City of Los Angeles Q3 Utilization Update
|
|
- Lester Harrington
- 5 years ago
- Views:
Transcription
1 City of Los Angeles 2016 Q3 Utilization Update Presented By: Justin Cao, MPH Executive Account Manager, Strategic Accounts Public Sector Michael Allard Underwriting Consultant, Public Sector California Mark Frey Director, Strategic Accounts Public Sector
2 Agenda Topic 1. Review the Objective & 2018 Renewal Considerations 2. Key Findings Summary 3. Review Utilization for Active Population Demographic Overview Total Paid Claims Overview Inpatient Paid Claims Overview Outpatient Paid Claims Overview Pharmacy Paid Claims Overview Pharmacy Brand Formulary Detail 4. Questions
3 Objective & 2018 Renewal Considerations Objective: The purpose of the following presentation is to provide the JLMBC with a preview of how City of Los Angeles utilization is trending through the first 9 months of 2016 (Q3 2016). This presentation compares the Q claims to the claims used to calculate the 2017 renewal 2018 Renewal Considerations: The Q utilization report includes 9 out of the 12 months of Paid Claims data that will be used for the 2018 renewal Three months of updated claims information is outstanding for the upcoming 2018 renewal. Rating Factors and Experience Adjustments for the 2018 Renewal will not be finalized until Spring 2017 Pooling Credit/Charges Conversion of Paid Claims to Incurred Claims Demographic Changes Rating Trend Retention ACA Fees
4 City of Los Angeles KEY FINDINGS SUMMARY Reports Referenced: Quarter Periodic Utilization Report KEY FINDING METRIC RELEVANCE Total Paid Claims PMPM increased by 6.4% through the first three quarters of 2016 Inpatient Claims PMPM increased by 2.28% Outpatient Claims PMPM increased by 12.51% Pharmacy Claims PMPM increased by 8.71% Total Paid Claims for the City of Los Angeles increased from $ to $ Total Paid Claims reflected within the report are unadjusted, which includes the impact of high cost claimants. Although the overall inpatient claims increase is low during this reporting period, the increase in claims cost for Inpatient Medical Services increased from $46.61 to $ Outpatient Paid Claims PMPM increased from $ to $ Increases were seen in all three outpatient service categories: Emergency Room increased 14.6%, Outpatient Visits increased 14.2% and Surgical increased 12.3%. Pharmacy Paid Claims increased from $77.64 to $78.14, due to an 11.9% increase in Brand Formulary Drugs. While the City of Los Angeles utilization is increasing, it is increasing at a slower rates as compared to Kaiser Permanente s Southern California Health Plan Average. Additionally, the value of high cost claimants reflects $2.7M over the pooling point. The value of this pooling credit is approximately $7.05 PMPM Principle driver of cost within the Inpatient Medical Service category is due to neonates. Four of the top 10 Diagnosis Related Group (DRG) are newborn and neonatal conditions with claims totaling $5.5M. Hospital Admissions/1000 for the DRG s noted above increased from 21 to 44, with the Average Length of Stay remained flat at just over 15 days. Over the past three reporting periods, the City has experienced a proportionally higher increase in the Outpatient $/Visit as compared to the Outpatient Visits/1000 for Emergency Room. Many surgical services are moving to an outpatient setting, so members are encouraged to receive care in the proper setting. Additionally, Kaiser Permanente continues to expand the number of services available to members through a telephonic appointment (and soon to be coming are video visits). These services can help members seek more timely care, reduce member out-of-pocket costs as well as lower the outpatient utilization costs for the City. Generic Formulary prescribing patterns remain high and account for 94.2% of all prescription drug utilization. The Top 10 Brand Formulary Drugs cost increased by 14%, from $4.3M to $5.0M during this reporting period. Additionally, the number of scripts increased by 14%, from 961 to 1,100.
5 Demographic Overview City of Los Angeles Q3 Members 31,828 31,501 32,022 Subscribers 13,001 13,416 13,204 Average Contract Size Average Age Male Female Total % Distribution Male 49.7% 49.8% 50.0% Female 50.3% 50.2% 50.0% KP Southern California Regional Average Q3 Average Age Male Female Total % Distribution Male 49.0% 49.1% 49.2% Female 51.0% 50.9% 50.8% 5 February 23, Kaiser Foundation Health Plan, Inc. For internal use only.
6 Total Paid Claims Overview Total paid claims for City of LA increased 6.4% vs, 7.4% for KP regional average. The claims costs shown to the left are un-adjusted, which includes the impact of high cost claimants. The value of the $2.7M pooling credit described below is $7.05 (PMPM). In the most recent period, 7 individuals had claims that exceeded the pooling threshold of $650,000 totaling $2.7 million. In contrast to the prior period, which experienced 5 individuals with claims totaling $896K above the pooling threshold. 6 February 23, Kaiser Foundation Health Plan, Inc. For internal use only.
7 Inpatient Overview Maternity Claims Cost: Increase $0.19 (1.7%) Surgical Claims Cost: Decrease $2.87 (-4.6%) Medical Claims Cost: Increase $5.94 (12.7%) Most significant change in Inpatient claims cost was focused primarily in the Medical Service Category o Principle driver of cost within the Medical service category was attributed to neonates (additional details regarding DRGs on following page). Not shown in chart above: Substance Abuse increased ~30% or $0.25 (PMPM), whereas Mental Heath costs decreased ~26% or $0.90 (PMPM) o For scale, Substance Abuse and Mental Health services combined account for ~3% of total Inpatient claims cost. 7 February 23, Kaiser Foundation Health Plan, Inc. For internal use only.
