2016 Individual and Family Plans. A different kind of health insurance for individuals, families and small businesses.

Transcription

1 2016 Individual and Family Plans A different kind of health insurance for individuals, families and small businesses.

2 A different kind of partner. InHealth Mutual was created to be a better option for Ohioans. We are a health insurance CO-OP a Consumer Operated and Oriented Plan. That means that together, we are making long-term decisions that impact health insurance in a positive way. InHealth is changing health insurance from the inside. With very different goals. We are not the same type of insurance carrier you have worked with in the past. We re different because our goals are different. Those include increasing competition to put pressure on rates, improving access to care and reinvesting any profits back into our members through enhanced benefits and lower premiums. In fact, you won t catch us making short-term decisions to increase value to shareholders because we don t have them. Instead, we answer to our members right here in Ohio. Ultimately, with InHealth, as time goes by we ll only get better because our focus is on the one thing an insurance company should be about providing you and your family with quality, affordable health coverage so you can access the health services you need. A philosophy that leads to insurance that truly works better. Where you have a say. As Ohio s only health insurance CO-OP, our Board of Directors includes our members! A novel concept, we know, and, it s just one of the ways you can be sure InHealth will stay on track and accountable to you. Beginning January 1, 2016, our members will comprise the majority of our Board of Directors 1

3 Strong, growing, financially solid and here for you. We are financially strong as a result of our business model and operational efficiency given our deliberate low overhead, measured growth strategy and large statewide broker distribution network. Further, we are on target with our goals and have adequate capital reserves. And, we are delighted to report that we have a healthy split of individuals/families and small businesses that come from every one of Ohio s 88 counties who trust us with their health insurance needs. Plus, to meet our capital needs and solvency requirements, the federal government provided us with a start-up loan and a solvency loan to support your health care needs. So you can be sure that we have the solid foundation to back the promises we make. Built for Ohioans by Ohioans We are an Ohio-based small business with employees, families, friends and neighbors that live and work in Ohio. We understand the economics of living and working in the Buckeye state. And, we are dedicated to providing quality insurance products and initiating cost innovations to benefit you and your family, as well as our communities. Within our wide variety of customized plans, you ll find the right option to meet your needs. You ll see we have: Many affordable plans Convenient enrollment options including online Multiple plan offerings to best meet your needs Online self-service tools and capabilities Claims tracking Local and professional customer service 2

4 New initiatives to serve you. Member Direct Connect To help you better understand just what a health insurance CO-OP is, the benefits uniquely available to you as a member, and your opportunities to participate, we offer Member Direct Connect meetings several times throughout the year. These sessions help you get the most out of your health insurance, understand how to use your benefits and all the services your broker provides. Plus it is your chance to give us direct feedback to help us better serve you. Member Direct Connects include: Presentations based on the expressed needs of the members attending Healthy food Networking opportunities Fun we often have raffles with great prizes, like FitBits and sporting event tickets Formulary updates are available online As part of InHealth s commitment to continuous quality improvement, our Pharmacy Benefits Manager updates our formulary on a quarterly basis. The most recent version of the formulary is always available on our website. We ve added retail payment locations Individual members can make cash payments at CVS Pharmacy or Dollar General locations throughout Ohio when you bring your invoices to make payments of $1,000 or under. Multiple payments can be made when the amount due is above $1,000. 3

5 How InHealth helps members advance their wellness goals Statewide provider network consisting of approximately 300 Ohio hospitals, over 25,000 physicians, nearly 5,000 ancillary providers and over 11,000 non-physician providers in all 88 counties Providing Essential Health Benefits Preventive care covered 100%* Disease management programs including those for asthma, diabetes, depression, coronary artery disease, congestive heart failure and renal disease Wellness programs including our Miracles and Milestones maternity program Pharmacy benefits that are accessible at over 1,500 locations around Ohio or by the convenience of mail order 24/7 nurse advice line Monthly e-newsletters, screening reminders, and online resources to help you make informed health decisions *The range of preventive care services covered at no cost share when provided in-network are designed to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive services to be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services Administration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibility and benefits for all members. Restrictions apply. Some of these benefits are not available to members enrolled in catastrophic and HSA plans. 4

