HCR ManorCare Advanced Heart Care Program FAQ

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1 What is the HCR ManorCare Advanced Heart Care Program? The HCR ManorCare Advanced Heart Care Program with Cleveland Clinic is a special program through your company medical plan* that offers members state-of-the-art services focusing on complex heart procedures. Care is provided by Cleveland Clinic with health benefits administration by Health Design Plus. This unique program allows those in need an opportunity to get quality care from one of the nation s leading heart-care providers. Participation/Administration 1. Whom does the program benefit? This program benefits any HCR ManorCare employee and his/her covered dependents enrolled in the Basic, Flex, Premier HRA, Advantage HSA, or the Paramount HMO Medical Plan, who meet clinical criteria for specific covered procedures. 2. What services does this program offer? The HCR ManorCare Advanced Heart Care Program focuses on certain complex cardiac procedures. These heart care procedures include inpatient heart surgeries and minimally invasive procedures. 3. Who reviews a member's eligibility for the program? Health Design Plus will confirm a member s program eligibility. Eligibility is also clinically determined based on a review of medical records by Cleveland Clinic. Health Design Plus is the member s point of contact for information regarding his/her program eligibility. 4. How does a member begin participation in the program? Members may begin participation in the program by calling Health Design Plus at Upon calling this number, Health Design Plus Representatives will qualify and verify eligibility and refer members to a Cleveland Clinic nurse to discuss medical needs. Once accepted, patients should use the phone numbers listed on their HCR ManorCare Advanced Heart Care Program ID card provided by Health Design Plus. 5. How does a member qualify for this program? The following initial criteria qualify a member for this program: The member s primary healthcare coverage is through HCR ManorCare s Basic, Flex, Premier HRA, Advantage HSA, or the Paramount HMO Medical Plan. For heart procedures, the member needs to have been recommended for a program-covered procedure from a cardiac specialist. Additional diagnostic or medical services may be required of the member prior to meeting clinical criteria. The member must meet clinical requirements evaluated by Cleveland Clinic. The member s local physician agrees to assume care for the member upon returning home. Failure to agree may result in the patient s procedure being cancelled.

2 * Associates must be enrolled in the Basic, Flex, Premier HRA, Advantage HSA, or the Paramount HMO Medical Plan. 6. What does a member need to provide Health Design Plus in order to obtain services? Members need to provide the employee s HCR ManorCare medical ID card and complete and return the Authorization Forms sent home in the Information Packet. 7. What does a member need to provide Cleveland Clinic in order to obtain services? Members need to provide Cleveland Clinic with copies of their medical records and their physician s contact information. In addition, when members register at Cleveland Clinic, they must present their HCR ManorCare Advanced Heart Care Program ID card, provided by Health Design Plus. 8. What forms need to be completed by members? Who provides the forms? Health Design Plus will mail members an Information Packet including the Authorization Forms that must be completed upon verification of eligibility. Members must complete a Patient Release of Medical Information Form to submit to their local physician s office regarding the medical release of their patient medical records. 9. Is there a member ID card provided? Who provides the member ID card and when will a member receive it? Yes, Health Design Plus will provide an ID card to use with this specific program. Patients will receive a Welcome Packet after qualifying for this program which includes the HCR ManorCare Advanced Heart Care Program ID card. This card is valid only for HCR ManorCare Advanced Heart Care Program services. For post-discharge medications, patients should use their Express Scripts pharmacy ID card at any in network pharmacy. 10. Does a member need to provide medical records? Yes, a member must provide any and all medical records as requested by Cleveland Clinic. Your medical records are needed by Cleveland Clinic s Heart and Vascular team so they can build you an individualized treatment plan to ensure the best clinical outcomes. Heart procedures cannot be scheduled without the proper medical records submitted. You will be provided instructions on how to work with your local doctor to provide the required medical records. 11. Does a patient need to arrange for follow-up health care, once he/she returns home after the procedure? Yes, in order to be eligible for this program, patients must arrange for follow-up health care with their local doctor. The scheduling of such follow-up care must be confirmed with Cleveland Clinic and Health Design Plus prior to the patient traveling to Cleveland Clinic. Failure to confirm such follow-up care may result in the patient s procedure being cancelled.

