Help Us Build A Healthy Connecticut!

Transcription

1 Help Us Buld A Healthy Connectcut! You have a new opton to offer your clents. A non-proft CO-OP created by physcans and governed by members. A dfferent knd of health nsurance company that s drvng competton and premum cost reductons n Connectcut. We ve already begun to change the local marketplace, and we hope you ll jon us n our msson. THE HEALTHYCT DIFFERENCE When they jon HealthyCT, your ndvdual, small group and large group clents can: Vote and run for our Board of Drectors, gvng them a say n the future of ther health nsurance company. Experence a non-proft health plan premum dollars we don t spend go back to mprovng programs and servces or stablzng premums over tme. Receve local support from our Connectcut-based leadershp, medcal team and dedcated account management. Grow wth a plan sponsored by physcans. Together, we can all drve hgher qualty and lower cost healthcare. Beneft from subsdes and tax credts for plans sold through Access Health CT (for elgble small groups and ndvduals). Offer electronc enrollment and change admnstraton optons to your clents. choce new plan optons servce local management and support competton premum reductons for 2015

2 PLAN FEATURES TO MEET YOUR CLIENTS NEEDS We offer a wde varety of tradtonal, hghdeductble and HSA-compatble plans wth features to meet your clents needs, ncludng: 100% coverage of n-network preventve care. Copayments for n-network PCP, specalst and behavoral health vsts for most plans. The same copayment for a 90-day supply of prescrpton drugs whether purchased locally or by mal. Out-of-pocket maxmums to lmt how much your clents spend. Smple plans desgns no referrals needed. Dental and vson coverage through age 19 for ndvdual and small group plans. Adult routne vson exams for large group and some small group and ndvdual plans. Coverage for emergency care servces worldwde. JOIN US We can t accomplsh our msson wthout you! Jon the brokers who have already been apponted to sell our products. We strve to make sellng our plans as easy as possble! Our dedcated sales team s avalable to assst wth your ndvdual, small group and large group quotes. For your convenence, you also can quote our ndvdual and small group plans on our webste ( or onlne quotng stes lke BeneftCentral ( and HealthConnect ( Please contact us for a complete lst of your optons. Plus, we want to make our relatonshp as rewardng as possble. That s why we offer a compettve commsson program that compensates you for each ndvdual, small group and large group contract you sell! IN-NETWORK ACCESS IN AND OUT OF CONNECTICUT Our members can receve n-network care throughout the state and across the country wth our comprehensve, statewde network that ncludes: Physcans, hosptals and healthcare professonals. Lab servces from Quest Dagnostcs and partcpatng provder offces and hosptal labs. Access to n-network care through the PHCS Healthy Drectons network for members who are out of state, travelng or have chldren attendng college. Coverage for emergences worldwde. For more nformaton about becomng an apponted broker, please vst the Brokers secton of our webste or call our Sales team at HERE TODAY, HERE FOR THE FUTURE We may be new, but we re here to stay! We contnue to grow every day and, lke our large compettors, we have to meet strngent gudelnes requred by the State of Connectcut. We re out to create long-term relatonshps so you can rest assured we ll do all we can to serve you and your clents today and tomorrow. Bro v1.0 Copyrght 2014 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.

3 Pharmacy Benefts All HealthyCT plans provde coverage for prescrpton drugs. Your clents pharmacy program helps ther employees get the medcne they need when they need t. Catamaran s our pharmacy benefts manager. We work wth them to create the lst of drugs our plans cover. Catamaran also: Processes members' pharmacy clams. Manages members' mal-order program, and sends prescrptons to ther homes. Offers a specalty drug program for hgh-cost medcatons. FILL PRESCRIPTIONS LOCALLY OR BY MAIL Members can fll many prescrptons at any pharmacy n the Catamaran network. Ths ncludes the major pharmacy chans, retalers, supermarkets and communty drug stores. For those takng medcaton to manage a health condton, the copayment s the same for a 90-day supply flled at a local pharmacy or by mal. fnd a partcpatng pharmacy go to healthyct.org/rx choose natonal formulary clck select clck contnue choose essental health beneft formulary clck locate a pharmacy coverage broad lst of covered drugs choce 90-day supply by mal or retal LEARN MORE The applcable Certfcate of Coverage ncludes full detals of the prescrpton drug beneft. Fnd the Certfcate of Coverage and the Summary of Benefts & Coverage at access large, statewde network

