You might be surprised at how much your health plan can do for you.

Transcription

1 You might be surprised at how much your health plan can do for you.

2 Discounts at Brookstone Chiropractic care Yoga instruction discount World-class Customer Service Not just when you re sick. But every day. When s the best time to use your health plan? Well, how about 10 minutes from now? Or tomorrow at 5:30 PM? Next Thursday, perhaps? Of course you can use it when you re under the weather. But why not use it when you re feeling great, too? Use your health plan any time you want. That s the basic idea at Oxford. For instance, when you re healthy, a really good health plan would help you stay that way. It would offer plans with no copayments for annual physicals and OB/GYN visits. It would also help keep you in shape by offering gym membership reimbursements, yoga classes and massage therapy. And it might even surprise you with discounts on skiing and snowboarding equipment, or weight loss programs, or home fitness equipment. But that s only part of the story. Because you also need a health plan that s got your back when you re sick. A plan that has a comprehensive network of top doctors and specialists. And over 300 hospitals in our service area. And practical programs designed to help keep conditions like asthma and diabetes under control. But that s only part of the story. For the whole story, turn the page. And check out all the value you get with Oxford. Because we believe that no matter how you re feeling, you can always get something out of your health plan. Nutrition counseling Discounts on magazine subscriptions Find a great doctor or hospital online Allergists

3 Doctor Network Never underestimate the value of a good doctor. Need a great doctor? A good doctor-patient relationship helps make you feel at ease and speeds up the healing process. That s why you ll find literally thousands of physicians and specialists in our network. This greatly increases the chance that you ll get access to the doctor of your choice. With over 60,000 doctors, you can feel good about your choices 1 Annual check-ups at no charge 2 Oxford s Freedom Network gives Members access to more than 60,000 physicians 3 and other providers who practice at over 80,000 sites, and to over 300 hospitals throughout our entire service area Oxford s Liberty Network in New York and New Jersey gives Members access to more than 39,000 Liberty physicians 4 and other providers who practice at over 55,000 sites, plus access to thousands more Freedom physicians in our Connecticut, Pennsylvania and Delaware networks Women may select an OB/GYN in addition to their primary care physician (PCP) Members also have access to the area s first fully credentialed network of complementary and alternative medicine providers The majority of physicians in our network are either board-certified or recently board-eligible, one of the best available measures of physician quality. In addition, we sponsor continuing medical education to help our doctors stay at the top of their respective fields. Doctors decide upon the appropriate care level for each of their patients Providers in the tri-state area identified Oxford as The best managed care company by a two-to-one margin over other managed care companies listed in a recent survey 5 Search for a doctor online: Step 1 Go to Step 2 Under Doctor Search, choose and click on the appropriate search option Step 3 Follow steps under Express Search or Advanced Search and click on the Search button Select an OB/GYN in addition to a primary care physician Review a list of questions to ask your doctor Board-certified podiatrists To search by network: Go to Advanced Search and select doctor type, state, county and the network (Freedom or Liberty) associated with your plan, then click on the Search button 1,3,4 All data as of June 30, This data represents all participating providers except ancillary providers. Dental and alternative medicine providers are included (6% of the total without chiropractors who are considered specialists). Providers who are multiply boarded are counted multiple times. 2 Some plans may require Member cost shares or have annual dollar limits. 5 Based on a survey by Walker Information, Q4/03.

