The Choice Is Easy C H O O S E Q U A R T Z + +

Transcription

1 The Choice Is Easy C H O O S E Q U A R T Z + +

2 Say Hello to Quartz Gundersen Health Plan, Physicians Plus, and Unity Health Plans Insurance Corporation have come together to introduce our new brand - Quartz. You ll find the same level of customer service you ve come to expect. We are happy to serve you, our valued member, through the State of Wisconsin Group Health Insurance Program. Learn more at ChooseQuartz.com. C H O O S E Q U A R T Z 1 The Quartz offering for the State of Wisconsin Group Health Insurance Program is underwritten by Unity Health Plans Insurance Corporation

3 GETTING STARTED WITH QUARTZ We want to make your transition as easy as possible. To help you, we have created four easy steps for you to follow as you become a new Quartz member. 1. Choose an In-Network Primary Care Physician As a new Quartz member, you need to select a Primary Care Physician (PCP) for services to be covered. You can find a list of participating PCPs by going to ChooseQuartz.com/findadoctor and selecting your network. Once you have chosen a PCP, we recommend that you call the clinic to determine if the physician you want is accepting new patients and to see if they can meet your needs. If you would like assistance selecting a new PCP at a UW Health clinic in Dane County, write Welcome Center on your application under PCP name and the UW Health Welcome Center will contact you. CONTACT QUARTZ Online: ChooseQuartz.com Phone: (844) TDD / TTY: 711 / (800) MyChart: QuartzMyChart.com 2. Find a Participating Specialist If you are receiving ongoing care from a specialist that is not an in-network practitioner with Quartz, you may need to transition your care. Quartz will work with you to switch your care. If you feel your condition is complex, please call Quartz Customer Service at (844) Sign up for MyChart MyChart, Quartz s secure online portal provides you access to your health insurance information including your benefit and claim information, authorizations and electronic communications, such as an explanation of benefits. Plus, if you receive care from a UW Health provider, you can access portions of your medical information. To request an account, visit QuartzMyChart.com and select Request an Account. If you have already signed up for MyChart through UW Health, you do not need to sign up again. For more information on the benefits and features of MyChart, visit QuartzBenefits.com/MyChart. 4. Review Your New Member Information Once you are enrolled, you will receive your new identification cards. To learn more about key health insurance topics, visit QuartzBenefits.com/members. Review this information carefully because it will help you make the most of your health plan. 2

4 Q U A R T Z O F F E R S T W O P R O V I D E R N E T W O R K S Quartz - UW Health Network DeForest DANE Windsor Sun Prairie Cross Plains Middleton Madison Monona Cottage Grove Mt Horeb Verona Fitchburg P Primary Care Locations Belleville Oregon Stoughton 2018 Quartz - UW Health Network Service Area If you want a Primary Care Physician (PCP) in Dane County (excluding the communities of Cambridge and Mazomanie), you should select the Quartz - UW Health Network. To help you find a participating practitioner or facility, follow the steps on pages 5 and 6. Please note: You and your family members can select different PCPs / clinics within the same network. 3

5 Quartz - Community Network Minnesota Chatfield Rushford Iowa CHIPPEWA Chippewa Falls Stanley Eau Claire Altoona Cornell EAU CLAIRE Augusta CLARK Greenwood Neillsville Lena Illinois Freeport 2018 Quartz - Community Network Care Locations Also includes Cambridge and Mazomanie in Dane County. Limited provider availability Provider availability meets program requirements Osseo WOOD Limited providers available, Whitehall Wisconsin Rapids not included in service area Independence JACKSON Blair Black River Falls Nekoosa Necedah TREMPEALEAU Galesville JUNEAU Winona Wisconsin LA CROSSE MONROE New Lisbon Friendship Holmen Tomah Mauston North Mount Calvary Onalaska Sparta Fond du Lac La Crosse Norwalk ADAMS Westfield Ripon La Crescent Elroy Oxford Fond du Lac Cashton Houston Brandon MARQUETTE Wonewoc FOND DU LAC Westby LaFarge Waupun Hillsboro Wisconsin Dells Brownsville Fox Lake Spring Grove Viroqua Portage Cambellsport Harmony Reedsburg Randolph Mayville Pardeeville VERNON RICHLAND Beaver Dam SAUK Horicon Lansing COLUMBIA Prairie du Sac Columbus Juneau Soldiers Grove Richland Center Lodi Decorah Plain Waukon DODGE Calmar Sauk City CRAWFORD Watertown Muscoda Spring Green Waterloo Ixonia Oconomowoc Postville Mazomanie Lake Mills Sussex Prairie du Chien Boscobel Highland DANE Johnson Creek Hartland Pewaukee Monona Brookfield West Union Fennimore IOWA Delafield Waukesha Dodgeville Cambridge Jefferson WAUKESHA Montfort Ft Atkinson New Berlin Fayette Mineral Lancaster JEFFERSON Muskego Point Mukwonago Edgerton Eagle Elkader New Glarus GRANT Evansville Milton Whitewater WALWORTH Darlington Platteville Argyle Albany ROCK Delavan LAFAYETTE GREEN Janesville Elkhorn Cuba City Shullsburg Monroe Brodhead Darien Beloit Clinton Lake Geneva Harvard Richmond Durand Roscoe McHenry Woodstock Belvidere Crystal Lake Rockford Algonquin Byron Elgin Davis Junction Rochelle 2018 Quartz - Community Network Service Area If you want a Primary Care Physician (PCP) located outside of Dane County and the communities of Cambridge and Mazomanie, you should select the Quartz - Community Network. To help you find a participating practitioner or facility, follow the steps on pages 5 and 6. Please note: You and your family members can select different PCPs / clinics within the same network. 4

