Health Insurance Monona Grove School District Overview of Provider - - PDF document

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Health Insurance

Monona Grove School District Overview of Provider Considerations

Agenda / Objectives

Superintendent: Dan Olson * Committee Purpose / Recognition / Process Benefit Consultant: Al Jaeger * Overview of Providers / Carriers and Plan Design Presentations: Who they are / How they accommodate / Long Term Approach * Dean Health Plan: * Physicians Plus: * Unity / UW Health: Questions / Answers: Note cards / Handouts / Google Docs Closing Statements by Carriers * Handouts of RX / Network / Wellness / One on one questions in Cafeteria Next Steps: Committee Review of Feedback / Finalize Process

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Health Insurance Overview

Employer Trust Fund (ETF)

(current plan)

Compared to Individual Dean/ Physician’s Plus / Unity Health Plan

Snapshot of Past / Current Benefits

Current / Renewal In-Network Out-of-Network In-Network Out-of-Network S pecialist In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network Rx M OOP: $410 / $820 Rx M OOP: Levels 1&2: $600 / $1,200 Level 3: $6,850 / $13,700 Tier 1 / Tier 2 / Tier 3 $5 / $15 / $35 $5 / 20% / 40% HM O - Traditional Uniform ETF $0 / $0 N/A 100% N/A Carrier Provider Network Routine/Preventive Care Deductible Coinsurance Lifetime Maximum Office Visits In-Network (Single / Family) Out-of-Network (Single / Family) Inpatient Hospital S ervices Outpatient Hospital Servic Emergency Room Prescription Drugs - Participating Pharmacy 100% Coinsurance 100% Coinsurance N/A Unlimited 100% Coinsurance N/A 100% Coverage N/A N/A 100% Coinsurance N/A $60 Copay $60 Copay

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Deductibles

(amount a family pays per contract year before benefits are paid) ETF Dean P-Plus Unity

Single

$0 $0 $0 $0

Family

$0 $0 $0 $0

Coinsurance

(benefit amount paid by insurance company)

ETF Dean P-Plus Unity 100% 100% 100% 100%

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Office Visits (amount paid by insurance)

ETF Dean P-Plus Unity Covered at 100% Covered at 100% Covered at 100% Covered at 100%

Prescription Drugs

ETF Dean P-Plus Unity

Tier 1: $5 Tier 2: 20% coins ($50 max) Tier 3: 40% coins ($150 max) Tier 1: $5 Tier 2: $15 Tier 3: $35 Tier 1: $5 Tier 2: $15 Tier 3: $35 Tier 1: $5 Tier 2: $15 Tier 3: $35

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Hospital Services (In patient & Out patient)

ETF Dean PPlus Unity Covered at 100% Covered at 100% Covered at 100% Covered at 100%

Emergency Room

ETF Dean P-Plus Unity $60 copay $60 copay $60 copay $60 copay

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Dependent Children

ETF Dean P-Plus Unity

Covered until the end of the month the dependent turns age 26 Dependents out of area have emergent and urgent care coverage. Rx coverage nationwide Covered until the end of the month the dependent turns age 26 Adult dependents residing outside of the service area will have access to in-network benefits within a designated provider network. RX coverage nationwide Covered until the end of the month the dependent turns age 26 Dependents out of area have emergent and urgent care coverage. RX coverage nationwide Covered until the end of the month the dependent turns age 26 Dependents out of area have emergent and urgent care coverage. RX coverage nationwide

Retirement Benefits (Repeated area of discussion)

Dean P-Plus Unity

PPO plan design – Retirees or active employees residing outside of the Dean core service area will have access to in- network benefits using either the HealthEOS network in Wisconsin and/or the PHCS Network outside

• f Wisconsin.

If a member is on an HMO out of network coverage

• nly includes

Urgent and Emergent care. If a member is on a POS or PPO, they have access to

• ut of network

benefits at greater member cost share. Retirees living

• utside of Unity’s

service area are eligible to enroll

• n the PPO plan.

This allows for in network level of benefits.

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Transplants (all plans require preauthorization)

Dean P-Plus Unity

Plan pays 100%. The transplant must be performed at an approved facility. Appropriateness is reviewed by Managed Care Division. (Interviewed) Can match ETF benefit Members are required to receive transplants in plan even if on a POS

• plan. If patient

elects to go out of network when there is an in- network facility available, there is no coverage for the transplant.

Home Health Services

ETF Dean P-Plus Unity

Covered at 100% for 50 visits per

• year. Plan may

approve an additional 50 visits Covered at 100% for 60 visits a

• year. Does not

allow an additional 50 like ETF. Can match ETF Covered at 100% for 60 visits a

• year. Does not

allow an additional 50 like ETF.

