Open Enrollment Meetings January 1, 2013 Goodwill Industries.
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Open Enrollment Meetings January 1, 2013 Goodwill Industries
Todays Agenda Medical Plan Review Being a Good Consumer Using the UHC Benefits Reminder: Health Advocate Enrollment Procedures/ID Cards
Effective January 1, 2013 There will be no change in carriers. The current plan designs will remain in place but there will be a slight increase in the employee contribution. Health Plan Review
Health care costs continue to rise New technology, drug development Poor lifestyle habits and behaviors Inability for consumers to recognize the difference in quality & cost Choice of options allow you to decide where to spend your money – paycheck or doctors office Plans both encourage employees/dependents to continue to utilize preventative services and fill prescriptions Health Plan Review
Insurance Terminology Annual Deductible The amount you must pay for certain covered health services in a calendar year before the plan will begin paying for major medical benefits in that calendar year. Coinsurance The amount or percentage the plan (UHC) pays and you pay after the deductible is met. Maximum Out-of-Pocket The maximum amount of Annual Deductible and Coinsurance you pay every calendar year. Once you reach the Out-of-Pocket maximum, benefits are payable at 100% of Eligible Expenses during the rest of that calendar year. NOTE: These do not include benefits that are subject to copays.
Plan Options Plan Designs The plan designs – deductible, coinsurance, out of pocket expenses – remains the same. Certificate of Coverage through UHC While the essential benefits of the plan stay the same, there are a few enhancements with the Womens Wellness coverage. Employee Contribution There will be slight increases to both plan options this year.
Choice Plus In NetworkOut of Network Annual Deductible Individual$1,500$5,000 Family$3,000$10,000 CoInsurance80%60% Maximum Out-of-Pocket Individual$4,000$10,000 Family$8,000$20,000 Preventive CareCovered at 100%60% after Deductible Dependent CoverageUp to age 26. NOTE: The Out-of-Pocket Maximum INCLUDES the Annual Deductible. Copayments do not accumulate to the Deductible or Maximum Out-of Pocket.
Navigate – WI HMO In NetworkOut of Network Annual Deductible Individual$2,000N/A Family$4,000N/A CoInsurance80%N/A Maximum Out-of-Pocket Individual$4,000N/A Family$8,000N/A Preventive CareCovered at 100%N/A Emergency CoverageIn-Network Deductible / Coinsurance Dependent CoverageUp to age 26. NOTE: The Out-of-Pocket Maximum INCLUDES the Annual Deductible. Copayments do not accumulate to the Deductible or Maximum Out-of Pocket.
Both Plans – Employee Cost Single per month Family per month Choice Plus$117.38$ Navigate (WI HMO) Choice (IL HMO) $108.56$282.17
Introducing the UnitedHealthcare Navigate SM Plan Cover area with cropped image. Do not overlap blue bar. Completely cover gray area.
UnitedHealthcare Navigate SM Plan Connects you to a primary care physician (PCP) that you can trust who will provide and manage most of your care The Navigate Plan Stresses delivery of quality care Coordinates care across specialists, hospitals and other health care providers Helps to improve the overall health care experience Helps set a path to better health outcomes
12 UnitedHealthcare Navigate SM Plan You must select a primary care physician (PCP) near where you live. Network coverage only (unless emergency) Referrals are required to see network specialists Not receiving the right care can result in: Unnecessary procedures Duplication of services Needed care not being recognized Poor quality and outcomes Patient confusion and frustration
Selecting a Primary Care Physician Search by clicking on the plan link.
The Primary Care Physician 14 Once you select a PCP, he or she will: Provide your preventive care and routine care for most illnesses & injuries Coordinate all of your care, from staying healthy to managing serious and chronic conditions Refer you to other network physicians and specialists as needed The following physicians can be selected as a PCP: General Practitioners Family Practitioners Internists Pediatricians Your PCP will be your guide to the right treatment, the right specialist, at the right time.
15 Selecting a Primary Care Physician You must select a PCP Each family member may select a different PCP in your area If you do not select a PCP, UnitedHealthcare will assign one Navigate health plan ID cards will include the name of your PCP You can request to change your PCP after you enroll. This process could take up to 6 weeks. Health plan ID cards will include name of your PCP
Selecting a Primary Care Physician 16 If you want to change your PCP Call Customer Care or log in to myuhc.com® Must submit change request by the 15th of the month to have new PCP by the 1st of the next month (e.g., submitted June 15 th, effective July 1st) If submitted on the 16th (or after), change wont occur until the following month (e.g., submitted June 16 th, effective August 1st) New health plan ID cards will be issued whenever there is a PCP change Retroactive changes will not be permitted June 2011 July 2011 August 2011
Your PCP evaluates you. 17 Obtaining Referrals Youre not feeling well. You make an appointment with your PCP You make an appointment with your PCP 1. Your PCP asks questions to try to understand what may be causing the illness. If necessary, your physician will order some tests. 2. Based on the evaluation, your PCP may: Provide a treatment plan and/or prescribe medications 3. OR Refer you to a network specialist
18 Obtaining Referrals Navigate members must receive referrals before seeing another network primary care physician or specialist Referrals are not needed for emergency care even if received at a non-network hospital Referrals are NOT REQUIRED for services from network: OB/GYNs and Chiropractors Behavioral health and substance abuse disorder clinicians Optometrist/ophthalmologist for refractive exams Urgent and convenience care centers
Good Consumers of Health Care Dollars Saving money starts with communication….. Make sure you at least have a Primary Care Physician. Ask questions and be in control of your care. Create a healthcare journal – track your own condition as well as your treatments and concerns.
