The School Board of Broward County, FL

Transcription

1 The School Board of Broward County, FL Open Enrollment 2015 Your Choices. Your Benefits. Your Health.

2 Your Choices. Your Benefits. Your Health. Table of Contents Completing Your Annual Biometric Wellness Screenings...1 How to Complete Your Annual HRA...2 What s New for Preferred Pharmacy Network...4 Transfer Your Rx...5 Preventive Care Coverage...6 Save on Heatlh Care Cost Coventry WellBeing Hour Nurse Line...9 My Online Services SM / Coventry Mobile App...10 Dependent Passport Program...11 Premier Plus Option Plan Premier Option Plan Consumer Driven Plan Basic Kids Plan Kids Enhanced Plan

3 Your Choices. Your Benefits. Your Health. Completing Your Annual Biometric Wellness Screenings Employees are required to complete an annual on-line Health Risk Assessment (HRA) and biometric wellness screening prior to enrolling into the Premier Plus Plan. There is no pass or fail on the annual HRA or biometric screening. Results are private and will only be shared with you. Biometric wellness screenings are provided at no cost to you. For your convenience, on-site biometric wellness screenings will be available during working hours at designated School Board locations beginning September 2 - October 31, 2014, or you may schedule your screening at a Quest Diagnostic Center outside of working hours. Please remember to bring your Coventry member ID card with you to your appointment. Please note that Quest Diagnostic Center is only utlilized for biometric wellness screening services. LabCorp should be utilized for all labwork prescribed by your doctor throughout the year. Complete a confidential annual on-line HRA. The HRA is easy to complete and only takes about 20 minutes. To complete your HRA, visit sbbc.chcflorida.com and login or register at My Online Services. Complete an annual biometric wellness screening at a designated School Board location or at a Quest Diagnostic Center near you. In order to receive credit for the screening you must use the link on the sbbc.chcflorida.com landing page to schedule your appointment. Please remember to bring your Coventry member ID card with you to your appointment. For additional details visit sbbc.chcflorida.com. Don t delay, register today! Biometric wellness screenings are provided at no cost to you. To make an appointment, visit sbbc.chcflorida.com and click on the link under MY SBBC BENEFITS to make an appointment. *In 2015, employees that choose to enroll in the Premier Plus Plan must complete a confidential on-line Health Risk Assessment (HRA) and biometric wellness screening. This HRA and biometric wellness screening must be completed between September 2 - October 31, sbbc.chcflorida.com 1

4 Your Choices. Your Benefits. Your Health. Completing Your Annual HRA Once you complete the required annual Health Risk Assessment (HRA) and biometric wellness screening, you are now eligible to enroll in the Premier Plus Plan for 2015 and you re on your way to a healthier you! There is no pass or fail on the annual HRA or biometric wellness screening. Results are private and will only be shared with you. All journeys have a beginning. Your successful wellness journey begins at sbbc.chcflorida.com. Login or register at My Online Services, and click on Take Your Personal HRA today. The HRA is a completely confidential, online questionnaire. It is designed to provide you a better understanding of your current health status and engagement levels. If you are considering enrolling in the Premier Plus Plan but do not complete your annual on-line HRA and biometric wellness screening between September 2 - October 31, 2014, you will be placed in the lower option Premier Plan for It s simple: To complete your HRA, visit sbbc.chcflorida.com and login or register at My Online Services. Here s wishing you all the best on the road to better health. Enjoy your journey and its many rewards. *In 2015, employees that choose to enroll in the Premier Plus Plan must complete a confidential on-line Health Risk Assessment (HRA) and biometric wellness screening. This HRA and biometric wellness screening must be completed between September 2 - October 31, sbbc.chcflorida.com

5 Your Choices. Your Benefits. Your Health. What s new for 2015 Great News Effective January 1 st, we are introducing a separate out-of-pocket maximum for your prescription drug copayments on all HMO plans, including both Kid plans. This means in calendar year 2015 your out-of-pocket prescription drug copayments cannot exceed $5,000 for an individual or $10,000 for a family. Once you ve met your maximum out-ofpocket, costs are covered at 100% with $0 copay. Keep in mind this benefit enhancement is in addition to your medical out-of-pocket maximum, which currently excludes prescription drug copayments. For more details, visit sbbc.chcflorida.com or call customer service at sbbc.chcflorida.com 3

