New Mexico Retiree Health Care Authority. Switch Enrollment October 2016
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1 New Mexico Retiree Health Care Authority Switch Enrollment October 2016
2 Who We Are Presbyterian serves to improve the health of individuals, families and communities Founded in 1908, Presbyterian Healthcare Services has served New Mexicans for more than 100 years. New Mexicans serving New Mexicans. Presbyterian is the only locally owned and operated delivery system with hospitals, a health plan, and physician group. With over 450,000 members, we are proud to serve 1 in 3 New Mexicans 2
3 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 3
4 Our Integrated System Presbyterian Heart Group Presbyterian Women s Center Presbyterian Children s Medical Center Presbyterian Kaseman Hospital/MD Anderson New additions Completed expansion at Presbyterian Rust Medical Center in Rio Rancho, in fall 2015 Opened comprehensive cancer center in Rio Rancho in early 2016 PMG Golf Course and Paradise Opened September 12th 2016 Adding one to two primary care sites each year in the Albuquerque metropolitan area Opened new clinic in Santa Fe in 2015 UC 7 Days a week Building an innovative healthcare campus in Santa Fe with inpatient and outpatient services (scheduled to open in 2018) 4
5 Benefit Plan Options Calendar Year Benefits Value HMO Premier PPO I N Retiree Premiums (Based on 20+ Years of Service) $ $225 N E T W O R K Deductible $1500/Individual $800/Individual Medical Out-of-Pocket Maximum $5500/ Individual $4500/Individual Preventive Care* Covered 100% Covered 100% Lab, X-Ray and Pathology Covered 100% Covered 100% Elective Out-of-Network Coverage? No Yes *Does not apply to deductible 5
6 Value HMO Benefit In-Network Out of Network Annual Deductible $1500/ Individual N/A Out of Pocket $5500/ Individual N/A Office Visit Primary - $35 Specialist - $55 N/A Preventive Care (including mammograms, pap test, colonoscopy & immunizations) Lab, X-Ray, and Pathology 100%* N/A 100%* 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 *Does not apply to deductible 6
7 Premier PPO Benefit In-Network Out of Network Annual Deductible $800/ Individual $800/ Individual Out of Pocket $4500/ Individual $4500/ Individual Office Visit Primary - $30 Specialist - $45 50% Preventive Care (including mammograms, pap test, colonoscopy & immunizations) Lab, X-Ray, and Pathology 100%* 50% 100%* 50% Emergency Room $125 $125 Urgent Care $35 50% All other covered services (including inpatient/outpatient, rehab and MRI, PET & CT) 25% 50% *Does not apply to deductible 7
8 8
9 Video Visits and PresRN Presbyterian Video Visits The doctor is always in 24/7 online, 365 days a year $0 Copay Schedule a Video Visit via mypres on any compatible computer, smart phone, or tablet Get treatment for common health issues like earaches, cold/flu symptoms, and allergies Prescriptions are e-prescribed to the pharmacy of your choice Doctor s note for school or work sent via PresRN Nurse Advice Line Staffed with experienced health plan Registered Nurses available 24/7/365 The Nursing team has access to member care plans and can contact the care coordinator or case manager if appropriate. The Nurses have access to the member s Electronic Health Record (MyChart), giving them the ability to view past tests and records and ensuring all nursing advice is tracked appropriately. Automatic messages are sent to a member s PCP or specialist and care coordinator (if applicable)
10 Wellness Initiative 2017 NMRHCA retirees and spouses/domestic partners can receive a $50 gift card for completing two or more wellness activities. Wellness at Work is our free wellness platform designed to help our members achieve their wellness goals. Services include: Single sign-on through mypres User friendly dashboard and mobile app Personal (confidential) health assessment Wellness workshops & educational tools Exercise routines, nutrition information, weekly diets Ability to sync with multiple fitness trackers and programs Ability to participate in challenges on-line Other programs available: Department of Health MyCD (Manage Your Chronic Disease) Consulting with Healthy Solutions for a chronic conditions Completing a smoking cessation program Quit for Life Upon completion of two events attended, classes completed, or assessments finished, submit the verification form on NMRHCA s webpage and , fax, or mail it to: NMRHCA.wellness@state.nm.us 10
11 Treatment Cost Calculator Well Visit - New Patient (age years) 11
12 Value Added Benefits Member Only Discounts on gym memberships, weight loss programs and more. Hearing Hardware Vision Massage Therapy Chiropractic Acupuncture Buy One Get One Free Isotopes Tickets 12
13 Presbyterian Customer Service Center (PCSC) Available 7:00 am to 6:00 pm Monday through Friday Benefit Questions Claim Inquiries Billing Issues Assistance selecting a Primary Care Physician (505) toll free info@phs.org 13
14 Presbyterian Highlights Video Visits / PresRN / MyChart Emergency Care Nationwide Locally owned and operated New Mexicans serving New Mexicans Not for profit Serving 1 and 3 New Mexicans 14
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2018 Monthly Medical Plan Cost 2018 Monthly Plan Cost including Limited Rx $233.60 $172.00 $142.00 $322.99 $261.39 $231.39 2018 Monthly Plan Cost including Unlimited Rx Out-of-Pocket Plan Maximum (OOP
For full details of services and costs for each plan, please consult the Evidence of Coverage at GeisingerGold.com or call us for more information.
This Summary of Benefits contains 2018 plan information for: Geisinger Gold Secure Rx (HMO SNP) For full details of services and costs for each plan, please consult the Evidence of Coverage at GeisingerGold.com