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Welcome State of New Mexico and Local Public Body Employees Your 2013 Open/Switch Enrollment www.lovelacehealthplan.com/stateofnewmexico.

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Presentation on theme: "Welcome State of New Mexico and Local Public Body Employees Your 2013 Open/Switch Enrollment www.lovelacehealthplan.com/stateofnewmexico."— Presentation transcript:

1 Welcome State of New Mexico and Local Public Body Employees Your 2013 Open/Switch Enrollment

2 Welcome to Lovelace Lovelace is an Integrated Delivery System Lovelace Westside Hospital – New child friendly ED and only in-patient pediatric unit on the Westside/Rio Rancho. Same day radiology. Family birthing center at Westside. Bariatric Services. Access to over 25 medical specialties. 24/7 ER. Lovelace Women’s Hospital – Only hospital in state devoted to women’s health. Breast Care Center. Family Birthing Center. Women’s Education. 24/7 ER. Advanced Neonatal Intensive Care Unit (NICU). Only Natural Birthing Center in NM. Lovelace Medical Center Downtown – Full Service Acute Care. State of the art Cardiac Care Center. Complimentary valet parking. NM’s only Intravascular Ultrasound and Gamma Knife Center. 64-slice CT Scanner. Dedicated Orthopedic Unit. 24/7 ER. Heart Hospital of LMCD – Only NM Hospital dedicated to Heart health. Cardiology. Surgical Services such as Vascular and endovascular. Radiology Services. 24/7 ER. Lovelace Rehabilitation Hospital – Only NM Hospital accredited by the CARF in five programs; Stroke, Brain Injury, Spinal Cord, and Inpatient and Outpatient Rehab Programs. Lovelace Regional Hospital-Roswell – Family Care Clinic. Family Birthing Center. Surgical Services. Orthopedics. Cardiology. 24/7 ER. Continued investment in state-of-the art technology!

3 Your Medical Groups and Doctors We work with major medical groups, such as the NM Heart Institute, UNM Medical Group, ABQ Family Health Center, Atrinea Health, NM Orthopedics Association and many other provider groups and independent physicians. The newest member to the Lovelace family is Southwest Medical Associates and we are constantly adding new providers who accept Lovelace Health Plan members. Since 2002, we have invested more than $316 million in Lovelace’s facilities equipment and people. Southwest Medical Associates place great emphasis on building relationships with their patients and offering personal care, state-of-the-art quality and exceptional customer service – especially when it comes to short wait times. This acquisition will launch a new physician model for Lovelace, a hybrid network of employed and community physicians who work together to provide coordinated care. The hybrid care model will benefit patients through; better coordination of care, improved communication between facilities and providers and improved patient flow throughout our comprehensive, integrated health system. Southwest Medical Associates provides expanded primary care services, including Family Medicine, Internal Medicine and Pediatrics, as well as Gynecology, Neurology and Podiatry. They also offer extended hours for primary care services to increase access to health care for their patients. SMA - Northside Clinic Location 6100 Pan American Frwy, NE Albuquerque, NM SMA - Westside Clinic Location 4420 Irving Blvd, NW Albuquerque, NM 87114

4 Where can I access care in New Mexico? An extensive network of physicians and hospitals to include over 9,000 doctors across New Mexico and bordering states with; 41 Hospitals including; Lovelace Westside Hospital Lovelace Women’s Hospital Lovelace Medical Center Downtown »Heart Hospital of New LMCD Lovelace Rehabilitation Hospital Lovelace Regional Hospital-Roswell 32 Urgent Care Centers Worldwide emergency care and urgent care

5 Can I access care outside of New Mexico? With Lovelace Health Plan you get comprehensive benefits and a national network – benefits pay at the In- network benefit level when accessing our national network through MultiPlan/PHCS: Access to over 530,000 providers & over 4,500 hospitals nationally though the MultiPlan/PHCS Network Access to OptumHealth’s Centers of Excellence and nationally recognized facilities To find a MultiPlan/PHCS contracted provider visit; or call them at;

6 Your July 2013 Medical Benefit Highlights Covered Services Lovelace HMO Plan Your Cost/Co-Payments Contract Year Deductible Single: $350 Two Party: $700 Family: $1,050 Contract Year Out-of-Pocket Maximum Single: $3,500 Two Party: $7,000 Family: $10,500 Lifetime MaximumNone