6 Your Choices. Your Benefits. Your Health. Preferred Pharmacy Network and Lower Copayments for Tier 1 Generic Drugs Maximize your benefits by utilizing the School Board s Preferred Pharmacy Network. This network is offered exclusively on the Premier Plus Plan and Premier Plans. The Preferred Pharmacy Network is a select network of retail pharmacies that rely on four key retail locations, as well as a broad selection of local independent pharmacies. We refer to these pharmacies as preferred. Included in the network are Walgreens, Publix, Costco, Navarro and 243 retail independent pharmacies. However, you may choose to utilize other pharmacies (non-preferred) within Coventry s Network at an additional $10. For a detailed list of preferred and non-preferred pharmacies, go to sbbc.chcflorida.com Premier Plus Plan Premier Plan Preferred $3/5/35/50 Preferred $3/5/45/60 Non-Preferred $13/15/45/60 Non-Preferred $13/15/55/70 4 sbbc.chcflorida.com

7 Your Choices. Your Benefits. Your Health. Transfer your Rx How to Easily Transfer a Prescription From One Pharmacy to Another If you would like to transfer your prescription to a preferred pharmacy, you do not need to contact your old pharmacy. Most pharmacies have a prescription transferring process that only requires a request and a small amount of information from you. The new pharmacy will contact your old pharmacy and request all the required information. You can easily transfer your prescription on-line, over the phone or in the store without any hassles or stress. Contact your preferred pharmacy and transfer your prescription today! Preferred Pharmacies include Walgreens, Publix, Costco, Navarro and 243 retails independent pharmacies. For a detailed list of preferred pharmacies go to sbbc.chcflorida.com. sbbc.chcflorida.com 5

8 Your Choices. Your Benefits. Your Health. Preventive Care Coverage Preventive Care Helps Keep Members Healthy At Coventry Health Care, we encourage members to receive preventive care items and services. The Affordable Care Act (ACA) requires specific preventive services and drugs to be covered at 100 percent when they are received through participating providers. Members who use our network providers will receive preventive care services paid at 100 percent. Coverage for Preventive Services Here are some examples of the preventive services that are covered with no copay, coinsurance or deductible. Child Preventive Exams: Preventive office visits including well child care Immunizations: (vaccines for children, birth to age 18- doses, recommended ages and populations vary): Influenza (flu) Pneumonia Hepatitis A Hepatitis B Diphtheria, Tetanus, Pertussis (Td/Tdap) Varicella (chicken pox) Measles, Mumps, Rubella (MMR) Polio Rotavirus Meningococcal Human Papillomavirus (HPV) Screening Tests: hearing, vision, phenylketonuria (newborns), sickle cell disease (newborns) Newborn Preventive Treatment: ocular medication against gonorrhea for all newborns Adult Preventive Exams: Preventive office visits including well woman exam Immunizations: (vaccines for adults - doses, recommended ages and populations vary): Influenza (flu) Pneumonia Hepatitis A Hepatitis B Diphtheria, Tetanus, Pertussis (Td/Tdap) Varicella (chicken pox) Measles, Mumps, Rubella (MMR) Meningococcal Zoster Human Papillomavirus (HPV) Screening Tests: breast cancer, cervical cancer, colorectal cancer, prostate cancer, HIV, routine blood and urine, cholesterol, osteoporosis The list is subject to change as federal guidance is issued. The full list of covered preventive services issued with the Interim Final Rules can be found at Talking with Your Provider about Preventive Care We process claims based on your provider s clinical assessment of the office visit. If a preventive item or service is billed separately, cost-sharing may apply to the office visit. If the primary reason for your visit is seeking treatment for an illness or condition, and preventive care is administered during the same visit, cost-sharing may apply. This means your provider may ask you to pay your appropriate health plan copay, deductible or coinsurance. Certain screening services, such as a colonoscopy or mammogram, may identify health conditions that require further testing or treatment. If a condition is identified through a preventive screening, any subsequent testing, diagnosis, analysis or treatment are not considered preventive services and are subject to the appropriate cost-sharing. If you have questions about a claim or provider visit, please call the customer service number on your Member ID card or speak with your provider. Please regularly check our website for new information about preventive care coverage as the government agencies refine guidance and requirements. 6 sbbc.chcflorida.com

