business Within this folder please find... Hi, we re Oscar Oscar for Business Getting Care Small Group Plans How to Work With Us The Nitty Gritty

Transcription

1 Contents Within this folder please find... Hi, we re Oscar Small Business 2017 About Us Service Area Map Oscar for Business For Our Brokers For Your Small Business Clients For Our Members Getting Care Network Overview In-Network Hospital List NJ Qualcare Network Coverage Care Away From Home Small Group Plans 2017 Plans How to Work With Us Broker Resources The Nitty Gritty Underwriting Rules

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3 Small Business 2017 HI, WE RE OSCAR What you need to know. 01. Oscar for Business covers small groups with employees. 02. A must be based in our NY service area. 03. Covered employees must live or work in our service area. NY plans include NJ network access. 04. If a covers the full premium for employees, the group must meet 100% participation. If employees contribute to premium, the group must meet 60% participation. See underwriting rules for details.

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5 About Us HI, WE RE OSCAR Hi, we re Oscar. The Oscar experience is completely unique. All Oscar members get: Dedicated Concierge Service Every Oscar member has a dedicated team of three care guides and one nurse. They re here to help our members find a doctor, understand their plan, save money, and answer any other questions they may have. Just give us a call, and we ve got your back. 21st Century Tools Our website and Oscar app provides members with free 24/7 Doctor on Call, doctor search and appointment scheduling, prescription history, lab work, and a step tracking program that rewards members with Amazon.com Gift Cards up to $240 per year for staying active. Great Care Our members aren t going to settle for subpar doctors and hospitals and neither will we. We partner with high quality providers who will connect to our systems to provide members with an easy and seamless care experience. We ve also just opened a Brooklyn clinic exclusively for Oscar members because we re always working to provide the best care. All plans include free preventative care and no referrals needed for specialists.

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7 Service Area Map HI, WE RE OSCAR New York Connecticut Our New York network does not include any Connecticut hospitals or physicians. Westchester Rockland New Jersey Bronx New York Our New York network includes access to New Jersey hospitals and physicians through the Qualcare network. Suffolk Queens Nassau Kings Richmond New York Service Area Qualcare Network Coverage for New York Employers Out of Service Area

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9 For our Brokers OSCAR FOR BUSINESS Oscar for Business. For our brokers. So much same old in the market. It s time for a new choice. We re using technology to make it easy for you to sell Oscar plans, meaning less time on paperwork and more time for everything else. We offer you Concierge service and are here to make it easy for you to do. We d like to have you as a partner, and we promise to return the favor.

10 For our Brokers OSCAR FOR BUSINESS A different, better choice. We offer Concierge service, free Doctor on Call 24/7, online appointment scheduling, and a step tracking program that rewards you up to $240 per year for staying active. Health care is one of the biggest expenses for your clients, so they deserve great service. We re creating real choice in a market that s long overdue for it. That s why Oscar belongs in every client conversation no matter their industry or price point. Simple for you. A breeze for your clients. From easy online enrollment to admin tools that are a cinch to use, Oscar works seamlessly. Our Business Concierge reps can help with everything from enrollments to billing questions to SEP s. That means more time for you to build lasting relationships with your clients and provide them with what they need most your expertise. Your success = our success. We can t do this without you, so we create unique and memorable assets to make selling easier. We re in it for the long haul, and have set premiums and commissions with an eye towards stability and steady growth. That means a commitment to you, our partners, at the core of what we do. And we welcome your feedback along the way to make things even better.

11 For your Small Business Clients OSCAR FOR BUSINESS Oscar for Business. For your small clients. Dealing with health insurance used to be stressful, but with Oscar it feels surprisingly easy. We simplified health insurance by adding technology and providing helpful, proactive Concierge support to owners and their employees. Health benefits are among the largest expenses for small es, and we give your clients a lot more than just insurance cards.

