Big Changes For Your Group s Healthcare

Transcription

1 Bg Changes For Your Group s Healthcare You understand how mportant t s to offer your employees qualty healthcare wthout breakng the budget. Now you have a unque choce for your workforce. Lke you, we re Connectcut-based and lookng for ways to mprove the qualty and lower the cost of healthcare n our state. WHY CHOOSE HEALTHYCT? Jon a CO-OP, or Consumer Operated and Orented Plan. HealthyCT members can vote and run for our Board of Drectors. We ve already begun to change the Connectcut healthcare market. And you ll have a say n the future of your health nsurance company. Beneft from a non-proft nsurance opton. We don t have shareholders so premum dollars we don t spend go back to mprovng programs and servces or stablzng premums over tme. Experence a plan sponsored by physcans. Together, we can all drve hgher qualty and lower cost healthcare. Support another local busness. It s good for us both, our state and our communtes. preventon 100% n-network preventve care prescrptons same copay for 90-day mal and retal VARIETY OF PLANS TO MEET YOUR EMPLOYEES NEEDS AND YOUR BUDGET Healthcare can be confusng. That s why we offer many dfferent plans to make t easy for you to choose. You even have the flexblty to offer your employees multple plan optons. access no referrals needed to see a specalst

2 HEALTHYCT PLAN FEATURES The same copayment for a 90-day supply of prescrpton drugs whether purchased locally or by mal. Doctor consults by phone 24/7/ % coverage of n-network preventve care. Copayments for n-network PCP, specalst and behavoral health vsts for most plans. Out-of-pocket maxmums to lmt how much your employees spend. Smple plan desgns no referrals needed. Several HSA-compatble choces. Annual n-network routne vson exams covered at 100%. network local and natonal partcpatng provders emergences covered worldwde LOCAL AND NATIONAL ACCESS TO QUALITY MEDICAL CARE Statewde network of over 18,000 provders and all hosptals. In-network lab servces from Quest Dagnostcs, partcpatng provder offces and hosptal labs. Access to n-network care from over 750,000 provders through the PHCS Healthy Drectons network for employees who are out of state, travelng, or have chldren attendng college. Prescrpton drug coverage. Coverage for emergency care servces worldwde. IT S EASY TO ENROLL To enroll n a HealthyCT plan, contact your health nsurance broker who can help you choose a plan and enroll. If you need help fndng a broker near you, gve us a call. We ll be happy to help you fnd one. To fnd a HealthyCT physcan, hosptal or healthcare professonal, please vst and select Fnd a Doctor. Emp v3.0 Copyrght 2015 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.

3 Your Pharmacy Beneft All HealthyCT plans provde coverage for prescrpton drugs. Your pharmacy program helps your employees get the medcne they need when they need t. We work wth a pharmacy benefts manager to create the lst of drugs your plan covers and to: Process your employees pharmacy clams. Manage your employees mal-order program and send prescrptons to ther homes. Offer a specalty drug program for hgh-cost medcatons. FILL PRESCRIPTIONS LOCALLY OR BY MAIL You and your employees can fll many prescrptons at any pharmacy n the network. Ths ncludes the major pharmacy chans, retalers, supermarkets and communty drug stores. For those takng medcaton to manage a health condton, the copayment s the same for a 90-day supply flled at a local pharmacy or by mal. fnd a partcpatng pharmacy go to healthyct.org/rx choose natonal formulary coverage broad lst of covered drugs choce 90-day supply by mal or retal clck select clck contnue clck locate a pharmacy LEARN MORE The applcable Certfcate of Coverage ncludes full detals of the prescrpton drug beneft. Fnd a Certfcate of Coverage at access large, statewde network

4 MANAGE RX COSTS Often, there are choces when t comes to choosng a drug. Effectveness, avalablty and cost are some of the thngs to consder. Your employees pharmacy beneft ncludes coverage for a wde varety of drugs so they can work wth ther physcan to fnd the one that s rght for them. Ter 1. Includes genercs, the least expensve drugs to treat many common llnesses. The U.S. Food and Drug Admnstraton (FDA) follows the same revew and approval process for genercs as they do for brandname drugs. The next tme you or your employees fll a prescrpton, ask f a generc verson s avalable and rght for you. Ter 2. Includes preferred brand drugs that usually cost more than genercs. Ter 3. Includes non-preferred brand drugs. These generally cost more than drugs n Ter 1 and Ter 2, so your employees share of the cost s hgher. Specalty drugs These are hgh-cost drugs used to treat complex medcal condtons. Brand and generc specalty medcatons appear n multple ters throughout the Natonal Formulary. Please note, specalty drugs are not avalable through local retal pharmaces. You and your employees can have a 30-day supply delvered rght to your home through the specalty pharmacy program. SPECIAL GUIDELINES Some drugs covered under the pharmacy beneft may have restrctons desgned to make them safer to use, based on factors such as FDA gudelnes, medcal lterature, and nput from physcans and the Pharmacy and Therapeutcs (P&T) Commttee. They nclude: Quantty Lmts. A lmt on how much of, or how long, you can take the drug. Pror Authorzaton. Some drugs and supples need our approval before your plan can cover them. Step Therapy. You and your employees may need to try a lower cost medcaton before usng the one your physcan prescrbes. to look up a drug go to healthyct.org/rx choose natonal formulary clck select Preventve Drugs Certan categores of preventve drugs are 100% covered under your HealthyCT plan. They nclude medcnes wth A and B ratngs approved by the U.S. Preventve Servces Task Force. For example, wth a prescrpton, some asprns and fluorde supplements come at no cost for members meetng certan age/gender requrements. clck contnue enter drug name >> clck search restrctons=yes >> clck name Emp v2.0 Ths pece s for nformatonal purposes and not ntended to be medcal advce. Please drect any medcal questons or concerns to an approprate healthcare provder. Copyrght 2015 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.

