2018 NMRHCA SWITCH ENROLLMENT BENEFIT PRESENTATION

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1 2018 NMRHCA SWITCH ENROLLMENT BENEFIT PRESENTATION January 2018 through December 2018

2 Presbyterian s Integrated System Hospitals 8 hospitals in 7 New Mexico communities Health Plan Presbyterian Health Plan 450,000 members statewide Commercial, Medicare, Medicaid More than 750,000 unique customers today Medical Group Presbyterian Medical Group Multi-specialty group More than 700 providers 73 clinics in 34 facilities 2

3 Access To Care Appropriate and Affordable Options for Care 3

4 PresRN Your Nurse Advise Line Speak to a registered nurse by phone 24/7, 365 days a year, even in Spanish. With PresRN, members have: Direct access to Presbyterian nurses Minimum 10 years clinical experience or No fee for members to access this service. Use national protocol to triage, diagnose and treat. Nurses have access to your plan info and electronic health record for past and current health conditions, treatments and Rx. Navigate you to appropriate care based on your diagnosis. Capture the details of your care in MyChart. Automatically message your PCP, Specialist or Care Coordinator. 4

5 Video Visits Video Conference with a Healthcare Provider Skype with a healthcare provider 24 hours a day, 365 days a year. With Video Visits, members can: Schedule a Video Visit on any computer, tablet or smart phone. Use at home, work or when travelling. Get diagnosis and treatment for common health issues like earaches, cold/flu symptoms and allergies within 1 hour. Receive prescriptions to the pharmacy of your choice. Receive a text or summary of your visit. View the details of the Video Visit in MyChart. Receive a doctor s note for school or work via . No fee for members to access this service. 5

6 MyChart: Be An Active Part of Your Care Team Presbyterian Health Plan members have secure online access to their Presbyterian electronic health records. With MyChart, members can: Send and receive messages with their care team. Schedule primary care appointments, confirm or cancel appointments. View lab and test results. Request prescription renewals. View visit summaries, health summary, care plan, allergies and immunizations. Receive health reminders. Pay doctor and hospital bills. No fee for members to access this service. 6

7 7

8 Investments in Access Presbyterian Medical Group September 2014 Presbyterian Medical Group May NM Highway 528 Rio Rancho Rust Medical Center Tower 2 November St. Michael s Dr. Santa Fe Presbyterian Medical Group September Unser Blvd. SE Rio Rancho 4588 Paradise Blvd. NW Albuquerque 8

9 Investments in Access Presbyterian Santa Fe Medical Center Coming 2018 Urgent Care 24/7 Emergency Services General Surgery Orthopedics Podiatry Physical, Occupational and Speech Therapies Lab and Imaging, including CT and MRI 30 Adult Inpatient Beds, some licensed ICU beds 6-Bed Birthing Unit Telehealth Services 9

10 Calendar Year Benefits Value HMO Premier PPO Benefit Plan Options I N N E T W O R K Deductible $1500/Individual $800/Individual Medical Out-of-Pocket Maximum Preventive Care Lab, X-Ray and Pathology $5500/ Individual $4500/Individual Covered 100% Deductible does not apply Covered 100% Deductible does not apply Covered 100% Deductible does not apply Covered 100% Deductible does not apply Elective Out-of-Network Coverage? No Yes

11 Value HMO Plan Value HMO Benefit In-Network Out of Network Annual Deductible $1500/ Individual N/A Out of Pocket $5500/ Individual N/A Office Visit Preventive Care (including mammograms, pap test, colonoscopy & immunizations) Lab, X-Ray, and Pathology Primary - $35 Specialist - $55 100% Deductible does not apply 100% Deductible does not apply N/A N/A N/A Emergency Room $175 $175 Urgent Care $40 N/A All other covered services(including inpatient/outpatient, rehab and MRI, PET & CT) 30% N/A

12 Premier PPO Benefit In-Network Out of Network Annual Deductible $800/ Individual $800/ Individual Out of Pocket $4500/ Individual $4500/ Individual Office Visit Premier PPO Plan Primary - $30 Specialist - $45 50% Preventive Care (including mammograms, pap test, colonoscopy & immunizations) Lab, X-Ray, and Pathology 100% Deductible does not apply 100% Deductible does not apply 50% 50% Emergency Room $125 $125 Urgent Care $35 50% All other covered services (including inpatient/outpatient, rehab and MRI, PET & CT) 25% 50%

13 Value Added Benefits Member Only Discounts on gym memberships, weight loss programs and more. Hearing Hardware Vision Massage Therapy Chiropractic Acupuncture Meals on Wheels Buy One Get One Free Isotopes Tickets 13

14 Presbyterian Customer Service Center Integrated Dedicated Customer Service Experience: Traditional Customer Service Claims, benefits, questions Advocate Services Locating a PCP Primary Care Scheduling Patient Financial Services Emergency Department Patient Navigation (505) or ASK PRES info@phs.org 14

15 Value of Presbyterian Non-Profit Organization Investing in New Mexico Locally Owned and Operated New Mexicans serving New Mexicans Emergency Care Nationwide Serving 1 in 3 New Mexicans Expanding Access and Improving Outcomes for New Mexicans Innovative Access to Care Video Visits, PresRN, MyChart, UC Scheduling 15

16 Thank You! 16

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