8 Inpatient Detail - Medical The Top 10 Medical DRG claims cost is $9.8 million for 2016 Q3 vs. $5 million in the prior period, which is an increase of $4.7 million. o Admits for these DRG s increased 38%. o Average Length of Stay for these DRG s increased 27%. 4 of the Top 10 DRG s are Newborn and Neonatal conditions with claims totaling $5.5 million. 2 of the 7 High Cost Claimants for 2016 Q3 are Newborn related claims. o Admits for these DRG s increased from 21 to 44. o Average Length of Stay for these DRG s remained flat at just over 15 days. 8 February 23, Kaiser Foundation Health Plan, Inc. For internal use only.
9 Outpatient Overview Outpatient Surgical Cost: Increase 12.3% ($4.89) KP Regional Avg Increase: 14.3% Emergency Room Cost: Increase 14.6% ($3.08) Outpatient Visits Cost: Increase 14.2% ($7.69) KP Regional Avg Increase: 8.0% KP Regional Avg Increase: 12.0% Emergency City of Los Angeles KP SoCal Regional Average Q Q3 PMPM $18.48 $21.12 $24.20 $18.79 $20.76 $22.41 ER Visits/ % Change -4.1% 3.4% 3.6% -2.3% 2.7% 2.7% ER $/Visit $1, $1, $1, $1, $1, $1, % Change 6.2% 10.5% 10.6% 6.4% 7.5% 5.1% Over the past three reporting periods the City is experiencing a proportionally higher increase in the cost/er visit compared to the number of ER visits. This is both congruent to KP s regional average and characteristic of appropriate ER use. 9 February 23, Kaiser Foundation Health Plan, Inc. For internal use only.
10 Pharmacy Overview City of Los Angeles KP SoCal Regional Average Scripts PMPY Q Q3 Brand/Formulary Generic/Formulary $/Script Q Q3 Brand/Formulary $ $ $1, $ $ $ Generic/Formulary $23.47 $26.14 $26.51 $25.92 $29.06 $29.59 % of Total Scripts Q Q3 Brand/Formulary 5.9% 5.8% 5.8% 6.3% 6.4% 6.3% Generic/Formulary 93.7% 94.2% 94.2% 92.5% 93.4% 93.6% % of Total Claims Q Q3 Brand/Formulary 66.5% 70.1% 72.1% 64.5% 68.8% 68.7% Generic/Formulary 31.6% 29.9% 27.9% 32.9% 30.9% 31.1% Note: Both Generic and Brand non-formulary account for less than 100 th of one percent of total scripts 10 February 23, Kaiser Foundation Health Plan, Inc. For internal use only.
11 Pharmacy Claims Cost Generic Formulary Cost: Increase 1.3% ($0.15 PMPM) Brand Formulary Cost: Increase 11.9% ($3.20 PMPM) 11 February 23, Kaiser Foundation Health Plan, Inc. For internal use only.
12 Pharmacy Detail Treating HEP-C with Harvoni or a similar specialty drug typically costs between $70K-$100K for a course of treatment (cost varies depending on other medical factors) The Top 10 Brand Formulary drugs increased 14% ($4.3 million to $5.0 million) from the prior period. The number of Scripts increased 14% (961 to 1,100). Harvoni scripts increased from 120 to 137 The number of scripts for Truvada, Atripla, and Stribild increased 21% (326 to 395). These three drugs are non-specialty drugs and are used in the treatment of HIV. 12 February 23, Kaiser Foundation Health Plan, Inc. For internal use only.
13 APPENDIX
14 High-risk pregnancy management Pre-existing conditions or health factors can raise the risk of birth complications and costly treatments. The huge volume of maternity cases we handle more than 90,000 a year helps our doctors gain expertise in high-risk pregnancies. High-risk pregnancy care, management, and support at Kaiser Permanente includes: thorough prenatal screenings to identify risk factors and health problems early on electronic medical record alerts that trigger preventive measures
15 Expectant mothers with risk factors: member engagement Available tools and programs * Counseling for pre-existing health conditions Chronic condition classes and programs Available online and at facilities tools and programs * Hypertension and heart health online tools Variety of quit-smoking resources Comprehensive substance abuse intervention programs for pregnant members; includes counseling and treatment Numerous resources to help women suffering domestic abuse Behavioral health counseling and treatment * Programs and classes vary by region.