4 MANAGE RX COSTS Our pharmacy beneft has two formulares: Essental Health Beneft Formulary (small groups/ndvduals) Natonal Formulary (large groups) The formulares are broken nto the followng ters: Ter 1. Includes genercs, the least expensve drugs to treat many common llnesses. The U.S. Food and Drug Admnstraton (FDA) follows the same revew and approval process for genercs as they do for brand-name drugs. Members should ask f a generc verson s avalable and rght for them. Ter 2. Includes preferred brand drugs that usually cost more than genercs. SPECIAL GUIDELINES Some drugs covered under the pharmacy beneft may have restrctons desgned to make them safer to use, based on factors such as FDA gudelnes, medcal lterature, and nput from physcans and the Catamaran Pharmacy and Therapeutcs (P&T) Commttee. They nclude: Quantty Lmts. A lmt on how much of, or how long, you can take the drug. Pror Authorzaton. Some drugs and supples need our approval before the plan can cover them. Ter 3. Includes non-preferred brand drugs. These generally cost more than drugs n Ter 1 and Ter 2, so the member s share of the cost s hgher. Specalty drugs Most specalty drugs appear n Ter 4 n the Essental Health Beneft Formulary for small groups and ndvduals. They appear n multple ters n the Natonal Formulary for large groups. These are hgh-cost drugs used to treat complex medcal condtons. Please note, specalty drugs are not avalable through local retal pharmaces. A 30-day supply can be delvered rght to members' homes through Catamaran s BrovaRx specalty pharmacy program. Preventve Drugs Certan categores of preventve drugs are 100% covered under HealthyCT plans. They nclude medcnes wth A and B ratngs approved by the U.S. Preventve Servces Task Force. For example, wth a prescrpton, some asprns and fluorde supplements come at no cost for members meetng certan age/gender requrements. Step Therapy. Members may need to try a lower cost medcaton before usng the one ther physcan prescrbes. to look up a drug go to healthyct.org/rx choose natonal formulary clck select clck contnue choose essental health beneft formulary enter drug name >> clck search restrctons=yes >> clck name Bro v1.0 Ths pece s for nformatonal purposes and not ntended to be medcal advce. Please drect any medcal questons or concerns to an approprate healthcare provder. Copyrght 2014 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.

5 All For Health & Wellness Good health s so mportant to lvng a happy, actve lfe. How we stay healthy, or get well when we re sck, s entrely up to us. But HealthyCT s here to help wth nformaton, programs and servces that ft nto even the busest day. EAT HEALTHY There are few better ways for mprovng overall health than by eatng well. So, we re connectng members wth local farms so they can get fresh food close to home. And f eatng healthy to lose weght s ther goal, check out our local, natonal, and onlne partners. eat healthy Here are fve easy ways for members to get started. For detals on these programs and more, go to: KEEP MOVING Exercse s a key component to any healthy lfestyle. But we also know that fndng the tme and money to stay ft can be a challenge. We ve got some great deas and resources for our members, whether they want to work out n a gym or fnd a nearby park to throw a Frsbee wth frends and famly. And they nclude dscounts wth local gyms, as well as lnks to many other local ftness and outdoor actvtes. keep movng

