2018 Agent Resource Guide. Small Employer Group Plan Pricing
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1 2018 Small Employer Group Plan Pricing
2 Avera Health Plans Your Trusted Partner Created in 1999 to be a health plan that offers more than just traditional health insurance coverage, Avera Health Plans strives to provide the most cost-effective, innovative health plans for more than 90,000 members. 2 Population Health Access to Care A message from our Chief Medical Officer 24/7 Care Know Your Options 4 Our Provider Network 5 Five Reasons to Choose Avera Health Plans The Avera Difference 6 Services Available to Members 7 Agent and Employer Resources 8 Small Employer Group Plan Pricing 24 Services, Lab and X-Ray Coverage 25 Online Resources 1
3 Preston Renshaw, MD Chief Medical Officer You ve probably heard the term population health throughout the world of health care over the last 10 years. Of late, population health has been suggested as a solution to the ongoing question of how to improve the quality of services received and also reduce the high costs of health care today. Population health strategy is a way to improve the overall health of our families, communities or workplaces by surrounding our members with services to meet all aspects of life. We all know that our health is more than just taking medications and having the recommended screening tests each year it s also about eating well, balancing stress and finding joy in life. To treat illness effectively or promote healthy lifestyles, members and providers need a deeper and more meaningful relationship to help deal with the social or environmental issues that can affect wellness goals. With that in mind, Avera Health Plans is not your usual insurance carrier. We want our members to take care of themselves by using the health benefits they ve already paid for. By surrounding members with services and wellness initiatives we hope to urge members to take action and begin that relationship. We value our members and want to do our best to help them stay healthy for years to come! Education about access to care is also important. Here is a sample of how we can provide our members the resources they need when they need it. 24/7 Care Know Your Options Avera Health Plans members have access to a number of services after normal business hours and on weekends so it s easier to avoid the cost of an emergency room visit if at all possible. FIND IN-NETWORK CLINICS AND PROVIDERS AT AveraHealthPlans.com 24/7 Nurse Hotline FREE FREE with the mobile app Physician s Office AveraNow* $ $$ Urgent Care Clinic $$$ E mergency Room * Restrictions apply.
4 We know you want health insurance that delivers more than just savings. At Avera Health Plans, you ll find caring professionals who stand by our mission ready to make a positive impact in the lives and health of your employees. 3
5 Our Provider Network Because we are part of South Dakota s largest health care system Avera Health our members benefit with low premiums and affordable benefits, which includes Avera Medical Group s highly skilled specialists. Avera Health Plans is supported by a high-quality network of providers throughout South Dakota, southwestern Minnesota, northwestern Iowa and northeastern Nebraska. Our goal is to contract with providers who will ensure all members receive quality service and value rates no matter where they live. Avera Health Plans provides in-network coverage with a non-avera provider or facility in the following cases: Emergency Visits Necessary emergency room visits are covered no matter which emergency room members visit. Second Opinions We offer an extensive network if there are no in-network experts for the specialty care needed. Out-of-State Employee Coverage If employees live outside the Avera network, Avera Health Plans can extend their network no matter where they live. College Student Coverage College-age dependents are covered, even if they study out of state, with a regional network. Coverage beyond Avera Avera Health Plans provider network includes many independent providers and clinics, including Regional Health System West River or Brown Clinic in Watertown. Search our provider directory to find in-network providers. 4
6 Five Reasons to Choose Avera Health Plans 1. You are our family Family Neighbor 2. We are your neighbor 5. We are your advocate Advocate 4. Our employees strive to give you a better experience Experience Health 3. We want to help you and your employees live a healthier lifestyle The Avera Difference Avera Health Plans offers fully insured members 24/7 online access with providers through the AveraNow mobile app at no cost ($49 value). Avera s partnership with the Hy-Vee Healthy You Mobile brings the provider and wellness exams to your parking lot. Our outstanding retention rate is reflected with consistent pricing year-to-year and flexible plan options. 5
7 Services Available for Members 24/7 Nurse Line The 24/7 Nurse Line provides help to make decisions as to the best course of action for medical care at no cost to our members. A registered nurse can provide medical information and assist with the decision whether the member should go to an emergency department or after-hours clinic, call a doctor, or simply use home care. Call 24 hours a day, seven days a week, 365 days a year to use this service. AveraNow AveraNow virtual visit program is designed to conveniently connect you with an Avera provider when there is no time to go to the clinic. Connect to a provider 24/7 through a smartphone, tablet or laptop. Avera Health Plans fully insured members can use this service at no cost in all 50 United States by entering a member coupon code. Some limitations apply. Hy-Vee Healthy You Mobile, Powered by Avera We are bringing our wellness exams to your communities with our mobile clinic. Avera Health Plans provides this benefit at no cost to members and employers. Ask your agent or client relations executive how to schedule a visit. MyHealthPlan Mobile App Our mobile app allows access to benefit information. Members can also send us secured messages if they have a question about their health insurance coverage. Members have access to: Provider directory Year-to-date deductible balances Claim status Eligibility status Pharmacy benefits View member ID card(s) 6
8 Agent and Employer Resources Client Relationship Executive Our client relationship executives will assist you in providing print materials, reports and enrollment assistance for employer group orientation. This service is available year round when there are questions around benefits or available resources. You can reach out to schedule health screenings, flu shots and/or wellness opportunities in the work place. Consolidated Omnibus Budget Reconciliation Act (COBRA) Administration We provide COBRA administrative services at no additional cost as an added benefit to employers who purchase our health insurance: Send member notices of COBRA rights Manage employer billing and receiving of COBRA premiums Monitor the qualified beneficiary s COBRA status We administer COBRA benefits to help maintain compliance with federal COBRA guidelines. Other Administrative Options Flexible Spending Account Administration Health Savings Accounts Health Reimbursement Arrangements Defined Contribution Plans Employee Assistance Programs StriveWell Wellness Program We can also quote a wide list of ancillary products from our broad list of carriers: Dental Insurance Short-Term Disability Long-Term Disability Term Life Insurance Supplemental Voluntary Life Vision Insurance 7
9 The following services are not covered by the medical office co-pay. They are covered under the member s deductible and coinsurance. CT Scan Allergy Testing Chemotherapy MRI Allergy Injections Nuclear Medicine Services PET Scan Blood Transfusions Radiation Therapy SPECT Scan Cardiovascular Testing Procedures * * Are procedures during an office visit considered a limited lab service? Services performed under a procedure code such as stitches would be subject to the deductible and coinsurance. The limited lab and X-ray benefit is for diagnostic services. 24
10 Online Resources As an agent, we offer you many resources online. Visit AveraHealthPlans.com and choose Agents. You will find: Brochures Drug formularies Forms Special enrollment period guidelines Online quoting for individuals and small employer groups Provider directory Questions? Agents with questions, please call the agent service line at or AveraHealthPlans.com
11 Notes Questions? Please call the agent service line toll-free at or Additional resources are available at AveraHealthPlans.com Enrollment Guide Provider Directory Drug Formulary Find an Agent AveraHealthPlans.com 17-AVHP-7732
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