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1 SmartHealth Employee Health Plan 2015

2 Important 2015 Changes Why The Changes SmartHealth Website Two Medical Benefit Plans PPO 400 and HDHP 1300 New ID Cards and Numbers Eligibility and Verification Claims Submission Authorization Process New Pharmacy Benefit Manager (PBM) Wellness Plan/Preventative Plan Care Management

3 2015 Benefit Changes Why? 2015 Strategy: Standardize plan designs: Across all health ministries and subsidiaries, Ascension will be driving to a smaller set of plan designs over 2015 and 2016 within SmartHealth Why are we making these changes? To improve administrative efficiency, reduce errors and provide clearer communications by streamlining to a smaller set of plan designs To enhance equity among associates especially as associates transfer among HMs To promote healthy lifestyle and become informed consumers 3

4 What is SmartHealth? SmartHealth is the medical plan offered to associates and eligible dependents of the Ascension Health ministries. There are 6 goals of SmartHealth that provide support and integration to members across entities and Health Ministries. Benefit Design Legal and Financial Support Care Mgmt & Wellness Programs Members & Ascension Health Alliance Entities Customer Service Administration Communications & Education Network Mgmt IT Mgmt Platform More information about SmartHealth & provider directories will be located at mysmarthealth.org in January

5 SmartHealth Provider Manual will be posted before January 1, 2015 Refer to What s New in Provider Manual Seton Health Plan = SmartHealth

6 SmartHealth Website mysmarthealth.org

7 2015 Medical Plans PPO 400 & HDHP 1300 Tier 1: Providers currently contracted directly with Seton Health Plan (SmartHealth) and Ascension Health Ministries physicians, Ancillary providers and facilities Tier 2: Providers Cigna OAP National Network Blue Cross Blue Shield (Seton IS Department) Tier 3: Out-of-Network Providers who are not in the Tier 1 or 2

8 Two New Medical Plans Option 400 / 10% HDHP 1300 / 0% Medical Plans Plan Sponsor: SmartHealth Plan Administrator: Seton Health Plan Tier 1: Seton Health Plan and Ascension Health Network contracted providers Tier 2: Cigna/BCBS National Network Lower Deductible / Out-of-Pocket Higher Deductible / Out-of-Pocket Pharmacy Plan Seton Central Outpatient Pharmacy (SCOP) Pharmacy Benefit Manager (PBM): Cigna Flat $ Co-pays across all tiers (e.g. Generic, Formulary, Specialty) Flexible Spending Account (FSA) Associate pays full $ contracted rates up to annual deductible Health Savings Account (HSA)

9 Schedule of Benefits PPO 400

10 Schedule of Benefits PPO 400

11 Schedule of Benefits HDHP 1300

12 Schedule of Benefits HDHP 1300

13 Sample ID Cards New ID Number Pharmacy Support

14 Eligibility & Verification In 2015 eligibility and verification is found in the Physician Self Service Center. We encourage providers to verify eligibility and benefits before each service is rendered. Log on to our Physician Self-Service Center to look-up claims status, eligibility, or authorizations Website: https://www.mediview.net/cmsweb/webinquiry.asp You must use the new member IDs that will be assigned January 2015 The member ID for 2015 will be a 9 digit number with a 2 digit suffix You must be a registered user to access this site.

15 Claim Submission IMPORTANT Claim Address for SmartHealth Employee Plans ONLY (PAPER & ELECTRONIC SUBMISSION) New billing address effective June 1, 2014 PO Box Chattanooga, TN Electronic Payer ID: 62308

16 Chiropractor and Physical Therapy Claims Submission Chiropractors, and non-facility Physical and Occupational Therapist directly contracted with ASHN Claims for SmartHealth Members will be submitted directly to ASHN Send paper claims to the address below: American Specialty Health Network P.O. Box San Diego, CA Send electronic claims to: Payer ID ASH01 Payment for services will be issued by ASH network according to the contracted reimbursement outlined in your agreement with ASH For general inquiries, call ASH Provider Services Department at

17 Chiropractor and Physical Therapy Claims Submission If you are a contracted Seton Health Plan Provider and not contracted through ASH Network Send paper claims to the address below: P.O. Box Chattanooga, TN Send electronic claims to: Payer ID 62308

18 Authorization Process Medical Management Department 4515 Seton Center Parkway, Ste 310 Austin, Texas Phone: (512) Fax: (512) To inquire about an authorization please refer the PSS portal or contact the Medical Management Department Authorization/referral request forms and Authorization Grids are available on-line at

19 Seton Central Outpatient Pharmacy This program offers the lowest pharmacy costs for employees. The co-pays are lower than the retail pharmacies (HEB, Walgreens, CVS, etc.) and prescriptions are delivered to the inpatient pharmacy nearest to the associate. Urgent medication requests should be filled at a retail pharmacy.

20 New! Pharmacy Benefit Manager

21 New! Pharmacy Benefit Manager Current 2014 Prior Authorizations will be transferred to Cigna Current 2014 Mail Order open refills will be transferred to Cigna Current Specialty patients will be transferred to Cigna Certain Medications for 2015 may now require a prior authorization Customer Service Number:

22 Women s Health Services The ACA requires group health plans to provide coverage for women s health services as part of an array of women s preventive services that must be included in health plans without cost sharing to covered participants. Cigna manages this plan. The Seton Healthcare Network Employee Health Plan will not provide coverage for contraceptive benefits that are in conflict with our Catholic Identity and the Ethical and Religious Directives for Catholic Health Care Services.

23 2015 Wellness Program Health Risk Questionnaire Well Visit & Primary care MD Designation Wellness Education Sessions

24 Care Management & Disease Management Diabetes & Pre-Diabetes Classes Free for all SmartHealth Members Weight Loss Program One-time $20 copay for 6 visits Tobacco Cessation Classes Eligible for free, 3 month supply of nicotine replacement therapy Medical Nutrition Therapy Asthma Management Program COPD Management Program

25 Provider Engagement and Contracting Seton Health Plan Provider Staff are here to assist and guide you through any concerns or issues from 8:00 am to 5:00 pm, Monday through Friday. Please visit our website for more information: & Susan Geistweidt, MHA Misty Arayata Provider Engagement Liaison Sr. Provider Engagement Liaison Sr. Office: (512) x Office: (512) x Seton Health Plan 4515 Seton Center Pkwy, Suite 310 Austin, Texas 78759

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