6 2016 Individual and Family Product Guide Below you will find an overview of our product portfolio. We created it with you in mind satisfying your health insurance needs whether you are covering yourself or you have an entire family to cover. Individual and Family Plan Catastrophic# 2016 Bronze 1 Plan Availability* Off-FFM and On-FFM Off-FFM and On-FFM Benefits Network Non-Network Network Non-Network Deductible (Individual/Family) $6,850/13,700 $20,550/$41,100 $6,300/$12,600 $18,900/$37,800 Embedded or Aggregate Ded. Co-Insurance % (What YOU pay after your deductible) Maximum Out-of- Pocket (Individual/Family) (Includes Deductible, Co-Insurance and All Co-Pays) Office Visit Primary/Behavioral Health Provider Embedded Embedded 0% 50% 40% 50% $6,850/$13,700 $20,550/$41,100 $6,850/$13,700 $20,550/$41,100 0% 50% $50 50% Specialist 0% 50% $110 50% Preventive Service No Charge 50% No Charge 50% Inpatient Hospitalization 0% 50% 40% 50% Imaging 0% 50% 40% 50% Maternity 0% 50% 40% 50% Urgent Care 0% 50% $80 50% Ambulance 0% 50% 40% 50% Emergency Room 0% 0% 40% 40% Prescription Drug Retail Pharmacy Generic 0% 50%(min $60) $25 50% (min $60) Preferred Brand 0% 50%(min $60) $95 50% (min $60) Non-Preferred Brand 0% 50%(min $60) $190 50% (min $60) Specialty 0% 50%(min $60) 25% 50% (min $60) Mail Order (90 Days Supply) 0% N/A 2x Retail N/A *Pediatric Dental: EHB is included with all Off-FFM Plans. Pediatric Dental EHB is not included in On-FFM Plans. Embedded Deductible: Each covered family member only needs to satisfy their individual deductible, not the entire family deductible, prior to receiving plan benefits. Aggregate Deductible: For Family coverage, the entire Family Annual Deductible must be met before co-pay or coinsurance is applied for any individual family member. Co-Insurance: The percentage the member pays after deductible. 5

7 Individual and Family Plan 2016 Bronze 2 HSA 2016 Silver 1 Plan Availability* Off-FFM and On-FFM Off-FFM and On-FFM Benefits Network Non-Network Network Non-Network Deductible (Individual/Family) Embedded or Aggregate Ded. Co-Insurance % (What YOU pay after your deductible) Maximum Out-of- Pocket (Individual/Family) (Includes Deductible, Co-Insurance and All Co-Pays) Office Visit Primary/Behavioral Health Provider $6,250/$12,500 $12,700/$25,400 $2,250/$4,500 $6,750/$13,500 Aggregate Embedded 0% 50% 30% 50% $6,250/$12,500 $25,400/$50,800 $6,750/$13,500 $20,250/$40,500 0% 50% $30 50% Specialist 0% 50% $50 50% Preventive Service No Charge 50% No Charge 50% Inpatient Hospitalization 0% 50% 30% 50% Imaging 0% 50% $250 50% Maternity 0% 50% 30% 50% Urgent Care 0% 50% $75 50% Ambulance 0% 50% $150 50% Emergency Room 0% 0% $300 $300 Prescription Drug Retail Pharmacy Generic 0% 50% (min $60) $15 50% (min $60) Preferred Brand 0% 50% (min $60) $60 50% (min $60) Non-Preferred Brand 0% 50% (min $60) $100 50% (min $60) Specialty 0% 50% (min $60) 25% 50% (min $60) Mail Order (90 Days Supply) 0% N/A 2x Retail N/A Out-of-Pocket Limit: The Out-of-Pocket Limit for any single Individual covered under a Family Policy shall not exceed the 2016 federal Maximum Out-of-Pocket Limit of $6, Such limitation only applies to In Network benefits; this limitation does not apply to the Out of Network Out-of-Pocket Limit. Preventive Services: The range of preventive care services covered at no cost share when provided in-network are designed to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive services to be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services Administration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibility and benefits for all members. Mail Order: Specialty Prescription Drugs limited to 30 Day Supply. #Catastrophic Plans: First three office visits covered prior to deductible. NOTE: The Policy has certain exclusions and limitations. This document is for illustrative purposes only. This is not a contract for insurance. The Policy will contain a complete list of covered services. For costs and complete details of coverage call your insurance agent or InHealth Mutual. 6

