Putting you in the driver s seat

Transcription

1 Putting you in the driver s seat Now more options for flexible and affordable health care Introducing Anthem Choice Connecticut a health plan that lets you take control of your costs 58156CTMENABS 12/15

2 Choose from hospitals across the state Our new tiered network is designed to save you money Value Tier 1 1. Bristol Hospital, Bristol 2. Charlotte Hungerford Hospital, Torrington 3. Connecticut Children s Medical Center, Hartford 4. Danbury Hospital, Danbury 5. Day Kimball Hospital, Putnam 6. Griffin Hospital, Derby 7. John Dempsey Hospital, Farmington 8. Johnson Memorial Hospital, Stafford Springs 9. Lawrence and Memorial Hospital, New London 10. Manchester Memorial Hospital, Manchester 11. Middlesex Hospital, Middletown 12. Milford Hospital Inc., Milford 13. New Milford Hospital, New Milford 14. Norwalk Hospital, Norwalk 15. Rockville General Hospital, Rockville 16. St. Francis Hospital & Medical Center, Hartford 17. St. Mary s Hospital, Waterbury 18. St. Vincent s Medical Center, Bridgeport 19. Sharon Hospital Inc., Sharon 20. Waterbury Hospital, Waterbury 21. Windham Community Memorial Hospital, Willimantic Participating Tier Bridgeport Hospital, Bridgeport 23. Greenwich Hospital Association, Greenwich 24. Hartford Hospital, Hartford 25. MidState Medical Center, Meriden 26. Hospital Of Central Connecticut, New Britain 27. St. Raphael Campus, New Haven 28. Stamford Hospital, Stamford 29. William W. Backus Hospital, Norwich 30. Yale New Haven Hospital, New Haven

3 Anthem Choice Connecticut Same great access to care, more ways to save Our newest health plan gives you options that are clear and simple. With up to three benefit levels, you decide when to pay less out of your own pocket. Freedom to choose Anthem Choice gives you the same great access to our in-network doctors and hospitals as our other plans. And you ll get the same preventive care benefits, too. But now you can choose a primary care physician (PCP) who can save you money. By selecting a PCP in our Enhanced Personal Health Care program, you ll know you re getting quality care at a lower cost. Tiered to save you money With Anthem Choice, PCPs and hospitals are grouped into one of three benefit levels: Value Tier 1, Value Tier 2 and out of network. 1 Value Tier 1 saves you the most When you see a PCP or visit a hospital in Value Tier 1, you ll save out-of-pocket costs. PCPs in Value Tier 1 are part of Anthem s Enhance Personal Health Care program, so your cost savings start with a lower out-of-pocket payment when you visit a Value Tier 1 PCP. And because hospitals in Value Tier 1 can deliver quality care at a lower cost, your out-of-pocket cost is lower when you elect to get care from a Tier 1 facility. What is Enhanced Personal Health Care (EPHC)? It s our industry-leading approach to provider collaboration and patient-centered care. Connecticut PCPs in this program have committed to spending more time with patients, coordinating care with other doctors and focusing on the best way to help you get and stay healthy. In fact, 75% of our in-network PCPs participate in the program that s more PCPs in a value-based program than any other carrier in the state. Use our Find a Doctor tool on anthem.com to locate a Value Tier 1 PCP. Participating Tier 2 offers more options at a slightly higher cost When you see a PCP in this tier or get care at a Participating Tier 2 hospital, you ll get quality care and you ll still be covered in-network you ll just pay a little more. Out of network gives you additional access 1 You ll always have the option to choose out-of-network providers if your plan offers that coverage. While you may find a wider selection of doctors, you ll also pay the most out of pocket. We ve got you covered Every Connecticut-based PCP in the network is available to you whether you choose from Value Tier 1 or Participating Tier 2. They re all covered in-network under these plans. Because Anthem has more PCPs participating in a value-based program than any other carrier in the state, you re probably already using a Value Tier 1 PCP. The same goes for Connecticut hospitals you can get care at any hospital in either tier and be assured you re covered. Value Tier 1 and Participating Tier 2 benefits apply only to care from Connecticut-based PCPs and hospitals. Other benefits such as specialist care and prescription drug coverage are not tiered in the Anthem Choice portfolio. Emergency room (ER) visits are not a tiered benefit, and the same out-of-pocket costs apply to ER visits in every tier. As with other Anthem plans, if you are admitted to the hospital following an ER visit your out-of-pocket payment is waived. Know your costs In addition to choosing an Anthem Choice plan, you can use our online cost-saving tools to control your out-of-pocket costs. Our Estimate Your Cost tool lets you compare the costs of more than 400 medical procedures so you can make more informed choices. You also can find out what a prescription will cost at a retail pharmacy or through our home delivery pharmacy using our Price a Medication tool. To find out more, go to anthem.com/anthemchoicect.

