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, for more than 70 years, we ve been offering the right products, information and services to give you what you need on your terms.
Let us help you find a plan that will work for your business Anthem Blue Cross and Blue Shield (Anthem) in New Hampshire, can give you the information and tools to help you better understand how it all works. You may already know our exchange plans. We ve designed them 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 exchange 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 We have years of experience providing health care benefits to millions of Americans. In fact, we ve been providing health care benefits to the people of New Hampshire for more than 70 years. That s experience you can count on. Pharmacy benefits that are right for your employees You ll get a full range of prescription drug coverage with a formulary (which we also call our list of covered drugs). It has hundreds of generic and brand-name medicines approved by the FDA. The list is divided into four tiers. 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. When you re looking at which plan is right for your group, it s a good idea to look at the formulary to see which drugs will be covered. We re here to make sure the health of your employees, and business, is in top shape. 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 $0 for preventive care, no-cost access to our 24/7 NurseLine and clinical and wellness programs that work together to promote overall health, including health coaching programs. Healthy support Employees can get rewarded for making healthy choices. They have access to Healthy Lifestyles online resources and webinars, a fitness reimbursement of up to $600/year per member and other health incentives. 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. Our Pathway networks also include: Lab, durable medical equipment and behavioral health services statewide. Urgent and emergency services nationwide. 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 centers and get maps and driving directions. Locate a hospital or emergency room. Access their member ID card on their phone. 1
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 current doctors are in our network Employees can also search for new doctors or 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 to help employees reach healthy goals Employees can get help with losing weight, quitting smoking and living stress free, all 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. 2
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Your employees health comes first. Our 2015 health plans were designed with that in mind We re happy to offer you three 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 Vision essential health benefits 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 Plan 1 Per member in-network costs are shown here Anthem Gold Pathway X HMO 500/20%/5000 Plus Anthem Silver Pathway X HMO 2000/30%/5500 Plus Anthem Bronze Pathway X HMO 6000/30%/6600 Plus Annual deductible $500 $2,000 $6,000 Annual out-of-pocket maximum Includes deductible and most copayments Office visits PCP or SPC Copay for first three visits, then deductible/coinsurance Prescription drug 3 Coinsurance After deductible for most covered services $5,000 $5,500 $6,600 $20 $35 $35 $15/$35/$70/30% to $500 $250 deductible, 2 then: $15/$35/$70/30% up to $500 $250 deductible, 2 then: $15/$35/$70/30% up to $500 20% 30% 30% Emergency room 20% after deductible 30% after deductible $250 copay + 30% after deductible per visit Preventive care $0 $0 $0 Inpatient 20% after deductible 30% after deductible $500 copay + 30% after deductible 1 These policies do not provide pediatric dental coverage. Standalone dental plans are available. Please contact your producer or Anthem Sales Representative for more details. 2 Pharmacy deductible does not apply to Tier 1 drugs. 3 Select formulary applies. 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. 4
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 may be reduced. And 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 anytime to speak to a registered nurse. Utilization Management Case Management ConditionCare Future Moms This includes precertification of medical procedures, imaging services and hospitalization. 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 with personalized support and guidance. Nurses are trained to answer general health questions. They also help callers understand symptoms and know if they really need to go to the ER. It authorizes care and aligns medical services with the member s benefits. It helps employees maximize their medical benefits, arrange post-discharge care and arrange 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 their 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. Contact your producer or Anthem Sales representative to find out more about our 2015 exchange plans. 5
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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 healthcare.gov. To view a Summary of Benefits and Coverage, please visit healthcare.gov. Health and wellness programs are flexible and may change or be replaced over time as we deem appropriate. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. Independent licensees 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.