8 2016 Individual and Family Product Guide Below you will find an overview of our product portfolio. We created it with you in mind satisfying your health insurance needs whether you are covering yourself or you have an entire family to cover. Individual and Family Plan 2016 Silver 2 HSA 2016 Silver 3 HSA Plan Availability* Off-FFM and On-FFM Off-FFM and On-FFM Benefits Network Non-Network Network Non-Network Deductible (Individual/Family) $3,750/$7,500 $10,000/$20,000 $4,000/$8,000 $10,000/$20,000 Embedded or Aggregate Ded. Co-Insurance % (What YOU pay after your deductible) Maximum Out-of- Pocket (Individual/Family) (Includes Deductible, Co-Insurance and All Co-Pays) Office Visit Primary/Behavioral Health Provider Aggregate Embedded 0% 50% 0% 50% $3,750/$7,500 $20,000/$40,000 $4,000/$8,000 $20,000/$40,000 0% 50% 0% 50% Specialist 0% 50% 0% 50% Preventive Service No Charge 50% No Charge 50% Inpatient Hospitalization 0% 50% 0% 50% Imaging 0% 50% 0% 50% Maternity 0% 50% 0% 50% Urgent Care 0% 50% 0% 50% Ambulance 0% 50% 0% 50% Emergency Room 0% 0% 0% 0% Prescription Drug Retail Pharmacy Generic 0% 50% (min $60) 0% 50% (min $60) Preferred Brand 0% 50% (min $60) 0% 50% (min $60) Non-Preferred Brand 0% 50% (min $60) 0% 50% (min $60) Specialty 0% 50% (min $60) 0% 50% (min $60) Mail Order (90 Days Supply) 0% N/A 0% N/A *Pediatric Dental: EHB is included with all Off-FFM Plans. Pediatric Dental EHB is not included in On-FFM Plans. Embedded Deductible: Each covered family member only needs to satisfy their individual deductible, not the entire family deductible, prior to receiving plan benefits. Aggregate Deductible: For Family coverage, the entire Family Annual Deductible must be met before co-pay or coinsurance is applied for any individual family member. Co-Insurance: The percentage the member pays after deductible. 7

9 Individual and Family Plan 2016 Gold Gold 2 Plan Availability* Off-FFM and On-FFM Off-FFM and On-FFM Benefits Network Non-Network Network Non-Network Deductible (Individual/Family) Embedded or Aggregate Ded. Co-Insurance % (What YOU pay after your deductible) Maximum Out-of- Pocket (Individual/Family) (Includes Deductible, Co-Insurance and All Co-Pays) Office Visit Primary/Behavioral Health Provider $2,000/$4,000 $6,000/$12,000 $1,250/$2,500 $3,750/$7,500 Embedded Embedded 20% 50% 20% 50% $3,500/$7,000 $10,500/$21,000 $4,500/$9,000 $15,000/$30,000 $20 50% $20 50% Specialist $40 50% $40 50% Preventive Service No Charge 50% No Charge 50% Inpatient Hospitalization 20% 50% 20% 50% Imaging $250 50% 20% 50% Maternity 20% 50% 20% 50% Urgent Care $75 50% $75 50% Ambulance $150 50% $150 50% Emergency Room $300 $300 20% 20% Prescription Drug Retail Pharmacy Generic $10 50% (min $60) $10 50% (min $60) Preferred Brand $40 50% (min $60) $40 50% (min $60) Non-Preferred Brand $60 50% (min $60) $60 50% (min $60) Specialty 25% 50% (min $60) 25% 50% (min $60) Mail Order (90 Days Supply) 2x Retail N/A 2x Retail N/A Out-of-Pocket Limit: The Out-of-Pocket Limit for any single Individual covered under a Family Policy shall not exceed the 2016 federal Maximum Out-of-Pocket Limit of $6, Such limitation only applies to In Network benefits; this limitation does not apply to the Out of Network Out-of-Pocket Limit. Preventive Services: The range of preventive care services covered at no cost share when provided in-network are designed to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive services to be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services Administration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibility and benefits for all members. Mail Order: Specialty Prescription Drugs limited to 30 Day Supply. NOTE: The Policy has certain exclusions and limitations. This document is for illustrative purposes only. This is not a contract for insurance. The Policy will contain a complete list of covered services. For costs and complete details of coverage call your insurance agent or InHealth Mutual. 8