9 Your Choices. Your Benefits. Your Health. Knowing where to go can help you save on health care costs Your Primary Care Physician (PCP) should be your first source for health care. He or she knows you best and can guide you to other services as needed. If you can t get to see your PCP right away, you have other choices including an urgent care center, a convenient care center and the emergency room. The following table can help you decide where to go. Convenient Care Center Urgent Care Center (UCC) Emergency Room (ER) Illustrative Copays & Savings (Premier Plus Plan) $10 Copay Savings vs ER $240 $10 Copay Savings vs ER $240 $250 Copay What is it Health centers, located in pharmacies, grocery stores and other retail stores, which treat common illnesses and are usually open evenings and weekends. Facilities that offer quality medical care for illnesses and injuries and are often open evenings and weekends. A group of rooms in a hospital created to treat emergency conditions, usually open 24 hours a day, seven days a week. When to go, in general For small problems when you can t see your family doctor right away. When you can t get in to see your doctor and you need care for an unexpected illness or injury that does not pose a serious danger to your health. When a sudden accident or medical condition causes severe symptoms or pain and not receiving immediate medical attention places your health in serious jeopardy. Examples of when to go Minor sicknesses, such as rashes, ear aches, sore throats, stomach aches and other problems Flu shots, vaccinations and other shots An injury, and it s after your doctor s office hours Need stitches for a non-critical injury Have a chronic problem, such as a sore throat or back pain, that isn t improving and can t wait until your doctor is available Away from home but need medical care in the area you re visiting Poisoning or drug overdose Difficulty breathing or shortness of breath Chest or upper abdominal pain or pressure Fainting, sudden dizziness, weakness, loss of consciousness Changes in vision Confusion or changes in mental status or difficulty speaking Uncontrolled bleeding or severe pain Coughing or vomiting blood Suicidal feelings Advantages Convenience when you can t get in to see your doctor for a small problem. Save time and money compared to visiting the ER. The ER is the only place to go for treatment in a true emergency. In case of emergency If you find yourself in need of emergency care, dial 911 or go to the nearest emergency room. sbbc.chcflorida.com 7

10 Your Choices. Your Benefits. Your Health. Coventry Health Care of Florida believes member health and wellbeing is our top priority. As part of our commitment, we offer discount programs and online tools designed to promote healthy living. WellBeing Online Members have access to Coventry's WellBeing online health and wellness portal, including a Health Risk Assessment questionnaire, online coaching programs such as tobacco cessation, blood pressure management, cholesterol management and others. To help members with their program and track progress, we offer additional tools such as a step tracker, a restaurant guide, and BMI calculator. WellBeing Discount Fitness Program* Most of us know that regular physical activity can improve your health and well-being. This program is designed to empower our members to take a more active role in improving their personal health. Members can choose from participating centers and receive a discount toward membership fees. To find a participating fitness center visit chcflorida.com or call * The fitness centers are not credentialed or contracted through Coventry. Healthways, Inc. is the exclusive vendor contracted by Coventry to administer covered fitness services. WellBeing Complementary Alternative Medicine (CAM) Program With Coventry WellBeing CAM Program, our members can make meaningful lifestyle changes to improve their diet, fitness level, emotional wellbeing, and more. With the CAM Program, members and their covered dependents have access to discounts of up to 30% for various alternative therapies through American WholeHealth Network (AWHN) including: Guided Imagery, Massage, Tai Chi, Pilates, Acupuncture, Yoga and Nutrition. WellBeing Weight Loss Discount Program Jenny Craig is all about eating well, moving more and living life! Jenny Craig offers Coventry members a FREE 30-Day Trial Program and a 25% discount off a Premium Program.* * Plans do not include a weekly food discount. Weight Watchers Online discount program offers Coventry members a savings of $10 off a 3-month subscription. Members have access to Weight Watchers Online for only $55 - less than $5 per week. QualSight LASIK Savings Coventry members have access to savings on the nation s most popular and successful elective procedure - LASIK eye surgery! Coventry has partnered with QualSight LASIK to bring members savings of 40% to 50% off the national average price for Traditional LASIK. QualSight s network of the nation s most experienced LASIK surgeons has collectively performed over 2.5 million procedures. Choose from over 800 locations nationwide for your free LASIK consultation to find out if you are a candidate for this life changing procedure. Hearing Exam & Hearing Aid Discount Program Through HearUSA, our members receive a 20% discount on a variety of products and services, including hearing aids, exams and educational classes at convenient locations across Florida. 8 sbbc.chcflorida.com