7 Your July 2013 Medical Benefit Highlights (cont.) Covered Services Lovelace HMO Plan Your Cost/Co-Payments Physician Services $25 Primary/OB/GYN Services* $40 Specialty care (No referral required) Lab and X-ray20% Coinsurance Preventive ServicesNo Co-pay* Inpatient Hospital Services$500 per admission Hospital Observation Services$250 Co-pay Surgery/Outpatient Facility20% Coinsurance Emergency Service (waived if admitted)$175 Co-pay Urgent Care Center$50 Co-pay MRI/PET Scans/CT Scans 20% Coinsurance (maximum $200 per test) Naprapathy ($500 contract year maximum) $50 Co-pay Acupuncture and Chiropractic Services ($1,500 combined contract year maximum) $40 Co-pay Durable Medical Equipment (DME)20% Coinsurance *Not Subject to the Deductible

8 Services Include: Medical Consultations Hospital Admission Guarantee Medical Repatriation Emergency Medical Evacuation Care of Minor Children Document assistance Return of Mortal Remains Lost Luggage Recovery Prescription Assistance Compassionate Visit Emergency Message Transmission Interpreter & Legal Referrals Services Include: Medical Consultations Hospital Admission Guarantee Medical Repatriation Emergency Medical Evacuation Care of Minor Children Document assistance Return of Mortal Remains Lost Luggage Recovery Prescription Assistance Compassionate Visit Emergency Message Transmission Interpreter & Legal Referrals What is Assist America? (Emergency Services Coordination) Travel emergencies can happen anywhere, anytime. Thankfully, you’re protected by Assist America Travel emergencies can happen anywhere, anytime. Thankfully, you’re protected by Assist America

9 Your HealthySteps Programs Baby Love Infant Car Seat Program Healthy Steps Coaching Healthy Trails Care Concierge Program Personal Health Assessment Healthy Weight Healthy Literacy Behavioral Health & Outreach and Education S.T.O.P. (tobacco cessation) Case Management Nurse Advice & Health Information Line Online Educational Tools Worksite Wellness

10 Your Baby Love, Infant Car Seat Program Eligible if the expectant mother receives the recommended number of prenatal visits within the recommended timeframe: Doctor’s office signs the form at each visit Member submits form to Lovelace when complete Infant car seat is delivered to the member’s home After your child is enrolled in the plan and completes their first four Well Child Checks, you will be upgraded to a Toddler Car Seat at NO COST!

11 Maternity Care Coordinate prior authorizations Durable Medical Equipment Home Health Care services Patients that are in the middle of treatment, such as cancer and cardiac services Schedule appointments To speak with a Care Concierge specialist, Contact us at; or us at; Maternity Care Coordinate prior authorizations Durable Medical Equipment Home Health Care services Patients that are in the middle of treatment, such as cancer and cardiac services Schedule appointments To speak with a Care Concierge specialist, Contact us at; or us at; Our Care Concierge team assists new members in their transition from non- contracted providers and services to providers contracted with Lovelace. What is Care Concierge? (Transition of Care)

12 Logging on is simple! 1. Visit us at lovelacehealthplan.com 2. Click on member access 3. Enter your user ID and password (if you’re a first time user you will need to register) View and verify; Eligibility Claim information and EOB’s Benefit Information Search our online directory for contracted providers Communicate with Customer Care by Watch wellness videos and much more… Visit us at; lovelacehealthplan.com

13 Your Dedicated Customer Care/Claims Team Local customer care dedicated specifically for the State of New Mexico and LPB employees Pre-Enrollment line to help you with your switch enrollment decisions Customer Care/Claims and Pre-Enrollment Line; Hours: 8:00am-5:00pm, Monday – Friday (se habla español) or or us at;

14 Why Choose Lovelace? Lovelace is committed to you and your family’s health We’re one of New Mexico’s oldest and largest employers Statewide network of doctors and hospitals with access to national resources though the largest independent primary network, MultiPlan/PHCS and OptumHealth Referrals not required to access specialists Local customer care and account management team No cost, value added benefits and discount programs such as HealthySteps, Assist America, Care Concierge and many more! One of the lowest out-of-pocket costs with your premiums, deductibles, out-of-pocket maximums and co-pays!

15 Thank you! Questions?


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