Indiana QHP Marketplace Basics 10/3/2014 Jo Nahod-Carlin Director, Marketing & Communications About MHS has been proudly serving Indiana residents for nearly two decades through Hoosier Healthwise and the Healthy Indiana Plan. MHS now offers a qualified health plan through the health insurance marketplace called. We provide healthcare that fits your budget, with a provider network you can trust. Plan Overview Local and Experienced Staff live and work in this community 7 outreach workers + network of licensed agents Nurses, Doctors, Social Workers, Community Health Workers, and staff at all levels have extensive experience in health care Strong support with non-profits and local organizations Affiliate of Centene, a Fortune 500 company with more than 28 years of delivering community-focused health care Committed to Health Innovative programs to promote healthy choices and active engagement in health Medically proven, effective programs and support to assist members with chronic diseases and behavioral health needs Innovative and patient-centered medical management teams collaborating on patient s behalf Strong local partnerships and a shared commitment to meet member needs and help them achieve their health goals 3 4 Highlights Annual wellness visits, screenings and immunizations are covered at 100%. Members choose the doctor they want. No referrals for a specialist. Financial incentive program that can help pay monthly premiums and deductibles. Gym reimbursement & membership discounts 24/7 Free Nurseline To locate formulary information for visit us online at http://ambetter.mhsindiana.com/healthwellness/formulary/ Free Sick Visits with certain plans 5 6 1
7 8 9 10 11 12 2
Ambetter Attributes Plan Overview EXAMPLE for complete listing of plans visit us online at http://ambetter.mhsindiana.com/ourplans/ Characteristic Description (HMO) **Data obtained 9.29.14 from Value Penguin. **Rates are based on Marion County, Household Size of one, Age 27, Household Income 35,000 (This is for research purposes only. The numbers shown are only estimates. Affordable Affordable premiums and low out of pocket expenses Suite of offerings to meet our members health needs medical, behavioral and pharmacy Product Greater access to health insurance coverage and benefits No fine print easy to understand benefits and help for how to use them Comfortable transition for members who may move on and off Medicaid Healthy rewards program Value Added Benefits Gym membership reimbursement PCP assignment/medical home a commitment to getting patients to see a dedicated Medical Management doctor that knows everything about them and make sure they are getting the care that s Approach right for them 24-hour nurse line Local presence of the health plan customer service by people that live and work in the community, when members have a question about health coverage Service Transparent process from enrollment (e.g., sales) through membership (e.g., customer Experience service) Helpful Ambetter helps members navigate the health care system Network Built on our existing provider network so there is continuity for members Deductible Coinsurance Out of Pocket Subsidy Premium / Monthly Cost Maximum Ambetter Bronze 3 $6,000 40% $6,350 $0.00 $228.46 Ambetter Bronze 3 + Vision $6,000 40% $6,350 $0.00 $231.61 Ambetter Bronze 4 $4,000 40% $6,350 $0.00 $236.85 Ambetter Bronze 4 + Vision $4,000 40% $6,350 $0.00 $241.04 Ambetter Bronze 3 + Vision + Adult Dental $6,000 40% $6,350 $0.00 $242.09 Ambetter Bronze 1 $5,000 40% $6,350 $0.00 $245.23 Ambetter Bronze 1 + Vision $5,000 40% $6,350 $0.00 $248.38 Ambetter Bronze 4 + Vision + Adult Dental $4,000 40% $6,350 $0.00 $251.52 Ambetter Bronze 1 + Vision + Adult Dental $5,000 40% $6,350 $0.00 $259.90 Ambetter Silver 5 $3,000 0% $6,350 $0.00 $273.53 Ambetter Silver 3 $2,500 30% $6,350 $0.00 $276.67 Ambetter Silver 5 + Vision $3,000 0% $6,350 $0.00 $277.72 Ambetter Silver 3 + Vision $2,500 30% $6,350 $0.00 $280.86 Ambetter Silver 4 $2,000 20% $6,350 $0.00 $288.20 Ambetter Silver 5 + Vision + Adult Dental $3,000 0% $6,350 $0.00 $290.30 Ambetter Silver 1 $1,500 30% $6,350 $0.00 $291.34 Ambetter Silver 4 + Vision $2,000 20% $6,350 $0.00 $292.39 Ambetter Silver 3 + Vision + Adult Dental $2,500 30% $6,350 $0.00 $293.44 Ambetter Silver 1 + Vision $1,500 30% $6,350 $0.00 $295.54 Ambetter Silver 4 + Vision + Adult Dental $2,000 20% $6,350 $0.00 $306.02 Ambetter Silver 1 + Vision + Adult Dental $1,500 30% $6,350 $0.00 $309.16 Ambetter Gold 4 $1,000 20% $6,350 $0.00 $334.31 Ambetter Gold 2 $500 20% $6,350 $0.00 $336.41 Ambetter Gold 4 + Vision $1,000 20% $6,350 $0.00 $339.55 Ambetter Gold 2 + Vision $500 20% $6,350 $0.00 $340.60 Ambetter Gold 4 + Vision + Adult Dental $1,000 20% $6,350 $0.00 $354.22 Ambetter Gold 2 + Vision + Adult Dental $500 20% $6,350 $0.00 $356.32 13 14 Utilizing Our Website Ambetter.mhsindiana.com What To Do Now That You re Enrolled? 