Health plans for Maine small businesses Available through the Health Insurance Marketplace

Transcription

1 Health plans for Maine small businesses Available through the Health Insurance Marketplace Effective January 1, 2016 We can help you navigate the health care road We re here to help. In fact, for more than 75 years we ve been offering the right products, information and services to give you what you need on your terms MEEENABS Rev. 08/15

2 Let us help you find a plan that will work for your business. Anthem Blue Cross and Blue Shield (Anthem) in Maine, can give you information and tools to help you better understand how it all works. We ve designed our SHOP plans carefully, because we know you need to keep your costs down while offering your employees the benefits they need to take control of their health. Why choose Anthem over other SHOP plans? With Anthem, your employees will have a full range of health benefits, as well as the latest health and wellness tools and resources at their fingertips. That makes it a lot easier for them to stay on top of their health. Take a look at what we offer: Stability Anthem has years of experience providing health care benefits to millions of Americans nationwide. In fact, we ve been providing health care benefits to the people of Maine for more than 75 years. That s experience you can count on. Pharmacy benefits designed to save money The Anthem Select Drug List is a list of select generic and brand-name medicines approved by the Food and Drug Administration (FDA). The list is designed to save money and is divided into four tiers. With our more traditional plans, Tier 1 drugs have the lowest cost share. Tiers 2 and 3 have progressively higher copays. Tier 4 drugs have a coinsurance up to a maximum dollar amount per prescription. Prescription drug coverage on our health savings account (HSA) plans is subject to the medical deductible and applicable coinsurance. To view the Anthem Select Drug List, visit anthem.com/pharmacyinformation. Total health care We offer your employees a total health solution so they can live healthier, feel better and save money doing it. Our plans and programs include 100% coverage for in-network preventive care, no-cost access to 24/7 NurseLine and clinical and wellness programs that work together to promote overall health, including health coaching programs. We re here to make sure the health of your employees, and your business, is in top shape. 1 Incentives and availability vary by state and plan. 2 Rewards issued based on claims history. 3 Self-reported by member. Healthy Support Employees can be rewarded for making healthy choices. 1 They have access to online resources including fitness trackers and webinars on health topics. They can also receive incentives of up to $150 per year: $50 gift card for completing an annual preventive wellness exam. 2 $50 gift card for receiving an annual flu shot. 2 $50 gift card for certifying tobacco-free. 3 Network value Having access to the best doctors in the area is important to your employees. We re well-known for our network strength and the well-respected providers who have chosen to participate in our networks. The latest online tools and mobile apps put your employees in control, no matter where they are. Your employees can get personalized guidance and easy-to-use tools wherever, whenever. It s never been easier. Once employees sign up, they can keep their health care coverage handy and get support, tools and all kinds of resources to help them reach their health goals while on the go. Here are just a few examples: Free mobile apps for when they need information ASAP All employees have to do is register at anthem.com, get their usernames and passwords and the mobile world of health care is theirs. For example, they can: Find an in-network doctor. Search for walk-in care centers and get maps and driving directions. Locate a hospital or emergency room. Access their member ID card on their phone. Our Estimate Your Cost tool is a great way to understand what a procedure may cost The tool shows what a person s estimated copay, deductible and other costs will be at a nearby hospital or facility, so decisions are easier to make. The tool also shows frequency of procedures and quality numbers that gauge performance and safety at each facility. Our Find a Doctor tool makes it easy to see which providers are in the network Employees can search for doctors, hospitals and other health care offices quickly. They can even choose a specialty or enter the name of a doctor or clinic. Healthy Lifestyles online support can help employees reach health goals Employees can get help losing weight, quitting smoking and living stress-free, with our Healthy Lifestyles online tools. We ve got online fitness tracking and customized workout plans, discounts on spa services and massage therapists, healthy recipes, quit-smoking programs and more.

3 LiveHealth Online allows your employees to see a doctor in minutes Your employees can see a doctor online or through a free app using their smartphone, tablet or computer with a webcam. Doctors can answer questions, make a diagnosis and prescribe basic medications. * It s an innovation designed to make health care more convenient and accessible. LiveHealth Online makes life easier and helps achieve real savings by reducing health care costs. * Prescription availability is defined by physician judgment and state regulations. LiveHealth Online is available in most states and is expected to expand to more in the near future. Visit the home page of livehealthonline.com to view the service map by state.

