2017 Plan Information
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- Horatio Williams
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1 2017 Plan Information
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3 LOCAL 600 R Dear UAW member: More than 50 years ago, UAW President Walter Reuther sought an alternative to traditional health insurance for his fellow UAW members. The plan he established ultimately became HAP. Today, HAP continues to carry out Walter s vision by providing high-quality and affordable plans to UAW Trust members. HAP is proud to be a UAW-represented organization with a long-standing history with the UAW. HAP has worked jointly with the leadership at UAW Local 600 for almost 20 years on many projects benefiting both HAP and UAW members. More than 105,000 autoworkers, retirees and their families have chosen HAP as their health plan partner. With so many health plans available, you ll want to examine all of the facts to get the plan that fits your needs. We re confident that, once you look at HAP, the choice will be easy. We re providing you with a look at the benefits many union families are already enjoying as HAP members. And our employees represented by UAW Local 600 are here to help you along the way. Our goal is to answer all of your questions and concerns. You can contact HAP Customer Service at these numbers: HAP HMO: (800) (TTY: 711) April 1 through Sept. 30: Monday through Friday from 8 a.m. to 7 p.m. Oct. 1 through March 31: Monday through Friday from 8 a.m. to 7 p.m. and Saturday from 8 a.m. to noon HAP Senior Plus (HMO): (800) (TTY: 711) April 1 through Sept. 30: Monday through Friday from 8 a.m. to 8 p.m. Oct. 1 through Feb. 14: Seven days a week, 8 a.m. to 8 p.m. Feb. 15 through March 31: Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to noon If you re a retiring UAW Chrysler, GM or Ford employee or a current UAW Trust member, join HAP by calling Retiree Health Care Connect at (866) In solidarity, Sincerely, Bernie Ricke, President UAW Local 600 Scott Allen, Associate Vice President Labor Affairs and VEBA Administration 1
4 The HAP Difference
5 We believe a health plan should go beyond doctors and copays. Everything we do is designed to make your life easier from the way we help answer your questions and provide an extensive list of doctors and hospitals to all of the valuable member benefits we include in our plans. When you re a member of HAP, you ll know you re covered, listened to and treated well. Personalized service We put the person in personal. As a HAP member, our Customer Service team will support you every step of the way. Real people will be with you to answer your questions and take care of your needs. You can call Customer Service or you can send us secure messages by logging in at hap.org. Your personal service coordinator To make sure our relationship gets off to a healthy start, you ll have your very own personal service coordinator for the first two years of membership. Your coordinator will help answer your health plan and benefits questions, find real solutions and guide you along the way. During your first 45 days as a HAP member, your coordinator will contact you to make sure you understand your benefit information and remain available to answer any questions you may have at the time. Assist America HAP helps protect you with emergency travel assistance and identity theft protection. HAP partners with Assist America to provide global emergency travel assistance so you and your family can get help with travel emergencies, such as lost prescriptions, luggage, eyeglasses, travel documents and more. Our partnership with Assist America also brings you trusted identity theft protection. It s free for HAP members. Get safe, continuous monitoring that includes: Credit card and document registration with lost and stolen recovery assistance by phone Credit and debit card internet surveillance when you register your cards 24/7 identity fraud support to help restore your personal information 3
6 Leading doctors and hospitals HAP is affiliated with the leading hospitals in 18 counties of southeast and east central Michigan. With thousands of participating doctors in our network, chances are yours is a HAP doctor. We re not your ordinary HMO Some HMO plans emphasize cost containment and rewards for underuse of services. HAP is different. We ve always promoted prevention and wellness. We offer free and low-cost programs to bring you the best, most experienced HMO plan in Michigan. Take a fresh look at HAP and you ll find an easy-to-use health plan with access to highly qualified doctors and hospitals a plan you ve known and trusted for over 50 years. Your doctor, your choice You can choose your doctor from a list of thousands of our highly qualified primary care physicians. Your PCP is your partner in your health. As a HAP member, when you choose your PCP, you re also choosing the network of doctors that you ll use for specialty care. If you select a PCP in the Henry Ford, ACCESS or Genesys networks, you ll receive specialty care from doctors within your same network. This allows all doctors who support your care to work together to ensure that you receive the care you need when you need it. If you choose a PCP in any of our other networks, you can see a specialist in any HAP network. As a HAP Senior Plus (HMO) member, you ll also choose a PCP.* Your PCP may recommend specialty services from a certain specialist or facility, but you can choose to receive the care you need from any HAP Senior Plus contracted specialist. Visit hap.org/doctors to see if your doctor is with HAP. You can also find a list of doctors and compare them based on what is important to you. No matter which network and doctor you choose, you re going to receive the great care you need. We re always here to help with any questions you might have. *HAP Senior Plus (HMO) is a health plan with a Medicare contract. Enrollment in the plan depends on contract renewal.