10 2016 Individual and Family Product Guide Below you will find an overview of our product portfolio. We created it with you in mind satisfying your health insurance needs whether you are covering yourself or you have an entire family to cover. Individual and Family Plan 2016 Gold 3 HSA Plan Availability* Off-FFM and On-FFM Benefits Network Non-Network Deductible (Individual/Family) $2,250/$4,500 $5,000/$10,000 Embedded or Aggregate Ded. Aggregate Co-Insurance % (What YOU pay after your deductible) 0% 50% Maximum Out-of-Pocket (Individual/Family) (Includes Deductible, Co-Insurance and All Co-Pays) Office Visit $2,250/$4,500 $10,000/$20,000 Primary/Behavioral Health Provider 0% 50% Specialist 0% 50% Preventive Service No Charge 50% Inpatient Hospitalization 0% 50% Imaging 0% 50% Maternity 0% 50% Urgent Care 0% 50% Ambulance 0% 50% Emergency Room 0% 0% Prescription Drug Retail Pharmacy Generic 0% 50% (min $60) Preferred Brand 0% 50% (min $60) Non-Preferred Brand 0% 50% (min $60) Specialty 0% 50% (min $60) Mail Order (90 Days Supply) 0% N/A *Pediatric Dental: EHB is included with all Off-FFM Plans. Pediatric Dental EHB is not included in On-FFM Plans. Embedded Deductible: Each covered family member only needs to satisfy their individual deductible, not the entire family deductible, prior to receiving plan benefits. Aggregate Deductible: For Family coverage, the entire Family Annual Deductible must be met before co-pay or coinsurance is applied for any individual family member. Co-Insurance: The percentage the member pays after deductible. Out-of-Pocket Limit: The Out-of-Pocket Limit for any single Individual covered under a Family Policy shall not exceed the 2016 federal Maximum Out-of-Pocket Limit of $6, Such limitation only applies to In Network benefits; this limitation does not apply to the Out of Network Out-of-Pocket Limit. Preventive Services: The range of preventive care services covered at no cost share when provided in-network are designed to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive services to be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services Administration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibility and benefits for all members. Mail Order: Specialty Prescription Drugs limited to 30 Day Supply. 9 NOTE: The Policy has certain exclusions and limitations. This document is for illustrative purposes only. This is not a contract for insurance. The Policy will contain a complete list of covered services. For costs and complete details of coverage call your insurance agent or InHealth Mutual.

11 Doctors you trust, coverage you need. With InHealth, our extensive network of doctors and hospitals provides the foundation for the health plans we ve created. With our robust provider network, we work tirelessly to ensure members receive the right care at the right place at the right time. We want you to access the care you need from the providers you know and trust because when you seek the appropriate level of care, it s a win-win. Convenient prescription care helps you better comply with your doctor s orders. And, you can receive medications from local independent pharmacies and national chains, alike. In fact, our Pharmacy Benefits Manager has worked hard to provide suitable and affordable methods to access the medications you need. We even provide mail order delivery directly to you frequently at a reduced cost. And, you can manage prescriptions online. Plus, finding the information you need is easy. Visit to find a list of providers in our network, nearby pharmacies, or medications on our formulary. 10

12 Plan Features When you choose InHealth for your health insurance plan, you can be sure that we will exceed your expectations with competitive rates and excellent coverage. Plus, we provide all InHealth members with professional, local customer service that is just a phone call away. Essential Health Benefits Our plans cover all 10 of the Essential Health Benefits as defined under the Patient Protection and Affordable Care Act of These basic categories include: Ambulatory patient services (outpatient) Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including dental and vision care Prescription Drug Benefits We know how important medications are to your health and wellbeing. Therefore, prescription drug benefits are included with every plan we offer. We partner with ProCare Rx, our pharmacy benefits manager, to offer solutions that ensure you receive the care and attention you deserve. At InHealth, we: Coordinate and integrate your care between multiple clinical areas, when needed Encourage the use of formulary drugs (a formulary is a list of preferred brand-name and generic medications for which members pay a lower out-of-pocket charge) Provide members with prescription drug benefit consultations Ensure that high-cost specialty drugs are managed consistently and cost effectively, whether they are administered as part of medical services or through a prescription Enable members to view both medical and prescription drug claims online Give members the ability to manage prescriptions online We believe that effectively integrating prescription drug benefits with InHealth plans helps enhance your member experience and improve your overall health. That s why our focus is on delivering a prescription drug benefit that balances quality care with total costs, which is especially important when managing chronic and/or complex conditions. 11