6 KNOW YOUR STUFF Educaton s a crtcal pece to health and wellness. The more our members know, the better prepared they ll be to make decsons wth ther physcan about the best and most affordable ways to manage ther health. They can start wth an onlne health assessment to help dentfy areas to focus on. Then they can choose from the onlne lbrary of wellness topcs and podcasts to help them reach ther goals.* They can also get 24/7/365 advce from a nurse.* know your stuff GET CONNECTED A communty can be a powerful thng. Sometmes the resources people need to stay well or to get back on track from an llness are rght around them. There s help avalable from local health professonals, hosptals and communty groups. Whether members want nformaton on how to stay ft, or need help after a hosptal stay, we ll help fnd the resources they need. get connected SAVE MONEY Who doesn t lke to save money? One of the reasons members choose HealthyCT s because we re nonproft, so money we don t spend goes back to mprovng programs and servces or nto stablzng premums over tme. We re also fndng ways to connect our members wth dscounts on a varety of health and wellness-related servces such as gym membershps and fresh, local produce delvered to ther door. save money Learn more at These programs are just a start! Check back often for new offerngs. Bro v1.0 *Comng n the fall Ths pece s for nformatonal purposes and not ntended to be medcal advce. Please drect any medcal questons or concerns to an approprate healthcare provder. Copyrght 2014 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.

7 An Ounce of Preventon Preventve medcne s key to your overall health and well-beng. Early detecton can help you stay healthy. It can also stop small problems from becomng bgger ones. HealthyCT plans cover those common preventve servces gven an A or B ratng by the Unted States Preventve Servces Task Force (USPSTF). (The USPSTF s an ndependent panel of prmary care physcans who are experts n preventon and evdence-based medcne.) no cost n-network preventve medcne Because preventve medcne s so mportant, these servces are avalable at no cost to HealthyCT members when they receve them from a physcan or healthcare professonal who s n our network. You'll fnd some examples of covered preventve servces on the back of ths page. For a complete lst, along wth coverage gudelnes and lmts, vst better health through preventon comprehensve lst of covered servces

8 PREVENTIVE SERVICES FOR ADULTS Preventve medcne goes beyond a routne physcal exam. HealthyCT plans cover many preventve servces, ncludng: Alcohol msuse screenng and counselng Asprn to prevent cardovascular dsease n men and women of certan ages Blood pressure screenng Colorectal cancer screenng (adults over 50) Depresson screenng Flu shots and other mmunzatons Obesty screenngs and counselng Preventve physcal exam Tobacco use screenngs and cessaton products Type 2 dabetes screenng for adults wth hgh blood pressure PREVENTIVE SERVICES FOR WOMEN Addtonal screenngs and counselng are avalable for women, ncludng: Breast cancer screenng/mammogram Breast cancer chemopreventon counselng for women at hgher rsk Cervcal cancer screenng Domestc and nterpersonal volence screenng and counselng Folc acd supplements for women who may become pregnant Osteopoross screenng for women over age 60 dependng on rsk factors Preventve physcal exam Tobacco use screenng and nterventons for all women, and expanded counselng for pregnant tobacco users PREVENTIVE SERVICES FOR PREGNANT WOMEN Preventon s especally mportant to the health of an expectant mother and her baby. Recommended preventve servces for pregnant women nclude: Anema screenng Bacterura urnary tract and other nfecton screenng Breastfeedng support and counselng Gestatonal dabetes screenng for women 24 to 28 weeks pregnant and those at hgh rsk of developng gestatonal dabetes Hepatts B screenng Rh ncompatblty screenng PREVENTIVE SERVICES FOR CHILDREN These covered preventve servces help promote chldren s growth and development: Behavoral assessments at certan ages Blood pressure screenngs at certan ages Fluorde chemopreventon supplements for chldren wthout fluorde n ther water source Immunzatons Iron supplements for chldren of certan ages Lead screenngs Obesty screenngs and counselng Oral health rsk assessments Preventve physcal exams Vson screenngs Bro v1.0 Ths pece s for nformatonal purposes and not ntended to be medcal advce. Please drect any medcal questons or concerns to an approprate healthcare provder. Copyrght 2014 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.

9 Focus On Patent- Centered Care HealthyCT members get a health plan started by physcans. They can get hgh qualty healthcare from a large network of hosptals and healthcare professonals across Connectcut. And that ncludes many prmary care physcans who can help them stay well and treat or manage a medcal condton. THE IMPORTANCE OF PRIMARY CARE Prmary means frst, essental, central. So t should be no surprse that prmary care physcans or PCPs should be the frst choce when t comes to an ndvdual's health. They can help patents get essental screenngs to avod or dentfy and treat some llnesses. And PCPs and staff serve as command central when patents need medcal tests or care they don t offer. pcp prmary care physcans are your 1st choce Because PCPs get to know ther patents well over tme, they can be n the best poston to: Support and gude patents when they're well, to better help them when they're sck. Make sure they get mportant health screenngs to prevent or detect problems. Treat many llnesses; usually at much less cost than a vst to the ER or urgent care. Help them understand medcal choces and choose the rght ones. Refer them to other health specalsts for tests and appontments, when needed. Keep a patent's comprehensve medcal fle, ncludng servces and reports from them and other healthcare provders. Focus on overall health and well-beng. care from a team that knows you better manage your healthcare costs

10 IMPROVING PRIMARY CARE Many PCPs are changng the way they work wth patents to delver a hgher level of care and servce. Patents n these practces can expect a great deal of support when t comes to gettng the help they need. Longer offce hours usually make accessng care easer. And patents learn how to keep themselves healthy. When PCP practces meet the hgh standards for patent-focused care set by the Natonal Commttee for Qualty Assurance, they can receve specal recognton as a patent-centered medcal home or PCMH. HEALTHYCT AND PATIENT-CENTERED CARE We re workng closely wth physcans, ncludng our Prmary Care Provder Advsory Councl. Wth the Councl, we re educatng physcans, employers and members about the value of prmary care and the extra value offered by PCMH practces. We ve nvested n educaton for PCP practces that want to earn PCMH recognton. And we re creatng a new model to support prmary care and pay patent-centered practces farly for the addtonal work and dedcaton requred to practce truly patent-centered care for our members and ther famles. FIND A PRIMARY CARE PHYSICIAN To fnd a PCP n our network, vst Select Fnd a Doctor. To fnd a PCMH-desgnated practce, enter your search nformaton and select Yes under the PCMH dropdown menu. THE PCMH DIFFERENCE: Lower total cost of care. Reduced use of unnecessary and avodable servces. Improved health measures. Increased use of preventve care. Better access to care. Improved patent satsfacton. Source: Connectcut Health Polcy Project Issue Bref, June 2014, Bro v1.0 Copyrght 2014 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.

11 Large Group Quote Gude TO RECEIVE YOUR QUOTE, PLEASE SEND US For Groups Detaled beneft summares. A current bll for the groups health nsurance, ncludng premum nformaton. Renewal for your current carrer. Employer contrbutons across all ters and products. Number of years wth pror carrer(s). If less than fve years, please nclude the name of the pror carrer(s). Complete Census (In Excel Format) All elgble employees. Date of brth, gender, zp code and contract status. Wavers, Medcare and COBRA contracts. Any excluded classes of employees;.e. unon. For Groups 100+ (All Prevously Noted Plus) Monthly clams actvty for the most recent perod, up to and ncludng the past 24 months (f avalable). De-dentfed large clams actvty correspondng to the clams perod(s) provded. - Total dollars pad for each clamant that goes over the poolng level. - Status of clamant(s) actve/nactve. Prognoss monthly contract counts, broken down by ter, correspondng to the clams perod(s) provded. Beneft plan descrpton durng experence perod, f dfferent from current plan desgn. Renewal for current carrer, ncludng work-up. ELIGIBILITY Group Sze Large groups are defned as busnesses that have 51 or more elgble employees. Group Elgblty Busnesses must be located n Connectcut or have an offce n the state. Addtonally, no more than 20% of elgble employees can resde outsde Connectcut. HealthyCT requres that there s an employeremployee relatonshp n effect and that the employer contrbutes at least 50% of the employee s overall premum.

12 Elgble Employees Elgble employees are permanent hourly/salary employees who work at least 30 hours per week throughout the year. Commssoned employees who receve a W-2 are elgble f they meet all other elgblty requrements. Employers may request a reduced mnmum number of hours for elgblty. Employer Contrbuton Level HealthyCT requres a mnmum employer contrbuton level of 50% of total premum for the group. The Mnmum Overall Employer Contrbuton Level Determnaton chart llustrates how we would determne whether a group s meetng ths mnmum level. We would not quote the cases n the last two scenaros. Inelgble Employees Part-tme employees. Independent/commssoned contractors who receve 1099 IRS flng. Trustees/members of the board of drectors and elected offcals, unless full-tme employees. Any other ndvdual who does not meet, or ceases to meet, elgblty requrements. COBRA And Retrees HealthyCT covers COBRA partcpants and ther elgble dependents as long as the total number of COBRA partcpants does not exceed 10% of the total group elgbles. If a fully nsured group covers retrees, they must be dentfed at ntal underwrtng. The total number of retrees cannot comprse more than 10% of the group s total elgbles. The employer must contrbute at least 50% of the entre retree premum, ncludng dependents f applcable. Partcpaton Requrements HealthyCT requres an overall partcpaton rate of at least 50% of total elgbles and 75% of net elgbles calculated as follows: Total enrolled dvded by all elgble must equal at least 50% AND Total enrolled dvded by all elgble, excludng spousal wavers, must equal at least 75% partcpaton. The effectve date for new busness s the 1st of the month only. New busness must be submtted at least 30 busness days pror to the effectve date. Any ncomplete portons of a new group submsson may result n the delay of your clent s ID cards. Securely send complete request for proposal nformaton to RFPrequest@healthyct.org MINIMUM OVERALL EMPLOYER CONTRIBUTION LEVEL DETERMINATION Example Monthly Rate Possble Employer Contrbuton Scenaros Employee Only $ % 100% 50% 75% 60% Employee + Famly $1, % 50% 50% 25% 40% $1,400 Overall Employer Contrbuton ($) $1,400 $900 $700 $550 $640 Overall Employer Contrbuton (%) 100% 64% 50% 39% 46% Meets HealthyCT gudelnes: Yes Yes Yes No No Bro v1.0 The nformaton provded n ths pece s for nformatonal purposes only, and nothng s consdered bndng or fnal untl all proper agreements and documentaton are executed by both partes. Copyrght 2014 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.

13 Small Group Elgblty Can my small group clent offer a HealthyCT plan? The nformaton provded below can help you determne elgblty. For questons, please call our Sales team at Partcpaton Requrement* 2 to 50 employees 65%, excludng qualfed wavers** For Example: 30 (total elgble) -6 (qualfed wavers) 24 (net elgble employees) x.65 (requred partcpaton) 16 (mnmum enrollment) Contrbuton Requrement* Mnmum 25% towards employees coverage Famly Health Statements Not requred Elgble Employees Regular full-tme employees workng at least 30 hours per week Non-Elgble Employee Classes Part-tme Seasonal 1099 contractors Mnmum Number of Lves 1 after qualfed wavers Sole propretors select ndvdual coverage Out-of-Area Employees Up to 30% of a group s employees can resde outsde of Connectcut Number of Plans Offered No lmt on number of plans offered. However, the group must have at least one enroll n each plan offered. Plan Effectve Date The frst of the month only Watng Perod Up to 90 days Optonal Offerng Our goal s to be a total replacement Plan Changes Annversary date only Case Submsson Due Date 5 days pror to the effectve date *Per federal regulatons, partcpaton and contrbuton requrements do not apply November 15-December 15. **Qualfed wavers nclude: Medcad, Medcare, spousal, HUSKY Health,TRICARE, ndvdual (on or off Access Health CT), and any carrers. Bro v2.0 The nformaton provded n ths pece s for nformatonal purposes only, and nothng s consdered bndng or fnal untl all proper agreements and documentaton are executed by both partes. Copyrght 2014 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.