A Commercial HMO Plan

Transcription

1 A Commercial HMO Plan

2 A Fresh Approach Vista360health is pioneering a bold, refreshing alternative to health insurance with a dedicated focus on health and wellness. We actively work to align enrollees and providers to help keep our members in the best of health. We appeal to a generation of active individuals and families who want a health plan that encourages and supports their personal wellness.

3 Health Advocacy We are a new Health Plan designed for today s world. A Plan intended to actually keep you healthy. We don't offer a one-size-fits all approach. We help the Patient and their Family navigate through the complex Healthcare delivery maze. We offer a FREE Telemedicine program to all our members. This gives you access to local physicians via your smart phone or computer 24/7/365.

4 M A te tel ts /7/365 to lo l HI AA mpl t text g. Telemedicine services should not replace treatment plans set forth by your PCP or manage long term chronic conditions. emd Access physicians work in partnership with your PCP and it is important to understand what can and cannot be treated via telemedicine. emd Access can be used to evaluate and treat minor, acute complaints: Allergies Minor trauma (burns and lacerations) Cough and cold Pink Eye Earaches Seasonal allergies Flu symptoms Sinus infections GI issues (nausea and diarrhea) Skin rashes Insect bites/stings Sore Throat Minor back and shoulder pain Swimmer s Ear Minor injuries (sprains and strains) Uncomplicated urinary tract infections and yeast infections emd Access physicians may assist with medical decision making: Does this need stitches? Can I take these two medicines together? What over-the counter medicine would you recommend for my? Do I (or does my child) need to go to the ER or Urgent Care for this? Should I see my PCP or my specialist for this? Can this wait for my PCP s next appointment in 2 days? What can I do to prevent altitude sickness/motion sickness? I have questions about my chronic disease. emd Access should NOT be used to treat severe issues or manage chronic disease: Anticoagulation management Hypercholesterolemia Arrhythmia Hypertension management Chest Pain New or refill prescriptions for controlled medicines (narcotics) COPD management Seizures, head injuries Diabetes management Shortness of breath Heart failure When in doubt, emd Access physicians will work with you to address or direct applicable requests to your PCP or appropriate healthcare team.

5 2017 Plan Options and Rates Benefit Embedded Annual per Cal Yr Copayment Out of Pocket Maximum per Plan Year Outpatient Services Primary Care Physician Office Visit 2017 SELECT BENEFIT PLANS GOLD SILVER BRONZE Benefit Maximum unless $1,000 Individual $3,000 Individual $6,900 Individual $2,000 Family $6,000 Family $13,800 Family 1 after the Annual 2 after the Annual 5 after the Annual $3,500 Individual $6,500 Individual $7,150 Individual $7,000 Family $13,000 Family $14,300 Family 1, unless Covered at 100% (no or Coins applies) Specialist Office Visit $40 Copay 2, unless Covered at 100% (no or Coins applies) 2 Laboratory Services $75 Copay $100 Copay Surgical Procedures in Physician's Office or Outpatient Surgery Facility Pre-Natal & Post-Natal Obstetrical Care 5, unless $50 Copay 5 5 $250 Copay $300 Copay $400 Copay $20 Copay for initial visit Outpatient Mental Health Treatment $40 Copay per visit Rehabilitation Services, Speech, Occupational & Physical Therapy $40 copay per visit $25 Copay for initial visit 2 2 $50 Copay for initial visit 5 5 Inpatient Services Hospital Confinement Obstetrical Svcs (delivery and all inpatient svcs) Prescription Drugs (30-day supply) Preferred Generic $0 Copay $0 Copay $0 Copay Non- Preferred Generic $10 Copay $15 Copay Preferred Brand $35 Copay $40 Copay Non-Preferred Brand $55 Copay $75 Copay Specialty 25% Coinsurance 3 $15 Copay after $50 Copay after $100 Copay after 35% Coinsurance Emergency Care Services Emergency Room Visit $500 Copay $600 Copay $600 Copay Urgent Care Visit $75 Copay $100 Copay $100 Copay

6 2017 INDIVIDUAL PREMIUMS GOLD SILVER BRONZE Age Non- Non- Non , , , , , , , , , , , , , , , , , , , , , , , , , , and over 1, , , ,018.71