12 For your Small Business Clients OSCAR FOR BUSINESS Good prices and great care. We say yes to both. In a world with expensive PPOs and restrictive HMOs, we offer something different: a better experience at an affordable price. We give your clients and their employees easy access to high-quality, connected care, with features like Concierge service, Doctor on Call, and online appointment scheduling. And no referrals needed for specialists! From admin tools to answers, we re on it. Our dedicated Business Concierge team is here to support your clients. Easy-to-read bills and an easy-to-use admin tool make daily tasks simple and quick, so they can focus on running their. Your clients do in the 21st century. So do we. We created a user-friendly website to manage coverage and pay bills. At Oscar, we re focused on embracing technology to make our product best serve your small clients. Our members love Oscar. And love is a powerful thing. Our members tell us that they d like to keep their Oscar plans at work. They re fans of our free 24/7 Doctor on Call service and our step tracking program that rewards you with Amazon.com Gift Cards up to $240 per year for staying active. Over 30% of our members tell us that they heard about us from a friend or family member. We get the basics right too, and that makes our members loyal and happy. Offering Oscar helps your clients attract and retain the best people around.

13 For our Members OSCAR FOR BUSINESS Oscar for. For our members. Come for the insurance, stay for the care. We re a health plan, an app, a Concierge team that s always here to help, a group of doctors on call 24/7, and a step tracking program that rewards you with Amazon.com Gift Cards up to $240 per year for staying active. We re for everybody, no matter your budget, health status, or occupation.

14 For our Members OSCAR FOR BUSINESS One app. All your healthcare needs. We like simple. We like quick and easy. And we like things to work. All the things that used to be hidden away in a doctor s filing cabinet are now at your fingertips. In the Oscar app, your info is organized simply in a timeline of all your care. Your prescription history, lab work, plan details, and step tracking it s all there. We re not quite sure why other health insurance companies made complexity and messiness their. It s time for health care to evolve. Ask us anything. Our team is here for you. Personal connections can make your healthcare experience great, that much we know. Other insurance companies leave you lost, navigating your own way through multiple departments, transfers, and automated responses. Oscar members get their own personal Concierge team to help with everything: coverage, tech, care management questions, and more. Say goodbye to talking to strangers about your health now you have a team on your side. And now we have our Oscar Health Center open for you. Members get access to primary care with state-of-the-art facilities and free wellness events. Come see our beautiful new space and meet our world-class Mount Sinai doctors. Call to book an appointment: (201) Talk to a doctor, 24/7. Free and from bed. Our free Doctor on Call service is easy to access from our website and app. It allows you to call a board certified doctor anytime, day or night. You can even send photos of your health issue, right from the app. Our doctors can give you a diagnosis, advice, and they ll even send prescriptions to a nearby pharmacy for pickup. It s great for things like strep throat, rashes, pinkeye, UTIs and more. More activity = more Amazon stuff. Active lifestyles should be rewarded. When you track your steps using the Oscar app, you earn points every day. Cash out your step tracking rewards for an Amazon.com Gift Card up to $240 per year. You can spend it on anything. Want new sneakers or a big bottle of laundry detergent? It s up to you.

15 Network Overview GETTING CARE We ve built a quality provider network, the Oscar way. Get the care you need, when and where you need it. Hospital System Highlights: Mt. Sinai More top doctors than any other system in NY on the Castle Connolly ranking, where doctors rate their peers. Montefiore Medical Center The top ranked hospital in the Outer Boroughs in US News. St. Francis Hospital The top ranked hospital in Long Island in US News. For a complete list of in-network hospitals see the In-Network Hospitals page. Oscar s 2017 NY network is designed to make it as easy as possible to navigate the complexities of healthcare. We have created an integrated and carefully curated network of 31 hospitals and over 20,000 first-rate physicians. Key hospital system partners include Mt. Sinai, Montefiore, and Catholic Health Services of Long Island. With our network, members get: Excellent access across specialties and geographies. A shared commitment to offering Oscar members a seamless care experience. Great care and great value. Unlimited 24/7 free calls with Doctor on Call. 60,000+ pharmacies nationwide. In-network urgent care nationwide. Emergency coverage worldwide. Members talk to a dedicated Concierge team member every time they call Oscar. No referrals needed for specialists. Detailed information to help members select the best doctor for their specific needs. Online scheduling with select network physicians. Want to search for a specific doctor? Search by specialty, location, or procedure using our online provider search tool at: NY/doctors And now we have our Oscar Health Center open for you. Members get access to primary care with state-of-the-art facilities and free wellness events. Come see our beautiful new space and meet our world-class Mount Sinai doctors. Call to book an appointment: (201) In addition, all of our New York plans provide New Jersey coverage through the Qualcare network, which provides access to 68 hospitals and over 26,000 physicians throughout NJ.

