We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byJayden Simpson
Modified over 4 years ago
©2007 Regence. Private and Confidential. Innova SM & Engage SM Expanding to groups of 100+ employees Enter Your Name & Logo Here
©2007 Regence. Private and Confidential. 2 Presentation Overview What are Self-Managed Plans? Innova and Engage for Groups 2+ Innova & Engage Pharmacy Products Vitality and Embedded Wellness Programs
©2007 Regence. Private and Confidential. 3 self-managed Bridging the gap Perceived Risk & Member Engagement Innova managed care HMOPPO Engage consumer-directed HSA PassiveEngaged Wellness Proactive Provider Choice Member Behavior Rewards RestrictedCategory choices No restrictions NoneTax Savings
©2007 Regence. Private and Confidential. 4 Positioning for Large Group Needs Benefits = investment Attract and retain talented employees Ensure employee productivity Support company culture Managing utilization and rate of increase Expect more because of size Want flexibility of design Programs that support company objectives Demand personalization and higher service levels Desire a long-term carrier relationship Want a partner, not another vendor
©2007 Regence. Private and Confidential. 5 Innova and Engage offer access to all Idaho providers, with plan benefits that give members true choices. Open-door Provider Access Employees are free to select the provider(s) they want, depending on the portion of the cost they wish to pay. All licensed providers fall into one of three categories, based on the reimbursement amount they accept from Regence. Preferred Providers (PPO) 94% of all Idaho doctors & specialists Traditional Providers (TRAD) An additional 4% of Idaho doctors & specialists Non-contract Providers Remaining 2% of Idaho doctors & specialists
©2007 Regence. Private and Confidential. 6 The provider category concept provides new options and choices Employers and Members. Provider Categories in Action Member DecisionEmployer Selection 90% 70% 70% 70% 50% 50% [ 80% ] [ 70% ] [ 50% ] Innova Engage 80% 60% 60% or [ 70% ] or Coinsurance Coverage 80% 60% 60% InnovaEngage
©2007 Regence. Private and Confidential. 7 Moderate cost differenceswith no balance billingcreates a predictable member choice. Benefits before deductible Innova offers predictable benefits before deductible, and robust coverage after deductible Regence Innova Member Decision Employer Selection Office visit co-pay $20 $35 $30 $45 or Member chooses when / where to apply their $400 credit, redeemable with any provider. Member chooses their co-pay amount, based on the provider they visit. Member chooses when / where to apply their co-pay benefit, up to the annual allotment. [ $400 ] or Office visits (per year) 4 visits 6 visits unlimited 6 visits [ $400 ] Out patient coverage: lab & x-ray $40 $55
©2007 Regence. Private and Confidential. 8 Coinsurance options 90% 70% 70% 70% 50% 50% 80% 60% 60% or 80% 60% 60% Deductible and co-insurance maximums are the same across all provider categories. Most robust benefit available with the broadest provider category (Category 1 = 90+ percent of all providers) Category 3 can choose to balance bill. Innova offers predictable benefits before deductible, and robust coverage after deductible Benefits after deductible Member DecisionEmployer Selection Regence Innova
©2007 Regence. Private and Confidential. 9 Innova Benefit Overview Deductible Riders Lifetime Maximum Coinsurance Maximum Coinsurance Outpatient Radiology & Lab credit Annual Up-Front office visits Benefit DetailBenefit Areas 4, 6 or unlimited $400 annually 90/70/70 80/60/60 70/50/50 $2 million $2000 $3000 $4000 $6000 Complementary Care, Mental Health & Chemical Dependency, Vision, EAP $250,$500,$750,$1000,$1500,$2000,$5000 Up-Front OV Copays $20/$35, $30/$45, $40/$55 Any available variables may be mixed- matched Family deductible and coinsurance max is 3 times individual Family aggregate applies Deductible and coinsurance max apply to all categories
©2007 Regence. Private and Confidential. 10 Did You Know... The most popular Innova product combination for groups of 2 to 99 employees: Source: Pivot Tables, Enrollment through February 2008 Co-PayOffice VisitDeductibleCoinsurance Coinsurance Maximum 30/45Unlimited$100080/60/60$2,000 20/35Unlimited$50080/60/60$2,000
©2007 Regence. Private and Confidential. 11 Coinsurance options [ 80% ] [ 50% ] [ 70% ] or Benefits after deductible Member DecisionEmployer Selection Engage offers simple, straight forward coverage with open-door access to all providers. Regence Engage Single co-insurance level simplifies member choices and encourages provider selections based on quality, not just cost. Deductible and co-insurance maximums are the same across all provider categories. Category 3 can choose to balance bill.