16 Prenatal and postpartum care: member engagement Available tools and programs Self-referral for pregnancy test Pregnancy education, exercise, and wellness classes Healthy Beginnings prenatal newsletters Details what to expect at next office visit and at each phase of pregnancy KP My Baby & Me app your doctor and view select test results at kp.org kp.org/maternity In-depth tools and resources include podcasts, virtual labor and delivery room tours, and your personal health record
17 THE CARE YOU NEED, WHEN YOU NEED IT. ROUTINE NONURGENT CARE OTHER NONURGENT CARE URGENT CARE EMERGENCY CARE WHAT IS IT FOR? An expected care need, like a recommended preventive screening or a visit for a health issue currently being treated. A new health concern or a change in an existing health condition that is not an urgent care need. An illness or injury that requires prompt medical attention, but is not an emergency medical condition. A medical or psychiatric condition that requires immediate medical attention to prevent serious jeopardy to your health.* WHAT SHOULD YOU KNOW? Examples of routine nonurgent care needs include: Physical exams Pre-travel exams Pap tests Well-child checkups Medication checkups Follow-up visits You can schedule an appointment online with your personal physician or ob-gyn. If your doctor isn t available within a time frame that works for you, call us to request an appointment with another available physician. Examples of other nonurgent care needs include: Trouble sleeping General digestion problems Gradual skin changes Joint stiffness Ongoing anxiety issues Weight loss or gain Schedule an appointment online with your personal physician, or call us to request the next available appointment in the primary care department you need. Examples of urgent care needs include: Minor injuries, including accidents and falls Sprains and cuts needing stitches Backaches Headaches High fever Mild breathing issues Sore throats Coughs, upper respiratory symptoms Earaches An urgent care need may also include situations where you are experiencing new or worsening symptoms, or have concerns about your medication. Symptoms that may indicate an emergency medical condition include: Chest pain or pressure that may radiate to the arm, neck, back, shoulder, jaw, or wrist Sudden onset of severe abdominal pain Severe shortness of breath Sudden decrease in or loss of consciousness Sudden inability to talk or to move one side of the body, or sudden slurred speech Severe, persistent bleeding that cannot be stopped Major injuries like gunshot or stab wounds or severe injuries from a vehicle accident Active labor when there isn t time for a safe transfer to a designated hospital before delivery WHAT DO YOU DO? Make an appointment: Online through My Health Manager at kp.org Call our appointment and advice line. Make an appointment: Online through My Health Manager at kp.org Call our appointment and advice line. Call for advice: If you have an urgent care need, call our appointment and advice line. We can even schedule a same-day or next-day appointment with your physician in most cases, if appropriate. If you reasonably believe you have an emergency medical condition, call 911 or go to the nearest hospital. Call our appointment and advice line If you have an illness or injury and you re not sure what kind of care you need, our advice nurses can help. With access to your electronic health record, they can assess your situation, help determine what type of care is most appropriate for your condition or symptoms, and even help you handle the problem at home until your next appointment. * An emergency medical condition is a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a reasonable person would have believed that the absence of immediate medical attention would result in any of the following: (1) placing the person s health (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (2) serious impairment to bodily functions; or (3) serious dysfunction of any bodily organ or part. A mental health condition is an emergency medical condition when it meets the requirements of the paragraph above or, for members who are not enrolled in Kaiser Permanente Senior Advantage, when the condition manifests itself by acute symptoms of sufficient severity such that either of the following is true: The person is an immediate danger to himself or herself or to others, or the person is immediately unable to provide for or use food, shelter, or clothing due to the mental disorder.
18 PEACE OF MIND MAY BE JUST A PHONE CALL AWAY. Get medical advice when you need it. Sometimes it s difficult to know what type of medical care you need. That s why we have telephone advice nurses available to help you. Our advice nurses are registered nurses who are specially trained to help assess medical problems and provide advice over the phone, when medically appropriate. They can often resolve a minor concern or advise you on what to do next, including making a same-day or next-day appointment. We believe your concerns shouldn t go unanswered. Call our telephone advice nurses anytime you need advice, 24 hours a day. To reach an advice nurse, call one of the following appointment and advice numbers in your area, Monday through Friday, 7 a.m. to 7 p.m. For after-hours care, call KPONCALL ( ). Anaheim Medical Center Antelope Valley area Baldwin Park Medical Center Coachella Valley area Downey Medical Center Fontana Medical Center Irvine Medical Center Kern County area Los Angeles Medical Center Moreno Valley area Ontario Medical Center Otay Mesa Outpatient Medical Center Panorama City Medical Center Riverside Medical Center San Diego Medical Center South Bay Medical Center West Los Angeles Medical Center Western Ventura County area Woodland Hills Medical Center TTY for the hearing/speech impaired kp.org Please recycle September 2013
19 Telephone appointments now available _Corbis_RF_HiRes_DG_CMYK.tif Now, you can get care from a doctor wherever you are Do you have a minor health condition? If it doesn t require an in-person medical exam, you may be able to address it with a doctor by phone. You ll get great care, and you ll save time. Some examples of conditions:* Allergies Colds and coughs Some follow-up visits Upper respiratory infections When you call us, we will: Make sure you re 18 and over Confirm you ve had at least 1 face-to-face visit with us Schedule a 1-hour window for the doctor to call you (continues on back) Need to make an appointment? Find phone numbers and hours on the back side of this page. * Telephone appointments are not appropriate for emergency conditions, such as severe shortness of breath, severe abdominal pain, severe bleeding, or urgent conditions like sprains, falls, or cuts needing stitches. If you reasonably believe you have an emergency medical condition, call 911 or go to the nearest emergency department. An emergency medical condition is a medical or psychiatric condition that requires immediate medical attention to prevent serious jeopardy to your health. For the complete definition of an emergency medical condition, please refer to your Evidence of Coverage. kp.org
20 (continued from front) Call for care at a location near you Baldwin Park, Downey, and South Bay Baldwin Park Medical Center Downey Medical Center Sat Sun, 7 a.m. to 1 p.m South Bay Medical Center 7 days, 24 hours Inland Empire and Coachella Valley Fontana Medical Center Sat, 7 a.m. to 3:30 p.m Moreno Valley Medical Center Sat, 7 a.m. to 3 p.m Ontario Medical Center Sat, 7 a.m. to 3:30 p.m Riverside Medical Center Sat, 7 a.m. to 3:30 p.m Kern County, Valleys, Western Ventura Antelope Valley Service Area Kern County Service Area Panorama City Medical Center Woodland Hills Medical Center Los Angeles Los Angeles Medical Center West Los Angeles Medical Center Orange County Orange County Anaheim Medical Center Orange County Irvine Medical Center San Diego San Diego Medical Center 7 days a week, 7 a.m. to 7 p.m For T TY, all locations call 711. Please recycle October 2016
WELCOME to Kaiser Permanente
WELCOME to Kaiser Permanente PPO PLAN RESOURCE GUIDE Colorado kp.org/kpic-colorado Greetings Subscriber name, we re glad to be your partner on this journey, and we look forward to a long and healthy relationship
More informationCITY OF LOS ANGELES JOINT LABOR-MANAGEMENT BENEFITS COMMITTEE
CITY OF LOS ANGELES JOINT LABOR-MANAGEMENT BENEFITS COMMITTEE PROPOSED MINUTES SPECIAL MEETING MARCH 2, 2017 9:00 A.M. CITY HALL, 200 NORTH SPRING STREET, ROOM 1060 Present: Committee Members: Regular:
More informationHPSM Medi-Cal Benefits A Guide on How to Get Your Health Care
HPSM Medi-Cal Benefits A Guide on How to Get Your Health Care Health care and insurance benefits can be difficult to understand. This guide introduces you to your basic Medi-Cal benefits, to the Health
More informationPresident Kaiser Permanente Southern California. Great Gains in Quality of Care and Patient Safety: The Kaiser Permanente Experience
Benjamin K. Chu, MD, MPH President Kaiser Permanente Southern California Great Gains in Quality of Care and Patient Safety: The Kaiser Permanente Experience The triple aim : A blueprint for a more satisfying
More informationMember Guide. Yo u r I n t r o d u c t i o n to K a i s e r Pe r m a n e n te
Member Guide Yo u r I n t r o d u c t i o n to K a i s e r Pe r m a n e n te MEMBER GUIDE :063*/530%6$5*0/50,"*4&31&3."/&/5& This guide provides general information, not medical advice or benefit coverage.
