2018 Connecticut Large Group (51+) Health Plan Portfolio

Transcription

1 2018 Connecticut Large Group (51+) Health Plan Portfolio

2 What do you value in a health plan? Businesses today are faced with a lot of difficult decisions. Finding the right health plan should not be one of them. So, no matter how you get into the health care system, we can help make it simpler. UnitedHealthcare is committed to helping find solutions to fit the health care needs of Connecticut large group (51+) employers through our Oxford products. You want to offer benefits that help attract employees and keep them healthier. We provide a variety of health plans that help you achieve your goals while educating and engaging employees in making health care choices to help control costs. Increasing level Member role/ level of member involvement Low Moderate Products PPO Value Option Value Option HMO Oxford HMO Network coverage Out-of-network coverage Account-based plan Primary care provider (PCP) Referral required Online tools and technology Member support programs Health and wellness programs Premium relative to other plans $$$$ $$$ $$ $$ Our Best, Largest: Freedom Network with access to the nationwide UnitedHealthcare Choice Plus Network 1 Better, Plus: Freedom Network access only Better, More: Liberty Network access only Key Our Best, Largest Better, Plus Better, More Good Basic Not Available Included 2

3 Our Oxford portfolio includes a variety of products with a wide range of flexible health plan solutions designed to be affordable. You can choose a traditional open-access plan, or pick from referral, account-based, tiered benefit, limited network or higher cost-share plans. We also integrate pharmacy benefits with our medical plans and offer a variety of specialty benefit options so you can offer your employees a comprehensive benefit package. Think about what you value most in a health plan and use the chart below to help you determine which product has the features and benefits you are looking for. of member involvement High Oxford Gated HMO Primary Advantage SM Oxford HSA PPO Oxford Non-Gated HMO HSA Liberty HMO Liberty HMO HSA $$ $$ $$ $$ $ $ 3

4 Connecticut large group plan descriptions The table below offers more information about the Connecticut large group plan offerings we highlighted on the previous pages. Products with a low level of member involvement PPO These products offer combined in- and out-of-network coverage, do not require referrals for specialist visits, and include an in-network deductible and coinsurance. These plans also provide access to the nationwide UnitedHealthcare Choice Plus Network when outside the Oxford service area. 2 Products with a moderate level of member involvement Value Option Value Option HMO Oxford HMO Oxford Gated HMO Primary Advantage SM (Non-Gated) These plans offer combined in- and out-of-network coverage, and do not require a referral for specialist visits. The deductible on these plans applies to outpatient surgery and inpatient facility charges only. Members enrolled in the Freedom Plan Value Option also have access to the nationwide UnitedHealthcare Choice Plus Network 1 when outside the Oxford service area. These plans offer in-network-only coverage and do not require a referral for specialist visits. The deductible on these plans applies to outpatient surgery and inpatient facility charges only. These plans provide an opportunity for groups who are comfortable with in-network-only products to enjoy the associated premium savings. Referrals for specialist visits are not required for members enrolled in the Oxford HMO. These plans allow members to receive covered services from the participating primary care physician (PCP) of their choice and requires a referral for specialist visits. These are in-network-only products that put an emphasis on benefits where health care encounters are most prevalent: preventive care, services provided by a PCP or OB/GYN, and Tier 1 prescription drugs, which are available through low copayments and are not subject to a deductible. If a higher level of care is required, Primary Advantage provides members access to comprehensive coverage through a vast network of specialists and hospitals. These services are subject to a deductible; however, once the deductible has been met, benefits are covered through clearly defined copayments, a feature designed to add predictability to health care spending. A referral is not required for specialist visits. Products with a high level of member involvement Oxford HSA PPO Oxford Non-Gated HMO HSA Oxford Liberty HMO Oxford Liberty HMO HSA These are consumer-driven health plans made up of two parts: a high-deductible health plan and an optional health savings account (HSA). With these plans, members are eligible to open an HSA and deposit money, before taxes. Members can use their HSA funds to pay for eligible medical and pharmacy expenses, including their deductible, or save it for future expenses. These plans also give members the choice to go in- or out-of-network for care, and referrals are not required for specialist visits. Some plans offer office and facility copayments after the deductible. These plans provide an opportunity for groups who are comfortable with in-network-only products to enjoy the associated premium savings. These traditional HMO plans are HSA-compatible members can open and deposit money, before taxes, into their own personal health savings account. Members can use the money to pay for eligible medical and pharmacy expenses, including their deductible, or save it for future expenses. Members enrolled in the Oxford Non- Gated HMO HSA are not required to obtain a referral for specialist visits. These products provide in-network-only benefits within the Oxford Connecticut Liberty Network of providers and associated premium savings for members. Members select a participating PCP of their choice, and specialist visits require a referral. The Oxford Connecticut Liberty Network provides access to retail pharmacies, including major chains, mass merchants and supermarkets. Walgreens, Rite Aid and Walmart are just some of the pharmacies where Oxford Connecticut Liberty Network members can fill prescriptions. Prescriptions cannot be filled at CVS, Target or many non-chain pharmacies. This product provides the same benefits as an Oxford Liberty HMO product, but may be paired with a health savings account (HSA) for members to use for eligible medical and pharmacy expenses. 4

