2015 Business health insurance plans

Transcription

1 2015 Business health insurance plans Live well. We ll insure you do.

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3 About us Healthy businesses depend on healthy employees. MercyCare s business health plans are backed by a company that s been helping people like you stay healthy for over 20 years. MercyCare provides quality, affordable health insurance for health care services close to home. MercyCare offers a variety of affordable plans including: HMO plans (Health Maintenance Organization) EPO plans (Exclusive Provider Option) PPO plans (Preferred Provider Option) High deductible options Health savings accounts If you already use our health system providers, you can continue your relationship with them. Did you know that MercyCare: Manages over 40,000 members? Is one of the largest HMO plan providers in the area? Has an open access network, meaning no referrals are needed for in-plan services? Provides you access to more than 400 medical professionals? Has local customer service to assist you? page 2

4 finding a provider Evansville H Watertown Johnson Creek Lake Mills * Jefferson Jefferson Cambridge Fort Atkinson H Whitewater Green Rock H Walworth Brodhead Edgerton Beloit Milton Janesville H Delavan Lake Walworth Geneva Sharon H Harvard McHenry McHenry Woodstock Illinois Crystal Lake Barrington If you are looking for a provider, MercyCare Health Plans offers a complete, up-to-date listing of our physicians, clinics and pharmacies at MercyCareHealthPlans.com. To locate a participating provider, follow these simple steps: 1. Visit MercyCareHealthPlans.com 2. Click on the Find a Doctor box on the home page 3. Select your plan or enter your group number 4. Search by location, specialty or name A printed copy of our provider directory is also available upon request. Please call MCHP at (800) to have a copy sent to you. *Where applicable. Not all providers are available on all plans. See your provider directory for plan providers. page 3

5 Hospitals 24-hour emergency care Mercy Hospital and Trauma Center 1000 Mineral Point Ave. Janesville, WI (608) (800) Mercy Walworth Hospital and Medical Center N2950 State Rd. 67 Lake Geneva, WI (262) Mercy Harvard Hospital 901 Grant St. Harvard, IL (815) Fort HealthCare, Inc. Fort Memorial Hospital 611 Sherman Ave. East Fort Atkinson, WI (920) Watertown Memorial Hospital 125 Hospital Dr. Watertown, WI (920) Urgent care Mercy East Urgent Care 3524 E. Milwaukee St. Janesville, WI (608) Monday-Friday, 8 am-8 pm Saturday-Sunday, 9 am-5 pm InQuicker Mercy South Urgent Care 849 Kellogg Ave. Janesville, WI (608) Monday, Wednesday, 8 am-7 pm Tuesday, Thursday, Friday, 8 am-5 pm Saturday, 8 am-noon Mercy North Urgent Care 3400 Deerfield Dr. Janesville, WI (608) Monday-Friday, 7 am-9 pm Saturday, Sunday, holidays, 9 am-9 pm InQuicker Mercy Mall Urgent Care 1010 N. Washington St. Janesville, WI (608) Daily, 7 am-7 pm, Closed holidays InQuicker Mercy Beloit Urgent Care 2825 Prairie Ave. Beloit, WI (608) Monday-Friday, 5-8 pm Saturday, 8 am-1 pm Mercy Walworth Urgent Care N2950 State Rd. 67 Lake Geneva, WI (262) Monday-Friday, 8 am-8 pm Saturday-Sunday, 9 am-1 pm Mercy Whitewater Urgent Care 507 W. Main St. Whitewater, WI (262) Monday-Friday, 5-9 pm Saturday, 9 am-2 pm Fort HealthCare Lake Mills Urgent Care 200 E. Tyranena Park Rd. Lake Mills, WI (920) Monday-Friday, 5-8 pm Saturday, 8 am- 8 pm Sunday, 10 am-8 pm Fort HealthCare, Inc. Fort Memorial Hospital-Urgent Care 611 Sherman Ave. East Fort Atkinson, WI (920) Monday-Friday, 5-11 pm Saturday, Sunday, holidays, noon-11 pm Watertown Memorial Hospital Urgent Care (located outside emergency department) 806 Schuman Dr. Watertown, WI (920) Daily, 10 am-8 pm Immediate care Mercy McHenry Immediate Care 3922 Mercy Dr. McHenry, IL (815) Monday-Friday, 8 am-8 pm Saturday, 8 am-6 pm, Sunday, 8 am-4 pm Mercy Woodstock Immediate Care 2000 Lake Ave. Woodstock, IL (815) Monday-Friday, 8 am-8 pm Saturday-Sunday, 8 am-6 pm page 4

