Group Health Insurance. Quality Coverage. Proven Value.

Transcription

1 Group Health Insurance Quality Coverage. Proven Value.

2 Group health insurance is one of the largest and most important investments for a business. Look to Coventry for quality coverage, simple administration, and proven long-term value. 2

3 Why Choose Coventry? Quality Coverage. Proven Value. Immediate Savings Before a health insurance plan can be the right fit for your business, it has to fit your bottom line. Coventry s variety of plan options and competitive rates provide our clients with an immediate savings on their health insurance premium without sacrificing coverage. On average, we save businesses 12 percent on their health insurance premium * putting money back in your employee s pockets and your company s budget. Long-Term Value Coventry s value goes beyond affordable monthly premiums. Our programs and services are designed to support member health, minimize costs, and provide a positive service experience to you and your employees. We deliver this value through: Broad access to physicians and hospitals with strong network discounts Improved employee health and claim cost management Integrated wellness programs for all employees Responsive account management and customer service About Coventry Health Care, Inc., an aetna company Local Health Plan Coventry Health Care has provided health insurance coverage to employers and individuals in Nebraska, Iowa and South Dakota for over twenty years. We serve over 267,000 members across the region with employer group, individual, Medicaid and Medicare coverage. Our local team of dedicated account managers, medical directors, provider relations staff and health plan leadership allows us to act swiftly and decisively in your best interest. National Strength Aetna (NYSE: AET) is one of the nation s leading diversified health care benefits companies, serving an estimated 44 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers compensation administrative services and health information technology services.. * Average savings of Iowa, Nebraska and South Dakota employers (group size 2-50) who moved to Coventry, combined Q1 and Q

4 Strong Local and National Networks In order to negotiate significant discounts for our members, Coventry contracts directly with hospitals, physicians and other medical providers. We work as a team with providers to coordinate care, and we continually expand our regional provider network to give our members more choices for local physicians and hospitals. High-Performance Networks A highperformance network (HPN) is a select network often formed by the hospitals and doctors of a single health system. Coventry and the featured health system collaborate to deliver greater provider service discounts and a focus on the delivery of quality, efficient patient care. Clients choose HPN plan options for: Reduced premiums and lower out-of-pocket costs Regional Point-of-Service (POS) and Preferred Provider Organization (PPO) Networks Members have access to a broad network of trusted local doctors and hospitals with cost-saving discounts for services. Coventry built strong relationships with more than 18,000 doctors and 260 hospitals 1 to make up our regional network. And, our network continues to grow. Long-term claim cost reduction through a focus on quality, efficient care Patient access to a select network of proven, trusted physicians and hospitals Coventry National Network Through the Coventry National Network, members have access to more than a half million providers nationwide. 2 Provider Directory. For a listing of providers or to create your own custom provider directory, visit: Iowa and South Dakota: Nebraska: Provider network status is subject to change at any time. Check our online provider directory for the most current listing of providers. PPO plan members have full in-network access to the Coventry National Network for both emergency and nonemergency care. POS and HMO members with dependent children living outside the service area can access this network through our Passport Program. 4 LOCAL DOCTORS 18,002 Number of primary care physicians and specialists in our regional POS network. 1 HOSPITAL ACCESS 262 Number of hospitals included in Coventry s regional POS network. 1 NATIONAL REACH 588,443 Number of doctors members have access to via the Coventry National Network. 2 1 Iowa, South Dakota, and Nebraska providers and hospitals in PPO network, as of October Coventry Provider Count Summary Report, July 27, 2013

