Colorado Small Business Enrollment Guide A BETTER WAY to take care of business

Transcription

1 2015 SMALL BUSINESS HEALTH Colorado Small Business Enrollment Guide A BETTER WAY to take care of business

2 Choose BETTER. 31 Important deadline Open enrollment begins on November 15, 2014 for coverage beginning January 1, Every day, organizations across the country make choices that alter the course of business, drive profits, and define tomorrow s marketplace. Now is the time to choose a partner who helps you and your business thrive. Welcome to your Kaiser Permanente for Colorado Small Business Enrollment Guide. This guide will help you understand what health care means for you, your employees and how to select the right health plan to meet all of those needs. Read on to learn why Kaiser Permanente is the best choice for you and your family. What s inside Understanding health care Why efficient health care matters Your partner for better health The power to choose Excellent care Online access anytime, anywhere Convenient classes, resources, and more Choosing the right plan for your business Health plan benefit highlights Here to help you Resources

3 2015 SMALL BUSINESS HEALTH Choose a health care partner who s more effective at keeping your employees and your bottom line healthy. Choose better. Choose Kaiser Permanente. We reduced costly medication errors by 57% increasing safety keeps employees healthier and more productive 7 Aligned incentives We focus on outcomes, not profits According to Aon Hewitt, we re 16% more cost-efficient than the all-plan average 1 Pharmacy Top-ranked for medication management 6 #1 in the nation on 17 out of 28 care measures, many of which target preventable conditions 5 A BETTER WAY to manage costs Excellent care You re at the center of everything we do, which is why the personalized care you get today leads to healthier tomorrows. Our doctors are 46% less likely to repeat unnecessary tests or procedures reducing total medical costs 2 Prevention Nationally recognized leader in preventive care Quality care National leader in clinical quality across all markets we serve 3 Kaiser Permanente Colorado ranked Highest in Member Satisfaction among Commercial Health Plans in Colorado in J.D. Power Member Satisfaction Study for the 7th year in a row! Please refer to resources on page 11. 3

4 Colorado Small 2015 Business SMALL BUSINESS Enrollment HEALTH Guide Why efficient health care matters Of members who participated in online healthy lifestyle programs, 90% better managed their diabetes, 87% improved their back pain, and 61% decreased their stress. 9 We reduced heart attack deaths by 89%, avoiding relating medical costs and productivity losses. 10 To successfully manage your total costs and improve business performance you need a partner who addresses the health of your employees early, consistently, and effectively, before your costs escalate. As you re looking at health care providers, consider the following questions: How many insurance plans work with your employee and their doctor to see if they are up to date on preventive care, such as diabetes tests? We re focused on prevention, we help your employees stay healthy- not just treat them when they are sick. We work closely with your employee and their doctor to help with: Recommended prevention screenings based on age and gender Care coordination for members with complex or multiple health conditions, including diabetes, asthma, chronic obstructive pulmonary disease (COPD), heart disease, or high blood pressure Wellness coaching to help you lose weight, get active, manage stress, or make healthier food choices Education and online resources Coordination of care after a hospital stay Medication management and pharmacy questions Do your other health care options reward quality and minimize waste? The traditional, fee-for-service system rewards more care more visits, more tests, and more procedures instead of the right care. You and your employees end up paying for this in the form of higher medical costs. One-third of medical costs can be attributed to wasteful, nonrecommended care. 8 4

5 2015 SMALL BUSINESS HEALTH Your partner for better health Making smart decisions about you and your employees health may be easier than you think, whether you re looking for a new plan or choosing health coverage for the first time. Take a look at all you get with your membership, and you ll see how Kaiser Permanente can help you live a healthier life. The power to choose Now you have more options than ever before. By shopping with Connect for Health Colorado, your employees may now select any health plan within the premium range you choose and you pay one simple bill. With Kaiser Permanente you have the best options for you and your employees. With more than 1,000 great doctors and convenient facilities to choose from, it s easier to get the care you need when you need it. We ve carefully selected our doctors so your employees can make the right choice for their family. Your employees can select and change their physician at anytime. 12 At our Kaiser Permanente medical offices, care happens all under one roof to make it more convenient for you and your employees. And when your employees get care with fewer delays, they get better faster. Members in Northern and Southern Colorado can choose to receive care from one of our collaborative care, network providers. We have more than 400 doctors, in these regions, who work alongside Kaiser Permanente teams to provide quality, patient-centered care. Team approach to excellent care Kaiser Permanente offers the largest network of doctors in the nation connected by leading-edge EHR system. Supported by our secure health record system, doctors, nurses, and specialists are better prepared to deliver the right care at the right time even if you go to different Kaiser Permanente locations in your area. This way, you and your employees are treated as a person, not a symptom. 5

