Saint Joseph Ave, Marshfield, WI , Phone: , TTY: 711, Fax: , or shp.quality.dept@securityhealth.org. You can file a grievance in person or by mail, fax, or . If you need help filing a grievance, Security Health Plan s Member Advocate is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, , (TDD). Complaint forms are available at ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau (TTY: 711).

6 High quality. We ll prove it. We don t usually like to boast, but we are proud of how well we take care of our members. Security Health Plan has consistently earned Excellent Accreditation status and has been rated as one of the top health plans in Wisconsin and in the nation by the National Committee for Quality Assurance.* This apples-to-apples comparison of the nation s health insurance plans is based on scores of specific quality measures, including member satisfaction ratings. It is proof that we are not your average insurance company. Independent studies show that Security Health Plan members generally + : Have fewer unnecessary hospitalizations Pay fewer unnecessary health care costs Find it easier to get tests and treatments they need Have fewer hassles with claims Are more satisfied with their health plan **

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8 1515 North Saint Joseph Avenue PO Box 8000 Marshfield, WI TTY: a.m. to 5 p.m. Monday through Friday * - NCQA s Health Plan Report Card; NCQA Health Insurance Plan Rankings, ** Based on Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) results and scores. HP (10/16) 2016 Security Health Plan of Wisconsin Images used under license from Shutterstock.com