Good Consumers of Health Care Dollars Use your insurance plans resources. Register on Know how to read your Explanation of Benefits. Use the Treatment Cost Estimator to determine and plan for the costs of your treatment. Remember, your health care involves both your coverage as well as your treatment.
Good Consumers of Health Care Dollars Take charge! Its your health and money! Use the Care24 services to help deciding on place of service (ER vs Urgent Care). Find out if generics are available and if they qualify for the pill-splitting program. Do your homework – find the Premium Designated physicians and facilities for your diagnosis.
Using the UHC Benefits Register for MyUHC website Once you receive your UHC ID Card Visit Select REGISTER NOW Type in the requested information Get started!
Using the UHC Benefits - MyUHC.com - Find a Doctor – send to cell phone - Find a Hospital - Look up Claims - Improve Health - Order Prescriptions online - Replace ID card - Enhanced Personal Health Record - Embrace Wellness - Check Benefits - Treatment Cost Estimator - And Much More! 71 percent of all eligible users access myuhc.com for claim/benefit information
Using the UHC Benefits - Care24 Services Seven days a week – 24 hours a day Toll-free number ( ) Access to registered nurses – assistance with place of service decisions
Health Advocate Offers a Personalized and Comprehensive Service Find qualified doctors, dentist, hospitals, other healthcare providers anywhere in the country Expedite appointments including hard-to-reach specialists; arranges for specialized treatments and tests Help resolve insurance claims; negotiates billing/payment arrangements Assist with eldercare such as finding adult daycare, assisted living and other related issues facing parents, parents- in-law Obtain unbiased health information about complex medical conditions to help make informed decisions Work with insurance companies to obtain appropriate approvals for needed services Answer general questions about test results, treatments and medication prescribed by the physician Assist in the transfer of medical records, x-rays and lab results Locate and research the newest treatments for a medical condition Assist with finding qualified wellness programs, providers and services
Consumer / Member Health Plan MDs/Hospitals Wellness Programs Disease Management Claim Appeals Health Advocate PBM or EAP Communication Resolution = happy member Health Advocate Connects Member Community & Government Programs
Healthcare Cost Estimator Pre-service pricing tool Integrated into Health Advocates work-flow Largest source of private sector claims data – MedStat Database of over 69 million member records
Privacy and Confidentiality Protection We protect your privacy Your healthcare information is kept strictly confidential We fully comply with the federal HIPAA law Medical Authorization Form
Employee Testimonials I used it and it was great! My daughter seen an out-of network provider and I called Health Advocate to assist with the billing. The clinic worked with them and ended up writing off half of the bill. Ive used Health Advocate 2 or 3 times already. Ive used them to help interpret why a service either isnt covered or isnt covered fully and to help decipher the multiple bills that are sent sometimes when you have hospital services (i.e. hospital, doctor, anesthesiologist…they all get their own bill!) I had a question about coverage for my sons allergy shots. I contacted Health Advocate & the question was answered right away from the source itself (United Health Care). No long waits and I dealt only with customer service representatives (not automated computer-generated messages). I will definitely contact them again.
How to Reach Health Advocate Telephone: (toll-free) Website: Open: Monday – Friday 8am and 9pm Eastern Time After hours: Health Advocate can be accessed 24/7. After hours and during weekends, on-call staff is always available for assistance with issues that need to be addressed during non business work hours.
Enrollment Reminders Open Enrollment: Nov 15 th -Nov 30 th PLEASE NOTE: This election will be from 1/1/13 – 12/31/13. For January 1 st, 2013 the medical, dental, and Flexible Spending enrollments are all aligned. The next opportunity for changes will be in November of 2013 for January 1, 2014 outside of a Qualifying Event. If you are not making any changes to your current plans, the only form to complete is the FSA Enrollment form if you are making an election for This must be done annually.
Enrollment Reminders If you need to make any changes (new enrollment/add/move to HMO/cancel coverage) or enrolling in the FSA plan for 2013, you will need to complete an enrollment form. You can send forms in by: Mailing forms to the Benefits Dept at MSC Scan and forms to Fax forms to Enrollment Forms Due: Nov 30th
THANK YOU! For any Benefits-related questions, call Goodwill at