5 Strong local and national networks Commercial Service Area Iowa, Nebraska and South Dakota3 As of January 1,

6 Value-Added Services COVENTRY COMPLIMENTS Coventry members save money on wellness and cosmetic services through Coventry Compliments, a no-cost discount program. Available discounted services include acupuncture, cosmetic dermatology, health clubs, LASIK eye surgery, sunglasses and more. EYEMED VISION CARE The EyeMed Vision Care program offers savings for all Coventry members on eye care needs, including eye exams, eyeglass frames and lenses. Members can choose from a network of local and national vision providers including Sears Optical, Target Optical, participating Pearle Vision locations and JCPenney Optical. Passport Program With the Passport Program, members can get coverage for dependent children residing outside the health plan service area. Passport Program members receive out-of-area coverage at the highest level of benefits for many services when they are obtained from providers in the Coventry National Network. Coventry National Network coverage is available on most Coventry POS and HMO plans. Contact your Coventry representative for more details. 6 Flexible Product Offerings Selecting the right health insurance plan is a strategic business decision. Coventry offers an array of plan options to make sure every employer has a plan that fits their employees and their budget. POS, PPO and HMO plans POS, PPO and HMO plans offer affordable, flexible coverage supported by strong regional and national provider networks. Referrals are not required for any Coventry plan. PPO plans offer local and out-of-area coverage for both non-urgent and urgent care. PPO members have full access to the Coventry regional network and the Coventry National Network. POS plans provide coverage for both in network and out-of-network providers, but employees receive the highest level of coverage when they stay in-network. HMO plans provide coverage for care received in-network and emergency care received outside of the network. Coventry Stable Funding Available to employers with 25 or more employees, Coventry Stable Funding offers the predictability and simplicity of a traditional plan with the potential cost-savings of a self-funded plan. Prescription Drug Coverage Coventry s pharmacy management program delivers optimal safety, effectiveness and cost control for our members. We pair our program with a national network of over 67,000 retail pharmacies, so it s easy for employees to access and use their coverage. Prescription drug coverage also includes mail-order services, specialty pharmacy, formulary management, and member cost and decision support tools. * Average savings of Iowa, Nebraska and South Dakota employers (group size 2-50) who moved to Coventry, combined Q1 and Q PREMIUM SAVINGS 12% Average annual savings on health insurance premiums when switching to Coventry Health Care. *

7 DIVERSE PRODUCT OFFERINGS Aetna Specialty Products Now that Coventry is a part of Aetna, you can unlock the right combination of benefits for employees. Clients can choose to add the following options to Coventry medical plans: Aetna Dental the 3rd largest dental carrier* offers a variety of plan designs at different price points. Aetna Disability the 5th largest in disability* offers affordable short-term, long-term and mid term disability insurance plan options. Coventry Consumer ChoiceSM Consumer-driven health solutions from Coventry Consumer Choice put your employees in control of their own health care costs. High-deductible health plans pair low premiums with a tax-advantaged financial account (see below). Coventry Consumer Choice makes it simple by integrating all medical plans, accounts, cards and services into a single system and all administration is handled by Coventry. HRA and HSA account administration for groups with 2-50 employees is included free of charge. Aetna Life over 160 years of experience delivers piece of mind with access to financial planning, legal services, funeral planning and guidance *2012 LIMRA data. The ABC s of Tax-advantaged financial accounts FSA HRA HSA FLEXIBLE SPENDING ACCOUNT. There are two types of employee-funded Flexible Spending Accounts: Health Care and Dependent Care. FSA accounts are offered by employers but funded by employees using pre-tax dollars, which reduces the payroll taxes paid by the employer. HEALTH REIMBURSEMENT ARRANGEMENT. An employer-funded account that can be used to pay for qualified health care expenses; often paired with a high deductible health plan (HDHP). HEALTH SAVINGS ACCOUNT. A tax-free account that can be funded by the employer or employee and must be paired with a highdeductible health plan. Funds put into an FSA do not roll over from year to year, so employees should plan ahead to determine how much to contribute each year. HRA funds can be used by the employee to help meet the high deductible, thus giving them more control over their health care spending and limiting their exposure. The employer can choose annual rollover options and will keep all accumulated dollars if the employee leaves employment. Employees can use HSA funds to pay their qualified medical expenses, including bills that go toward meeting the deductible. The tax-free HSA funds can also be used to build a tax-sheltered safety fund for future medical expenses or even retirement. Funds in an HSA go with the employee if he or she leaves employment. 7

8 Managing Employee Health and Wellness At Coventry, we help you achieve long-term value from your health plan by keeping your employees healthy. Included with every Coventry Health Care plan, Coventry Complete Care connects your employees with the right care at the right time in the right setting to ensure your claim costs stay manageable. Coventry WellBeing SM Coventry WellBeing supports members with online self-care resources to help improve their overall well-being. See next page for more information. Coventry PersonalCare Condition Support Coventry s disease management services are available to members with diabetes and asthma. Our staff works closely with members physicians to provide the right tools to improve personal care for their conditions. Coventry Compass Care Our complex case management program supports members with serious acute or chronic medical conditions. These members work with Coventry care guides, registered nurses experienced in supporting catastrophic or high-risk patients. Care guides advocate for members and help them navigate the health care system to help achieve favorable clinical and financial outcomes. Coventry Healthy Outcomes When and where employees get their care plays a significant role in health care costs and quality. Coventry s trained clinical staff works with providers to pre-authorize coverage for services to reinforce use of evidence-based medicine and to promote higher-quality care. BIG SAVINGS 5% to 9% Average claim cost savings achieved through Coventry health, claim and pharmacy management programs. 1 SMALL IMPACT LESS 0.35% THAN Percentage of claims not approved following Coventry Healthy Outcomes review Impact Savings Report, IA and NE combined, 6/2012 through 5/2013, 100+ size groups. 2 Medical claims, IA and NE combined, 6/2012 through 5/2013, 100+ size groups.

