3/17/2016 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 1
3/17/2016 Health Insurance Overview Employer Trust Fund (ETF) (current plan) Compared to Individual Dean/ Physician’s Plus / Unity Health Plan Snapshot of Past / Current Benefits ETF Carrier Current / Renewal HM O - Traditional Uniform Provider Network Deductible In-Network (Single / Family) $0 / $0 Out-of-Network (Single / Family) N/A Coinsurance In-Network 100% Out-of-Network N/A Lifetime Maximum Unlimited Office Visits In-Network 100% Coinsurance Out-of-Network N/A S pecialist In-Network 100% Coinsurance Out-of-Network N/A Routine/Preventive Care In-Network 100% Coverage Out-of-Network N/A Inpatient Hospital S ervices In-Network 100% Coinsurance Out-of-Network N/A Outpatient Hospital Servic In-Network 100% Coinsurance Out-of-Network N/A Emergency Room In-Network $60 Copay Out-of-Network $60 Copay Prescription Drugs - Participating Rx M OOP: Rx M OOP: Pharmacy $410 / $820 Levels 1&2: $600 / $1,200 Level 3: $6,850 / $13,700 Tier 1 / Tier 2 / Tier 3 $5 / $15 / $35 $5 / 20% / 40% 2
3/17/2016 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% 3
3/17/2016 Office Visits (amount paid by insurance) ETF Dean P-Plus Unity Covered at Covered at Covered at Covered at 100% 100% 100% 100% Prescription Drugs ETF Dean P-Plus Unity Tier 1: $5 Tier 1: $5 Tier 1: $5 Tier 1: $5 Tier 2: 20% coins Tier 2: $15 Tier 2: $15 Tier 2: $15 ($50 max) Tier 3: 40% coins Tier 3: $35 Tier 3: $35 Tier 3: $35 ($150 max) 4
3/17/2016 Hospital Services (In patient & Out patient) ETF Dean PPlus Unity Covered at Covered at Covered at Covered at 100% 100% 100% 100% Emergency Room ETF Dean P-Plus Unity $60 copay $60 copay $60 copay $60 copay 5
3/17/2016 Dependent Children ETF Dean P-Plus Unity Covered until the Covered until the Covered until the Covered until the end of the month end of the month end of the month end of the month the dependent the dependent the dependent the dependent turns age 26 turns age 26 turns age 26 turns age 26 Dependents out of Dependents out of Adult dependents Dependents out of area have area have residing outside of area have emergent and emergent and the service area emergent and urgent care urgent care will have access urgent care coverage. coverage. to in-network coverage. benefits within a designated provider network. RX coverage Rx coverage RX coverage RX coverage nationwide nationwide nationwide nationwide Retirement Benefits (Repeated area of discussion) Dean P-Plus Unity PPO plan design If a member is on Retirees living – Retirees or an HMO out of outside of Unity’s active employees network coverage service area are residing outside of only includes eligible to enroll the Dean core Urgent and on the PPO plan. service area will Emergent care. If This allows for in have access to in- a member is on a network level of network benefits POS or PPO, they benefits. using either the have access to HealthEOS out of network network in benefits at greater Wisconsin and/or member cost the PHCS share. Network outside of Wisconsin. 6
3/17/2016 Transplants (all plans require preauthorization) Dean P-Plus Unity Plan pays 100%. Can match ETF Members are The transplant benefit required to must be receive performed at an transplants in plan approved facility. even if on a POS plan. If patient elects to go out of Appropriateness network when is reviewed by there is an in- Managed Care network facility Division. available, there is (Interviewed) no coverage for the transplant. Home Health Services ETF Dean P-Plus Unity Covered at 100% Covered at 100% Can match ETF Covered at 100% for 50 visits per for 60 visits a for 60 visits a year. Plan may year. Does not year. Does not approve an allow an allow an additional 50 visits additional 50 like additional 50 like ETF. ETF. 7
3/17/2016 Skilled Nursing Facility ETF Dean P-Plus Unity 120 days per 30 days per Can match ETF 90 days per benefit period contract period confinement Physical, Speech, & Occupational Therapy ETF Dean P-Plus Unity Combined 50 60 visits for Can match ETF 40 therapy visits visits per year physical / per year. We do (amongst all occupational / not allow an therapies); plan speech therapy. additional 50 like may approve an ETF. Therapies additional 50 visits performed while per therapy type at home per year accumulate to home health. Conversely ETF members who have therapy at home accumulate to therapy limits. 8
3/17/2016 Chiropractic ETF Dean P-Plus Unity Covered at 100% Covered at 100% Covered at 100% Covered at 100% Maintenance care Maintenance care Maintenance care Maintenance care not covered. not covered. not covered. not covered. About Dean Health Plan Local Company, Local Focus 30 Years of Excellence • Headquartered in Madison, WI • Established in 1983 • 700 + Employees • Full ‐ service health insurance experts • Covering over 400,000 Wisconsin residents Benefits of Our Integrated System Integrated System • Focus on a proactive, preventive • Integrated network of clinics, approach to care hospitals and health care partners • Decreases duplication of services & • Dean Health Plan is part of SSM provides better health care value Health • SSM and Dean have been partners in the Madison community for over 100 years 17 9
3/17/2016 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 10
3/17/2016 Dean Benefits 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 20 . In The Community Meaningful Community Efforts St. Mary’s St. Clare St. Mary’s Janesville • Each hospital identifies three health Madison Baraboo conditions for which we will make Mental & Behavioral Health Fall Prevention significant efforts to improve the health of Chronic Disease: Smoking our population. Type 2 Diabetes & Heart Disease Cessation • EpiPens are provided to all school partners Maternal Child Health Obesity 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 to be invested in our local community as over a three year period. part of the Grants for Good initiative 11
3/17/2016 In The Community $120,000+ raised through Promoted healthy garden three area heart walks & a projects & encouraged physical activity among kids sponsorship of $50,000 $9,755 raised and 1,100 $3,000+ raised for school supplies, 120 Thanksgiving pounds of food collected, Day meals donated & over amounting to 74,550 meals 450 pounds of additional to feed those who needed it food collected in our community 2016 Living Healthy Program Visit deancare.com/livinghealthy to learn more and to activate your Living Healthy portal. 23 12
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