A different kind of health insurance.

Transcription

1 A different kind of health insurance. For individuals, families, and small businesses. We were built for you. CHM_SMM01_1013

2 A different kind of partner for the new world of health insurance. The Affordable Care Act is bringing big changes to every aspect of health insurance. InHealth Mutual was created to be a better option for consumers, businesses and you. To begin with, we are a CO-OP a Consumer Operated and Oriented Plan. That means we are making long-term decisions that impact health insurance in a positive way. InHealth is changing health insurance from the inside. Focused on your clients and your success. We are not the same type of insurance carrier you have worked with and your clients have settled for in the past. As a nonprofit CO-OP, InHealth is not driven to make money for shareholders and Wall Street. We are dedicated to a more important goal giving you the quality, affordable health coverage options that are right for your clients. We are required to apply profits toward lowering premiums, improving benefits and implementing programs to improve the quality of health care delivered to our members. We are truly accountable to our members, and that is what ultimately leads to health insurance that works better for the families and businesses you represent. CO-OP means members have a say. You can be sure that InHealth will stay on track because, as Ohio s only CO-OP, our members have a voice in their care. Beginning in 2015, the majority of our Board of Directors will be our members. 1

3 Financially solid and here for the long haul. To meet our capital needs and solvency requirements, the federal government provided a start-up loan of nearly $16 million dollars and a solvency loan of $113 million to support the health care needs of your clients. So you can be sure that we have the solid foundation to back the promises we make to you and your clients. We know what it takes to thrive in Ohio. Like you, we are an Ohio-based small business with employees, families, friends and neighbors that live and work in Ohio. We understand the economics of running a business in our great State. Providing quality insurance products and initiating cost innovation is how we make sure that we are taking care of the people in our communities and serving businesses like yours. Our wide variety of customized plans enable you to offer the right plan to the clients you serve. We offer: Affordable plans Convenient enrollment options including online Flexibility to offer multiple plans to your employees to best meet their individual needs Online self-service tools and capabilities Claims tracking Local and professional customer service How InHealth is helping provide healthier living: Providing Essential Health Benefits Preventive Care covered 100% Disease Management programs Statewide Provider Network consisting of 223 hospitals, over 23,000 physicians, and nearly 4,000 ancillary providers covering all 88 counties Information to help you make informed decisions about your health 24/7 Nurse-Line Wellness programs to improve the lives of our members Pharmacy Benefits that are accessible at thousands of locations around Ohio and over 65,000 locations nationwide or by the convenience of mail order 2 Toll-Free:

4 2014 Small Group and Individual Product Guide Below is an overview of our product portfolio. We are confident our product portfolio will satisfy the health insurance needs of the small business down the road or the family next door. Group Plans Metallic Value Deductible (S/F) Co-Insurance* B6000-DC Bronze $6,000/$12,000 S % S S $1,500/$3,000 S $1,000/$2,000 G % G $1,000/$2,000 20% G $500/$1,000 20% Individual Plans Metallic Value Deductible (S/F) Co-Insurance * C6350-DC Catastrophic $6,350/$12,700 0% B6000-DC Bronze $6,000/$12,000 S % S2000-DC % G1000-DC $1,000/$2,000 20% G % * Co-Insurance = percentage the member pays after deductible 3

5 Doctors you trust, coverage you need. Our extensive network of doctors and hospitals provide the foundation for the health plans we have created. Your clients will have access to a robust provider network with over 23,000 Ohio providers including 223 Ohio hospitals. To help make prescription care even easier, our members can receive their medications from thousands of local independent pharmacies and national chains. In fact, our Pharmacy Benefits Manager has worked very hard to provide our members with simple and affordable methods to access the medications they need. We even provide the convenience of mail order delivery directly to members frequently at a reduced cost. Network MOOP (S/F) PCP SP UC ER Rx Card (Retail - MO) $25//$150/25% - 2.5X $60 $20/$60/$80/25% - 2.5X $60 $20/$60/$80/25% - 2.5X $60 $20/$60/$80/25% - 2.5X $60 $20/$60/$80/25% - 2.5X $3,000/$6,000 $20 $40 $20/$40/$60/25% - 2.5X $3,500/$7,000 $20 $40 $20/$40/$60/25% - 2.5X $4,500/$9,000 $20 $40 $20/$40/$60/25% - 2.5X Network MOOP (S/F) PCP SP UC ER Rx Card (Retail - MO) $6,350/$12,700 $25//$150/25% - 2.5X $5,000/$10,000 $50 $15/$60/$125/25% - 2.5X $15/$60/$125/25% - 2.5X $4,000/$8,000 $3,500/$7,000 $20 $40 $10//$60/25% - 2.5X $10//$60/25% - 2.5X (S/F) = Single/Family, MOOP = Annual Maximum Out-of-Pocket, PCP = Primary Care Physician SP = Specialist Office Visit, UC = Urgent Care, ER = Emergency Room = charges are applied to Deductible and then Co-insurance, MO = Mail Order First three PCP visits are paid at 100% without regard to deductible Specialty drugs and some generic drugs are covered by a 25% cost share (up to per medication) by the member 4 Toll-Free:

6 Resources to Help Members Get and Stay Healthy. We are in this together. At InHealth, we encourage members to take responsibility for their own health. Whether they participate in our wellness programs, seek wellness advice on their own, or work with their doctor to develop personalized health regimens; the result is engaged participants who are healthier and happier. And, of course, healthier members help us fulfill our promise of lower premiums for all. InHealth Cares Connecting Individuals We are committed to excellence in quality care that goes beyond insurance coverage. The InHealth Cares program is building individual, family and community support systems that eliminate barriers to health care through education on chronic conditions, providing a medical home, supporting lifestyle changes, supporting behavioral needs within the individual and family unit, and providing opportunities to participate in wellness and prevention services. Ultimately, we provide a more compassionate and effective insurance program that empowers our members. Our focus is on: The InHealth Cares program connects individuals or caregivers with a Nurse Manager, a Licensed Social Worker, a Medical Home Provider and a Member Advocate to form a complete support team. Together, they enable members to navigate the health care system to effectively manage their clinical and/or behavioral health conditions and achieve greater well-being. Connecting Families For families dealing with a chronic, complex or disabling condition, or an acute catastrophic condition, we pair them with Member Advocate Families who have dealt with the same situation. Additional support could include an InHealth Nurse, an InHealth Social Worker or a Medical Home Provider whatever it takes to ensure the best outcomes. Connecting Communities InHealth takes a proactive role within the community. We are developing new programs and working closely with existing wellness and prevention programs to help improve services, provide resources and extend awareness. By referring more members to these beneficial programs, InHealth Cares strengthens the communities we serve and improves health for all. 5

7 Plan Features Your clients can look to InHealth for health insurance plans that exceed expectations with affordable rates and excellent coverage. Along with the exceptional service you provide your clients, InHealth members have professional, local customer service that is just a phone call away. Essential Health Benefits Our plans cover the Essential Health Benefits which are consistent with those set forth under the Patient Protection and Affordable Care Act of These Essential Health Benefits cover ten basic categories including: Ambulatory patient services (outpatient) Emergency services Hospitalization Maternity and newborn care Preventive Care Services Preventive care services, as defined by federal regulation, are paid at 100 percent when received in-network. Age and frequency schedules apply. Covered preventive care services include, but are not limited to: Covered Services When medically necessary, charges are payable subject to the calendar-year deductible, coinsurance and, for out-of-network providers, Reasonable and Customary Fees. Services include: Ambulance Services Behavioral Health Services Clinical Trials Diabetic Equipment Education and Supplies Diagnostic Services/ Imaging Emergency Care and Urgent Care Services Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Physician office visits for preventive care services Adult physicals Routine ob/gyn visits Well-child visits Routine mammograms Habilitative Services Home Care Services Hospice Services Human Organ and Tissue Transplant (Bone Marrow/ Stem Cell) Services Inpatient Services Maternity Services Medical Supplies, Durable Med Equipment, and Appliances Outpatient Services Physician Home Visits and Office Services Prescription Drug Benefits Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral (provided by our partner carrier Delta Dental) and vision care PSA (prostate-specific antigen) Colonoscopy Adult and child immunizations (including flu and pneumonia shots) Toll-Free: Preventive Care Services Surgical Services Reconstructive Services Mastectomy Sterilization Temporomandibular/ Craniomandibular Joint Disorder & Craniomandibular Jaw Disorder Therapy Services 6

8 InHealth Notes: Important: The information contained in this promotional brochure provides a general description of features, benefits, requirements, and restrictions of the product(s) offered by InHealth Mutual. Please refer to the Certificate of Coverage for coverage details, plan benefits and limitations. Plan benefits may be subject to change.

9 OUR MISSION: InHealth Mutual is a nonprofit insurer built for members by members to provide quality, affordable health insurance that is responsive to the needs and wants of all Ohioans. The policy information within this brochure/document has certain exclusions and limitations. For costs and complete details of the coverage, call your insurance agent of InHealth Mutual at For additional information about InHealth or to request a proposal please contact our home office to be connected to your local representative at Toll-Free: Local: