Unique health plan solutions for your small business

Transcription

1 Unique health plan solutions for your small business

2 Affordable health plans for your small business You want health insurance that gives your employees the coverage they need at a price you can afford. That s why PersonalCare offers a complete array of health plans for companies with 2 to 50 employees. Our portfolio includes products that your employees want, including PPOs, Qualified High Deductible Health Plans (QHDHP), and hybrid designs of both products, pairing selected first-dollar coverage benefits along with cost savings features. With PersonalCare, you ll have the support of a health plan that is focused on offering our customers: Service excellence Financial discipline and maintaining a low-cost structure Industry leading technology to assist members in managing their overall health care and consumer tools to help them make wise decisions Day-to-day execution of business fundamentals Efficient customer service and claims payment Sneak a peek at some of our top plans! This brochure will give you an overview of the PersonalCare s Small Business plan options. To learn more about how you can offer your employees affordable and competitive health coverage, please talk to your broker, consult one of our friendly account executives at (888) or visit us at ( PersonalCare s PPO plans PersonalCare offers a wide selection of providers and several PPO plan options. We make it easy to choose a PPO plan to meet your needs with options of lower out-of-pocket maximums, deductibles ranging from $500 to $7,500, and either calendar- or contract-year deductibles. All PPO plans allow access to both in-network and out-of-network providers. Value PPOs offer you an extremely affordable standard PPO plan option. There are a variety of deductible, copay, and coinsurance options from which to choose. Hybrid PPOs offer you the premium savings of a high deductible plan with the security of first-dollar drug coverage. Available with 100 percent medical coverage, these plans can be paired with a Health Reimbursement Account (HRA) to offset the member s financial responsibility. Freedom PPOs offer members the widest selection of providers incorporating most of the Coventry Health Care National Network providers contracted in Illinois, while holding the line on costs. Members may visit any provider. Payment is based on the tier assignment for that specific provider or facility. Deductibles and out-of-pocket maximums accumulate across all benefit levels, so expenses always count against all four tiers at the same time. QHDHPs include comprehensive prescription drug coverage and first-dollar wellness coverage. Introducing the Prime and Consumer Prime plans featuring the Coventry Fund the best of both worlds Prime PPO plans are geared toward the small employer looking to offer a cost-competitive health plan, while still allowing reasonable first-dollar copays for highly-valued benefits. The Prime plans feature first-dollar coverage for primary care provider visits (including OB/Gyn), wellness care and Tier One prescriptions. All three options provide 100 percent in-network coverage after deductible, while applying simple copays to items such as provider visits, advanced imaging and emergency department visits. Consumer Prime PPO plans take the Prime PPO concept and enhances it with a first-dollar Coventry Fund package that helps members with their higher financial responsibility. The plans are a good first-step toward a Consumer Directed Health Plan strategy because Coventry funds the reimbursement accounts, not the employer. The Consumer Prime plans feature the following: A built-in reimbursement account that covers in-network copays, deductibles and coinsurance Instant spending accounts set-up at no charge to the employer Fund balances that rollover at renewal and can accumulate up to two times the initial fund amount Online tools for easy tracking of account balances, rollovers and plan out-of-pocket costs PersonalCare s Consumer Directed Health Plan (CDHP) solution: C3 Coventry Consumer Choice C3, PersonalCare s affordable CDHP solution, offers a full suite of consumer-directed products, including Flexible Spending Accounts (FSAs), Health Reimbursement Arrangements (HRAs), Health Savings Accounts (HSAs) and Premium-only plans. Employers can choose the option that fits their unique culture, but no matter which plan they choose, C3 offers affordability and easy administration. C3 is administered in-house and is designed to work in concert with PersonalCare medical plans. Using an integrated option offers employers and their employees many advantages, including: A single-source solution for medical management, spending account administration and customer care All basic HRA, FSA and Prime HSA administrative services are delivered at no cost! Additionally, we let you choose the bank account you desire for funding purposes. There are no set-up fees to connect our claims payment system to your account PersonalCare offers a complete array of health plans for companies with 2 to 50 employees. With PersonalCare s Small Business plans, your employees receive: C3 Smart Payment processing automatically sends payment to the correct party, whether it is the member or the provider Spending account deductible or coinsurance eligible expenses get reimbursed to the provider, while copays, prescription costs, and other 213(d) eligible expenses get reimbursed to the member High level of customer service provided by Coventry s Consumer Coaches help employees make educated health care decisions Medical plan and spending account integration reduces the need to manually submit receipts for reimbursement With a single login, employers and members can access general health plan data and spending account information Spend or Save functionality allows members to hold reimbursements until they see fit Pharmacy and additional services No matter which type of plan you choose, comprehensive pharmacy benefits are included with your health plan. With our preferred drug plan for non-qhdhps, members have a three-tier copay structure, depending on whether they select Tier One (mainly generic), Tier Two (formulary name brand) or Tier Three for non-formulary name brand and some non-formulary generic prescription drugs. s vary for each prescription drug category. For our QHDHP members, they can enjoy 100 percent drug coverage after meeting their medical deductible or pay 20 percent of our contracted rate for all Tier One, Two or Three prescriptions. Current available drug benefits: Rider 1* Tier One: $7 Tier Two: $35 Rider 2 Tier One: $10 Tier Two: $30 Rider 3 Tier One: $15 Tier Two: $25 Tier Three: $50 Rider 4 Tier One: $15 Tier Two: $30 * This is the default rider for small business and includes a 3 month mail order supply for just 2x the copay. Comprehensive health coverage Commercial health plan rankings published in U.S.News & World Report/NCQA America s Best Health Plans 2008 show PersonalCare is one of the highest ranked health plans in the nation, and is, for the third straight year in a row, the top-ranked commercial health plan in the state of Illinois. PersonalCare achieved these rankings by outscoring other health care competitors in a wide variety of Health Plan Employer Data and Information Set (HEDIS ) and Consumer Assessment of Healthcare Providers and System (CAHPS ) categories. Worldwide emergency care Online wellness program Vision and dental discounts Simple, satisfying service! To learn more about how you can offer your employees affordable and competitive health coverage, please talk to your broker, consult one of our friendly account executives at (888) or visit us online ( America s Best Health Plans is a trademark of U.S.News & World Report.