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Skilled Nursing Facility

ETF Dean P-Plus Unity

120 days per benefit period 30 days per contract period Can match ETF 90 days per confinement

Physical, Speech, & Occupational Therapy

ETF Dean P-Plus Unity

Combined 50 visits per year (amongst all therapies); plan may approve an additional 50 visits per therapy type per year 60 visits for physical /

• ccupational /

speech therapy. Can match ETF 40 therapy visits per year. We do not allow an additional 50 like

• ETF. Therapies

performed while at home accumulate to home health. Conversely ETF members who have therapy at home accumulate to therapy limits.

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Chiropractic

ETF Dean P-Plus Unity

Covered at 100% Maintenance care not covered. Covered at 100% Maintenance care not covered. Covered at 100% Maintenance care not covered. Covered at 100% Maintenance care not covered.

About Dean Health Plan

17

Local Company, Local Focus

• Headquartered in Madison, WI
• 700 + Employees
• Covering over 400,000 Wisconsin

residents

Integrated System

• Integrated network of clinics,

hospitals and health care partners

• Dean Health Plan is part of SSM

Health

• SSM and Dean have been partners

in the Madison community for

• ver 100 years

30 Years of Excellence

• Established in 1983
• Full‐service health insurance experts

Benefits of Our Integrated System

• Focus on a proactive, preventive

approach to care

• Decreases duplication of services &

provides better health care value

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Dean Service Area

Dean Clinic

• 46 Dean Clinic locations
• 4,000+ providers in network
• 547 specialists

Partnerships

• Dean Health Plan partners with a

large number of primary care clinics, specialty care clinics and hospitals to provide care closer to home

• In rural communities

partnerships are established with local clinics for broader access to care. For example, UW Health of Belleville is a plan provider for Dean.

By the Numbers

51

School District Partnerships Specialists

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Dean Benefits

20

What you need to know today

• You have a choice
• Choice in benefit plans that meet your needs
• Choice in access to the providers you want to care

for your family

• You have comprehensive coverage
• We’ll closely match your current medical and

prescription drug benefits

• You are a valued partner
• Our offering provides a 3 year partnership, just to

get things started

.

In The Community

Meaningful Community Efforts

• Each hospital identifies three health

conditions for which we will make significant efforts to improve the health of

• ur population.
• EpiPens are provided to all school partners

to keep children with life‐threatening allergies safe in schools.

Grants for Good

• St Mary’s Madison provides four grants to

community organizations who partner with us on improving these health conditions

• ver a three year period.
• St. Mary’s

Madison

• St. Clare

Baraboo

• St. Mary’s

Janesville

Mental & Behavioral Health Fall Prevention Chronic Disease: Type 2 Diabetes & Heart Disease Smoking Cessation Maternal Child Health Obesity

to be invested in our local community as part of the Grants for Good initiative

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In The Community

Promoted healthy garden projects & encouraged physical activity among kids $9,755 raised and 1,100 pounds of food collected, amounting to 74,550 meals to feed those who needed it in our community $120,000+ raised through three area heart walks & a sponsorship of $50,000 $3,000+ raised for school supplies, 120 Thanksgiving Day meals donated & over 450 pounds of additional food collected

2016 Living Healthy Program

23

Visit deancare.com/livinghealthy to learn more and to activate your Living Healthy portal.

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The Dean Difference

NCQA Excellent Accreditation

Dean Health Plan is proud to have maintained NCQA’s Excellent Accreditation—the highest level awarded—since obtaining accreditation in 2000. NCQA is the industry standard for measuring the quality of care delivered. www.ncqa.org

Access to Providers

We have more than 4,000 providers, 28 hospitals and 184 primary care sites in 20 counties throughout southern Wisconsin.

Technology & Innovation

Get online access to your personal health information with and view and manage insurance benefit information with

Complex Case Management

If you’ve been diagnosed with a chronic health condition or have a complex health care need, we’ll provide you with the resources you need in a timely manner.

Wellness & Rewards

Powered by WebMD the Living Healthy program can help you achieve a healthier lifestyle

24

Change Isn’t Easy

That’s why we are committed to offering the . transition possible into the Dean Health Plan network.

25

Care Transition

Employees currently undergoing treatment will be assisted with the completion of Transition of Care documentation that will be reviewed by our Medical Management Team for transition assistance.

Member Guide

New members will receive a printed Member Guide upon enrollment. The guide contains helpful tips and information so you can begin your experience with Dean Health Plan the exceptional way.

Call for Assistance or Visit a Health Insurance Representative at a Dean Clinic location

Customer Care Center: (800)279‐1301 (TTY dial 711)

• r visit:

Dean East Dean West Dean Fish Hatchery Visit deancare.com/newmember to complete our

• nline checklist. In minutes, you’ll unlock important

resources and learn more about being a member.

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26

Talk with Us Today

Provider Network Information

Ask us if your current provider is in our network. Get connected to resources that can help you find the specialty care you need.

Drug Formulary

Check our prescription drug listing for your current prescriptions. Get information on our convenient mail order services through WellDyne Rx.

Comparison of Current Benefits

Compare the difference between your current benefit plan and your Dean plan.