More informationScripps Health Plan HMO Offered by Scripps Health Plan Services Combined Evidence of Coverage and Disclosure Form Effective January 1, 2017
Scripps Health Plan HMO Offered by Scripps Health Plan Services Combined Evidence of Coverage and Disclosure Form Effective January 1, 2017 Scripps Health Plan 0 Effective January 1, 2017 rev 7 7 2017
More informationBenefits That Benefit You
Benefits That Benefit You Liisa Granfors-Hunt Director of Account Management Corporate Synergies & Cathy Sapp Executive Director Teladoc WHAT IS TELEMEDICINE? A modern way of delivering care that is becoming
More informationVISITING MEMBER SERVICES. Getting care away from home. For travel in other Kaiser Permanente areas
2016 VISITING MEMBER SERVICES Getting care away from home For travel in other Kaiser Permanente areas Getting care in Kaiser Permanente service areas This brochure will help you get a wide range of care
More informationCompliance Responsibility of SNFs, HHAs and CORFs on Notice of Medicare Non Coverage (NOMNC)
FOR NETWORK PROVIDERS OF KAISER PERMANENTE networknews NOVEMBER 2007 Produced by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. with the Mid-Atlantic Permanente Medical Group, P.C. Kenya
More informationStaying Healthy Guide Health Education Classes. Many classroom sites. Languages. How to sign up. Customer Service
Staying Healthy Guide Health Education Classes We care about the health of our members. That is why our health plan offers health education classes to help our members stay healthy and learn how to be
More informationState of New Jersey DEPARTMENT OF BANKING AND INSURANCE INDIVIDUAL HEALTH COVERAGE PROGRAM PO BOX 325 TRENTON, NJ
CHRIS CHRISTIE Governor KIM GUADAGNO Lt. Governor State of New Jersey DEPARTMENT OF BANKING AND INSURANCE INDIVIDUAL HEALTH COVERAGE PROGRAM PO BOX 325 TRENTON, NJ 08625-0325 TEL (609) 633-1882 FAX (609)
More informationCUSTOMER SERVICE MEMBER FOCUS A NEW WAY TO REACH. Hawai i 2017 Issue I NUMBERS TO KNOW
Hawai i 2017 Issue I MEMBER FOCUS A NEW WAY TO REACH CUSTOMER SERVICE At Ohana, we strive to provide the best member experience possible for you each and every day. We know navigating health care is challenging,
More informationBenefits. Benefits Covered by UnitedHealthcare Community Plan
Benefits Covered by UnitedHealthcare Community Plan As a member of UnitedHealthcare Community Plan, you are covered for the following MO HealthNet Managed Care services. (Remember to always show your current
More informationAn EPO Employee and Retiree Medical Plan...
An EPO Employee and Retiree Medical Plan... Member Handbook...with PPO Benefit Option The benefits and service you love. Plus. IMPORTANT CONTACT INFORMATION PLAN INFORMATION AND MEMBER SERVICES Office
More informationTotal Cost of Care Technical Appendix April 2015
Total Cost of Care Technical Appendix April 2015 This technical appendix supplements the Spring 2015 adult and pediatric Clinic Comparison Reports released by the Oregon Health Care Quality Corporation
More informationThe MITRE Corporation Plan
Benefit Type Plan Year Type Calendar Year Annual Medical Out of (for certain services) Employee Employee + 1 Family Annual Prescription Drug Out of Employee Employee + 1 Family Copayments: One copay per
More informationHealthy together. Care and coverage that fits your life
This is an advertisement Healthy together Care and coverage that fits your life The right plan for families. $0 primary care visits for children with improved Standard Option. kp.org/feds Federal employees
More informationcommunity. Welcome to the Pennsylvania UnitedHealthcare Community Plan for Kids CHIP Member Handbook CSPA15MC _001
Welcome to the community. Pennsylvania UnitedHealthcare Community Plan for Kids CHIP Member Handbook CSPA15MC3673270_001 www.chipcoverspakids.com Telephone Numbers Member Services Monday Friday, 8:00 a.m.