6 2015 SMALL BUSINESS HEALTH Online access anytime, anywhere Stay better informed about health and better able to manage it with online and mobile tools that help you and your employees get the support you need. Your employees can their Kaiser Permanente physician, refill most prescriptions, make appointments online with a Kaiser Permanente physician, view test results online, and get advice from a registered nurse 24 hours a day. Convenient classes, resources, and more Empower your employees to take their health beyond checkups with a partner that provides the inspiration and information you need to live life to the fullest. Fit wellness into your schedule, no matter how busy the day is. With the many health classes offered, there s something for everyone. Yoga classes, eating well, baby care, specific health conditions, and much more. Classes vary by location and some may require a fee. A focus on prevention Preventive screenings help keep you and your employees healthy by providing an early alert for many health conditions. That way, they can be treated before they become serious. Under health care reform, many are available at no charge. Here are some examples of preventive care services: Routine preventive physical exams Well-child visits (0 23 months) Well-woman visits Immunizations Annual flu shots Routine preventive laboratory tests Flexible sigmoidoscopies and colonoscopies Bone density scans Tuberculosis tests Autism screenings Mammograms Contraceptive care and counseling Breastfeeding support For a complete list of our preventive care services, visit kp.org/prevention. 6

7 2015 SMALL BUSINESS HEALTH 2015 Small Group Plan Benefit Highlights KP CO Gold KP CO Gold KP CO Silver 0/30 500/ /35 KP Select CO 13 KP Select CO 13 KP Select CO 13 Gold 0/30 Gold 500/20 Silver 1200/35 Plan Type Copayment Deductible Deductible Features Individual plan annual (subscriber only) None $500 $1,200 Family plan annual (individual/family) None $500/$1,000 $1,200/$2,400 Individual plan annual out-of-pocket maximum (subscriber only) $6,350 $6,350 $6,350 Family plan annual out-of-pocket maximum (individual/family) $6,350/$12,700 $6,350/$12,700 $6,350/$12,700 Benefits Preventive care Routine physical exam, mammograms, etc. No Charge No Charge No Charge Outpatient services (per visit or procedure) Primary care office visit $30 $20 $35 Specialty care office visit $60 $40 $65 Most X-rays 20% 20% after 35% after Most lab tests 20% 20% after 35% after MRI, CT, PET $500 20% after $300 after Outpatient surgery 20% 20% after 35% after Mental health visit $30 $20 $35 Inpatient hospital care Room and board, surgery, anesthesia, X-rays, lab tests, medications $500 per day up to 4 days 20% after 35% after Maternity Routine prenatal care visit, first postpartum visit No Charge 20% after 35% after Delivery and inpatient well-baby care $500 per day up to 4 days 20% after 35% after Emergency and urgent care Emergency Department visit $500 $300 35% after Urgent care visit $75 $75 $100 Prescription drugs Plan pharmacy (up to a 30-day supply) Generic: $15 Brand: $45 Generic: $15 Brand: $45 Generic: $15 Brand: $45 after $500 Mail order (up to a 90-day supply) Generic: $30 Brand: $90 Generic: $30 Brand: $90 Generic: $30 Brand: $90 after $500 7

8 2015 SMALL BUSINESS HEALTH 2015 Small Group Plan Benefit Highlights KP CO Silver KP CO Silver KP CO Bronze 1500/ /30/HSA 4500/50 KP Select CO 13 KP Select CO 13 KP Select CO 13 Silver 1500/50 Silver 2000/30/HSA Bronze 4500/50 Plan Type Deductible HSA-qualified Deductible Features Individual plan annual (subscriber only) $1,500 $2,000 $4,500 Family plan annual (individual/family) $1,500/$3,000 $4,000/$4,000 $4,500/$9,000 Individual plan annual out-of-pocket maximum (subscriber only) $6,350 $6,350 $6,350 Family plan annual out-of-pocket maximum (individual/family) $6,350/$12,700 $12,700/$12,700 $6,350/$12,700 Benefits Preventive care Routine physical exam, mammograms, etc. No Charge No Charge No Charge Outpatient services (per visit or procedure) Primary care office visit $50 $30 after $50 Specialty care office visit $70 $50 after $70 after Most X-rays 35% after 15% after 40% after Most lab tests 35% after 15% after 40% after MRI, CT, PET $300 after 15% after 40% after Outpatient surgery 35% after 15% after 40% after Mental health visit $50 $30 after $50 Inpatient hospital care Room and board, surgery, anesthesia, X-rays, lab tests, medications 35% after 15% after 40% after Maternity Routine prenatal care visit, first postpartum visit 35% after 15% after 40% after Delivery and inpatient well-baby care 35% after 15% after 40% after Emergency and urgent care Emergency Department visit 35% after 15% after 40% after Urgent care visit $100 15% after $100 after Prescription drugs Plan pharmacy (up to a 30-day supply) Generic: $15 Brand: $45 after $500 Generic: $10 after Brand: $30 after Generic: $20 after Brand: 40% after Mail order (up to a 90-day supply) Generic: $30 Brand: $90 after $500 Generic: $20 after Brand: $60 after Generic: $40 after Brand: 40% after 8