4 Your employees health comes first. Our 2016 health plans were designed with that in mind. We re happy to offer you four plans through the Health Insurance Marketplace. Our plans cover all essential health benefits, including: Preventive care at $0 Prescription drugs Outpatient (ambulatory) care Emergency services, including emergency room and walk-in center Inpatient care (hospital stays) Laboratory services Mental health and substance abuse services Maternity (pregnancy) and newborn care Pediatric dental and vision essential health benefits 1 Rehabilitative and habilitative services and devices (habilitative services help people learn, keep or improve skills they may not be developing normally) Chronic disease management services Health and wellness tools and resources Product type Plan name Network name Contract code Deductible (individual/family) Coinsurance Out-of-pocket maximum (individual/ family) Office visits (PCP/SPC) Walk-in center Emergency room Outpatient surgery Hospital inpatient Retail pharmacy: 30-day supply tier 1/tier 2/tier 3/tier 4 (pharmacy Deductible 2 : individual/family) Home delivery pharmacy: 90-day supply tier 1/tier 2/ tier 3/tier 4 Anthem Gold X Maine 500/20%/5000 Plus Maine 1LTG /$1,500 20% $5,000/$10,000 $20 3 visits before deductible/20% Deductible/20% Deductible/20% Deductible/20% Deductible/20% $15/$40/$80/30% to 2.5x/3x/3x/30% to Anthem Silver X Maine 2000/30%/5500 Plus Maine 1LRM $2,000/$4,000 30% $5,500/$11,000 $35 3 visits before deductible/30% Deductible/30% $300 $300 $15/$40/$80/30% to 2.5x/3x/3x/30% to Anthem Bronze X Maine 5000/30%/6600 Plus Maine 1LRD $5,000/$10,000 30% $6,600/$13,200 $35 3 visits before deductible/30% Deductible/30% $ % $ % + 30% /$1,000 pharmacy deductible, then $15/$35/$70/30% to 2.5x/3x/3x/30% to PPO-HSA Anthem Silver X Blue Choice PPO 2800/20%/4000 Plus w/ HSA Blue Choice PPO 1LUG $2,800/$5,600 20% $4,000/$8,000 Deductible/20% Deductible/20% Deductible/20% Deductible/20% Deductible/20% Deductible/20% Deductible/20% All of our Anthem SHOP plans use the Anthem Select Drug List, a list of drugs that includes a select number of medications in all therapeutic categories and classes. These plans also include the Preventive Healthy Support Package. 1 These policies do not provide any dental benefits to individuals aged 19 or older, except as specifically covered in your Certificate of Coverage. This policy is being offered so the purchaser will have pediatric dental coverage as required by the Affordable Care Act. If you want adult dental benefits, you will need to buy a plan that has adult dental benefits. This plan will not pay for any adult dental care, so you will have to pay the full price of any care you receive. 2 Pharmacy deductible, when applicable, does not apply to tier 1 drugs. Note: Coverage is generally available only from in-network providers, except for urgent or emergency care. All cost-share and coverage information in this brochure assumes covered services are provided by an in-network provider.

5 Take a look at how our health and wellness programs can keep your employees and your business healthy. Your employees are your most valuable asset. Of course you want them to be healthy, but there s more to it than that. When your employees are healthy, there s a healthy chance that: Productivity increases. Total medical spending is reduced. The bottom line -- good health is good for business. With fewer health complications, you ve got a healthier, more productive workforce and potentially lower overall health care costs. With Anthem, you re getting one of the most complete suites of wellness and clinical care in the industry. Program What is it about? How does it help? 24/7 NurseLine A toll-free number any member can call at anytime to speak to a registered nurse. Case Management ConditionCare Future Moms After a major hospitalization or procedure due to illness or injury, members can get phone and/or video support from our nurses. Cancer, NICU and transplant services are included. Designed for members with chronic conditions like asthma, diabetes or heart disease. It provides mothers-to-be (and dads-to-be) with personalized support and guidance. Nurses are trained to answer general health questions. They also help callers understand symptoms and choose the right place for care. It helps employees maximize their medical benefits, arrange post-discharge care, as well as community health services. It provides targeted information, guidance and support with 24/7 access to health professionals. This helps members better understand and manage their condition so they make healthier choices for optimal wellness. It helps them achieve healthier pregnancies and deliveries. We work with their own team of obstetric specialists to give the member access to expert information and direction before, during and after pregnancy. MyHealth Advantage It analyzes a member s overall health information. It helps by suggesting ways members can be healthier and reduce out-of-pocket expenses. It aims to lower costs by increasing member compliance with medical best practices and improving health care quality. Both members and providers are contacted if the system is alerted to potential problems or gaps in care. Healthy Lifestyles Cancer Care Quality Members can use this online health resource to improve their health. This is a new program that allows oncologists to compare planned cancer treatments against evidence-based clinical criteria and potentially receive enhanced reimbursement. It helps members keep track of their health in areas such as weight loss, nutrition, physical activity, tobacco use, stress and depression. Some plans may include incentives. The goal of this program is to promote access to quality, evidence-based, affordable health care for members and to provide the framework to begin changing the cancer care paradigm. This program also allows our members to be identified earlier for our Case Management program. Contact your producer or Anthem Sales representative to find out more about our 2016 SHOP plans.

6 Health care should be on your terms And we re here to make sure it is. Call your producer or Anthem Sales representative today. This document is only a brief summary of benefits and services. Our plans have exclusions, limitations and terms under which the plan/policy may be continued in force or discontinued. For more complete details, including what s covered and what isn t: See your Certificate booklet. Call your producer or Anthem Sales representative. Visit sbc.anthem.com. To view a Summary of Benefits and Coverage, please visit sbc.anthem.com. Health and wellness programs are flexible and may change or be replaced over time as we deem appropriate. LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross and Blue Shield. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.