5 Network access We know how important it is to find the right doctor. That s why we offer local and nationwide networks, and the UnitedHealth Premium designation program, 3 to help you find one. Freedom Network: Through our Freedom Network, employers enrolled in our Oxford plans have access to 20,324 providers 6 and 28 hospitals 5 in the state, plus an additional 57,090 providers in New York and 27,500 providers in New Jersey. 4 Liberty Network: Through our Oxford Connecticut Liberty Network, employers enrolled in our Oxford Liberty plans have access to 20,070 providers 6 and 28 hospitals 5 in the state, plus an additional 51,177 providers in New York and 24,900 providers in New Jersey ,440 doctors 5,647 hospitals Broad national network: Our UnitedHealthcare Choice Plus national network 7 provides seamless access to care for 99 percent of the U.S. population in 96 percent of all U.S. counties. 1 UnitedHealth Premium designation program 2 : This program recognizes doctors who meet standards for quality and cost efficiency. We use evidence-based medicine and national industry guidelines to evaluate quality. The cost-efficiency standards rely on local market benchmarks for the efficient use of resources in providing care. This program applies to certain specialists and some providers. You can search for Premium-designated providers within our doctor search tool on your health plan website, oxfordhealth.com. Awards and recognition At UnitedHealthcare, we strive to deliver consistent performance, solid fundamental execution and an innovative approach to health care. We are privileged to be recognized with awards for our work. UnitedHealthcare s parent company, UnitedHealth Group, was the top-ranking company in the insurance and managed care sector on Fortune s 2016 World s Most Admired Companies list. This is the seventh straight year UnitedHealth Group ranked No. 1 overall in its sector (February 2017). 8 UnitedHealth Group was recognized as one of America s 50 most community-minded companies for 2017 in the Civic For the sixth consecutive year, the National Business Group on Health honored UnitedHealth Group with a Platinum award for being named one of the Best Employers for Healthy Lifestyles (2016). 10 5

6 Delivering on what employers value You ll be surprised to learn how many tools we offer to help make your job easier. You value: Comprehensive benefit plans Integrated medical and pharmacy benefits Specialty benefits Innovative employer tools Simple, worry-free onboarding process Supportive customer service We offer: A variety of plan designs ranging from open access to primary care provider-centric to consumer-driven and more. These can be sold as a package letting you select the options that might work best with your employee population. All medical plans come with our pharmacy benefit. This includes a network of retail pharmacies that are available to you across the country and mail order services that can give your employees up to a 90-day supply of their medication(s), often at a lower price than retail and it s delivered to their home with standard shipping at no additional cost. Attract and retain the best employees by offering more options. We offer a full suite of dental, vision, life and disability products in addition to our medical products. Your health plan website, oxfordhealth.com, is designed to make it easier for you to keep track of your company s health care coverage, download forms, conduct real-time transactions, and access information and tools to help your employees take control of their health. From the Transactions tab, you can perform the typical, day-to-day functions that come with managing your company s health care coverage. All of this can be done on your own time, when it s most convenient for you. Check: Billing, eligibility and benefits. Enroll: Employees, dependents and spouses. This is also where you can terminate members. Request: Subscriber and member lists, usernames, materials and health plan ID cards. Change: Member information, addresses, usernames and passwords. The Tools & Resources tab is where you can find the information you need on Oxford policies, forms and benefit offerings. You can also use this tab to find materials to help your employees get the care they need, stay healthy and make the most of their Oxford benefits. When you use these materials and refer your employees to their health plan website, you re helping them take an active role in managing their health and getting familiar with their benefits. We ll handle many of the administrative tasks: Customer service Representatives are available to answer your questions during open enrollment. Clear online and print communications. Oxford Express Our 24-hour interactive voice response (IVR) system gives benefit administrators easy access to check member eligibility status and obtain billing and payment information. Reliable, personal service and support for employers and employees. 6