4 Complementary & Alternative Medicine Relax. Unwind. Stretch out. We ve got you covered in more ways than one. There s more than one set way to achieve a healthy spirit, mind and body. So we created the area s first fully credentialed network dedicated to complementary and alternative medicine (CAM). Today, it includes more than 3,500 providers in the following fields: 6 Joint Pain Migraines Ways to better skin Nutrition Naturopathic Medicine (Connecticut only) Yoga Chiropractic Medicine Massage Therapy Acupuncture The reason we can call our network fully credentialed is because every one of our CAM providers must adhere to strict standards. That means: An alternate way to get well Meeting state licensure requirements Meeting clinical experience requirements and committing to continuing education in his or her discipline Having specialty certifications, where applicable Meeting malpractice requirements Becoming recredentialed every three years Members can learn more about our CAM network at Once there, you can search for a CAM provider. Or, Members can link to ConsumerLab.com at no charge and read about the latest test results on a range of vitamins, herbs and minerals, and natural products and supplements. There s even a section on recalls and warnings. Members may access Oxford s CAM network by: 1. Contracted Rate 7 Members can visit participating CAM providers in New York, New Jersey and Connecticut as often as they wish, without a PCP referral, at a specially negotiated rate. Simply select a participating provider, schedule an appointment and pay the provider at the time of the visit. This is not an insured benefit, so there is no need for a PCP referral, PCP reimbursement, or paperwork. In most cases, this contracted rate reflects a discount from the provider s normal fee. 2. Standard In-Network Benefits In certain regions, Oxford offers covered benefits for specific types of CAM care. For chiropractic 8 and naturopathic coverage, Members must obtain a referral from their PCP for the initial visit. Precertification is required for any visits after the initial visit for plans that require precertification. For naturopathic care, only a referral is required. The Member is responsible for a copayment at the time of the visit. Members of open access, or non-gated, plans are not required to obtain referrals to visit participating chiropractors or naturopaths. Depending on the plan design, Oxford may require that chiropractors and naturopaths submit care plans for utilization review. Nutritionists Massage therapy Aids to digestion 6 Based on Sept provider data. Includes acupuncturists, chiropractors, massage therapists, naturopaths, nutritionists and yoga instructors. Provider type and availability vary by state and plan. 7 The contracted rate is not an insured benefit, but rather a fair standardized rate for care. In most instances, this rate reflects a discount from the provider s normal fee. 8 If you have out-of-network coverage and access chiropractic care through a non-participating provider, the services will be reviewed for medical necessity. Members and providers can either: request prior approval through TRIAD (a national chiropractic network) by submitting the Voluntary Prior Approval Agreement Form, along with an Initial Care Plan Form; or, submit clinical notes for medical necessity review to TRIAD after services are rendered and claims are submitted. (Note: not all Members are included in the TRIAD arrangement.) complementary & alternative medicine

5 Oxford On-Call Poison ivy or poison oak? The wee hours of the morning. Lunchtime. The big holiday weekend. Who knows when you ll need some healthcare guidance? You may not always be able to reach your doctor, but questions about your health are always worth asking. No matter what time of day it is. That s why we created Oxford On-Call, our healthcare guidance line. Laryngitis or strep throat? Natural hair loss or too much stress? Twenty-four hours a day, 365 days a year, you can speak with informative registered nurses who can help guide you to the most appropriate source of care. In fact, all Oxford nurses have strong clinical backgrounds and many have experience in emergency nursing. And every Oxford nurse has instant access to an extensive database. So if a Member is enrolled in one of our disease management programs and requires special attention, our nurses can identify him or her and provide guidance on the spot. Ice it or apply heat? Scratchy throat or strep throat? Homesick or too much guacamole? By giving you the answers you need, our nurses can help you start feeling better. Our nurses: Our 24-hour healthcare guidance line Leg cramps or pulled muscle? Indigestion or food allergy? Identify caller symptoms and recommend next steps using one of the most advanced patient assessment systems available May recommend a visit to the emergency room, suggest an appointment with a physician or advise how to care for a problem at home Issue a referral directly to specialists when medically appropriate May make follow-up calls to promote continuity of care Keep primary care physicians (PCPs) informed by faxing call records, provided the Member has given us permission and the PCP s fax number is on record Answered an average of 5,300 calls per month in 2003 At 3:00 AM, Oxford On-Call is the next best thing to calling your mom. Especially when your mom s asleep. Call now or call later? Recent survey results: 9 98% of Members who called report they are satisfied with Oxford On-Call 96% of Members who called tried the self-care that was recommended to them 9 Survey performed by Oxford On-Call staff, 4/04.