3 Coverage (all determinations shall be subject to HCR ManorCare s benefit design) 1. What services/benefits are covered under the HCR ManorCare Advanced Heart Care Program? Travel expenses for you and a companion (including travel, hotel, and parking). All services while a patient is at Cleveland Clinic, except convenience items (services not related to heart care are not covered under this program: telephone, companion meals in the hospital, etc.). Medically necessary services or equipment related to this program provided in Cleveland after discharge from Cleveland Clinic (excluding outpatient pharmacy). 2. What services/benefits are NOT covered under this program? Any elective outpatient services in Cleveland not related to the covered program services. Convenience items (services not related to heart care are not covered under the program: telephone, companion meals in the hospital, etc.). Non-program expenses (meals, entertainment, telephone, and gratuities). See HCR ManorCare Advanced Heart Care Program Travel Cost Guide for details. The following services will be covered under the Patient s current health plan and are subject to the Basic, Flex, Premier HRA, Advantage HSA, or the Paramount HMO Medical Plan policy provisions. Outpatient pharmacy for prescriptions after discharge from Cleveland Clinic. Outpatient pharmacy is covered under a patient s current medical and prescription drug plan option and may be subject to cost-sharing. Follow-up care after returning home, including cardiac rehabilitation. * To comply with IRS Rules, employees enrolled in the Advantage HSA Plan must meet the annual deductible before the plan will make any payments. 3. What travel expenses are covered for a member and his/her companion? The following expenses are covered for the member and one companion: Concierge service to arrange travel and lodging. Transportation for a member and one companion. Lodging for the member awaiting hospitalization and lodging for the companion for their entire stay in Cleveland. Round-trip transportation between the airport/station and the hotel and between the hotel and Cleveland Clinic. See the Authorization Forms, which include a brief description of travel guidelines included in the Information Packet as well as online at: Once a member s procedure is scheduled, he or she will receive detailed information regarding covered travel expenses and reimbursement methods pertaining to the chosen method of travel.

4 4. Can members choose what doctors/hospital to use for the services covered by the program? Cost No. Cleveland Clinic is the hospital of choice for this program. Your physician will be selected by Cleveland Clinic s Heart and Vascular team based upon your individual medical need and the physician's area of expertise. 1. Is a member charged for services? A member will be charged for services not covered by the program. Examples of items not covered (not allinclusive) include meals, hotel incidentals, and inpatient convenience items, such as telephone service. 2. Are patients responsible for any copays or coinsurance under this program? No. 100% of the cost of your care by Cleveland Clinic is paid by HCR ManorCare. If you are in the HCR ManorCare Advantage HSA Plan, due to IRS rules, you will be responsible for meeting your plan year deductible before services are paid at 100% by the plan. You may contact your medical plan administrator to determine your deductible balance. 3. What, if any, services need to be reported to the IRS? Travel The program is designed to cover only IRS-approved expenses and thus no reporting to the IRS is required. 1. Who handles a member s travel itinerary? After a member s procedure is scheduled, the member will be referred to an American Express Travel Group Coordinator to schedule travel arrangements. 2. Can a member s family travel with him/her? Yes. A member can choose one travel companion for which transportation and lodging expenses will be covered. See travel guidelines for covered expenses. 3. Can members choose their transportation and lodging service providers without using the American Express Travel Group (Travel Group)? In order to receive travel benefits under this program, a member must use the Travel Group. Any transportation and/or lodging reservation changes must be made through the Travel Group. 4. Are members and dependents required to have a traveling companion? In most instances, members are not required to have a traveling companion. However, clinical criteria for specific procedures may indicate when a traveling companion is required.

5 After Services are Completed 1. How is the discharge process handled? Cleveland Clinic develops a patient s non-emergency care plan while in Cleveland and for a patient s return home. Patients receive written instructions for self-care and contact information (including after hours) to their Cleveland Clinic clinical team for questions. Cleveland Clinic works with the patient to schedule his/her first follow-up appointment with the patient s local physician and provides Health Design Plus information to coordinate home care as necessary. 2. Does a patient need to submit claims to his/her current medical carrier? For services covered under this program, claims do not need to be submitted. For services not covered under this program, claims would need to be submitted to your medical carrier. Please see Coverage, 1 & 2 for more information. 3. What happens if a member experiences emergency medical health issues once they are discharged and return home? Once a member returns home, a member should contact 911 for any medical emergencies that may occur. 4. Does a member need to have an established relationship with a local doctor(s) as part of the follow-up process? Yes, in order to be eligible for the program, a member must have an established relationship with a local doctor(s). The member s doctor(s) must be willing to assume future and ongoing care once the member returns home. 5. What physician should members use for follow-up? Their own, or a Cleveland Clinic physician? General Upon return home, members should use their own local physician(s). However, if a member chooses to use Cleveland Clinic physician(s) for their follow-up care, the charges will apply toward their current medical plan. Please see Coverage, 1 & 2 for more information. 1. How many times can a member use this benefit? Members can use this program as many times as needed as long as they are enrolled in the HCR ManorCare Basic, Flex, Premier HRA, Advantage HSA, or the Paramount HMO Medical Plan, and meet clinical criteria for specific covered services.

6 2. Who can a patient and travel companion call for care concerns and immediate issue resolution? Patients and travel companions who need to voice a concern regarding their care or who may need assistance in resolving an inpatient or outpatient issue may contact a Health Design Plus Nurse Care Manager at any time by calling toll-free Health Design Plus Nurse Care Managers are available Monday Friday, 8:30 AM to 5:00 PM Eastern Time. 3. How can a member receive more information about the HCR ManorCare Advanced Heart Care Program? Members can receive more information about the program by calling A Health Design Plus Representative will answer your questions and send an Information Packet to the member s home mailing address Health Design Plus, Inc. All Rights Reserved. MI