7 Hassle-free, paperless referrals With HAP, you have the freedom to see your HAP dermatologist or allergist without referrals. In fact, with contracted providers, many specialty and ancillary office visits don t require referrals. Here are some of those specialties: Dermatology Cardiology Podiatry Standard X-ray OB-GYN Routine labs Allergy When you need a referral to see a specialist or ancillary provider such as for an MRI or for nonroutine labs, we offer a paperless referral process. Your PCP does all the work while you simply show up at your appointment. Your referral will already be there. Emergency care When an emergency situation arises, you shouldn t have to question if your hospital admission is covered. With HAP, you have 24/7 emergency coverage.* If you ever believe a condition requires emergency care, please go to the nearest hospital s ER for medical attention or call 911. If you re admitted to a hospital not affiliated with HAP, please notify us within 48 hours. When it s safe, you may be transferred to an affiliated hospital. Urgent care When a minor injury comes up that doesn t require an emergency room visit, but may require prompt attention such as a sprained ankle, fever or a wound that requires stitches you can choose to receive care from more than 65 urgent care facilities in Michigan within the HAP network. If you find yourself outside of HAP s service area, we ll still cover you for urgent or emergency care.* To find an urgent care center near you, visit hap.org or call Customer Service at one of the numbers listed on the back of this brochure. Your copay for urgent care is much lower than the copay for emergency room care. * The emergency and urgent care benefit information provided is a brief summary, not a complete description of benefits. For more information, contact HAP. Benefits, formulary, pharmacy network, premiums, copays or coinsurance may change on Jan. 1 of each year. Limitations, copays and restrictions may apply. 5
8 Hospital affiliations All listed hospitals may not be available for all HAP health plans. Before selecting a hospital, check with your doctor, provider directory or contact Customer Service at one of the numbers listed on the back of this brochure. Genesee Genesys Regional Medical Center, Health Park, Grand Blanc Hurley Medical Center, Flint McLaren Flint, Flint Lapeer McLaren Lapeer Region, Lapeer Livingston St. Joseph Mercy Livingston Hospital, Howell Macomb Henry Ford Macomb Hospital, Clinton Township McLaren Macomb, Mt. Clemens St. John Macomb-Oakland Hospital, Warren Campus, Warren Monroe ProMedica Monroe Regional Hospital, Monroe Oakland Beaumont Hospital, Royal Oak Beaumont Hospital, Troy Beaumont Hospital, Farmington Hills Crittenton Hospital Medical Center, Rochester DMC Huron Valley-Sinai Hospital, Commerce Township Doctors Hospital, Pontiac Henry Ford West Bloomfield Hospital, West Bloomfield McLaren Oakland, Pontiac Providence-Providence Park Hospital, Southfield Campus, Southfield Providence-Providence Park Hospital, Novi Campus, Novi St. John Macomb-Oakland Hospital, Madison Heights Campus, Madison Heights St. Joseph Mercy Oakland, Pontiac Straith Hospital for Special Surgery, Southfield 6
9 Saginaw Aleda E. Lutz VA Medical Center, Saginaw Covenant HealthCare, Saginaw St. Mary s Medical Center, Saginaw St. Clair McLaren Port Huron, Port Huron St. John River District Hospital, East China Lake Huron Medical Center, Port Huron Washtenaw St. Joseph Mercy Chelsea Hospital, Chelsea St. Joseph Mercy Ann Arbor Hospital, Ann Arbor University of Michigan Health System, Ann Arbor VA Ann Arbor Healthcare System Wayne Beaumont Hospital - Grosse Pointe, Grosse Pointe DMC Children s Hospital of Michigan, Detroit DMC Detroit Receiving Hospital, Detroit DMC Harper University Hospital, Detroit DMC Hutzel Women s Hospital, Detroit DMC Rehabilitation Institute of Michigan, Detroit DMC Sinai-Grace Hospital, Detroit Garden City Hospital, Garden City Henry Ford Hospital, Detroit Henry Ford Wyandotte Hospital, Wyandotte John D. Dingell VA Medical Center, Detroit, MI Karmanos Cancer Institute, Detroit Beaumont Hospital Dearborn, Dearborn Beaumont Hospital Trenton, Trenton Beaumont Hospital Taylor, Taylor Beaumont Hospital Wayne, Wayne St. John Hospital and Medical Center, Detroit St. Mary Mercy Livonia, Livonia Other Battle Creek VA Medical Center, Battle Creek Caro Community Hospital, Caro Deckerville Community