6 Disease Management Education. Encouragement. Clinical expertise. Support. More specifically, what you ll find in every one of our disease management programs. Ways to help manage your diabetes Our disease and specialty case management programs are developed by clinical teams consisting of Oxford Medical Directors. Through these programs, we focus on educating and encouraging Members as well as cultivating close communication between patient and physician. At the same time, we keep our participating physicians informed of the latest treatments, and clinical practice and preventive guidelines. Better Breathing program Some of Oxford s Disease Management programs include: Better Breathing Program An educational program for children and adults with asthma. Members in this program receive information about the triggers of asthma and how to avoid them, as well as the proper way to administer their medications. In addition, newly diagnosed Members have the option to receive a free peak flow meter to help monitor their condition. Living with Diabetes SM Program Promotes the use of the most recent American Diabetes Association treatment guidelines and provides Members with educational materials. Newly diagnosed Members have the option to receive healthy cookbooks to help them eat right. Active Care Engagement SM (ACE) Program Oxford s ACE program is a health management program for high-risk Members with congestive heart failure, coronary artery disease, and diabetes. The program is designed to help Members manage their chronic condition to help improve health status and quality of life. Member support includes regular care calls that focus on lifestyle modification, education, symptom management, and medication adherence. Additionally, ACE supports physicians in their successful management of such high-risk Members. Managing Chronic Conditions Peak Flow meter at no charge Healthy cookbooks Heart Smart SM Program This program helps Members with cardiovascular disease (CVD) and congestive heart failure (CHF) (who are not in the ACE program) understand and improve their health and quality of life. Materials are available to educate Members about hypertension, cholesterol management, the immediate and long-term needs associated with medication compliance, and lifestyle modification. Oncology Program Education plays an important role in the early detection of cancer. And it s no less important in the treatment phase. For this reason, we offer individualized case management for Members with specific oncological diagnoses. Nurses regularly contact these Members to provide support, telephonic assessments, plus educational materials. Nurses also work in concert with Members physicians to support and reinforce the treatment plans and emphasize symptom management. better breathing living with diabetes heart smart SM Oxford Health Plans

7 Active Partner Childhood immunization reminders Tips for colic Baby massage A string around your finger. A Post-it note. A wake-up call. All rolled into one. That s the general idea behind our Active Partner Mailings. Oxford developed Active Partner preventive mailings to remind Members to make appointments for the preventive care they need. Members who have not received a preventive exam within the recommended time period are sent reminders. Reminder mailings: Childhood immunizations Adolescent well care Pap smear Flu vaccinations Mammogram An ounce of prevention equals our philosophy exactly. That s why we offer our Members the following additional resources: Mammogram reminders Tips on postnatal care Healthy Mind Healthy Body magazine A source of the latest information on prevention, nutrition, and exercise, as well as important benefit and coverage information. Delivered to Members homes two times a year. Oxford Healthy Mother, Healthy Baby A program that complements the care expectant Members receive from their doctor by providing educational information on prenatal and postnatal care as well as childhood immunizations. Self-Help Library SM Educational guides for Members with asthma, diabetes, and depression, helping them learn more about self-care, treatment guidelines and preventing complications. Members with diabetes and asthma receive these materials soon after they are diagnosed, and Members experiencing depression can obtain the guide in confidence upon request. How we help you stay healthy Healthy Mind Healthy Body magazine

8 Healthy Bonus Discount Programs Discounts to the gym. Discounts to the spa. With Oxford, staying in tiptop shape just became a little easier. Tempur-Pedic ComfortPillow TM We know a good thing when we see it, and it seems you do, too. That s why we re always looking for new offers to add to our already popular Healthy Bonus program. 10 Apparently, helping to keep you on your toes is what keeps us on ours. The Healthy Bonus program includes: Magazine subscriptions Karate classes Brookstone 15% discount on a select list of innovative products from Brookstone by calling Magazine Subscriptions Health, 10 issues for $10; Cooking Light, 11 issues for $16; Yoga Journal, 7 issues for $11. OMNIfitness 10% off home fitness equipment, up to a $150 value. Princeton Ski Shops and Out of Bounds $15 off any purchase of $100 or more. STOTT PILATES TM 15% off suggested retail prices on STOTT PILATES videos and equipment. Puritan s Pride Vitamins 10% savings off already low prices on over 1,400 products. QuitNet Get a lifetime membership to this popular online smoking cessation program for $65. That s 35% off the regular price. Safe Beginnings 20% discount on childproofing items, including safety gates, cabinet locks, outlet covers, and window guards. Spa Finder $15 discount on a $100 gift certificate purchase. Oxford Members are eligible for a free trial issue of Spa Finder Magazine, plus free shipping on their gift certificate purchase. TCBY $1.00 off any sugar-free menu item over $2.00. Tiger Schulmann s Karate TM free introductory class and a two-week membership package for $49. Includes a uniform and two personal lessons. Weight Management programs 15% off an online program, plus a free 45-minute consultation at Rob Nevins Personalized Fat Loss Programs. Members also receive free registration, plus additional savings on a special online program at Weight Watchers. WellQuest Fitness Network a one-time registration fee of $49 ($29 additional fee for each family member) to WellQuest entitles Members to a discounted rate at any one of WellQuest s fitness centers. Gym discounts Home fitness equipment For a complete list of our Healthy Bonus programs and benefits, Members can log on to In addition to Healthy Bonus, we also offer: Gym Reimbursement 11 Oxford Members must complete a minimum of 50 visits per six-month period to receive a $100 reimbursement. 12 This can total up to $200 per 12-month period. Covered spouses receive up to $50 per six-month period. This benefit is limited to you and your spouse/domestic partner. 13 Members must follow the requirements listed on the Gym Reimbursement Form and submit a completed form. Discounts that are good for you Skiing & snowboarding equipment 10 Offers are valid through June 30, Some restrictions and/or exclusions may apply. Discounts can t be combined with any other discounts or special offers. 11 This reimbursement is not available with all plans. Check your Certificate of Coverage to determine eligibility. 12 Oxford Members and their spouses/domestic partners must be covered by Oxford Health Plans for the entire six-month period to be eligible for reimbursement. These amounts represent the most common level of reimbursement. Some groups may purchase a higher level of reimbursement. 13 Reimbursement for domestic partners is limited to Members of groups that have purchased Domestic Partners coverage.