1. Go to ambetter.mhsindiana.com. Login to the site with your information and complete your Health Risk Screener. This information is used so that you can better understand your health care needs. Ambetter will then be able to provide customized, educational information and services specific to your needs. 2. Find a Primary Care Provider (PCP). 3. Schedule annual exam with your PCP. Make sure you understand the preventive care services that you should be receiving at your visit and write down questions for your doctor before you go. 15 16 Choosing Your PCP The Provider Directory lists all participating PCPs along with their addresses, phone numbers, and languages other than English the provider may speak. An Ambetter member will have the freedom to choose any participating Ambetter Family Practice, General Practitioner, or Internal Medicine provider for your PCP. Female members may choose an OB/GYN as their PCP during the term of a pregnancy. Chose a Provider Step 1. Go to ambetter.mhsindiana.com and click on Find A Provider Once the PCP has been selected, Ambetter recommends that the member make an appointment to meet with their doctor right away. This will give the member and their doctor a chance to get to know each other. To make an appointment with the PCP, you need to call your PCP's office. Remember to take your Member ID card with you every time you go to the doctor's office. 17 18 3
Step 2 Follow the prompts Chose a Provider How to Make Payments 19 20 How to Use Insurance What does the insurance card look like? How to Minimize Out of Pocket Costs Members can earn up to $125 annually on their My Health Pays reward card for: Completing their new member welcome survey ($50) Getting your Annual Wellness Exam ($50) Getting your annual flu shot ($25) The member ID card will be mailed out to the member before coverage begins. Rewards are automatically put on your My Health Pays rewards card once they are earned, so there s nothing extra to do! You can then use your reward dollars to help pay for your copays, deductibles and monthly premiums. Additional information can be found on our website ambetter.mhsindiana.com. 21 22 How to Minimize Out of Pocket Costs Members can earn up to $240 annually with our gym Membership Benefits. With Ambetter you can: Earn $20 every month by visiting the gym of your choice at least eight times. Get discounts on gym membership fees at approved locations. Just visit Ambetter.mhsindiana.com to find an eligible gym in your area. Global fit is our partner Bally's, Curves, 24 Hour Fitness, Anytime Fitness and other national chains as well as small local gyms and fitness centers. Resources ambetter.mhsindiana.com 1-877-687-1182 (TDD/TYY: 877-941-9232) Seven days a week from 8 a.m. to 5 p.m. Member Services Open Enrollment (11/15/2014 to 2/15/2015) Special Enrollment Payment Information Questions Call Centers Etc. Nurse Response (24-hour nurse hotline) Brochures and informational cards to hand out to consumers. Jo Nahod-Carlin, Director of Marketing & Communications jcarlin@mhsindiana.com Credentialing Questions - Anthony Tyms, Manager of Contracting - atyms@mhsindiana.com 23 24 4
Jo Nahod Carlin Director of Marketing & Communications MHS & 1099 N. Meridian Street, Suite 400 Indianapolis, IN 46204 Office: 1 317 684 9478 Ext. 20165 Fax: 1 317 684 1785 Email: jcarlin@mhsindiana.com Websites: mhsindiana.com & ambetter.mhsindiana.com 25 26 This is a project of ACA Marketplace Stakeholders in Indiana, which invited all health insurance organizations participating in the ACA Health Insurance Exchange Marketplace to provide a quick overview of their plan options. We want to affirm that no preference is given to any provider, as the same template format and opportunity is provided to each of the health plan organizations. We d like to thank the following organizations for their support: The ASPIN Health Navigator Project is supported by Funding Opportunity Numbers CA NAV 14 002 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of oral, written, and electronic communications are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies unless cited otherwise. The UWW/IaUW Navigator was supported by Funding Opportunity Number CA NAV 13 001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. 27 5