for Individuals and Families LIVE LIFE ASSURED

Transcription

1 for Individuals and Families LIVE LIFE ASSURED

2 Options as unique as you Coverage that s all yours Health Tradition for Individuals is designed for people who may not have access to a group or employer plan they like and who want Mayo Clinic Health System quality care. If you re just starting your career and are no longer covered by your parents policy, work for yourself or just want a reliable policy you can keep no matter where you work, we offer many affordable choices and peace of mind. Our Standard HMO plans were created with you in mind Our Standard HMO plans include deductible, copayment and coinsurance options. Individuals and families can choose based on their anticipated needs. New plan options include 2 primary care visits with no copay. Health Tradition HMO plans are available through the Health Insurance Marketplace at HealthCare.gov. You may enroll through the Marketplace, with us directly or through one of our agents. No matter how you enroll, you ll have the opportunity to apply for Marketplace discounts based on your annual income and family size. Our HMO Qualified High Deductible plans are designed to work independently or with a Health Savings Account. HDHP plans typically have lower premiums and higher deductibles than other plans. HDHPs are used with health savings accounts (HSAs) to pay for qualified out-of-pocket medical costs. The accounts are funded with pre-tax dollars, lowering the amount of federal taxes you owe. Contributions to an HSA are made by you or, in some cases, by your employer. Contributions limited to a maximum amount each year. They can be used to pay for qualified medical expenses, which include most medical care such as dental, vision and over-the-counter drugs. We are happy to answer any questions or or assist you in selecting a plan that best fits your needs. ACCREDITED HEALTH PLAN HEALTH PLAN WITH HEALTH INSURANCE MARKETPLACE URAC accredited, Health Plan and Health Plan for Health Insurance Exchange (HIX) The Summary of Benefits and Coverage for each plan is available at HealthTradition.com. It describes benefits in greater detail. Complete benefits are contained in the Certificate of Coverage, the official plan document. If there are any inconsistencies between this brochure and the Certificate of Coverage, the Certificate of Coverage will govern the benefits available. Ways to enroll Go to HealthTradition.com/enroll Compare plans and prices and enroll right on our website. Go to Healthcare.gov To apply for reduced premiums or plans, you may qualify through the Health Insurance Marketplace at Healthcare.gov. Application assistance is available by phone at (800) Call an agent who represents Health Tradition A list of agencies is available at HealthTradition.com under contact us. Call us We re available to answer any questions you may have. (608) or (888)

3 Everyone deserves to live life assured With affordable health plans from Health Tradition with Mayo Clinic Health System Your access to Mayo Clinic quality care We are a local, physician-led organization with a unique connection to one of the most respected names in health care. When you select Health Tradition, you re selecting easy access to a Mayo Clinic Health System care team led by your Primary Care Provider (PCP). Personally connected to you Insurance doesn t have to be impersonal. It s easy to make an appointment and talk with us by phone or in person at our Onalaska, Wisconsin office. As a Health Tradition member, you have access to many resources and people who can help. Insurance isn t just for when you re sick Taking advantage of regular can prevent or identify illness earlier, when treatment is often easiest and most effective. In partnership with Mayo Clinic Health System, we ve made easy. Call, or connect through Mayo Clinic Health System s Patient Online Services, where you can correspond with your care team, view your history and request appointments. Helping you stay well. There for you when it counts.» Excellent A long list of screenings, exams and immunizations are covered with no out-of-pocket cost or red tape» Local customer service We re helpful people right here in Wisconsin who can answer your questions» Free help to quit tobacco Enroll in a proven program that combines counseling with nicotine replacement therapies» Healthy living programs Interactive personal health management tools and information to support healthy living» Become a better health care consumer Resources like Health Insurance 101 and an information-packed member website help you get the most for your health care dollar» The 24/7 Nurse Line An experienced RN is always available for reliable answers when you have questions about symptoms or care