Hospital, Deckerville Harbor Beach Community Hospital, Harbor Beach Henry Ford Allegiance Health, Jackson Hills & Dales General Hospital, Cass City Hillsdale Community Health Center, Hillsdale Huron Medical Center, Bad Axe Marlette Regional Hospital, Marlette McKenzie Memorial Hospital, Sandusky Memorial Healthcare, Owosso Mercy Children s Hospital, Toledo, Ohio Mercy Health Defiance Hospital, Toledo, Ohio Mercy Health St. Anne Hospital, Ohio Mercy Health St. Charles Hospital, Oregon, Ohio* Mercy Health St. Vincent Medical Center, Toledo, Ohio MidMichigan Medical Center-Clare, Clare MidMichigan Medical Center-Gladwin, Gladwin MidMichigan Medical Center-Midland, Midland ProMedica Flower Hospital, Ohio ProMedica Toledo Hospital, Ohio Scheurer Hospital, Pigeon St. Joseph Health System-Tawas, Tawas City St. Mary s of Michigan-Standish Hospital, Standish West Branch Regional Medical Center, West Branch 7
10 Global emergency travel assistance Protection wherever you travel You can travel worry-free, knowing you can call on Assist America for emergency travel assistance whenever you re more than 100 miles away from home or in another country. When traveling, your length of stay can be no more than 90 days in a row. Assist America doesn t replace HAP s worldwide emergency medical coverage, but Assist America will completely arrange and pay for all the assistance it provides without limits on the covered cost. Here are some of the ways we assist: Hospital admission guarantee Emergency trauma counseling Emergency medical evacuation Lost prescription, eyeglasses or luggage help Document translation help and much more The Assist America call center is fully staffed 24/7. Android and iphone users may download Assist America s mobile app from the app store associated with their phone for a one-touch connection to the call center. HAP Advantage program With HAP Advantage, HAP members get discounts and extras on health and wellness activities, services, shopping and events. It s one more way HAP helps to stretch your health care dollars. Here are some of the ways we assist: Fitness venues Sports retailers Entertainment activities You ll find a complete list of discounts at hap.org/advantage. 8
11 Weight management programs You can enjoy a variety of programs and tools that focus on healthy living, such as eating plans and exercise. When you join HAP, take advantage of programs that include: W eight Watchers Join Weight Watchers for a reduced rate. Weight Watchers teaches effective methods for losing weight and keeping it off. More than 63,000 HAP members have lost more than 226 tons so far. istrive for Better Health Get a personalized digital wellness manager with access to free wellness tools and programs, powered by WebMD Health Services. HAP s Restore CareTrack disease management program If you have a chronic condition such as asthma, coronary artery disease or diabetes, we support your relationship with your doctor free of charge. With Restore CareTrack, you have options to help you take control. They may include: Working with a nurse health coach over the phone In-home telemedicine monitoring program to help you monitor your medications and condition through daily sessions Behavioral health specialists who will help you identify emotional triggers and behavioral conditions that can affect your physical well-being as well as your ability to follow your doctor s treatment plan Medication review to ensure the right medication and dosage is taken at the right time 10
12 HAP s Restore Case Management program Our Restore Case Management program is free to HAP members. It helps with the personal support you need. With this program, a registered nurse will work closely with you and your doctor to make sure you re receiving the care you need when you need it. The nurse will help with: Scheduling appointments with specialists and treatment facilities Providing a full understanding of each condition Learning how to manage medications Coordinating home visits with doctors, registered nurses and therapists when needed Making sure you get the medical equipment you need Connecting you with community resources that assist with basic everyday needs For more information about HAP s Restore programs or to refer yourself, please restore@hap.org. Or call us at (313) for Restore Case Management or (800) for Restore CareTrack