9 health management and wellness Coventry WellBeing SM Coventry WellBeing uses effective self-management tools to engage employees in their health decisions. This online resource provides engaging, targeted support to help members enhance their quality of life. Health Risk Assessments The best way to begin any wellness program is by evaluating risk. The health risk assessment (HRA) is a confidential online questionnaire that takes less than 20 minutes to complete. Participants answer questions about nutrition, weight, physical activity, stress, safety and mental health. Upon completion, the HRA generates an evaluation of the participant s current state of health, including a printable summary for participants to share with physicians. The HRA is completely confidential, easy to access and helps employees understand their motivation and confidence levels for changing behavior. Personalized Coaching Programs Based on the results of the HRA, participants are directed to personalized coaching programs to address their most prevalent risks, including: Balance TM weight management Breathe TM tobacco cessation Nourish TM nutrition improvement Move TM physical activity Relax TM stress management Achieve TM cholesterol management Care TM blood pressure management Care TM insomnia Care TM depression Tracking Success Coventry s tracking tools reinforce positive behavior from online coaching sessions. Users can track progress in physical activity (e.g., walking), health statistics (e.g., blood pressure), and thinking patterns (emotions and negative thinking). Plus, tracking tools are compatible with the iphone and ipod Touch, making it easy to track on the go. Digital coaching emulates a face-to-face session. Using expertise from health professionals in multiple areas, each program uses consultation, planning, tools and resources, and follow-up communications to help members achieve their well-being goals. KidsHealth KidsHealth covers almost every health-related topic related to children from birth through adolesence. Parents and children can access age-appropriate information about parenting, general health, medical problems, development, emotions, fitness, nutrition and safety. 9

10 Local Account Management, Prompt Customer Service For employers Dedicated Account Team Your dedicated Account Management team will proactively identify and resolve issues to ensure a smooth transition to Coventry. Beyond implementation, your Account Manager is your one point of contact for day-to-day issues, strategic benefit planning and guidance, and health plan performance analysis. Online Account Management For convenient, secure, around-the-clock access to your plan information, Coventry offers Online Account Management to streamline plan administration: Add employees and dependents, terminate coverage and make employee address and telephone updates Make payments, view invoices and check account balances View, print and request ID cards and request Certificates of Creditable Coverage For members Proven Customer Service Your employees have immediate access to our experienced customer service staff for questions about their plan. Our group of experts, located in the Midwest, consistently meet and exceed service quality standards. My Online Services Coventry provides online benefit information and tools to help members make wise health care decisions: View, print or request a copy of their ID card, view claim details and benefits, and contact customer service Personal Health Records to track and share medical information Provider comparison tools with hospital quality ratings, procedure pricing information, and detailed physician and hospital profiles Prescription drug pricing and information about costs, usage, precautions and side effects CLAIM EFFICIENCY 1.8 Average number of days in which Coventry processes group health insurance claims.* SERVICE QUALITY 9 out of 10 Number of customer inquiries resolved on the first call to Coventry customer service.* PAYMENT ACCURACY 99% Percentage of accuracy in member claim payments for all group health insurance plans.* *2013 2Q service results for Iowa, Nebraska, and South Dakota plans combined, Bismarck, ND service center. 10

11 Learn more about Coventry and how our plans work Employers are encouraged to review all plan documents included in the Coventry proposal. These documents may include the proposal, Schedule of Benefits and the Evidence of Coverage. If you do not have these documents, please request them from your Coventry representative. For your employees Your employees can learn more about Coventry and how our plans work prior to becoming a member. Please direct your employees to visit: Iowa and South Dakota: Nebraska: From the home page, select Members > Learn more today, then choose Other Important Information. Prospective members are encouraged to review this information, which can include: Submitting a claim form for covered services. Finding a network health care professional and information about him or her. Benefits restrictions and obtaining care when outside the system or service area. Obtaining care after normal office hours or emergency care. Receiving primary care, including points of access and pharmacy procedures. Reviewing the prescription drug formulary. Filing a complaint or appeal including your right to an independent review of an appeal. Information about our chronic disease and case management programs. Member rights and responsibilities. Notice of Privacy Practices. What utilization management is and how decisions are made including financial compensation policy. Standards our network providers must meet. Our quality improvement program. Evaluation of new medical technology. Obtaining specialty, behavioral health or hospital care. Benefits and services included in and excluded from coverage. Charges for which members are responsible. Preventive care guidelines, health appraisals and selfmanagement tools.

12 II-B-AD-SG-CHC-10/13 CHNI 343-1