5 Focus On Patent- Centered Care When you choose HealthyCT, your employees get a health plan started by physcans. They can get hgh qualty healthcare from a large network of hosptals and healthcare professonals across Connectcut. And that ncludes many prmary care physcans who can help them stay well and treat or manage a medcal condton. THE IMPORTANCE OF PRIMARY CARE Prmary means frst, essental, central. So t should be no surprse that prmary care physcans or PCPs should be the frst choce when t comes to good health. They can help your employees get essental screenngs to avod or dentfy and treat some llnesses. And a PCP and staff serve as command central when your employees need medcal tests or care they don t offer. pcp prmary care physcans are your 1st choce Because PCPs get to know ther patents well over tme, they can be n the best poston to: Support and gude them when they're well, to better help them when they're sck. Make sure they get mportant health screenngs to prevent or detect problems. Treat many llnesses; usually at much less cost than a vst to the ER or urgent care. Help them understand ther medcal choces and choose the rght ones. Refer them to other health specalsts for tests and appontments, as well as other communty resources, when needed. Keep a comprehensve medcal fle, ncludng servces and reports from them and other healthcare provders. Focus on ther patents' health and well-beng. care from a team that knows you better manage your healthcare costs

6 IMPROVING PRIMARY CARE Many PCPs are changng the way they work wth patents to delver a hgher level of care and servce. Patents n these practces can expect a great deal of support when t comes to gettng the help they need. Longer offce hours usually makes accessng care easer. And patents learn how to keep themselves healthy. When hgh-performng PCP practces meet the strct standards for patent-focused care, they can receve specal recognton as a patent-centered medcal home or PCMH. HEALTHYCT AND PATIENT-CENTERED CARE We re workng closely wth physcans, ncludng our Prmary Care Provder Advsory Councl. Wth the Councl, we re educatng physcans, employers and members about the value of prmary care and the extra value offered by PCMH practces. We ve nvested n educaton for PCP practces that want to earn patent-centered recognton. And we re creatng a new model to support prmary care and pay patent-centered practces farly for the addtonal work and dedcaton requred to practce truly patent-centered care for our members and ther famles. FIND A PRIMARY CARE PHYSICIAN To fnd a PCP n our network, vst Select Fnd a Doctor. To fnd a PCMH-desgnated practce, enter your search nformaton and select Yes under the PCMH dropdown menu. THE PCMH DIFFERENCE: Lower total cost of care. Reduced use of unnecessary and avodable servces. Improved health measures. Increased use of preventve care. Better access to care. Improved patent satsfacton. Source: Connectcut Health Polcy Project Issue Bref, June 2014, Emp v2.0 Copyrght 2015 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.

7 All For Health & Wellness Good health s so mportant to lvng a happy, actve lfe. How you and your employees stay healthy, or get well when you re sck, s entrely up to you. But we re here to help wth nformaton, programs and servces that ft nto even the busest day. EAT HEALTHY There are few better ways for mprovng your overall health than by eatng well. So, we re connectng wth local farms so you and your employees can get fresh food close to home. And f eatng healthy to lose weght s your goal, check out our local, natonal and onlne program partners. eat healthy Here are fve easy ways to get started. For detals on these programs and more, go to: KEEP MOVING Exercse s a key component to any healthy lfestyle. But we also know that fndng the tme and money to stay ft can be a challenge. We ve got some great deas and resources for those who want to work out n a gym or fnd a nearby park to throw a Frsbee wth frends and famly. And they nclude dscounts wth local gyms, as well as lnks to many other local ftness and outdoor actvtes. keep movng