3 Value PPO PPO options 90/70 80/60 Out-of-pocket Maximum SBP VAL /70 09 $25 $35 $175 $500 10% 10% 10% $1,000/3,000 $1,000 30% $2,000/6,000 SBP VAL /70 09 $25 $35 $175 $750 10% 10% 10% $1,000/3,000 $1,500 30% $2,000/6,000 SBP VAL /70 09 $25 $35 $175 $1,000 10% 10% 10% $1,000/3,000 $2,000 30% $2,000/6,000 HRA SBP VAL /70 09 $25 $35 $175 $1,250 10% 10% 10% $1,000/3,000 $2,500 30% $2,000/6,000 HRA SBP VAL /70 09 $25 $35 $175 $1,500 10% 10% 10% $2,000/6,000 $3,000 30% $4,000/12,000 HRA SBP VAL /70 09 $25 $35 $175 $1,750 10% 10% 10% $2,000/6,000 $3,500 30% $4,000/12,000 HRA SBP VAL /70 09 $25 $35 $175 $2,000 10% 10% 10% $2,000/6,000 $4,000 30% $4,000/12,000 HRA SBP VAL /70 09 $25 $35 $175 $2,250 10% 10% 10% $2,000/6,000 $4,500 30% $4,000/12,000 HRA SBP VAL /70 09 $25 $35 $175 $2,500 10% 10% 10% $2,000/6,000 $5,000 30% $4,000/12,000 HRA SBP VAL /70 09 $25 $35 $175 $2,750 10% 10% 10% $2,000/6,000 $5,500 30% $4,000/12,000 HRA SBP VAL /70 09 $35 $45 $200 $3,000 10% 10% 10% $2,000/6,000 $6,000 30% $5,000/15,000 HRA SBP VAL /70 09 $35 $45 $200 $3,500 10% 10% 10% $2,000/6,000 $7,000 30% $5,000/15,000 HRA SBP VAL /70 09 $35 $45 $200 $4,000 10% 10% 10% $2,500/5,000 $8,000 30% $5,000/10,000 HRA SBP VAL /70 09 $35 $45 $200 $5,000 10% 10% 10% $2,500/5,000 $10,000 30% $5,000/10,000 HRA SBP VAL /70 09 $35 $45 $200 $7,500 10% 10% 10% $2,500/5,000 $15,000 30% $5,000/10,000 HRA SBP VAL /60 09 $25 $35 $175 $500 20% 20% 20% $2,000/6,000 $1,000 40% $4,000/12,000 SBP VAL /60 09 $25 $35 $175 $750 20% 20% 20% $2,000/6,000 $1,500 40% $4,000/12,000 SBP VAL /60 09 $25 $35 $175 $1,000 20% 20% 20% $2,000/6,000 $2,000 40% $4,000/12,000 HRA SBP VAL /60 09 $25 $35 $175 $1,250 20% 20% 20% $2,000/6,000 $2,500 40% $4,000/12,000 HRA SBP VAL /60 09 $25 $35 $175 $1,500 20% 20% 20% $2,000/6,000 $3,000 40% $4,000/12,000 HRA SBP VAL /60 09 $25 $35 $175 $1,750 20% 20% 20% $2,000/6,000 $3,500 40% $4,000/12,000 HRA SBP VAL /60 09 $25 $35 $175 $2,000 20% 20% 20% $2,000/6,000 $4,000 40% $4,000/12,000 HRA SBP VAL /60 09 $25 $35 $175 $2,250 20% 20% 20% $2,000/6,000 $4,500 40% $4,000/12,000 HRA SBP VAL /60 09 $25 $35 $175 $2,500 20% 20% 20% $2,000/6,000 $5,000 40% $4,000/12,000 HRA SBP VAL /60 09 $25 $35 $175 $2,750 20% 20% 20% $2,000/6,000 $5,500 40% $4,000/12,000 HRA SBP VAL /60 09 $35 $45 $200 $3,000 20% 20% 20% $2,000/6,000 $6,000 40% $5,000/15,000 HRA SBP VAL /60 09 $35 $45 $200 $3,500 20% 20% 20% $2,000/6,000 $7,000 40% $5,000/15,000 HRA SBP VAL /60 09 $35 $45 $200 $4,000 20% 20% 20% $2,500/5,000 $8,000 40% $5,000/10,000 HRA SBP VAL /60 09 $35 $45 $200 $5,000 20% 20% 20% $2,500/5,000 $10,000 40% $5,000/10,000 HRA