More informationWELCOME. to Kaiser Permanente. kp.org/flexiblechoice/mas kp.org/newmember 2018 FLEXIBLE CHOICE PLAN REFERENCE GUIDE
WELCOME to Kaiser Permanente 2018 FLEXIBLE CHOICE PLAN REFERENCE GUIDE kp.org/flexiblechoice/mas kp.org/newmember Greetings This reference guide will help you make the most of your membership with Kaiser
More informationMember Guide Your Introduction to Kaiser Permanente
Member Guide Your Introduction to Kaiser Permanente Member guide Your Introduction to Kaiser Permanente This guide provides general information, not medical advice or benefit coverage. For complete details
More informationBETTER INFORMED. BETTER TOGETHER.
BETTER INFORMED. BETTER TOGETHER. easy to get appointments free to focus on my patients excellent prenatal care test results online I can choose my doctor wide range of specialists I m part of the decision
More informationIrvine Unified School District ASO PPO /50
An Independent member of the Blue Shield Association Irvine Unified School District ASO PPO 500 90/50 Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix) THIS
More informationCHIP Member Handbook. For Harris and Jefferson Service Delivery Areas. Call toll-free TexasChildrensHealthPlan.org
CHIP Member Handbook For Harris and Jefferson Service Delivery Areas March 2018 MS-0318-149 Call toll-free 1-866-959-6555 TexasChildrensHealthPlan.org Quick Guide Who To Call If you need: Texas Children
More informationBlue Shield of California
An independent member of the Blue Shield Association City of San Jose Custom ASO PPO 100 90/70 Active Employees Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage
More informationAetna Better Health Kids Full Cost Option Member Handbook
Aetna Better Health Kids Full Cost Option Member Handbook Write important numbers here Your Child s Member ID Number Your Other Children s Member ID Numbers Your Child s Primary Care Provider (PCP) Telephone
More informationFrequently Discussed Topics
Frequently Discussed Topics L.A. Care Health Plan Please read carefully. What are Copayments (Other Charges)? Aside from the monthly premium, you may be responsible for paying a charge when you receive
More informationA Commercial HMO Plan
A Commercial HMO Plan 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
More informationHealth Home Flow Hypothetical Patient Scenario
Health Home Flow Hypothetical Patient Scenario Client Background: Soozie SoonerCare Soozie is a single female, age 42, 5'6" tall 215 pounds. She smokes 2 packs of cigarettes a day. At age 24, Soozie was
More informationA COMPLETE explanation of your plan
A COMPLETE explanation of your plan Legislative changes effective January 1, 2017 are not included in this document. An updated Evidence of Coverage will be available by January 31, 2017. For University
More informationKaiser Permanente Group Plan 301 Benefit and Payment Chart
301 Kaiser Permanente Group Plan 301 Benefit and Payment Chart 10119 CITY AND COUNTY OF SAN FRANCISCO About this chart This benefit and payment chart: Is a summary of covered services and other benefits.
More informationEMTALA Emergency Medical Treatment and Active Labor Act
EMTALA Emergency Medical Treatment and Active Labor Act William F. Jourdain EMTALA BASICS! Federal law enacted in 1986! Where a person comes to the dedicated emergency department (DED) or hospital property
More informationHealth Coverage + Care
SACRAMENTO WOMEN S GUIDE TO Health Coverage + Care Women in Sacramento County have new options for getting health coverage and care. Use this guide to find out which option is right for you. This guide
More informationHealthy together Open enrollment period presentation for SDCERS
Healthy together 2018-19 Open enrollment period presentation for SDCERS 1 Copyright Copyright 2017 2017 Kaiser Foundation Kaiser Foundation Health Health Plan, Inc. Plan, Inc. SDCERS : Experience the Kaiser
More information2016 Open Enrollment Presentation for: University of California Senior Advantage
2016 Open Enrollment Presentation for: University of California Senior Advantage 2 Three ways we make good health easier Quality care. We do what it takes to help you get healthy, and partner with you
More informationUnitedHealthcare Community Plan Alliance Member Handbook
CAPITAL AREA UnitedHealthcare Community Plan Alliance Member Handbook 941-1057 8/11 Important Phone Numbers Member Services.... 1-800-701-7192 (8 a.m. 5:30 p.m., Monday Friday).... TTY: 711 NurseLine Services
More informationUTILIZATION MANAGEMENT Section 4. Overview The Plan s Utilization Management (UM)
Overview The Plan s Utilization Management (UM) Program is designed to meet contractual requirements and comply with federal regulations while providing members access to high quality, cost effective medically
More informationWelcome to Kaiser Permanente
Welcome to Kaiser Permanente Core Member Guide Contents Getting started 2 Specialty care 3 Prescriptions 4 Urgent care 5 Emergency care 5 Hospitalization 6 Online tools 6 Member resources 7 Additional
More informationINDIAN HEALTH SERVICE (IHS) ADDENDUM TWO (2) SOONERCARE O-EPIC PRIMARY CARE PROVIDER/CASE MANAGEMENT
INDIAN HEALTH SERVICE (IHS) ADDENDUM TWO (2) SOONERCARE O-EPIC PRIMARY CARE PROVIDER/CASE MANAGEMENT for AI/AN MEMBERS 1.0 PURPOSE The purpose of this Addendum (hereafter ADDENDUM 2) is for OHCA and PROVIDER
More informationOther languages and formats
Dear member, We re glad you re part of our health plan! It s important to us that you have the most up-to-date information about your benefits. We re sending you the following notices with this letter:
More informationARTICLE II. HOSPITAL/CLINIC AGREEMENT INCORPORATED
REIMBURSEMENT AGREEMENT FOR PRIMARY CARE PROVIDER SERVICES Between OKLAHOMA HEALTH CARE AUTHORITY And SOONERCARE AMERICAN INDIAN/ALASKA NATIVE TRIBAL HEALTH SERVICE PROVIDERS ARTICLE 1. PURPOSE The purpose
More informationOur Patients WE REMAIN FOCUSED ON YOU!