9 2015 SMALL BUSINESS HEALTH 2015 Small Group Plan Benefit Highlights KP CO Bronze 3500/40/HSA KP Select CO 13 Bronze 3500/40/HSA KP CO Bronze 4500/50%/HSA KP Select CO 13 Bronze 4500/50%/HSA Plan Type HSA-qualified HSA-qualified Features Individual plan annual (subscriber only) $3,500 $4,500 Family plan annual (individual/family) $7,000/$7,000 $9,000/$9,000 Individual plan annual out-of-pocket maximum (subscriber only) $6,350 $6,350 Family plan annual out-of-pocket maximum (individual/family) $12,700/$12,700 $12,700/$12,700 Benefits Preventive care Routine physical exam, mammograms, etc. No Charge No Charge Outpatient services (per visit or procedure) Primary care office visit $40 after 50% after Specialty care office visit $60 after 50% after Most X-rays 30% after 50% after Most lab tests 30% after 50% after MRI, CT, PET 30% after 50% after Outpatient surgery 30% after 50% after Mental health visit $40 after 50% after Inpatient hospital care Room and board, surgery, anesthesia, X-rays, lab tests, medications 30% after 50% after Maternity Routine prenatal care visit, first postpartum visit 30% after 50% after Delivery and inpatient well-baby care 30% after 50% after Emergency and urgent care Emergency Department visit 30% after 50% after Urgent care visit 30% after 50% after Prescription drugs Plan pharmacy (up to a 30-day supply) Generic: $20 after Brand: $45 after 50% after Mail order (up to a 90-day supply) Generic: $40 after Brand: $90 after 50% after 9

10 2015 SMALL BUSINESS HEALTH Here to help you in a time of change When the landmark Affordable Care Act became law in March 2010, it ushered in the most comprehensive changes for health care in 45 years. The scope of change is enormous and it will be a challenging time. We re here to support you and provide information you need to make the right decisions for your business. Kaiser Permanente is strongly positioned to fulfill the promise of health care reform. Helping members stay healthy has been the cornerstone of our integrated approach to care from the beginning. This approach to total health supported by leading-edge technology and a broad range of benefits maximizes your investment in a healthy workforce. 10

11 2015 SMALL BUSINESS HEALTH Resources 1 Hewitt Health Value Initiative benchmarking study Kaiser Foundation Health Plan, Inc., Aon Hewitt, March 22, To get a copy of the Hewitt Health Value Initiative report for your region, contact your account manager. 2 Uncoordinated Care: A Survey of Physician and Patient Experience, California HealthCare Foundation, See note 1. 4 Improving America s Hospitals: The Joint Commission s Annual Report on Quality and Safety, The Joint Commission, Kaiser Permanente 2012 HEDIS scores. Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compass and represent all non- PPO lines of business. Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality. The source for data contained in this publication is Quality Compass 2012 and is used with the permission of NCQA. Quality Compass 2012 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass and HEDIS are registered trademarks of NCQA. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality. 6 See note 5. 7 Kaiser Permanente Colorado data from one hospital site, A. Benedict Cosimi, MD, Modern Day Bloodletting: Is That Laboratory Test Necessary? Archives of Surgery, May Healthy Lifestyle Programs Outcomes, Kaiser Permanente Internet Services Group, April Thomas Delate, PhD, et al., Reduced Health Care Expenditures After Enrollment in a Collaborative Cardiac Care Service, Pharmacotherapy, November Results from our cardiac rehabilitation program in Colorado. 11 Kaiser Foundation Health Plan of Colorado, Inc. received the highest numerical score among commercial health plans in the Colorado region in the proprietary J.D. Power 2014 U.S. Member Health Plan StudySM. Study based on 34,315 total member responses, measuring five plans in the Colorado Region (excludes Medicare and Medicaid). Proprietary study results are based on experiences and perceptions of members surveyed December 2013-January Your experiences may vary. Visit jdpower.com. 12 Please see the network provider directory for a list of providers included in your plan. 13 Only available in Colorado Springs. This plan provides Colorado Springs and surrounding areas coverage at any Kaiser Permanente medical office in Colorado, includes care at more than 400 network providers, hospital visits exclusively at Memorial Central and North Hospitals, and refills for maintenance medication must be filled at a Kaiser Permanente medical office pharmacy or through Kaiser Permanente mail order. 11

12 Kaiser Foundation Health Plan, Inc., of Colorado and Kaiser Permanente Insurance Group are Qualified Health Plans in the Connect for Health Colorado marketplace Kaiser Permanente _14_SG_Connect_for_Health_CO_Bro