Click to edit Master title style. Caterpillar Health Alliance HMO. Plan Year starting January 1, 2013
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1 Click to edit Master title style Caterpillar Health Alliance HMO Plan Year starting January 1, 2013
2 Click to edit Master title style Who is Health Alliance? Began in 1979; based in Urbana, IL Founded by doctors More than 300,000 members Local offices + employees = local service Committed to value-driven coverage Focused on wellness and prevention
3 Where are the eligible employee Click to edit Master title style areas for the Health Alliance HMO? Please note: Not all zip codes within the highlighted counties may be eligible.
4 Click to edit Master title style Coverage / You Will Pay Plan Year Deductible $0 Plan Year Out-of-Pocket Maximum Individual / Family $2,500 / $5,000 Lifetime Maximum Benefits Unlimited Service / Benefit Inpatient Hospital Care You Will Pay 20% coinsurance Urgent Care Center Visit $20 copayment Office Visit Primary Care Physician $20 copayment per visit Office Visit Specialist $40 copayment per visit Immunizations (100% covered) $0
5 Click webvisits to edit Master title style Select participating Methodist Medical Group doctors only $10 copayment per webvisit For consultation, not urgent care Internet connection needed
6 Preventive Click to edit Benefits Master title style One annual wellness exam per member is covered at a $0 copay. We cover preventive screenings and tests, when medically appropriate, even when you are healthy. Immunizations are 100% covered by Health Alliance. A complete listing of preventive benefits can be found online at HealthAlliance.org.
7 Spinal Manipulation Coverage (chiropractic Click to edit care) Master title style Spinal manipulation and mobilization is covered, when preauthorized by Health Alliance, for the care of spinal disorders where significant improvement can be expected within two months after treatment begins. Hot/cold pack therapy used in conjunction with approved manipulation and mobilization is also covered. Under the Caterpillar Health Alliance HMO plan, spinal manipulations cost members a $20 copayment per visit. Referrals from Primary Care Physicians are required and services must be preauthorized prior to beginning treatment.
8 Where is the Health Alliance HMO provider Click to network? edit Master title style - Methodist Medical Center - OSF Pekin Hospital - - Proctor Hospital Graham Hospital - - St. Mary s Hospital - Advocate-BroMenn Regional Medical Center - Carle Foundation Hospital - Decatur Memorial Hospital
9 How Click do to HMO edit Master plans work? title style Seek Care In-Network: More than 6,000 doctors and 85 hospitals for Caterpillar employees and retirees. No coverage for out-of-network care except in emergencies and when needed care is not available in network. Primary Care Physician (PCP): You select a primary care physician for yourself and each covered family member at enrollment. Referrals and Preauthorization: Your Primary Care Physician refers you to specialist physicians and preauthorizes procedures, when necessary. Payment: You pay the applicable copayment or coinsurance amount. Health Alliance pays the rest.
10 Why do I need a Primary Care Physician? Click to edit Master title style Coordinated care; a single point of reference for all health history, health records and questions. Personal attention a Medical Home that gives continuous and comprehensive care. Women may select an Ob/Gyn in addition to their Primary Care Physician. You designate your Primary Care Physician when you enroll. You can change your Primary Care Physician at any time by calling Customer Service at
11 What if I need to see a specialist Click to edit Master title style or have surgery? Specialist visit: Referral from your PCP is required for coverage. Elective hospital admissions: Preauthorization from your PCP is required for coverage. Services not available in-network: Preauthorization from your PCP is required for coverage.
12 What Click about to edit medical Master emergencies title style that happen outside the HMO network? Preauthorization is not required for coverage for medical emergencies. Subject to copayments. Urgent care centers visits are considered innetwork and only a $20 copayment applies. For non-emergent health issues, this is a huge savings versus an emergency room visit copayment. Follow-up care sought outside of the Health Alliance HMO network is not covered.
13 Scenario Click to # edit 1 Master title style You get your blood pressure checked at work just after the winter holidays. Your numbers are high, and are again when you have your blood pressure checked the next week. You decide a visit to your Primary Care Physician is in order. Here s what you ll pay out-of-pocket: With Health Alliance HMO: $20 copayment (Primary Care Physician office visit) With the PPO: 100% of physician charges until your deductible is met. After that, you pay 20% of total charges OR your plan may not cover office visits at all.
14 Scenario Click to # edit 2 Master title style Your child is entering fifth grade and needs several immunizations to comply with state mandates. What can you expect to pay? With Health Alliance HMO: All you pay is a $20 Primary Care Physician office visit copayment since vaccinations are covered at 100%. With the PPO: 100% of physician charges until your deductible is met. After that, you pay 20% of total charges and you pay 100% of the charges for immunizations.
15 What are some advantages of HMO Click plans? to edit Master title style NO deductible Predictable out-of-pocket costs Capped health care expenses (MOOP) Most copayments and coinsurance are waived after reaching the annual maximum out-of-pocket. Personal attention and coordinated care from a Primary Care Physician.
16 Assist Click America to edit Master title style Health Alliance members have access to a unique global emergency services program from Assist America. This program immediately connects you to doctors, hospitals, pharmacies and other services if you experience a medical emergency while traveling 100 miles or more away from your permanent residence, or in another country. Free for all members.
17 Health Alliance Customer Service Click to edit Master title style Dedicated Caterpillar line Local Representatives Average wait time to talk with a representative is 16.5 seconds. Available Monday-Friday, 8 a.m. to 5 p.m. Member Self-Service automated system Available 2-10 p.m., Monday-Friday, and 24 hours on Saturday and Sunday AT&T s Language Line, for interpreter help.
18 Click to edit Master title style HealthAlliance.org/Caterpillar Visit HealthAlliance.org/caterpillar. You ll find information just for you: HMO Benefit Summaries Information on Wellness Benefits Provider Search Free Online Health Resources, and more
19 What are things to consider before enrolling Click to in edit an HMO? Master title style You spend two or more months per year outside of Illinois. You have children outside of Illinois in college who will require Caterpillar health coverage. You have frequent overseas travel for Caterpillar and you have a chronic illness.
20 Click to edit Master title style Basic HMO Reminders Get care in-network. Designate a Primary Care Physician when you enroll. Seek referrals to specialists and preauthorizations from your PCP. No referrals required for Ob/Gyn.
21 Click to edit Master title style For questions about this presentation or the Caterpillar/Health Alliance HMO plan, please call the Caterpillar dedicated Customer Service line at
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