4 Standard HMO Plans Covered Services Gold 1000/80 Gold 2000/80 w/copay 2000/ /80 w/copay 3000/60 w/copay 6000/80 Annual Deductible Indiv/Family Annual Out-of-Pocket Maximum Indiv/Family $1,000/$2,000 $2,000/$4,000 $2,000/$4,000 $4,000/$8,000 $3,000/$6,000 $6,000/$12,000 $3,000/$6,000 $3,000/$6,000 $5,000/$10,000 $6,000/$12,000 $6,350/$12,700 $6,350/$12,700 Preventive Care* 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage Annual Physical Exam 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage Routine Eye Exam One per member per coverage year. Limits apply. Routine Hearing Exam One per member per coverage year. Limits apply. Lifetime Maximum Unlimited After meeting your deductible you pay (copays do not apply to deductible) Office Visits 20% $30 copay/ $60 specialist 20% $30 copay/ $60 specialist $75 copay/ $150 specialist 20% Chiropractic Services 20% $30 copay 20% $30 copay $75 copay 20% Urgent Care** 20% $30 copay 20% $30 copay $75 copay 20% Emergency Room Services** Ambulance Hospitalization Inpatient and Outpatient Outpatient Diagnostic Lab and 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 20% $30 copay 20% $30 copay $75 copay 20% Prescription Drug Coverage Based on the Health Tradition Formulary. $15 Generic $40 Brand $75 Non-formulary 20% Specialty $15 Generic $40 Brand $75 Non-formulary 20% Specialty $10 Generic $70 Brand $150 Non-formulary $10 Generic $50 Brand $155 Non-formulary $30 Generic $100 Brand $150 Non-formulary $30 Generic $60 Brand $100 Non-formulary 20% Specialty * This Benefit Plan provides 100% 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.

5 New! Plans with 2 no-copay primary care office visits HMO Qualified High-Deductible Plans 3000/70 w/copay 5500/80 w/copay Gold HDHP 100 HDHP 85 HDHP 100 Low HDHP 100 High Essential HDHP- Catastrophic $3,000/$6,000 $5,500/$11,000 $2,000/$4,000 $3,000/$6,000 $5,250/$10,500 $6,250/$12,500 $6,600/$13,200 $5,400/$10,800 $6,350/$12,700 $2,000/$4,000 $4,000/$8,000 $5,250/$10,500 $6,250/$12,500 $6,600/$13, % coverage 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage 100% coverage Unlimited See deductible information at left In addition to meeting your deductible you pay $75 copay/$125 specialist 0% 15% 0% 0% 0% $75 copay $75 copay 0% 15% 0% 0% 0% $75 copay $75 copay 0% 15% 0% 0% 0% $75 copay $75 copay 0% 15% 0% 0% 0% $10 Generic $60 Brand $145 Non-formulary $30 Generic $100 Brand $150 Non-formulary Generic 5% Brand 10% Non-formulary 50% If the level of coverage is anything other than single, the entire family deductible must be met by either one member solely, or all members collectively, before plan payment begins. Catastrophic plans are available only to people under 30 and to some with low incomes. No cost-sharing for first 3 primary care visits.

6 Excellent, compassionate care by Mayo Clinic Health System doctors in your own community Mayo Clinic Health System primary and specialty care A relationship with the doctor who knows you best You will select a local Primary Care Provider, also called your PCP. You may choose a doctor, physician assistant or nurse practitioner as your PCP. This provider will get to know you, your medical history and your preferences. Having your own PCP to coordinate care makes it more personal. It s also more effective. Your PCP may consult with specialists within Mayo Clinic Health System, and refer you when medically indicated. Required referrals for specialty care Your care team works closely with Health Tradition to ensure you receive the most appropriate care at the appropriate facility. A referral from your PCP may be to a Mayo Clinic specialist practicing locally. When medically indicated, you may be referred to Mayo Clinic in Rochester or another out-of-network provider. These referrals require written plan approval before services are received. Health Tradition will keep you informed by letter of out-of-network services being considered and those that are approved. La Crosse Eau Claire Rochester Your primary and specialty care provider network Health Tradition Health Plan insures people all over western Wisconsin. Members know they have simple access to excellent care and coverage that s there when they need it. More than 70 locations Use the provider search at HealthTradition.com to choose a primary care provider in your community. Enroll today! For more information or to enroll, please contact us at (toll-free) or (local) 1808 East Main Street Onalaska, WI P.O. Box 188 La Crosse, WI Health Tradition Health Plan HTHP-V624 (09/14)