6 FIND A DOCTOR PARTICIPATING IN YOUR NETWORK ChooseQuartz.com/findadoctor allows you to search for participating practitioners and facilities. Step 1 Start Your Search Go to ChooseQuartz.com/findadoctor Step 2 Select Your Network On the Find a Doctor landing page, select your network, either State / Local - UW Health or State / Local - Community. 5

7 Step 3 Select Your Criteria You may search by doctor name or facility name. To search by doctor, use one or more of the following J Location Enter an address, city and state or ZIP code J Practitioner Name Enter a practitioner s last name and / or first name J Gender of the practitioner J Language the practitioner speaks J Whether a practitioner is Accepting New Patients J Specialties J Primary Care Type J Hospital Admitting Privileges J Medical Group Affiliation As you make your selections and select Apply, the results will be updated. Behavioral Health Information If you are looking for a behavioral health practitioner, select the Behavioral Health tab. Dental and Pharmacy Benefits If you are enrolled in dental coverage, Delta Dental of Wisconsin will administer your dental benefits. Visit deltadentalwi.com/state-of-wi for more information. Navitus Health Solutions administers your pharmacy benefits. Visit for more information. You can download a copy of the entire directory for either the Quartz - UW Health Network or the Quartz - Community Network by selecting Show Printable List. This will allow you to view all in-network practitioners and facilities in each network. If you would like a printed copy of either Provider Directory, please call (844)

8 O N L I N E T O O L S Visit ChooseQuartz.com to find a variety of online tools to learn more about the programs available to you. Tools include J MyChart J UW Health MyChart App for iphone and Android J Online Chat J Member Resources J e-visits MyChart MyChart is a secure online service that provides a convenient way for you to view your health plan information and portions of your medical information. MyChart offers J 24-hour access to your health plan information where you can review your Quartz benefits and your claims J Secure communication with Quartz Customer Service J Electronic communications including your explanation of benefits J Plus, if you receive care from a UW Health clinic, you can access portions of your medical record, schedule simple appointments and send messages to your health care team Interested in becoming a MyChart member? Quartz members age 18 and older can sign up using one of these options J Visit QuartzMyChart.com and select Request an Account J Sign up during your UW Health appointment. Just ask your nurse or practitioner for an activation code J Sign up at your UW Health Primary Care Clinic. No appointment needed. Ask any receptionist for assistance (photo identification required) Sign up today to take advantage of the benefits that MyChart offers! UW Health MyChart App for iphone and Android Do you receive care from a UW Health clinic? If so, UW Health offers a free MyChart app for iphones and Androids. With the MyChart app, you can view your test results, send and receive messages, view health reminders and your health summary all through your smartphone. To download the app, search for MyChart in the App Store through any Apple device or the Android market. Once downloaded, select UW Health as the provider. In order to use the smartphone, you must have a MyChart account set up. To set up an account, visit QuartzMyChart.com. Online Chat Quartz offers the ability to chat online with a Customer Service representative making it more convenient to obtain real-time answers to your questions. To chat with us online, visit ChooseQuartz.com and select the chat icon. Member Resources We ve provided online information to help you better understand the ins and outs of your health plan everything from understanding forms like the explanation of benefits to learning more about health care expenses. Visit QuartzBenefits.com/members and select from a range of topics J Forms & Resources provides links to important documents in MyChart and downloadable forms such as the Determination of Benefits Worksheet and the General Authorization Form. J How to Get Care offers information to help you determine where to get the most appropriate care and prior authorization requirements J How Insurance Works offers educational videos like Understanding Your Explanation of Benefits and Understanding Your Health Care Expenses e-visits Quick, online visits between you and a UW Health doctor for common health problems. No appointment necessary! For more information, visit QuartzBenefits.com/evisit. 7

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10 Q U A R T Z A N D U W H E A L T H W Quartz offers you access to many local providers, including those at UW Health. This includes J Referral-free appointments to UW Health s physicians. J UW Hospital Wisconsin s No. 1 rated hospital* and home to a Level One adult and pediatric trauma center. J American Family Children s Hospital Pediatric specialists and state-of-the-art care for children and their families. J UW Health at the American Center Madison s east side community-based health and wellness facility. J Meriter Hospital for maternity and other services. * Ranked by U.S. News & World Report , , , and editions 9

11 O R K I N G T O G E T H E R F O R Y O U The UW Health Welcome Center We understand that changing your doctor is a scary thought. The UW Health Welcome Center is here to help you. The Welcome Center is a one-stop-shop designed to make your transition into the UW Health system as seamless as possible. As a new Quartz member and a new UW Health patient, the UW Health Welcome Center will J Help you find a UW Health PCP J Work with you to move your medical records from your previous clinic J Gather your medical history J Talk about any long-term illness or preventive care needs you may have J Help you set up an appointment at the Welcome Center Clinic, if needed J Help you find community resources if needed (such as transportation, filling out an advance directive and more) If you would like a PCP at a UW Health clinic, indicate Welcome Center on your application under Select Physician or Clinics. The Welcome Center will help you select a UW Health PCP. You can also call (608) or (800) weekdays from 8 a.m. to 5 p.m. or patient.resources@uwmf.wisc.edu. 10

12 H E A L T H M A N A G E M E N T P R O G R A M S Quartz has developed a number of health programs that offer members self-management support. These programs are free, voluntary and confidential. Members gain information and skills to better manage their conditions and strengthen the partnerships they have with their health care providers. Through the Health Management programs, members can J Learn more about their condition(s) J Understand what care is recommended J Become actively involved in their health and care plan J Create stronger relationships with their provider J Better manage their condition(s) J Participate in Living Well with Chronic Conditions 11

13 Health Management Programs J Included in all Health Management programs Resource referral Guidelines for living with your condition Helpful resources and educational mailings Medication adherence and pharmacist coaching as needed Tobacco cessation assistance J Asthma Health Management Program Asthma control test Asthma Triggers and Management brochure Annual flu vaccine reminder J Diabetes Health Management Program Dilated eye exam reminders Annual flu vaccine reminder Preventive Health Programs J Preventive Health Services Reminders Immunizations for all age groups, including the HPV and flu vaccines Breast and cervical cancer screenings Chlamydia screening Colorectal cancer screening J 9 Months & MoreSM Program Pregnancy, breast-feeding, childbirth and postpartum information Guidance on practitioner visits Postpartum gift (for those who meet the program requirements)* Free text messaging service / mobile app For Information J Call (866) or visit QuartzBenefits.com * Please note: All health and wellness rewards and reimbursements paid to adult members are considered taxable income and Quartz is required to report these amounts to your employer. 12

14 B E N E F I T S Visit etf.wi.gov for information on medical, dental and prescription drug benefits including details on deductibles, copayments and out-of-pocket expenses. Visit ChooseQuartz.com for more information about Quartz services and programs. You can search for practitioners, sign up for MyChart and find links to important benefit information. Choose Quartz to select Quartz as your health insurance plan, contact your payroll / benefit office for enrollment information or visit etf.wi.gov. 13

15 F R E Q U E N T L Y A S K E D Q U E S T I O N S Q: How do I know if the doctor I m currently seeing is a Quartz provider? A: You can search to see if your doctor is a participating provider by going to ChooseQuartz. com/findadoctor. Select your provider network State / Local UW Health or State / Local Community. The online provider listing shows the in-network practitioners and facilities. Q: What hospitals or emergency rooms are in-network for me? A: To learn more about which hospitals and emergency rooms are in-network for you, visit ChooseQuartz. com/findadoctor and select your network. Q: Can I select a PCP with a closed practice if I have seen him / her in the past? A: Yes, if you are a current patient and if he / she is a Quartz provider. If you are not a current patient but have seen that physician in the past, please contact the physician s clinic. Availability of physicians with closed practices depends on that physician s patient load and appointment wait times. Q: Can I change my PCP after I select one? How? A: You can change your PCP at any time. To select a new PCP, visit QuartzMyChart.com or call (844) PCP changes are effective on the day of Quartz s receipt of your request unless you request a future date. Q: Does my new PCP need my medical records? A: Yes. After you choose a PCP, contact his / her office to discuss the process. If you are choosing a UW Health PCP, contact the Welcome Center at (608) for assistance with the process. You may have to sign a release to have your records transferred. If you have current health care needs or an ongoing health condition, please make sure your new PCP receives your records as soon as possible. Q: How should I schedule an initial appointment with my new PCP? Do I need to schedule a physical with my new PCP? A: If you have ongoing health care needs or a current reason to see your PCP, please call your PCP s office as soon as possible to schedule an appointment. If you do not have any current or ongoing health care needs, we recommend that you schedule a new patient visit with your PCP. New patient visits are routine and often scheduled several weeks in advance. Q: What if I have urgent health care needs or need care outside Quartz s service area before the first visit to my new PCP? A: If you have a life-threatening medical situation, call 911 or go directly to the nearest medical facility. If you believe you are in need of urgent care, contact your PCP clinic first, even after hours or if you are outside of Quartz s service area. Your PCP clinic will tell you how to get appropriate care. Q: How do I know how much I will pay for my health care services? A: The best way to learn this is by reviewing your Schedule of Benefits or your Summary of Benefits and Coverage (SBC). The Schedule of Benefits or SBC lists any coinsurance, copayments, deductibles or any other amounts for which you are responsible. For a more detailed explanation, you can also complete a Determination of Benefits Worksheet found at ChooseQuartz.com. To complete this form, you will need to get some very specific information, such as provider NPI, billing code and amount billed, before sending it to Quartz. Q: What is a copayment? A: A copayment is the dollar amount you are responsible for paying each time those services are provided, subject to any limits specified on the Schedule of Benefits. To view your Schedule of Benefits, visit QuartzMyChart.com or request one from Quartz. Q: What is coinsurance? A: Coinsurance is the term used to identify the percentage of health care costs you are responsible for paying each time those covered services are provided. You pay the percentage listed on your SBC. 14

16 F R E Q U E N T L Y A S K E D Q U E S T I O N S Q: What is a deductible? A: A deductible is the amount you are required to pay for certain covered medical services before Quartz will make a payment. Your deductible is listed on your Schedule of Benefits and Coverage (SBC). Once the deductible is met, you pay a percentage of the cost of the covered medical services. See your SBC for specific details. Q: How does a deductible plan work?* A: A deductible is a predetermined amount of money a member or family must pay per benefit period before Quartz will make a payment toward a covered service. This means you must first pay the deductible found on your SBC. After the deductible is met, Quartz will pay its percentage of the coinsurance until you have met the dollar amount listed as the annual out-of-pocket limit. * For the high deductible health plan (HDHP), if you have family coverage, the family deductible must be satisfied before Quartz will make a payment for covered services. Q: What charges are applied to the deductible?* A: Please refer to your plan s SBC for a list of services. Copayments are not applied to the deductible. * For the high deductible health plan (HDHP), if you have family coverage, the family deductible must be satisfied before Quartz will make a payment for covered services. Q: Are pre-existing conditions covered? A: Yes. Pre-existing conditions are covered under your policy. Q: What preventive care coverage do I have? A: Preventive care services, as defined and required by federal law, are covered without a copayment, coinsurance or deductible when received from a participating PCP. Specific problems discussed or treatments applied during your visit may be subject to out-of-pocket charges (copay, coinsurance or deductible). For a list of preventive care services, visit healthcare.gov/preventive-care-benefits. Q: What is medical management? A: Quartz carefully reviews prior authorization requests and pre-certification notifications that are submitted by participating practitioners. This process of medical management, sometimes called care management or utilization management, is conducted by experienced staff, which includes registered and licensed practical nurses with the support of board certified physicians. Medical management staff work with your PCP or your treating provider to coordinate pre-service review (before care or services are delivered), concurrent review (while care or services are being provided) and post-service review (after care or services have been provided) related to your care. Quartz works with participating physicians and medical management staff to help ensure decisions regarding treatment are based only on appropriateness of care. Quartz does not reward practitioners or other individuals involved in the medical management process for issuing denials of coverage or care. Quartz does not offer financial incentives for medical management decision makers to encourage decisions that result in under-utilization. Q: What is complex case management? A: If you have a serious or complicated medical problem, you may qualify for complex case management services. Complex case management is a process in which experienced registered nurses and licensed social workers work with both you and your doctor to coordinate, monitor and evaluate the options and services available to best meet your health care needs. Quartz s complex case management staff may become involved with you if you experience a critical event or a diagnosis for a complicated problem. Your doctor may refer you to our care team or you and / or your caregiver may contact us at (608) In addition, you may be referred for case management through Quartz s medical management processes, a treating practitioner or by a referral from one of Quartz s health management programs. Q: Where can I find information about Quartz s policies and practices regarding collection, use and disclosure of protected health information? A: To learn more about Quartz s policies and procedures concerning the privacy of your information, go to QuartzBenefits.com/privacypractices. 15

17 Remember, if you have any questions about how to use your Quartz plan or how to receive care from a participating provider, please don t hesitate to contact Quartz Customer Service through the message center within MyChart at QuartzMyChart.com or call (844)

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20 + + ChooseQuartz.com J Quartz Customer Service (844) UH01065 (0917)