9 You might be surprised at how much a web site can do for you. Research herbal remedies at ConsumerLab.com At Members can search for a provider, research hundreds of health topics, check referrals, take a health quiz, get a new ID card, access their benefits and personalized healthcare information, and more. All in a few simple keystrokes. All you have to do is enter a user name and password. Here are some of the resources available on our site in the oxfordhealth Center: WebMD a leading consumer-focused healthcare information web site Search for the best hospital for a hernia operation Tell us about that new person in your life KidsHealth advice for all new and expectant parents; sign up for an enewsletter Complementary and alternative medicine information on the program and find a provider in your area Subimo Healthcare Advisor TM and PharmaAdvisor TM online resources for researching the best hospitals or treatment options, and comparing drugs or researching alternatives, respectively Healthy Bonus Member discounts on wellness-related products and services Oxford Healthy, Mother Healthy Baby information for expectant mothers to complement the care they receive from their doctor Healthy Mind Healthy Body magazine health-related articles including prevention and nutrition ConsumerLab.com independent information and test data on vitamins, herbs and minerals, supplements, natural products and recalls At oxfordhealth.com/myoxford, Members can: Search for a doctor Check: claims/benefits/referrals Change: PCP/address/ /user name Request: ID card/forms/rosters Notify us of pregnancy and birth Search for a doctor Request new materials, order a new ID card, or check a claim Info for new or soon-to-be parents Member Services A web site that s easy to use didn t come easily. But, then again, nothing worthwhile ever does. We were recently recognized as a Standard of Excellence winner in the 2003 WebAward Competition for achieving a standard to which all corporate web sites should strive. We also took home three 2003 ehealthcare Leadership Awards: for best interactive web site, best e-business site and best overall site. Visit and see for yourself how we re working to help Members get into healthier habits. health.com

10 Customer Service Call us when you have a simple question or in a time of stress Good old-fashioned Customer Service. You know. With the emphasis on customer. And service. Customer Service Statistics 14 Consistently quick response times Award-winning web site Answer rate: 98% Average speed to answer: 18 seconds Claims turnaround time: 18 days At Oxford, all of our Service Associates undergo a rigorous training program and receive continuous refresher courses. Maybe you have a simple question. Maybe you re calling us in a time of stress. Whether you re in the emergency room and want to check your benefits, or you just have questions about a claim, we want to respond quickly, accurately and courteously. When you call, you ll talk to someone specifically trained to handle your concerns. The result is greater accountability and better response times. Trained, courteous and knowledgeable Service Associates All Service Associates receive timely refresher courses Our Members can get answers to their questions in three different ways: Our Customer Service Department staffed with Service Associates Our award-winning web site, where Members completed an average of 2.6 million self-service web transactions in 2003 Oxford Express, our interactive voice response telephone system Many of our Members have discovered how handy our web site is. They re using it to check benefits and claims, search for providers, order new Member ID cards, and much more. They re also using Oxford Express, our interactive voice response telephone system, to perform many of the same tasks. And they re doing it all at their convenience, whenever they want, 24 hours a day, 365 days a year. 15 Because every day is different, we offer health plans that you can take advantage of night or day. Not just when you re sick, but when you re feeling great, too. It s called getting more value for your dollar. And at Oxford, it s simply one of the many benefits we build into every health plan we offer. 14 Oxford corporate average for Excluding periodic downtime for server maintenance. Customer Service

11 MS Oxford Health Plans, Inc. 7210