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HealthAmericaOne offered to individuals and families by HealthAmerica.

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Presentation on theme: "HealthAmericaOne offered to individuals and families by HealthAmerica."— Presentation transcript:

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2 HealthAmericaOne offered to individuals and families by HealthAmerica

3 HealthAmericaOne Overview –HealthAmerica –HealthAmericaOne –Distribution –Plan Designs and Benefits –Eligibility –Sales Process –Underwriting/Enrollment –Premium Payment –Service

4 HealthAmerica Inc. HealthAmerica – 31+ years in managed care Serves more than 730,000 members in PA and OH and 11,000 employer groups Over 26,000 providers and 200 hospitals Offers products to employers and Medicare recipients

5 HealthAmericaOne Developed for individuals and families under the age of 65 and not eligible for Medicare Preferred Provider Organization (PPO) Not Guaranteed Issue Benefit designs include annual deductibles, varying coinsurance levels and Rx copayments Core Benefits Only HSA Compatible Plans Available

6 Service Area Map

7 Regulatory Product offered through a non-employer group trust in the State of Ohio –All members must join (no charge) Underwritten by Coventry Health & Life Governance by the State of Ohio Pennsylvania maintains oversight of consumer protections

8 Distribution Wholesalers –Currently 12 Statewide Select Agencies –Currently 5 Statewide Producers –Currently 1,100+ Statewide and Ohio

9 Producers Producer Responsibilities –Presentation of HealthAmericaOne to Clients –Application Completion –Presentation of Final Rate –Renewal

10 Plan Designs In-Network and Out-of-Network Benefit Levels Out-of-Pocket Maximums –$2,500 to $10,000 In-Network –Unlimited Out-of-Network Annual Deductibles, Varying Coinsurance Levels, and Rx Copayments –Apply toward OOP Lifetime Maximums –$4,000,000 In-Network –$50,000 Out-of-Network

11 Plan Designs Nine Qualified High Deductible Plans –Deductibles between $1,200 and $3,000 –Coinsurance levels 90%, 80% or 50% –OOP Max $5,000/$10,000 Six Non-Qualified Plans –Deductibles between $500 and $10,000 –Coinsurance levels of 100% or 80% –OOP Max from $2,500 to $20,000

12 Plan Types Qualified (QHDHP) vs Non-Qualified What is a QHDHP? –Qualified HDHPs meet certain Internal Revenue Service (IRS) guidelines, allowing them to be paired with HSA’s and providing a tax-free way to help members build savings for future medical expenses.

13 QHDHP vs. Non-QHDHP Plans DeductibleOut of Pocket Maximum (OOP Max) Prescription Drugs Health Savings Account (HSA) Qualified High Deductible Health Plan (QHDHP)  Does not apply to Qualified Preventive Services  Includes Rx costs/copays  Includes Deductible  Member Pays HAPA1 discounted cost until deductible is met  After deductible is met, member pays copays until OOP Max is met  When OOP Max is met, Rx covered at 100%  Can be attached to a QHDHP  For more information: Search “HSA” Non-Qualified Health Plan  Does not apply to Qualified Preventive Services  Does NOT include Rx copays  Includes Deductible  Member ALWAYS pays copays  Member pays copays after OOP Max is met  Cannot be attached to a HAPA1 PPO

14 Benefits Hospital Inpatient Care Qualified Preventative Services Prescription Drugs Emergency Care Home Health Care Maternity Services (for complications only) Mental Health Services (outpatient only) Value-Added Programs PA vs. OH Benefits

15 PA and Ohio Benefits PennsylvaniaOhio Substance Abuse According to PA Act 106:  Detox—7 days per admission; 4 admissions per lifetime.  Non-Hospital Residential—30 days/year; 90 days per lifetime.  Outpatient—60 visits per year; 120 per lifetime. Up to 30 OP visits can be exchanged for up to 15 non- hospital residential days.  Inpatient—Not a covered benefit.  Outpatient—10 visits per year (any licensed provider). Combines with Mental Health. Mental Health  Inpatient—Not a covered benefit.  Outpatient—10 visits per year with any licensed provider.  Inpatient—Not a covered benefit.  Outpatient—10 visits per year (any licensed provider). Combines with Substance Abuse.

16 Benefit Limitations Not Covered: –Maternity (except complications) –Voluntary Sterilization/Family Planning –Chiropractic care –Dental/Vision care –Hearing Aids –Private Duty Nursing DME has $7,000 lifetime maximum

17 Eligibility –Subscriber Under 65, not eligible for Medicare Under 18, must have guarantor over 18 Spouse and/or children may be independent applicants Must reside within PA and OH –Dependents Under 65, not eligible for Medicare Eligible up to age 25 Newborns

18 Applications Submit through benefitexpress (BE) –Application and Sales Process Completed Online Applicants can complete own application Agents can use paper applications and submit via benefitexpress on behalf of clients Underwriting completed in hours

19 Applications Applications pend up to 45 days for missing information Applications expire 60 days after original signature date Effective dates not guaranteed Effective date always on first of the month Retro-effective dates not permitted

20 Pricing Illustrative Rate –Each person evaluated on following demographic factors: age, gender, zip code, tobacco use and employment status. Final Rate –Each person evaluated based on demographic factors plus medical information on application. Accept, decline or possible rate-up to 30% Automatic Decline List Pre-Existing for 365 days

21 Pre-Existing Not Subject to Pre-Ex –Medical conditions disclosed on application and accepted –New medical conditions diagnosed after member’s effective date Subject to Pre-Ex –Medical conditions not disclosed on application that were diagnosed prior to the member’s effective date –6 month look back

22 Premium Premium Payment –10 day free-look period –Deduction from checking or savings account Monthly ACH transfer only –Deduction on 10th of current month –10 day grace period for premium payment

23 Service –Wholesale Agencies for Subproducers –Dedicated Member Services Team for HealthAmericaOne Phone:

24 Why HealthAmericaOne? Secure online application and sales process Rapid (1-2 days) underwriting turnaround Wide array of plan designs Strong physician and hospital networks Excellent name recognition Dedicated Customer Service area Outstanding agency and broker support Strong commission and incentive programs

25 HealthAmericaOne Questions ?


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