©2007 Regence. Private and Confidential. 12 Engage Benefit Overview Deductible Riders Lifetime Maximum Coinsurance Maximum Coinsurance Benefit DetailBenefit Areas 80/80/80 70/70/70 50/50/50 $2 million $2000 $3000 $4000 $6000 Complementary Care, Mental Health & Chemical Dependency, Vision, EAP $0 $500 $1000 $2000 $5000 Any available variables may be mixed- matched Family deductible and coinsurance max is 3 times individual Family aggregate applies Deductible and coinsurance max apply to all categories
©2007 Regence. Private and Confidential. 13 Did You Know... The most popular Engage product combination for groups of 2 to 99 employees: Source: Pivot Tables, Enrollment through February 2008 DeductibleCoinsurance Maximum $200070/70/70$6,000
©2007 Regence. Private and Confidential. 14 Coverage Away from Home Inside Regence States (ID,OR,UT,WA) – Members see Regence providers just like at home – Eastern WA EWA coverage through BlueCard w/ exceptions Outside Regence – Innova Category 1 -- BlueCard PPO Category 2 – BlueCard Traditional – Engage BlueCard Traditional
©2007 Regence. Private and Confidential. 15 Expansion Product Guidelines Expansion of Innova and Engage products to fully insured groups of any size (2+) Innova and Engage may not be sold with Existing products Underwriting for Large Groups – Will follow current state specific rules/practices – Participation - 75% for Employees (was 80% under existing)
©2007 Regence. Private and Confidential. Pharmacy Products
©2007 Regence. Private and Confidential. 17 Pharmacy Benefit Value For Employers Reducing absenteeism for health reasons Employees who are engaged and productive Medication therapy to reduce treatment need For Employees Access to medications Incentives and resources to focus on their health
©2007 Regence. Private and Confidential. 18 Rx Product Rule Highlights Mandatory pharmacy with Innova or Engage medical plan purchase. Dual options Groups cannot select from both Innova, Engage and Existing pharmacy plans. Groups can select among Innova and Engage pharmacy plans (Choose same Rx plan if purchasing both Innova & Engage) Rx accumulators from Regence products carry forward to new products when applicable in areas such as: Deductible Annual Member Out-of-Pocket Maximum Consecutive Regence claims history/prior authorizations
©2007 Regence. Private and Confidential. 19 Innova and Engage Pharmacy Products Innova & Engage Rx*Groups 2+ Rx 1Rx 2Rx 3 Generics **$5$7$10 Brand Formulary$2525%35% Brand Non-formulary$5050% DeductiblesChoose from $0, $250, $500 Annual Member OOP Max (per member)$3K$4K$5K Annual Plan LimitNA MAC AYes Retail (30-day supply) 1 copay/coinsurance Mail Order (up to 90-day limit) 3x co-pay/coinsurance Self-Administered Injectables limited to 30-day supply * All business rules remain the same for groups 2-100+ on Innova/Engage. ** Generics not subject to deductible for groups 2-100+ when purchasing Innova or Engage.
©2007 Regence. Private and Confidential. 20 Prevention & Wellness Through Value-Based Design Growing interest among employers Reducing financial barriers for medication therapies of higher clinical value Improving medication adherence to prevent catastrophic conditions Costs may be more manageable for those actively involved in their health
©2007 Regence. Private and Confidential. 21 Generics RegenceRx continues to promote all generics through: Placement of generics at lowest formulary tier Generic incentive program Employer/member tools: Flyers on health care services Web site myregence.com regencerx.com Prior authorizations, step edits, MAC policy
©2007 Regence. Private and Confidential. 22 Maximum Allowable Cost – A (MAC A) The policy that governs how a medication pays when a generic equivalent is available but the brand is chosen Calculated as the difference between the allowed cost of the medication and the generic equivalent plus the members copay/co-insurance, not to exceed the total allowed cost of the brand
©2007 Regence. Private and Confidential. 23 MAC A Example $200 brand cost - $25 generic equivalent cost $175 +$50 non-formulary brand copay for member on Rx-1 plan for Innova $225 amount is greater than brand cost $200 what the member would pay - In this example, only the member's $50 copay would apply to his/her maximum out of pocket and/or deductible. -In any case for MAC A, only the member's copay/coinsurance applies to the maximum out of pocket and/or deductible.