4 Hybrid PPO Similar to QHDHPs, but with first-dollar drug coverage; ideal for pairing with an HRA 100/70 80/60 Out-of-pocket Maximum SBP Hybrid /70 0% 0% 0% $2,000 0% 0% 0% $0/0 $4,000 30% $3,500/10,500 HRA SBP Hybrid /70 0% 0% 0% $3,000 0% 0% 0% $0/0 $6,000 30% $4,000/12,000 HRA SBP Hybrid /70 0% 0% 0% $5,000 0% 0% 0% $0/0 $10,000 30% $5,000/15,000 HRA SBP Hybrid /60 20% 20% 20% $1,000 20% 20% 20% $2,000/6,000 $2,000 40% $4,000/12,000 HRA SBP Hybrid /60 20% 20% 20% $2,500 20% 20% 20% $3,000/9,000 $5,000 40% $5,000/15,000 HRA SBP Hybrid /60 20% 20% 20% $5,000 20% 20% 20% $5,000/15,000 $10,000 40% $10,000/30,000 HRA Freedom PPO Largest provider network including Coventry Health Care National Network; four benefit levels enhances member choice Out-of-pocket Maximum SBP Freedom 4 09 $15/30/45 $25/40/55 $175 $500/750/1,250 10/20/30% 10/20/30% 10/20/30% $2,000/3,000/4,000 $2,500 50% $5,000 SBP Freedom 5 09 $15/30/45 $25/40/55 $175 $1,000/1,500/2,000 10/20/30% 10/20/30% 10/20/30% $2,000/3,000/4,000 $3,500 50% $5,000 HRA SBP Freedom 6 09 $15/30/45 $25/40/55 $175 $2,000/2,500/3,000 10/20/30% 10/20/30% 10/20/30% $2,000/3,000/4,000 $5,000 50% $5,000 HRA QHDHP HSA compatible; first-dollar wellness Out-of-pocket Maximum SBP QHDHP % 0% 0% $1,500 0% 0% 0% $1,500/3,000 $3,000 30% $6,000/12,000 HRA SBP QHDHP % 20% 20% $1,500 20% 20% 20% $3,000/6,000 $3,000 40% $6,000/12,000 HRA SBP QHDHP % 0% 0% $2,000 0% 0% 0% $2,000/4,000 $4,000 30% $8,000/16,000 HRA SBP QHDHP % 0% 0% $2,500 0% 0% 0% $2,500/5,000 $5,000 30% $10,000/20,000 HRA SBP QHDHP 4 08 Embedded 0% 0% 0% $2,500 0% 0% 0% $2,500/5,000 $5,000 30% $10,000/20,000 HRA SBP QHDHP % 20% 20% $2,500 20% 20% 20% $5,000/10,000 $5,000 40% $10,000/20,000 HRA SBP QHDHP % 0% 0% $3,000 0% 0% 0% $3,000/6,000 $6,000 30% $10,000/20,000 HRA SBP QHDHP % 0% 0% $5,000 0% 0% 0% $5,000/10,000 $10,000 30% $15,000/30,000 HRA Prime A new product blending features of a traditional PPO and QHDHP delivering valued benefits at an affordable price 100/60 Out-of-pocket Maximum SBP Prime /60* $20 ded. then $40 ded. then $150 $1,000 0% 0% 0% $0/0 $2,000 40% $2,000/6,000 HRA SBP Prime /60** $25 ded. then $50 ded. then $150 $2,000 0% 0% 0% $0/0 $4,000 40% $4,000/12,000 HRA SBP Prime /60** $30 ded. then $60 ded. then $200 $3,000 0% 0% 0% $0/0 $6,000 40% $6,000/18,000 HRA ** Consumer Prime 1000 contains a first-dollar Coventry Fund: $250 single; 500 employee +1; $750 family. ** Consumer Prime 2000 and 3000 contain a first-dollar Coventry Fund: $500 single; $1,000 employee +1; $1,500 family.

5 (888) PC (2/09)