7 Delivering on what employees value What if you could help improve your employees health and well-being, increase productivity and job performance, and increase employee satisfaction and retention all at no additional cost to you? Understanding and identifying the health risks of your employees is the first step in creating a comprehensive wellness strategy that can address behavior change. Your employees value: Mobile access to health care information Online health and wellness tools Physical fitness reimbursement We offer: The UnitedHealthcare Health4Me mobile app allows employees to find nearby providers, check the status of a claim, see an account balance or speak directly with a nurse. And, when members have a minor health issue like pinkeye or a sore throat, they could save time with a Virtual Visit. A Virtual Visit lets members see and talk to a doctor from their mobile device or computer. A doctor can see and speak to them about minor medical concerns, provide a diagnosis and, if appropriate, send a prescription to their local pharmacy. All in 30 minutes or less. Rally is an interactive health and wellness component of your employee s health plan website. By harnessing the power of data, social connections and rewards, your employees can receive personal lifestyle plans that focus on goals, competition, tracking progress and healthy living. Rally offers a personalized interaction experience that includes: step-based Challenges, discussion Communities, individual action plans called Missions, health information and more. With Oxford Sweat Equity Physical Fitness Reimbursement, 11 members can get up to $200 every six months for fitting in regular workouts. It s a special thank you to members for their efforts to lead a healthy life. 24/7 access to health care guidance Reliable member support (excluding periodic downtime for maintenance) Speak with knowledgeable registered nurses 24 hours a day, seven days a week by phone or online chat to help manage illness or injury, or get maternity education support. Members can also call and listen to recorded messages on more than 1,100 health topics. We provide tools to help your employees stay healthy at oxford.uhcpreventivecare.com, including information about which immunizations and screenings are recommended for all family members at different stages of their lives. We send special mailings HealtheNote Reminders on the topics of women s health, child and adolescent immunizations, coronary artery disease, and diabetes to the homes of your employees who we think can benefit from this information. We also offer condition management programs to help members with chronic health issues (such as chronic kidney disease, diabetes and heart failure) enhance self-care, identify warning signs and access resources for assistance reducing the need for urgent or emergency services. By developing trusted relationships, we can reinforce and support provider treatment plans, and help members get the most out of their care encounters. Health discount program Our health discount program helps give your employees access to a wide range of health- and wellness-related programs, products and services, helping employees save money and gain healthy lifestyle information. 12 7

8 For more information, please contact your broker or Oxford sales representative. 1 Nationwide network may not be available for all groups. 2 Tristate area includes Connecticut, New Jersey and certain New York counties (Ulster, Sullivan, Dutchess, Orange, Putnam, Rockland, Westchester, Bronx, New York, Queens, Kings, Richmond, Nassau and Suffolk). 3 For informational purposes only. Designations are displayed in online physician directories on your health plan website. You should always visit your health plan website for the most current information. Premium designations are a guide to choosing a doctor and may be used as one of many factors you consider when choosing a doctor. If you already have a doctor, you may also wish to confer with him or her for advice on selecting other doctors. Doctor evaluations have a risk of error and should not be the sole basis for selecting a physician. Please visit your health plan website for detailed program information and methodologies. 4 Network Report, September This data represents all participating (network) providers except ancillary providers e.g., laboratories, radiology centers, urgent care centers, hospitals, etc.). Dental, behavioral health practitioners, complementary and alternative medicine providers are included. Providers who are board certified in more than one specialty, and/or practice at more than one location, are counted only once and at only one location. 5 Network Report, July This data represents all participating (network) facilities except long-term care, rehab and veterans hospitals. 6 Network Report, November This data represents all participating (network) providers. National Network access not available with the Oxford Connecticut Liberty Network. 7 As of June 2017, UnitedHealth Networks national network statistics. 8 FORTUNE is a registered trademark of Time, Inc. FORTUNE and Time Inc. are not affiliated with, and do not endorse products or services of UnitedHealth Group. 9 As determined by an annual survey administered by True Impact and analyzed by VeraWorks. For more information, visit civic50/. 10 Awards criteria is based on a wide range of well-being contributors including job satisfaction, community involvement, financial security, emotional health and social connectedness. For more information, visit 11 Reimbursement amounts vary depending upon your plan. Plan participants should refer to their health plan documents or check with their benefits administrator to determine eligibility and how much they may be reimbursed. They may submit a request for reimbursement under the program once every six months. Plan participants should consult with an appropriate tax professional to determine if they have any tax obligations from receiving reimbursement under this program. 12 The health discount program is administered by HealthAllies, Inc., a discount medical plan organization. The health discount program is NOT insurance. The discount program provides discounts at certain health care providers for medical services. The discount program does not make payments directly to the providers of medical services. The discount program member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. HealthAllies, Inc. is located at P.O. Box 10340, Glendale, CA 91209, , Healthy Bonus offers are not insured benefits and are in addition to, and separate from, your Oxford benefit coverage. These arrangements have been made for the benefit of members, and do not represent an endorsement or guarantee on our part. Offers may change from time to time and without notice and are applicable to the items referenced only. Offers are subject to the terms and conditions imposed by the vendor. We cannot assume any responsibility for the products or services provided by vendors or the failure of vendors referenced to make available discounts negotiated with us; however, any failure to receive offers should be reported by calling the toll-free phone number on your health plan ID card. Oxford HMO products are underwritten by Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. MT Oxford CTLG 51+ Product Capabilities Brochure CT / Oxford Health Plans LLC. All rights reserved Rev. 5