11 Your Choices. Your Benefits. Your Health. 24-Hour Nurse Line Answers when you need them. Professional advice, anytime you need it. The nurse line is part of our member resource system that provides members with direct access to a registered nurse 24 hours a day, 365 days a year. This value added benefit is designed to support you during an urgent situation. When you need answers to your health-related questions call our 24-Hour Nurse Line. The Nurse Line has registered nurses available to offer friendly, helpful advice on topics like fever, back and muscle pain, medication questions, minor burns, dizziness, headaches, colds and viruses, swelling or cuts and stomach pain. The nurse will ask you some questions about your problem and help you decide if you need to go to the hospital, see a physician or care for yourself at home. Take advantage of the 24-Hour Nurse Line anytime. Call anytime sbbc.chcflorida.com 9

12 Your Choices. Your Benefits. Your Health. My Online Services SM sbbc.chcflorida.com Coventry offers online resources designed to help members get the information they need. Coventry members can register on our website and access their health benefits information in a safe and secure environment. The following capabilities and many more are just a click away. View or print detailed benefit information Search for participating providers Access the Provider Comparison Tool, which offers quality ratings for hospitals, pricing information for procedures and detailed profiles on doctors and hospitals Search for prescription drug pricing and research drugs by generic or brand names. Learn about costs, uses, precautions and side effects Access educational resources through the National Institutes of Health Print ID cards Going Places? Take Coventry along. Download Coventry s Mobile App Stay connected to your benefit information while on the go. With Coventry Mobile, you have secure access to the following: Medical claims status with detailed summaries Allergy & immunization details Benefit usage details Family history ID cards Surgery and procedure history Current medications Authorized dependents accounts Emergency contact information Plus, use the provider search feature to obtain a list of participating network doctors, hospitals and urgent care centers within a few easy steps and without having to log in. TM Coventry Mobile is compatible with smartphones such as Android, BlackBerry and iphone, and devices such as ipod touch and tablets. Provider search is not available for Blackberry smartphones. 10 sbbc.chcflorida.com

13 Your Choices. Your Benefits. Your Health. Dependent Passport Program Peace of mind while they re away With the Passport Program, dependents who are enrolled in one of our health plans and live outside the service area will now receive out-of-area coverage at the highest level of benefits for services that are obtained from providers that are in the Coventry National Network.* Using the Passport Program Always present your Coventry member ID card so that providers can contact Coventry to verify coverage. Just like your in-network benefit, certain services require pre-authorization. Failure to obtain necessary pre-authorization will result in a reduction of benefits. Find a Provider To find a participating provider, call Customer Service at the number listed on your Member ID Card. How to Participate Please contact your on-site representative to find out how your dependents can participate in the Dependent Passport Program. Your dependent may be able to participate in the Passport Program if: Eligible for dependent coverage as explained in your Group Agreement. Resides outside your plan s designated service area to live with a parent or attend school. * Certain covered services, including Behavioral Health Services may not be provided through the Coventry National Network, therefore members may be required to return to the service area to obtain care. sbbc.chcflorida.com 11

14 12 sbbc.chcflorida.com Premier Plus HMO Plan

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16 14 sbbc.chcflorida.com Premier HMO Plan

18 16 sbbc.chcflorida.com Consumer Driven Plan

20 18 sbbc.chcflorida.com Kids Basic Plan

22 20 sbbc.chcflorida.com Kids Enhanced Plan

24 Contact Numbers Coventry Health Care of Florida Customer Service :00 a.m. - 6:00 p.m. sbbc.chcflorida.com Pharmacy :00 a.m. - 8:00 p.m. WellBeing :00 a.m. - 6:00 p.m. 24-Hour Nurse Line hours / 7 days The School Board of Broward County, FL Benefits Department :30 a.m. - 5:00 p.m. CHGS2386 (8/14)