Embracing a Healthy Lifestyle through the State Health Plan New Plan Options and Incentives for 2014
Agenda • Why are we Making Changes for 2014? • New Plan Options for 2014 • Introducing New Wellness Incentives • Open Enrollment for 2014 • Additional Resources 2
Why Are We Making Changes for 2014? • The State Health Plan is providing more choice for members. The Treasurer conducted a listening tour across the state last year and the Plan has conducted various focus groups and surveys and the message has been clear: members say they want more options. • Many of the changes and new choices are designed to encourage members to become more engaged in their health and take steps to live a healthier life. • The Plan also believes an engaged membership will help ensure that the State Health Plan remains financially stable in the years ahead. 3
Health Plan Options for 2014 NEW: Consumer-Directed Enhanced 80/20 Plan Traditional 70/30 Plan Health Plan (CDHP) with HRA • • The current Standard 80/20 Plan A new health plan option • The current Basic 70/30 with a new name to match the • A high-deductible medical plan Plan with a new name new features • A Health Reimbursement Account • No incentives available • $0 Affordable Care Act (ACA) (HRA) to help offset the • Preventive Services No $0 Affordable Care Act deductible (ACA) Preventive Services • $0 ACA Preventive Medications • 85/15 Coinsurance • • No $0 ACA Preventive New Wellness Incentives • $0 Affordable Care Act (ACA) Medications • Reduce copays Preventive Services • $0 ACA Preventive Medications • CDHP Preventive Medication List ($0 deductible) • New wellness incentives • Additional HRA funds for visiting certain providers Open Enrollment will be conducted October 1 – 31, 2013. You must complete enrollment — otherwise, you and your covered family members will be enrolled in the Traditional 70/30 Plan effective January 1, 2014. 4
A New Focus On Wellness NEW: Consumer-Directed Health Enhanced 80/20 Plan Traditional 70/30 Plan Plan (CDHP) with HRA • • Wellness premium credits when: Wellness premium credits when: • No incentives available • • Subscriber completes a Health Subscriber completes a Health • No $0 ACA Preventive Services Assessment Assessment • No $0 ACA Preventive • • Subscriber attests for him/herself Subscriber attests for him/herself Medications and spouse (if applicable) to not and spouse (if applicable) to not smoking...or to being in a smoking...or to being in a smoking smoking cessation program cessation program • • Selecting a Primary Care Selecting a Primary Care Provider Provider (PCP) for self and all (PCP) for self and dependents dependents • Additional wellness incentives • • Additional wellness incentives $15 added to the HRA when the PCP (or someone in that practice) • $15 copay reduction for utilizing listed on the ID card is seen the PCP (or someone in that • practice) listed on the ID card $10 added to the HRA when a Blue Options Designated • $10 specialist copay reduction Specialist is seen for utilizing a Blue Options • Designated Specialist $50 added to the HRA when a Blue Options Designated Hospital • $0 inpatient hospital copay for is utilized for inpatient services utilizing a Blue Options Designated Hospital 5
Wellness Premium Credits Wellness Activity How to Complete It When Members Can Take It Subscribers don’t have to wait until Subscriber selects a Log into the BEACON/eEnroll system to Primary Care select a PCP. If members have trouble October to choose a PCP. They can Provider (PCP) locating a provider, they can contact choose one NOW . If they change their A PCP must also be 888-234-2416. mind, they can select a different provider selected for each any time. (It takes 5 calendar days to dependent covered on the update in the system) State Health Plan. Subscriber Through the State Health Plan website A new shorter assessment is NOW completes a (www.shpnc.org), click on NC available on the Personal Health Portal. confidential Health Smart and log into Personal If the member has completed a Health Health Assessment Health Portal . Health Assessments can Assessment since Nov. 1, 2012, through (HA) also be completed by telephone at 800- the Personal Health Portal, it will count 817-7044. toward the premium credit. Members may also complete the HA during Open Enrollment via the enrollment portal. Subscriber attests to Through the online enrollment system. During enrollment, Oct. 1-31, 2013. being a non- For instructions, go to the State Health To quit smoking, the Plan offers smoker/commits to a Plan website (www.shpnc.org), click on assistance through QuitlineNC. Important Forms under “Quick Links” cessation program Members can access online at and attests for and select Enroll in a plan . www.QuitlineNC.org or call 800-QUIT- NOW (800-784-8669) spouse if applicable 6