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17 In-Network Hospital List GETTING CARE The 2017 Oscar New York Network. Oscar s network in New York provides access to over 20,000 in-network providers and 31 area hospitals. Oscar s plans cover care received with doctors and hospitals in our network, and no referral needed for specialists! Out of network care will not be covered except in the case of an emergency. Our 2017 Participating Hospitals: Bronx Montefiore Medical Center - Moses Campus Montefiore Westchester Square Montefiore Medical Center - Wakefield Campus The Children s Hospital at Montefiore Montefiore Medical Center - Einstein Campus Kings Mount Sinai Brooklyn Brooklyn Hospital Center Kingsbrook Jewish Medical Center Nassau Mercy Medical Center St. Francis Hospital St. Joseph Hospital South Nassau Communities Hospital Winthrop University Hospital Rockland Nyack Hospital New York Mount Sinai Beth Israel Mount Sinai Hospital New York Eye & Ear Infirmary of Mount Sinai Mount Sinai Roosevelt Mount Sinai St Luke s Queens Flushing Hospital Medical Center Jamaica Hospital Medical Center Mount Sinai Hospital of Queens Medisys Health Network Suffolk Brookhaven Memorial Hospital Medical Center Good Samaritan Hospital Medical Center John T. Mather Memorial Hospital St. Catherine of Siena Medical Center St. Charles Hospital & Rehabilitation Center Richmond Richmond University Medical Center Westchester Montefiore Mount Vernon Hospital Montefiore New Rochelle White Plains Hospital Center

18 New Jersey Qualcare Network Coverage GETTING CARE Our 2017 Participating Hospitals: The Qualcare network provides coverage throughout all counties in New Jersey. Atlantic County Atlanticare Regional Medical Center - City Campus Atlanticare Regional Medical Center - Mainland Campus Shore Medical Center Bergen County Hackensack University Medical Center Hackensack University Medical Center, Pascack Valley Englewood Hospital and Medical Center Bergen Regional Medical Center Holy Name Medical Center The Valley Hospital Burlington County Deborah Heart and Lung Center Virtua Marlton Virtua Memorial Lourdes Medical Center of Burlington Camden County Cooper University Hospital Kennedy University Hospital - Cherry Hill Kennedy University Hospital Stratford Our Lady of Lourdes Medical Center (Camden County) Virtua Berlin Virtua Voorhees Cape May County Cape Regional Medical Center Cumberland County Inspira Medical Center Vineland Essex County Clara Maass Medical Center Newark Beth Israel Medical Center Saint Barnabas Medical Center Saint Michael s Medical Center Hackensack University Medical Center at Mountainside East Orange General Hospital University Hospital Gloucester County Kennedy University Hospital - Washington Township Inspira Medical Center Woodbury Hudson Jersey City Medical Center (Liberty Health) Palisades Medical Center Hunterdon County Hunterdon Medical Center Mercer County University Medical Center of Princeton at Plainsboro Capital Health Regional Medical Center Capital Health Medical Center - Hopewell Campus Saint Francis Medical Center Robert Wood Johnson University Hospital at Hamilton Middlesex County JFK Medical Center Saint Peter s University Hospital Robert Wood Johnson University Hospital at New Brunswick Raritan Bay Medical Center (Perth Amboy and Old Bridge) Monmouth County Monmouth Medical Center Bayshore Medical Center (Meridian Health) Jersey Shore Medical Center (Meridian Health) Riverview Medical Center (Meridian Health) Centrastate Medical Center Morris County Saint Clare s Health System - Denville Campus Saint Clare s Health System - Dover Campus Chilton Medical Center (Atlantic Health System) Morristown Medical Center (Atlantic Health System) Ocean County Jersey City Medical Center (Liberty Health) Palisades Medical Center Passaic County St. Mary s Hospital - Passaic St. Joseph s Healthcare System Salem County Inspira Medical Center Elmer The Memorial Hospital of Salem County Sommerset County Memorial Sloan-Kettering Cancer Center Robert Wood Johnson University Hospital Somerset Sussex County Newton Medical Center Union County Trinitas Regional Medical Center Overlook Medical Center (Atlantic Health System) Robert Wood Johnson University Hospital at Rahway Warren County Hackettstown Regional Medical Center St. Luke s Warren Hospital