4 Case study: Running into knee surgery Mark s been a runner since high school. He s familiar with the aches and pains that can come from running, but one day Mark fell and hurt his knee so he went to see his PCP, who referred him to an orthopedic specialist. Mark and the specialist agreed he d be a good candidate for arthroscopic knee surgery. The surgery typically requires a two-day hospital stay. Mark is covered by Anthem s Consumer Choice Gold Century Preferred PPO plan that includes a Value Tier 1 and Participating Tier 2 option. Here are his options for out-of-pocket costs: Anthem Choice Actual cost Value Tier 1 member cost Participating Tier 2 member cost Out-of-network 1 member cost Deductible N/A $2,000 deductible $4,000 deductible $8,000 deductible Coinsurance maximum Cost-share maximum N/A N/A N/A 30% after deductible up to $5,200/$10,400 N/A $6,600/$13,200 $13,200/$26,400 PCP $135 $20 copay $40 copay Specialist $150 $50 copay $50 copay Hospital outpatient $3,150 $2,000 (plan deductible) $4,000 (plan deductible) Surgeon $2,600 $50 $50 Total cost $6,035 $2,120 $4,140 $6,035 In this example, Mark s Anthem Choice plan gives him options to reduce his out-of-pocket costs. Under the Value Tier 1, Mark can save $20 on his PCP copay and up to $2,000 on his plan deductible. His overall savings add up to more than $2,000. Mark could save more than $2,000 if he gets care from Value Tier 1 doctors and hospitals.

5 Anthem Choice Connecticut Frequently asked questions How do the Value Tier 1 and Participating Tier 2 benefit options work? As with all Anthem Blue Cross and Blue Shield (Anthem) plans, you have access to any in-network doctor or hospital in the state. What makes Anthem Choice different is that you have the opportunity to lower your out-of-pocket costs when you choose care from a hospital or PCP in Value Tier 1. You re still covered in-network if you use a Participating Tier 2 PCP or hospital, but your out-of-pocket cost will be higher. How do PCPs and hospitals in Value Tier 1 differ from those in Participating Tier 2? The doctors and hospitals in the network all meet necessary credentialing requirements. However, because PCPs in Value Tier 1 are part of our Enhanced Personal Health Care program, they have committed to spending more time with patients, coordinating care with other doctors and focusing on the best way to help members get and stay healthy. Hospitals in Value Tier 1 are able to deliver quality care at a lower total cost, so these savings are passed on to you. When you use a Participating Tier 2 PCP or hospital, you can expect to receive the same quality care, but you won t pay the lowest out-of-pocket cost available under your plan for those services. Am I required to choose a PCP in these health plans? No; however, we suggest you select a PCP because those who have a relationship with a PCP have been shown to have fewer preventable ER visits and hospital admissions than those who don t. 2 When selecting a PCP, remember to choose one from the Value Tier 1 option to pay the lowest out-of-pocket amount. How do I know which benefit option my doctor or hospital is in? Use the Find a Doctor tool on anthem.com for a full list of in-network Connecticut PCPs and to find out which tier your PCP is in. If you need help, please call the Member Services number on the back of your member ID card. Go mobile Which costs go toward my out-of-pocket maximum? Your copays, deductibles and all go toward your out-of-pocket maximum. Both Value Tier 1 and Participating Tier 2 benefit costs go toward your out-of-pocket maximum, which may vary by your plan type. For more FAQ and other great information about Anthem Choice, go to anthem.com/anthemchoicect. Use your mobile device to search for doctors, hospitals and more with our free app from the App Store or Google Play TM. You can even get detailed directions to a doctor s office. Just search for Anthem Blue Cross and Blue Shield to download it.

6 Resources at your fingertips Go to anthem.com/anthemchoicect to find everything you need: }} Use our Find a Doctor tool to see if a doctor is in Value Tier 1 or Participating Tier 2. }} Get a list of Value Tier 1 and Participating Tier 2 hospitals under your plan. }} See answers to the most frequently asked questions about using a consumer choice product portfolio plan. } } With our Estimate Your Cost tool, you can estimate your out-of-pocket costs, and compare costs and quality of across Connecticut. 1 As with all HMO plans, HMO plans under the Anthem Choice portfolio do not offer out-of-network coverage. 2 UCLA Center for Health Policy Research website: In California, Primary Care Continuity Was Associated With Reduced Emergency Department Use and Fewer Hospitalizations (accessed January 2016): healthpolicy.ucla.edu. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.