7 Benefit Annual per Plan Year / Embedded Annual () per Cal Yr Copayment Out of Pocket Maximum per Plan Year 2017 TRADITIONAL BENEFIT PLANS GOLD SILVER BRONZE Benefit Maximum $1,500 Individual $3,000 Individual $5,000 Individual $3,000 Individual $6,000 Individual $10,000 Family 1 after the Annual 2 after the Annual 4 after the Annual $5,000 Individual $7,150 Individual $7,150 Individual $10,000 Family $14,300 Family $14,300 Family Outpatient Services unless 1, unless 2, unless 4, unless Primary Care Physician Office Visit $15 Copay $25 Copay Specialist Office Visit $40 Copay $50 Copay Laboratory Services $75 Copay $100 Copay $40 Copay after 4 4 Surgical Procedures in Physician's Office or Outpatient Surgery Facility $250 Copay $350 Copay $400 Copay after Pre-Natal & Post-Natal Obstetrical Care $15 Copay for initial visit $25 Copay for initial visit Outpatient Mental Health Treatment $40 Copay per visit $50 Copay per visit Rehabilitation Services, Speech, Occupational & Physical Therapy $40 copay per visit $50 copay per visit Inpatient Services Hospital Confinement Obstetrical Svcs (delivery and all inpatient svcs) Prescription Drugs (30-day supply) Preferred Generic $0 Copay $0 Copay Non-Preferred Generic $10 Copay $15 Copay Preferred Brand $35 Copay $40 Copay Non-Preferred Brand $55 Copay $55 Copay Specialty 25% Coinsurance 3 $0 Copay after $15 Copay after $50 Copay after $100 Copay after 4 Emergency Care Services Emergency Room Visit $500 Copay $600 Copay Urgent Care Visit $75 Copay $100 Copay $600 Copay after $100 Copay after

8 2017 INDIVIDUAL PREMIUMS GOLD SILVER BRONZE Age Non- Non- Non , , , , , , , , , , , , , , , , , , , , , , , , , and over 1, , , ,044.49

9 Benefit Annual per Plan Year / Embedded Annual () per Cal Yr Copayment Out of Pocket Maximum per Plan Year 2017 CHOICE BENEFIT PLANS GOLD SILVER BRONZE Benefit Maximum $1,500 Individual $3,700 Individual $6,550 Individual $3,000 Family $7,400 Family $13,100 Family 1 after the after the after the $4,500 Individual $3,700 Individual $6,550 Individual $9,000 Family $7,400 Family $13,100 Family Outpatient Services unless 1, unless, unless, unless Primary Care Physician Office Visit 1 Specialist Office Visit 1 Laboratory Services 1 Surgical Procedures in Physician's Office or Outpatient Surgery Facility 1 Pre-Natal & Post-Natal Obstetrical Care 1 Outpatient Mental Health Treatment 1 Rehabilitation Services, Speech, Occupational & Physical Therapy 1 Inpatient Services Hospital Confinement 1 Obstetrical Svcs (delivery and all inpatient svcs) 1 Prescription Drugs (30-day supply) Preferred Generic 1 Non-Preferred Generic 1 Preferred Brand 1 Non-Preferred Brand 1 Specialty 1 Emergency Care Services Emergency Room Visit 1 Urgent Care Visit 1

10 2017 INDIVIDUAL PREMIUMS GOLD SILVER BRONZE Age Non- Non- Non , , , , , , , , , , , , , , , , , , , , , , , , and over 1, , , ,030.09

11 2017 ZERO DEDUCTIBLE Benefit BENEFIT PLANS Benefit Maximum GOLD Annual per Plan Year / Embedded Annual () per Cal Yr Copayment Out of Pocket Maximum per Plan Year Outpatient Services unless otherwise specified $7,150 Individual $14,300 Family 2, unless otherwise specified Primary Care Physician Office Visit $30 Copay Specialist Office Visit $60 Copay Laboratory Services Surgical Procedures in Physician's Office or Outpatient Surgery Facility $75 Copay then 2 $250 Copay then 2 Pre-Natal & Post-Natal Obstetrical Care $30 Copay for initial visit Outpatient Mental Health Treatment $60 Copay per visit Rehabilitation Services, Speech, Occupational & Physical Therapy $60 copay per visit Inpatient Services Hospital Confinement $500 Copay per day Obstetrical Svcs (delivery and all inpatient svcs) $500 Copay per day Prescription Drugs (30-day supply) Preferred Generic $0 Copay Non-Preferred Generic $10 Copay Preferred Brand $50 Copay Non-Preferred Brand 5 Specialty 5 Emergency Care Services Emergency Room Visit 2 Urgent Care Visit $75 Copay

12 2017 INDIVIDUAL PREMIUMS Age Non , , , , , , , , , , , , , , , , and over 1, ,583.64