Wellness Services

See how your family can earn $150 for every person over 18 as part of our Living Healthy program.

pplusic.com

About Physicians Plus

• Our members have access to a network of over 3,100 health care

providers in 21 southcentral Wisconsin counties – Meriter, UW Hospitals and 23 other regional hospitals – 550 primary care physicians (the most in Dane County) including the specialists and primary care physicians of:

• Meriter Clinics
• UW Clinics
• Independent doctors and clinics, like Madison Women’s Health,

Associated Physicians, Melius, Schurr & Cardwell, and Wildwood Clinic

• Accreditation from the NCQA
• Customer service excellence built on quality, accessibility and first call

resolution

• 24‐hour access to a registered nurse via NursePlus
• Access to unmatched health & wellness programs via a robust online

wellness portal (WellPlus) customizable to meet every clients wellness needs

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pplusic.com

Commitment to Choice

• Choice is not a luxury, it is a

necessity

• Willing and able to offer benefits

alongside other insurance carriers in the marketplace

• If you are committed to good

health, we are too!

– Multi‐year achievement strategy

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pplusic.com

Commitment to Wellness

• We provide the tools members

need to set and achieve their health and wellness goals via our robust online wellness system, WellPlus:

– Customizable and flexible – Onsite wellness classes and workshops to influence healthy habits both on and off the job – Mobile App, Web Portal for easy access to tracking, content, and more – Rewards members financially for making healthy choices and tracking

• n WellPlus

pplusic.com

Pharmacy

• Drug formularies differ from

carrier to carrier

– If an existing medication is not covered by our formulary we have a formal drug transition process – Only transition member if and when it is appropriate to do so

• Our pharmacy experts are

committed to helping members find cost effective solutions

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pplusic.com

Meriter Monona Clinic

• Primary care, specialty care and therapy

services – all in the same location!

– All doctors are accepting new patients – 96% of the clinic’s patients would recommend their Primary Care Physician

• Expanded clinic hours
• Guaranteed same or next day

appointments

• An experienced, expert health care team

dedicated to your family’s health and wellness

• On‐site lab and x‐ray, including

mammography and bone density screenings

• Owned by UW Health
• Focus on providing quality health care to our members – UW Health’s

patients

• All decisions made locally in the best interest of the community
• Financial Stability
• Outstanding Customer Service
• Highly personalized approach to service and problem solving ‐ we

want to make it easy to do business with us

• High Performing Provider Networks
• Leader in Health and Wellness
• Lead through innovation

What Differentiates Unity

33

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• HMO and POS
• Flexible Plan Designs to match current benefits as closely as possible
• POS along side HMO to allow choice in providers
• Rate Stability
• Long term partnership with multi year not to exceed rate guarantees

Plan Design

34

• UW Health Welcome Center
• Assist Monona Grove Employees/Dependents with:
• UW Health Primary Care Selection
• Medical Records transfer
• Setting appointments for Monona Grove members who have immediate needs
• Updating Medical Chart for first appointment at UW Health
• Transition of Care – Medical and Rx
• UW Health Medical Management team
• Individuals who are currently in ongoing treatment
• 90 day New Member Override for prescriptions that require Prior

Auth.

Transition

35

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• UW Health Care Management
• Dedicated UW Health System Liaison for Monona Grove School

District

• Ongoing Education Programs with tools and resources to manage

Health issues

• Weight Management/Stress Management/Smoking Cessation

and more

• Guide Monona Grove S. D. employees through the UW Health

System

• Onsite Blood Pressure Checks, Immunizations and more
• Customize programs to meet the district’s employees needs

M.G. Partnership with UW Health

36

• HRA/Biometrics
• Online Health Risk Assessment access through MyChart
• Onsite Biometric screenings
• Health Coaching
• 3‐6 Telephonic Conversations over several months
• Coaching is based on the employee’s HRA
• Eating Habits/Weight Management/Lowering Stress/Tobacco

Cessations/Increased Physical activity

Wellness

37

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• Personal Wellness Portal
• Tracking Tools (Exercise/Weight/Food/Water/Blood Pressure Logs)
• Nutrition Resources (Gluten Free/Diabetic/Heart Health meal plans)
• Exercise Resources (FIT‐BIT Integration/Boot Camp Fitness and more)
• Online Workshops (Nutrition/High Blood Pressure/Exercise)
• Fitness First and More ‐ Earn $200/per year
• Workout at a Fitness First participating Health Club –to Earn Cash
• Health and Wellness Classes (CPR/Parenting/Fitness Boot Camps)
• Healing Choices (Acupuncture/Massage Therapy and more)
• Weight Management (Weight Watchers)

Wellness

38

Wrap Up

Questions / Answers:

• Note cards
• For those not here: FAQ Handout/Google Docs

Closing Statements by Carriers

• Handouts of RX / Network / Wellness
• One on one questions in Cafeteria

Next Steps:

• Committee Review of Feedback
• Finalize Process