19 Care Away From Home GETTING CARE What s covered when you need care away from home? Oscar plans cover care with doctors in your area, but when you re away from home, you still have options for care. See below for details on how to get great care for everything from common issues to emergencies. And if you have any questions, reach out to your Concierge. We re here for you and available to answer any questions. Doctor on Call, free 24/7 Not feeling well? Talk to a board-certified doctor for free over the phone 24/7 for advice on common conditions like sinus infections, pink eye, or the flu. When You Need An Rx Get prescriptions filled at any one of Oscar s national pharmacy partners including CVS, Walgreens, Rite-Aid, WalMart, and many more. In Case of Emergency For things like sprains and other non-life-threatening issues, visit an urgent care center in our nationwide network. We ll cover your visit as if you were home. And of course... Emergencies happen. If there s a life-threatening emergency when you re away from home, don t panic. Visit the closest emergency room and it s covered.

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21 Oscar New York Business Plans 2017 SMALL GROUP PLANS What members pay for certain benefits can get tricky. We ve highlighted the most common scenarios below. Check the plan s Summary of Benefits & Coverage (SBC) document for more details. Simple Market Bronze Silver Gold Platinum Bronze Silver Gold Platinum The Basics Free 24/7 calls with doctors Up to $240/year in step tracking rewards Free preventive care Individual Deductible* $7,150 $7,150 $3,000 $1,500 $4,000 $2,000 $600 $0 Individual Out-of-Pocket Max* $7,150 $7,150 $3,000 $1,500 $7,150 $6,750 $4,000 $2,000 Prices before you meet your deductible Primary Care visits Negotiated Rate $10 $10 $10 Negotiated Rate Negotiated Rate Negotiated Rate $15 Specialist visits Negotiated Rate $50 $50 $50 Negotiated Rate Negotiated Rate Negotiated Rate $35 Mental Health visits Negotiated Rate $50 $50 $50 Negotiated Rate Negotiated Rate Negotiated Rate $15 Physical, Occupational, and Speech Therapy Negotiated Rate $50 $50 $50 Negotiated Rate Negotiated Rate Negotiated Rate $25 Urgent Care Negotiated Rate $100 $100 $100 Negotiated Rate Negotiated Rate Negotiated Rate $55 Labs Negotiated Rate $25 $25 $25 Negotiated Rate Negotiated Rate Negotiated Rate $35 Generic Drugs $5 $0 $0 $0 Negotiated Rate $10 $10 $10 Preferred Brand Drugs Negotiated Rate $50 $50 $50 Negotiated Rate $35 $35 $30 Non-Preferred Brand Drugs Negotiated Rate Negotiated Rate Negotiated Rate Negotiated Rate Negotiated Rate $70 $70 $60 Specialty Drugs Negotiated Rate Negotiated Rate Negotiated Rate Negotiated Rate Negotiated Rate $70 $70 $60 Prices after you meet your deductible Primary Care visits 50% $30 $25 $15 Specialist visits 50% $50 $40 $35 Mental Health visits 50% $30 $25 $15 Physical, Occupational, and Speech Therapy Why aren t there copays or 50% $30 $30 $25 Urgent Care coinsurance amounts here? 50% $70 $60 $55 Labs 50% $50 $40 $35 With our Simple plans, you pay for covered services up to your deductible. After that, Oscar pays for everything. Xrays & Diagnostic Imaging 50% $50 $40 $35 MRIs & Advanced Imaging 50% $50 $40 $35 Emergency Room 50% $250 $150 $100 Inpatient Facility & Skilled Nursing Facility 50% $1,500 $1,000 $500 Outpatient Facility 50% $100 $100 $100 Outpatient Professional 50% $100 $100 $100 Generic Drugs No more copays. No coinsurance. $10 $10 $10 $10 Preferred Brand Drugs $35 $35 $35 $30 Non-Preferred Brand Drugs $70 $70 $70 $60 Specialty Drugs $70 $70 $70 $60 ALL OF THIS INFORMATION AND MORE CAN BE FOUND ON OUR BROKER * Family deductibles and maxes are simply twice the individual amounts RESOURCES PAGE: HIOSCAR.COM/BUSINESS Negotiated Rate - Member pays Oscar s negotiated rate until reaching the plan s deductible

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