13 Covered Services Charges for medically necessary services are subject to the calendar-year deductible, coinsurance, or, for out-of-network providers, reasonable and customary fee schedules. Services include: Acupuncture Hospice services Surgical services Ambulance services Human organ and Reconstructive services tissue transplant (bone Behavioral health marrow/stem cell) Rehabilitative services, services services including physical, speech, occupational, Clinical trials Inpatient services and pulmonary Chiropractic care therapy and cardiac Maternity services rehabilitation Diabetic equipment education and supplies Medical supplies, durable medical equipment, and Mastectomy Durable Medical appliances Sterilization Equipment Outpatient services Temporomandibular/ craniomandibular Physician home visits joint disorder and and office services craniomandibular jaw disorder Emergency care and urgent care services Habilitative services Home care services Prescription drug benefits The policy information within this brochure/document has certain exclusions and limitations. For costs and complete details of the coverage, call your insurance agent or InHealth Mutual. 12

14 Preventive Care. Preventive care is important to InHealth. After all, we are seeking to change the industry s paradigm from a focus on sickness and disease to one of wellness and prevention. While InHealth provides the quality coverage you need, we would rather help you prevent illness altogether. Preventive care helps reduce your healthcare costs and is one of the most important steps you can take to manage your health and improve your quality of life. With routine preventive care, you can identify and address risk factors before they lead to illness. When you receive preventive care services from a provider in our network, your services are covered with no cost-sharing, no copay, coinsurance or deductible. However, out-of-network charges may apply if the services are performed by a non-network provider. Preventive care visits include complete physical exams, vaccines to prevent disease, cancer screening tests and certain lab tests.* Most preventive care falls into one of the following broad categories: Office visits for preventive physical exams (e.g. adult physicals and well-child visits) Screening tests (e.g. diabetes, cholesterol, high blood pressure, colonoscopy, PSA-Prostate Specific Antigen, and STDs) Adult and child immunizations (e.g. hepatitis, shingles, flu, pneumonia, and chicken pox) Counseling and education interventions (e.g. diet and nutrition, disease prevention and alcohol or drug abuse) Women s Services (e.g. contraception, prenatal services, breast cancer screenings, routine mammograms, and well woman routine OB/GYN visits and well child visits) The list of covered preventive services is subject to change based on federal and state regulations. For the most current standards that apply to all InHealth plans, please contact Customer Care at or visit: 13

15 *The range of preventive care services covered at no cost share when provided in-network are designed to meet the requirements of federal and state law. The Department of Health and Human Services has defined the preventive services to be covered under federal law with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services Administration (HRSA) Guidelines. Members may have additional coverage under their health plan. Providers should verify eligibility and benefits for all members. 14

16 We are in this together with resources to help members get and stay healthy. At InHealth, we encourage members to take responsibility for their own health. Whether you participate in our wellness programs, seek wellness advice on your own, or work with your doctor to develop personalized health regimens, the result is better health. And, of course, healthier members help us fulfill our promise of lower premiums for all. InHealth Cares To empower and stabilize members with chronic diseases, we offer patient-centered chronic disease management programs that currently cover six disease states. Along with services that support health and wellness and give options for healthcare services, we also provide clinical oversight of services, member advocacy, member clinical support, member education, and improved access and availability to appropriate and necessary care. As you consider and investigate medical options, turn to InHealth for educational, oversight and management support through: Utilization management programs Care coordination and case management programs 24/7 nurse advice line Chronic disease management 12-module education programs* that include free case management, self-care, educational materials and more. Asthma Depression Diabetes Coronary Artery Disease Congestive Heart Failure Renal Disease Wellness programs* including maternity which also provides a Baby Welcome kit with a diaper bag, baby monitor and breast pump or first month of formula Ask your broker for more detailed information on these programs. 15 *Restrictions apply. Some of these benefits are not available to members enrolled in catastrophic and HSA plans.