Who can be a Primary Care Provider? • A Primary Care Provider can practice: • General / Family Medicine • Internal Medicine • Pediatrics, or • Obstetrics and Gynecology • A Primary Care Provider can be: • Licensed Nurse Practitioners • Physician’s Assistants Specialty Providers cannot be selected as a PCP. 7
What Is a Blue Options Designated Provider? • Blue Options Designated providers meet Blue Cross Blue Shield of North Carolina (BCBSNC) criteria for: • Delivering quality health outcomes • Cost effectiveness • Accessibility by members • The Blue Options Designated provider network includes hospitals and certain types of specialists: • General Surgery • Ob-Gyn • Gastroenterology • Orthopedics • Cardiology • Neurology To find a Designated Blue Options provider, members may go online to www.shpnc.org and click on Member Services, then on “Find a Doctor or Facility” or call 888 -234-2416 8
ACA Preventive Medications • The Affordable Care Act (ACA) has identified some preventive medications for certain age groups should be covered at 100% for new plans. Drug or Drug Category Criteria Aspirin (to prevent cardiovascular events)-Generic OTC Men ages 45 to 79 years and women ages 55 to 79 81mg and 325mg years Fluoride – Generic OTC and prescription products Children older than 6 months of age through 5 years old Folic Acid – Generic OTC and prescription products 0.4 – Women through age 50 years 0.8 mg Iron Supplements – Generic OTC and prescriptions Children ages 6 to 12 months who are at risk for iron products deficiency anemia Smoking Cessation – Generic OTC patches and gum Members must contact QuitlineNC for OTC product coverage Vitamin D – Generic OTC and prescription products Men and Women ages who are age 65 and over and are at increased risk for falls Women’s Preventive Services & contraception coverage Women through age 50 1) Barrier contraception- i.e. caps, diaphragms 2) Generic hormonal contraception 3) Emergency contraception 4) Implantable medications 5) Intrauterine contraception You must meet criteria and have a Prescription for these medication to have them covered at 100% 9
The Enhanced 80/20 Plan • An enhanced version of the current Standard 80/20 Plan, with these features • New name – The Enhanced 80/20 Plan • New incentives to encourage members to manage their health and lower health costs • Preventive Care – There will be no copays on Affordable Care Act (ACA ) preventive services or preventive medications. • Primary Care Provider (PCP) – To receive a $15 PCP copay reduction, a PCP must be selected by Oct. 31, 2013. • If the selected PCP is not available at the time of the appointment, the member may visit any provider in the same practice and still receive the copay reduction • If a member wants to change PCPs, they can go to their enrollment portal and select a new PCP. A new ID card with the PCP’s information will be mailed to the member. The PCP change must be made before visiting the new PCP. • Providers* - When a specialist or hospital is needed, members have the option to select a Blue Options Designated Provider: • Specialists – To receive a $10 Specialist copay reduction, choose a Blue Options Designated provider • Hospitals – To avoid a $233 Inpatient Hospital copay, select a Blue Options Designated Hospital *Members may visit any provider in the BCBSNC Blue Options network and be considered “in - network:” The additional rewards are tied to the incentives outlined above and throughout this presentation. 10
Lower Your Premiums with Wellness Premium Credits — The Enhanced 80/20 Plan Complete up to Three Wellness Activities Enhanced Plan By October 31, 2013 Premium Credits Subscriber attests to being a non- $20 per month smoker/commits to a cessation program and attests for spouse if applicable Subscriber (only) completes a confidential $15 per month Health Assessment (HA) Subscriber and any covered dependents select $15 per month a Primary Care Provider Reduce your premium by up to… $50 per month 11
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