13 Compare HAP to a traditional Trust plan Deductible 1 HAP HMO 4 $400 per person $675 per family Traditional care network (in network) $400 per person $675 per family Coinsurance 3 10% Out-of-pocket limit 5 $800 per person $1475 per family Unlimited office visits 2 Unlimited specialist office visits 2 Preventive services 2 Eye and hearing exams 2 Eyeglasses and contacts Weight Watchers Reduced rate Emergency and urgent care coverage Assist America global emergency travel assistance Personal service coordinator 1 See Page 12 for an example of how deductibles work. Deductibles do not apply to protected UAW Trust members. 2 Minimal copay may apply. A complete Summary of Benefits is included at the back of this booklet. 3 Coinsurance is the amount you pay after you meet your deductible. 4 HAP commercial product. 5 The out-of-pocket limit is the most you ll pay for the combined total of all copays, coinsurance and deductibles for covered services within a benefit period. 11
14 Understanding deductibles Single example Jeff is enrolled in a Trust HMO plan. His new deductible is $385. Jeff has been experiencing knee pain and his doctor orders an MRI that costs $750. Because the visit is covered without a copay, Jeff must pay up to his deductible amount of $385 toward the MRI. Now Jeff has met his deductible. This means that HAP pays the remainder of the bill for the MRI. HAP will also pay for other covered expenses, such as surgery or a stay in the hospital. Jeff will only have to pay copays and any prescription drug costs for the rest of his benefit period. Jeff Jeff pays the first $385 of the covered service because it applies to his deductible. After Jeff meets his deductible, all covered services (including knee surgery if necessary) are paid at 100 percent by HAP. Plan pays for covered services Deductible amount: $385 Jeff s MRI $750 Two-person family example The HMO family deductible amount is $650. Once one person meets his or her deductible of $385, HAP will pay 100 percent of covered services for that person (although copays will still apply). The other family member will have to meet the remaining $265 of the family deductible. Once the $650 family deductible is met, HAP will pay 100 percent for all covered services for all members on the plan. (Copays will still apply.) Note: When there are more than two people in the family, the family deductible is met when any combination of two or more people reach $650. Jeff Plan pays for covered services Jeff s deductible amount: $385 Jeff s MRI $750 $650 The family deductible amount Pam s X-ray and lab test $500 Plan pays for covered services Remaining deductible amount: $265 Pam In an example with two or more people, $650 of the family deductible amount must be met. Building off our last example, Jeff is married to Pam. Jeff reaches his deductible amount of $385. Pam has X-ray services and a laboratory test. She hasn t met her deductible yet, so she pays the first $265 of the bill for these covered services. After both Jeff and Pam meet their deductibles, the family deductible of $650 is considered met. That means that Jeff and Pam and any others on their HAP plan will only have to pay copays and any prescription drug costs for the rest of the year. 12 * The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact HAP. Benefits, formulary, pharmacy network, premiums, copays or coinsurance may change on Jan. 1 of each year. Limitations, copays and restrictions may apply.
15 For information on benefits for UAW Trust members, visit UAWRMBT.chooseHAP.org or call HAP at one of these numbers: HAP Senior Plus (HMO): (800) * (TTY: 711) HAP HMO: (800) (TTY: 711) If you re a retiring UAW Chrysler, GM or Ford employee or current UAW Trust member, join HAP by calling Retiree Health Care Connect at (866) (TTY: 711). * Outside of these business hours, you may access our automated system at the same number and leave your name and phone number. A HAP Medicare Customer Service representative will return your phone call the next business day.
16 Health Plans for Everyone Individual Group Medicare Medicaid hap.org/uawrmbt Subsidiaries Alliance Health and Life Insurance Company ASR Health Benefits HAP Midwest Health Plan HAP Preferred Inc. HAP does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status in the administration of the plan, including enrollment and benefit determinations Health Alliance Plan of Michigan, A Nonprofit Company 0M 9/
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