17 Disease Management Programs* Chronic disease, according to the Ohio Department of Health, is the leading cause of death and disability in our state and our nation. In fact, nearly 60% of all Ohioans reported having at least one of the following 10 chronic diseases or clinical risk factors arthritis, asthma, cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, heart disease, high cholesterol, high blood pressure and stroke. Our InHealth Cares Disease Management Programs empower our members with chronic diseases to prevent the progress of these diseases while stabilizing their symptoms to improve the quality of their lives. InHealth s Disease Management offerings are 12-module education programs that begin providing benefits as soon as the member is enrolled and continue after the member completes the program. Further, for our members who suffer from more than one chronic disease, the education process is concurrent. Upon enrollment, each member in our Disease Management Program is assigned a case manager/disease education manager who monitors claims every three months to ensure medication and health care provider visits are in line with the enrollee s care plan. The key elements of these programs include disease education, self-monitoring, physician visits, medication compliance, nutrition, and exercise (if appropriate) whereby our members learn essential self-management strategies to help live better on a daily basis, decrease ER visits and reduce hospital stays. For members enrolled in these programs, there will not be a copay for any visit associated with managing their disease (PCP and specialist). This does NOT apply to ER visits or hospitalizations. Ask your broker for more detailed information on these programs. How to enroll in our Disease Management and Wellness Programs A diagnosis alone does not automatically enroll a member in a disease management program. Enrollment is a separate step, and it s simple. Members just call the customer number associated with the program in which they are planning to enroll and an InHealth Care Coordinator will walk them through the process. Here are the numbers you ll need to enroll: Call Toll Free at for Diabetes, Asthma, Coronary Artery Disease, Congestive Heart Failure and Kidney Disease Call Toll Free to enroll in the Depression and/or Maternity Programs *Restrictions apply. Some of these benefits are not available to members enrolled in catastrophic and HSA plans. 16

18 Savings and Wellness Programs HealthSmart Check List Each year, members who complete and return this simple 12-question health assessment during their first sixty days of coverage (new enrollees and renewing members) are eligible for an annual one-time reduction of $250 off of their Plan Year 2016 annual deductible. Families are eligible for a maximum reduction of $500. HealthSmart Assessment - We encourage physicians to use this tool during a preventive screening office visit to capture information annually about our members existing and preexisting diagnoses and procedures so they can make better health care decisions and we can create a better insurance product. This preventive screening is not subject to coinsurance or deductibles. Miracles and Milestones - Your Baby s Development and Your Baby s First Year - For our expectant members, our maternity program* includes monthly calendars that take new mothers step-by-step through pregnancy and birth, and baby s first year. In addition, we provide a Baby Welcome Kit with the guidebook What to Expect When You re Expecting, a diaper bag, baby monitor and breast pump or first month of formula. 17 *Restrictions apply. Some of these benefits are not available to members enrolled in catastrophic and HSA plans.

19 InHealth is responding to the community InHealth is committed to your health and the health of our communities throughout Ohio. Through listening tours, regional meetings, and advisory committees, we are learning what it takes to respond to the needs and wants of all Ohioans. In fact, many of our innovations were inspired by these conversations. These include: Our 2+2 program featuring two free visits to a primary care physician and two free visits to a behavioral health specialist above and beyond what s covered through preventive care. Health Savings Accounts Acupuncture: Up to $40/visit; $1,000/year Pediatric dental benefits built in to all Off-Exchange individual plans 18

20 Managing your insurance online As your dedicated healthcare partner, InHealth Mutual offers easy-to-access and understand online tools that make managing health insurance easy for you. Member Portal You can conveniently manage your individual InHealth Plan on the member portal at This online resource provides a secure and private portal to check benefits, find a pharmacy or doctor, check on claims, pay premiums, find tips for healthy living and much more. The InHealth Member Portal includes: Access important documents View and pay your premium Member Policy Benefits Sheet Explanation of Benefits Summary of Benefits and Coverage Privacy Statement HIPAA Statement Contact Information HealthSmart Check List Order a new ID card View your Member Handbook Review member rights and responsibilities Find a doctor/hospital (Provider Network search) Find a pharmacy (Pharmacy Network search) Obtain Important Pharmacy Information and documents Manage prescription drugs Pocket Formulary Pharmacy paper claim form Check a medication (Formulary) Pharmacy mail order brochure Preventive Prescription Drug List Learn how to file complaints and appeals 19

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24 Toll-Free: Local: We were built for you. 501 W. Schrock Road Westerville, OH 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 has certain exclusions and limitations. For costs and complete details of coverage, call your insurance agent. For additional information about InHealth or to request a proposal please contact our home office to be connected to your local representative at InHealth Mutual is a trade name of Coordinated Health Mutual, Inc CHM_SMM153_0915