Our Patients WE REMAIN FOCUSED ON YOU! Healing our nation s heroes continues to be our first priority. And during the administrative furloughs, we will continue to meet our operational requirements in
More informationCover for pregnancy and childbirth
Cover for pregnancy and childbirth 2017 How we cover pregnancy and childbirth in 2017 The Maternity Benefit covers day-to-day and in-hospital medical expenses for expectant mothers and newborns. Overview
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services
More informationMedical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
More informationSelf-Insured Schools of California: Schools Helping Schools
Self-Insured Schools of California: Schools Helping Schools Blue Shield of California Access+ HMO Plan 2016/2017 Enrollment Guide Blue Shield of California offers health benefits to school districts that
More informationThis is the start of something good
Hello Greetings from Kaiser Permanente , you re starting off on the right foot with Kaiser Permanente. We re glad to be your partner on this journey, and we look forward to a long
More informationOn the. Services for our Medicare health plan members who are visiting other Kaiser Permanente regions or Group Health Cooperative service areas
On the GO Services for our Medicare health plan members who are visiting other Kaiser Permanente regions or Group Health Cooperative service areas Y0043_N011615 accepted Travel WELL and get the care YOU
More informationYour Guide to keeping your Kaiser Permanente Medicare health plan
Your Guide to keeping your Kaiser Permanente Medicare health plan KP Library: 42-35102677_Corbis_RF_LG_CMYK.psd Your Kaiser Permanente group Medicare health plan is changing and we re still here for you.
More informationFCPS BENEFITS COMPARISON FOR PLAN YEAR 2018 Active Employees and Retirees Under 65
BENEFIT Medical Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Individual Annual Deductible $250 $500 $250 $500 None Family Annual Deductible $500 $1,000 $500 $1,000 None Medical Plan
More informationWalk-in Clinic. Dear Patients. Frequently Asked Questions (FAQ)
Walk-in Clinic Klamath Tribal Health & Family Services 330 Chiloquin Boulevard Chiloquin, OR 97624 (541) 882-1487 Frequently Asked Questions (FAQ) Monday Friday, 8:00 a.m. 3:30 p.m. * First Wednesday of
More informationHealth plans for New Hampshire small businesses Available through the Health Insurance Marketplace
Health plans for New Hampshire small businesses Available through the Health Insurance Marketplace 1 38476NHEENABS Rev. 09/14 We can help you navigate the health care road We re here to help. In fact,
More informationKaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION
Kaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION 2019 Summary of Important Changes for Contract Renewals for the Kaiser Permanente Group Plan (These changes are subject to regulatory
More informationKEY CONTACTS NORTHERN CALIFORNIA. National Provider Contracting & Network Management: Department Phone No. Fax No. TTY (510) (510)
SECTION 4 KEY CONTACTS NORTHERN CALIFORNIA National Provider Contracting & Network Management: Provider Relations & Contracting (510) 268-5525 (510) 268-5577 Customer Service: Member Issues Member Appeals
More informationMedicare Retirees - County Of Sonoma New Medical Plan Options Comparison Chart for 2008/2009 (With Consumer Driven Health Plan)
DEDUCTIBLE $1,000 individual $3,000 family $500 individual $1,500 family None None HRA AMOUNT $500 individual (does not apply towards Out of Pocket Maximum) $1,500 family (does not apply towards Out of
More informationKaiser Permanente (No. and So. California) 2018 Union
Kaiser Permanente (No. and So. California) General Information Lifetime Maximum Benefit Annual Maximum Benefit Coinsurance Percentage Precertification Requirements Precertification Penalty Health Savings
More informationHEALTH PLANS FOR PARTICIPANTS
Kern County 2018 Retiree HEALTH PLANS FOR PARTICIPANTS OVER AGE 65 (Must have BOTH Medicare Parts A & B) For current participating physician information, please contact each plan directly. This summary
More informationMERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015
MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015 DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS facilities and Aligned
More information2018 MEMBER HANDBOOK
2018 MEMBER HANDBOOK TABLE OF CONTENTS Welcome...1 Coverage Overview...1 Eligibility...1 2 How to Use this Coverage...2 3 Benefits...3 5 What Is Not Covered...5 6 Advance Directives...6 Your Rights and
More information2017 SEMI-MONTHLY PREMIUMS. Employee and Spouse $ Employee and Child(ren) $ Family $332.12
2017 BB&T BENEFITS PROGRAM GUIDE SUPPLEMENTAL INFORMATION FOR CALIFORNIA ASSOCIATES PREPARING FOR BENEFITS ENROLLMENT This supplement to the 2017 BB&T Benefits Program Guide contains additional information
More information2016 OPEN ENROLLMENT MEDICAL PLANS
2016 OPEN ENROLLMENT MEDICAL PLANS Table of Contents Section I. Enrollment Guidelines Page 3 Health Plan Comparison Chart Page 4 Health Plan Premiums and Employee Cost-Sharing Page 5 Section II. Blue Shield
More informationKEY CONTACTS NORTHERN CALIFORNIA. National Provider Contracting & Network Management: Department Phone No. Fax No. TTY (510) (510)
SECTION 4 KEY CONTACTS NORTHERN CALIFORNIA National Provider Contracting & Network Management: Provider Relations & Contracting (510) 268-5525 (510) 268-5577 Customer Service: Member Issues Member Appeals
More informationCrisis Triage, Walk-ins and Mobile Crisis Services
Section 10.15 Crisis Triage, Walk-ins and Mobile Crisis Services 10.15.1 Introduction 10.15.2 References 10.15.3 Scope 10.15.4 Did you know? 10.15.5 Definitions 10.15.6 Procedures 10.15.6-A Triage 10.15.6-B
More informationPARTICIPANT HANDBOOK. City and County of San Francisco Department of Public Health Updated February 2017
PARTICIPANT HANDBOOK City and County of San Francisco Department of Public Health Updated February 2017 www.healthysanfrancisco.org Contents About this Handbook...1 What is Healthy San Francisco?...1 Your
More informationPrograms and Procedures for Chronic and High Cost Conditions Related to the Early Retiree Reinsurance Program
s and Procedures for Chronic and High Cost Conditions Related to the Early Retiree Reinsurance HealthPartners Disease and Case Management programs are targeted to those who have been identified with a
More informationQuartz - UW Health Network
Quartz - UW Health Network 2018 PROVIDER DIRECTORY State of Wisconsin Group Health Insurance Program TM CONTENTS CONTACT QUARTZ Quartz Customer Service (844) 644-3455 (toll-free) (608) 644-3430 (local)
More informationTOTALLY THERE FOR YOU HMO. Member Handbook
TOTALLY THERE FOR YOU HMO Member Handbook Welcome to Total Health Care USA We are pleased to have you as a member and we look forward to serving your health care needs. Total Health Care USA will provide
More informationEnrollment Guide WASHINGTON COUNTY PUBLIC SCHOOLS. Washington County Public Schools Enrollment Guide C1
Enrollment Guide WASHINGTON COUNTY PUBLIC SCHOOLS 2014 Washington County Public Schools Enrollment Guide C1 Table of Contents Welcome... 1 Exclusive Provider Organization (EPO)... 2 Preferred Provider
More informationThe Emergency Medical Treatment and Labor Act (EMTALA)
The Emergency Medical Treatment and Labor Act (EMTALA) Presentation to the 2016 Nurse Leaders in Native Care Conference Mary Ellen Palowitch MHA,RN Division of Acute Services Survey & Certification Group
More informationOptima Health Provider Manual
Optima Health Provider Manual Supplemental Information For Ohio Facilities and Ancillaries This supplement of the Optima Health Ohio Provider Manual provides information of specific interest to Participating
More informationMARATHON HEALTH CENTER a benefit of CHG Health and Wellness
Health & Wellness MARATHON HEALTH CENTER a benefit of CHG Health and Wellness WE ARE A DIFFERENT KIND OF HEALTHCARE COMPANY. OUR MISSION IS TO INSPIRE PEOPLE TO LEAD HEALTHIER LIVES. CHG Healthcare Services
More informationGood health is part of the plan.
Good health is part of the plan. Presbyterian Health Plan has a long tradition of providing quality health care to State of New Mexico employees and their families. For 108 years, Presbyterian has been
More informationOHIO PREGNANCY ASSOCIATED MORTALITY REVIEW (PAMR) TEAM ASSOCIATED FACTORS FORM
OHIO PREGNANCY ASSOCIATED MORTALITY REVIEW (PAMR) TEAM ASSOCIATED FACTORS FORM Please Circle: OFFICIAL WORKING COPY Case # DEATH REVIEW PROCESS 1. Estimate the degree of relevant information (records)
More informationTALK. Health. The right dose. May is Mental Health Month. 4 tips for people who use antidepressants
VOLTEE PARA ESPAÑOL! SPRING 2016 Health THE KEY TO A GOOD LIFE TALK IS A GREAT PLAN May is Mental Health Month. Everyone deserves good mental health. Whether you have a minor mental health condition that
More informationCareFirst BlueChoice. District of Columbia
CareFirst BlueChoice District of Columbia Welcome We are pleased to offer you enrollment in our CareFirst BlueChoice Health Maintenance Organization (HMO) plan. Designed for today s health conscious and
More informationKaiser Permanente. An Integrated Health Care Model for Marsh & McLennan Companies Benefits Overview October 19, 2017
Presented by: Erica Elder Executive Account Manager Kaiser Permanente An Integrated Health Care Model for Marsh & McLennan Companies 2018 Benefits Overview October 19, 2017 Welcome! Our agenda for today
More informationSelf-Insured Schools of California: Schools Helping Schools
Self-Insured Schools of California: Schools Helping Schools Blue Shield of California Access+ HMO SaveNet SM Plan 2016/2017 Enrollment Guide Blue Shield of California offers health benefits to school districts
More informationMy Path to Good Health
My Path to Good Health Get health insurance for you/your family - page 2 How to choose a doctor - page 7 Use your health insurance - page 8 Go to the Doctor - page 9 Keep your health insurance - page 13
More informationPatient s Full Name DOB Age. Patient s SSN Sex: Male Female Preferred Language. Place of Birth: City State Country
Hoover Hearing Clinic A division of Hoover ENT Hoover, Alabama 35244 205-733-9694 Tel PATIENT INFORMATION ACCOUNT # DATE MD NEW UPDATE Patient s Full Name DOB Age Patient s SSN Sex: Male Female Preferred
More informationMEMBER HANDBOOK. Health Net HMO for Raytheon members
MEMBER HANDBOOK Health Net HMO for Raytheon members A practical guide to your plan This member handbook contains the key benefit information for Raytheon employees. Refer to your Evidence of Coverage booklet
More information2019 Select HMO. Benefit guide. One of the most affordable CalPERS HMO plans CAMENABC Rev. 07/18
2019 Select HMO Benefit guide One of the most affordable CalPERS HMO plans 40184CAMENABC Rev. 07/18 Why choose the Select HMO plan? We re glad you re taking time to check out all that Anthem has to offer
More informationSkilled nursing facility visits
Modified Premier HMO 20 Non Union This Summary of Benefits is a brief overview of your plan's benefits only. For more detailed information about the benefits in your plan, please refer to your Certificate
More informationWelcome to Regence! Meet your employer health plan
is an Independent Licensee of the Blue Cross and Blue Shield Association Regence BlueCross BlueShield of Utah Welcome to Regence! Meet your employer health plan 1 Health insurance is a big, wonderful benefit.
More informationVirtual Meeting Track 2: Setting the Patient Population Maternity Multi-Stakeholder Action Collaborative. May 4, :00-2:00pm ET
Virtual Meeting Track 2: Setting the Patient Population Maternity Multi-Stakeholder Action Collaborative May 4, 2017 1:00-2:00pm ET Highlights and Key Takeaways MAC members participated in the virtual
More informationmember handbook blueshieldca.com/bscbluegroove
member handbook blueshieldca.com/bscbluegroove With Main Groove, you get a Personal Physician from our medical provider network, and predictable, lower outof-pocket costs than with Basic Groove, plus access
More informationThis plan is pending regulatory approval.
Bronze Full PPO 3000 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective October 1, 2015 THIS MATRIX IS INTENDED TO BE USED
More informationEVIDENCE OF COVERAGE AND PLAN DOCUMENT
EVIDENCE OF COVERAGE AND PLAN DOCUMENT A complete explanation of your plan SELECT (Plan E9H) 531170 Important benefit information please read Dear Health Net Member: Thank you for choosing Health Net
More informationHealthy together. Care and coverage that fits your life. buykp.org Enrollment Maryland. Kaiser Permanente for Individuals and Families
Healthy together Care and coverage that fits your life Kaiser Permanente for Individuals and Families buykp.org 2018 Enrollment Maryland Welcome to care that fits your life Convenient cost estimates Get
More informationQuick start guide (TTY 711) AVA-MEM
Quick start guide www.anthem.com/vamedicaid 1-800-901-0020 (TTY 711) AVA-MEM-0732-17 Welcome to the Anthem HealthKeepers Plus plan We re glad you chose us! This booklet will help you learn how to use your
More informationThe HMO provider network is available by clicking on this website address: Plan Provider Directory Search<b/>
GENERAL PROVISIONS Web Site Address Find a Plan Doctor or Facility Health Plan Telephone Number NCQA Accreditation Status http://www.bcbsil.com The HMO provider network is available by clicking on this
More informationRULES OF TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT WORKERS COMPENSATION DIVISION
RULES OF TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT WORKERS COMPENSATION DIVISION CHAPTER 0800-02-25 WORKERS COMPENSATION MEDICAL TREATMENT TABLE OF CONTENTS 0800-02-25-.01 Purpose and Scope
More informationThese electronic documents must be used as provided, without additions, deletions, or other modifications.
Kaiser Foundation Health Plan, Inc. Electronic Documents Policy This policy document constitutes the explicit, written permission of Kaiser Foundation Health Plan, Inc., (Health Plan) for the Purchaser
More information2016 Summary of Benefits
2016 Summary of Benefits Health Net Jade (HMO SNP) Kern, Los Angeles and Orange counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0175 CMS Accepted 09082015
More informationChat with a Doctor: On-Demand, Asynchronous Physician Advice
Chat with a Doctor: On-Demand, Asynchronous Physician Advice Session 189: March 7, 2018 Ari Melmed, MD, FACEP Assistant Regional Director for Telehealth, Colorado Permanente Medical Group 1 Conflict of
More information2018 CareOregon Advantage Plus (HMO-POS SNP) Summary of Benefits
2018 CareOregon Advantage Plus (HMO-POS SNP) Summary of Benefits For Oregon counties: Clackamas, Clatsop, Columbia, Jackson, Josephine, Multnomah, Tillamook, Washington and Yamhill H5859_1099_CO_1018 CMS
More informationMedicare Coverage. You Can Count On. A simple guide to your University of California benefit choices. Medicare
Medicare Group Plans Medicare Coverage You Can Count On A simple guide to your University of California benefit choices Health Net Seniority Plus (Employer HMO) H0562_18_2989EGBROC_08232017 Health Net
More informationIllustrative Benefits, Value Added Services and Premiums are effective January 1, 2016 through December 31, 2016
PLAN FEATURES Combined In and Out of Network Deductible (Plan Level/includes Network Deductible) Network & Out-of-Network Providers $0 Member Coinsurance N/A Applies to all expenses unless otherwise stated.
More informationBlue Options. Health Plan Information Guide. What should I know about my benefits? What happens next? Where do I go to get assistance?
Blue Options Health Plan Information Guide What happens next? What should I know about my benefits? Where do I go to get assistance? Welcome At Florida Blue, we provide you with guidance and support because
More informationSummary of Benefits. January 1, 2018 December 31, Providence Medicare Dual Plus (HMO SNP)
Summary of Benefits January 1, 2018 December 31, 2018 Providence Medicare Dual Plus (HMO SNP) This plan is available in Clackamas, Multnomah and Washington counties in Oregon for members who are eligible
More information4. Utilization Management (UM) / Resource Management (RM)
4. Utilization Management (UM) / Resource Management (RM) 4.1 Overview of Utilization Management/Resource Management Program KFHP, KFH, and TPMG share responsibility for Utilization Management (UM) and,
More informationSTAY HEALTHY ON THE GO
Traveling as a Kaiser Permanente member: VISITING MEMBER SERVICES STAY HEALTHY ON THE GO Getting the care you need while traveling in other Kaiser Permanente regions or Group Health Cooperative service
More information