8 KNOW YOUR STUFF Educaton s a crtcal pece to health and wellness. The more you and your employees know, the better prepared you ll be to make decsons wth your physcans about the best and most affordable ways to manage your health. You can start wth an onlne health assessment to help dentfy areas to focus on. Then choose from the onlne lbrary of wellness topcs and podcasts to help reach your goals. You can also get 24/7/365 advce from a nurse. know your stuff GET CONNECTED A communty can be a powerful thng. Sometmes the resources you and your employees need to stay well or to get you back on track from an llness are rght around you. In many cases they re free. There s help avalable from local health professonals, hosptals and communty groups. Whether you and your employees want nformaton on how to stay ft, or need help after a hosptal stay, we ll help fnd the resources you need. get connected SAVE MONEY Who doesn t lke to save money? Maybe one of the reasons you chose HealthyCT s because we re nonproft, so money we don t spend goes back to mprovng programs and servces or nto stablzng premums over tme. We re also fndng ways to connect you and your employees wth dscounts on a varety of health and wellness-related servces. save money Learn more at These programs are just a start! Check back often for new offerngs. Emp v2.0 Ths pece s for nformatonal purposes and not ntended to be medcal advce. Please drect any medcal questons or concerns to an approprate healthcare provder. Copyrght 2015 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.

9 Fnd Your Healthy Strde HCT Healthy Strdes s the personalzed health and wellness program for you and your employees. It s comprehensve. It s confdental. Your Healthy Strdes program ncludes: An onlne health and wellness webste. Programs to consult wth a doctor or call a nurse 24/7/365. A varety of great programs, dscounted gym membershps, great educatonal resources and more. HEALTHY STRIDES ONLINE Take your frst strde toward wellness wth Healthy Strdes onlne: Take a Health Assessment to get your customzed plan. Track your nutrton needs wth a meal planner, food log, and food & water trackers. Learn about health topcs at the Health and Vdeo Lbrary. Partcpate n workshops on smokng cessaton, preventve care and more. Compete n ftness challenges. Connect wth a traner or detcan. Get started at today! Access thousands of artcles and vdeos n the Health Lbrary. Take Healthy Strdes wth you wherever you go wth the moble app. Emp v1.0 Copyrght 2015 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.

10 An Ounce of Preventon Preventve medcne s key to your employees' overall health and well-beng. Early detecton can help them stay healthy. It can also stop small problems from becomng bgger ones, affectng productvty and your bottom lne. Your HealthyCT plan covers those common preventve servces gven an A or B ratng by the Unted States Preventve Servces Task Force (USPSTF). (The USPSTF s an ndependent panel of prmary care physcans who are experts n preventon and evdence-based medcne.) no cost n-network preventve medcne Because preventve medcne s so mportant, these servces are avalable at no cost to your employees when they receve them from a physcan or healthcare professonal who s n our network. better health through preventon You'll fnd some examples of covered preventve servces on the back of ths page. For a complete lst, along wth coverage gudelnes and lmts, vst If your employees have questons about ther coverage, they can call Member Servces usng the number on ther ID card. comprehensve lst of covered servces

11 PREVENTIVE SERVICES FOR ADULTS Preventve medcne goes beyond a routne physcal exam. HealthyCT plans cover many preventve servces, ncludng: Alcohol msuse screenng and counselng Asprn to prevent cardovascular dsease n men and women of certan ages Blood pressure screenng Colorectal cancer screenng (adults over 50) Depresson screenng Flu shots and other mmunzatons Obesty screenngs and counselng Preventve physcal exam Tobacco use screenngs and cessaton products Type 2 dabetes screenng for adults wth hgh blood pressure PREVENTIVE SERVICES FOR WOMEN Addtonal screenngs and counselng are avalable for women, ncludng: Breast cancer screenng/mammogram Breast cancer chemopreventon counselng for women at hgher rsk Cervcal cancer screenng Domestc and nterpersonal volence screenng and counselng Folc acd supplements for women who may become pregnant Osteopoross screenng for women over age 60 dependng on rsk factors Preventve physcal exam Tobacco use screenng and nterventons for all women, and expanded counselng for pregnant tobacco users PREVENTIVE SERVICES FOR PREGNANT WOMEN Preventon s especally mportant to the health of an expectant mother and her baby. Recommended preventve servces for pregnant women nclude: Anema screenng Bacterura urnary tract and other nfecton screenng Breastfeedng support and counselng Gestatonal dabetes screenng for women 24 to 28 weeks pregnant and those at hgh rsk of developng gestatonal dabetes Hepatts B screenng Rh ncompatblty screenng PREVENTIVE SERVICES FOR CHILDREN These covered preventve servces help promote chldren s growth and development: Behavoral assessments at certan ages Blood pressure screenngs at certan ages Fluorde chemopreventon supplements for chldren wthout fluorde n ther water source Immunzatons Iron supplements for chldren of certan ages Lead screenngs Obesty screenngs and counselng Oral health rsk assessments Preventve physcal exams Vson screenngs Emp v2.0 Ths pece s for nformatonal purposes and not ntended to be medcal advce. Please drect any medcal questons or concerns to an approprate healthcare provder. Copyrght 2015 by HealthyCT, Inc. All rghts reserved. No part of ths document may be reproduced or transmtted by any means, electronc or mechancal, for use wth any entty other than HealthyCT, Inc. wthout the express wrtten permsson of HealthyCT, Inc.