©2007 Regence. Private and Confidential. 24 Equivalents vs. Alternatives Exact Generic EquivalentGeneric Alternative Same chemical structure as the brand Different chemical structure from the brand, but same therapeutic class Example: Simvastatin is exact generic equivalent for Zocor Example: Lisinopril is a generic alternative for Aceon
©2007 Regence. Private and Confidential. 25
©2007 Regence. Private and Confidential. Wellness Products
©2007 Regence. Private and Confidential. 27 Why Worksite Wellness? Importance of social ties Chance of becoming obese increased by 57% if s/he had a friend who became obese (NEJM) Valuable environment to influence health Healthier, engaged employees good for bottom line Goetzel RZ, Ozminkowski RJ. Whats Holding You Back: Why Should (or Shouldnt) Employers Invest in Health Promotion Programs for Their Workers? North Carolina Medical Journal. 2006; 67,6:428-430. Christakis, Nicholas A. MD PHD, MPH and Fowler, James Phd, The Spread of Obesity in a Large Social Network over 32 Years, Volume 357: 370-379, July 26, 2007
©2007 Regence. Private and Confidential. 28 Wellness Program Availability Vitality Regence Select 51+ Wellness Innova /Engage 2-99 Innova /Engage 100+ Member ProgramsINCLUDEDEMBEDDED CareEnhance Nurse Line Health Coach Special Beginnings Regence Disease Management Case Management Vitality Employer Support (pkg)INCLUDEDNOT AVAILABLEOPTIONAL Wellness Consultant NA Employer Reporting NA Worksite Programs NA Communication Resources NA Additional Worksite ServicesOPTIONALNOT AVAILABLEOPTIONAL Customized Rewards * NA Biometric Screening NA
©2007 Regence. Private and Confidential. 29 One-to-one Health Coaching empowers members to achieve personal health goalssuch as weight loss and stress management. Regence Case Management helps members with complex health needs understand their benefits and maximize treatment options. Support When You Need It Most Innova & Engage go beyond basic insurance to provide personalized Health and wellness support to all members, at no additional charge. Special Beginnings maternity program enhances one of the most significant member touch points with a supportive 9-month education experience. C A broad array of advice and support from experts and other members of the community provides a forum for education and outreach at myRegence.com
©2007 Regence. Private and Confidential. 30 Presentation Summary Self-managed plans represent the core of the current market needs by giving members choices in the areas that are most relevant to them Choice of doctors Choice of co-pay amount Choice of co-insurance level Innova provides the predictability of a copay plan while keeping engagement and choice through multi-level benefits and multiple in network choices Engage provides a simple intuitive benefit through a single coinsurance level and deductible for all categories of provider. The lack of steerage means true open door access
©2007 Regence. Private and Confidential. 31 Transforming Member Behavior... …one family at a time COMMUNITY Leveraging the power of our members Engagement Family wellness activities myRegence community blogs CONSUMERISM Level of member self-management Active Participation Rewards Provider choice CAUSE Reducing waste, confusion & fear Informed Choice Customized navigation Care Enhance
©2007 Regence. Private and Confidential. Thank You!
©2007 Regence. Private and Confidential. 33 ©2007 Regence. Private and Confidential
Allied Funding Advantage How Alternative Funding Works.
© 2009 Regence. Private and Confidential. 1 Activate SM – Healthy Living Rewarded Rewards employees for healthy choices Employees pay their doctors online.
2008 Annual Enrollment Training Presentation April 2008.
1 January 5, 2014 ©Copyright 2010 Jacqueline Madrigal Benefits Manager.
C & C Benefits Group, LLC In Business Since 1977 Specializing In Guaranteed Acceptance Health Plans Licensed Health Agent In 30 States Required by law.
©2007 Regence BlueCross BlueShield of Utah Regence HSA Healthplan A new kind of health care coverage [Enter Your Own Information Here] [Enter Your Clients.
©2008 Regence BlueCross BlueShield of Utah Regence HSA Healthplan A new kind of health care coverage [Enter Your Own Information Here] [Enter Your Clients.
University of California Active 2013 Open Enrollment.
H.B. Fuller Company 2010 Open Enrollment: Helping you Buy Well, Use Well, Be Well October, 2009.
2013 Annual Enrollment Meeting Annual Enrollment is November 19 – November 30.
American General Life Companies FOR PRODUCER USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC 1 February 2013 Big Changes for Small Businesses Jay Drucker,
How to Save on Your Health Insurance. How Did We Get Here?
USA BENEFITS GROUP GUARANTEED ISSUE HEALTH PLANS USABG EAGLE DIVISION PROVIDING HEALTH INSURANCE SOLUTIONS FOR 36 YEARS.
1.03 Healthcare Finances.
Copyright © 2010 by the American Academy of Actuaries What Is Actuarial Value? Cori E. Uccello, FSA, MAAA, MPP Senior Health Fellow American Academy of.
The Center for a Changing Workforce 1 Everyday Low Benefits: Health Insurance in the Age of Wal-Mart The Center for a Changing Workforce Seattle, WA.
1 Filling the Holes in Part D: SPAPs to the Rescue? Marc Steinberg, Families USA Health Action 2005 * January 27,
The Impact of Drug Benefit Caps Geoffrey Joyce, PhD.
© 2018 SlidePlayer.com Inc. All rights reserved.