6 When it comes to safeguarding your health, MercyCare Health Plans gives you access to a network of top Mercy Health System specialists right here at home, so it s easy to get the care you need, when you need it. Mercy offers over 150 specialty services that range from the most basic to the highly complex. Right here at home, our patients receive the highest standard of care, including: Verified Level II emergency trauma Certified primary stroke care Cardiac catheterization labs 24/7 Certified heart failure care Certified chest pain care Accredited cancer care (radiation and chemotherapy) Accredited joint replacement care Radiology department staffed 24/7 MD-1 emergency response vehicle ICU critical care physician coverage 24/7 Neurosurgery physician coverage 24/7 Orthopaedic physician coverage 24/7 Plastic surgery physician coverage 24/7 InQuicker for emergency and urgent care And so much more To see more of what MercyCare Health Plans has to offer, visit our website at MercyCareHealthPlans.com. Quality, affordable health care close to home *This data is based on a survey of public records as of 10/14/14. page 5

7 MercyCare My Plan Manage your health insurance online With MercyCare My Plan, you can view your benefits, claims and eligibility, request additional ID cards, change your primary care provider, ask questions and so much more. Visit MercyCareMyPlan.com to log in. Mercy MyChart Your health record. At your convenience. As a MercyCare member, you have access to Mercy MyChart, your online medical record. Review your medical history Schedule appointments Send messages to your provider View test results Request prescription refills Print your child s immunization records And more Get the app or visit MyChart.MercyHealthSystem.org page 6

8 worksite wellness programs How healthy is your workplace? Take the next step for you and your employees. page 7

9 MercyCare is here to help by offering the following services: Health Risk Assessments (HRA) Web-based health risk assessments are available for all members. Company receives aggregate health and productivity reports if 25 or more employees complete the HRA. (upon request) Health screenings Annual screenings for blood pressure, cholesterol and diabetes are offered at your worksite. Individual counseling on healthy lifestyles and results. Bilingual materials available. Smoking cessation programs Onsite smoking cessation programs (minimum six participants). Members are eligible to have this cost reimbursed under their Stay Healthy benefit. Health screening follow-up Members with abnormal results receive a follow-up by phone and/or letter. Referral to our programs (diabetes, high blood pressure, high cholesterol, chronic kidney disease and asthma) helps members manage their disease. Influenza vaccination clinics (subject to availability of vaccine) Provided onsite. Speakers Bureau We can to arrange speakers and other employee health promotion programs. To find out more and apply, visit MercyCareHealthPlans.com page 8

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11 definitions to help Here are some definitions to help you understand insurance coverage: Premium: Premium is a fixed amount you pay to MercyCare Health Plans, usually every month. You pay this even if you don t use medical care that month. Deductible: If you need medical care, a deductible is the amount you pay for care before MercyCare starts to pay its share. Once you meet your deductible, MercyCare begins to cover some costs of your care. Many plans provide preventive services, and sometimes other care, before you ve met your deductible. Copayment: Copayment is a fixed amount you ll pay for a medical service. For example, if your visit to the doctor s office is $150 and your copay is $25, you pay $25 and MercyCare pays the remaining $125. Coinsurance: Coinsurance is similar to copayment, except it s a percentage of costs you pay. For instance, you may pay 20% of the cost of a $100 medical bill. So you would pay $20 and MercyCare would pay the rest. page 10

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13 MercyCare has a plan for you! MercyCare s group plans are laid out in metal tiers and detailed on pages Our group plans offered through the Marketplace are grouped into four metal levels (bronze, silver, gold and platinum) to help you compare plans. All health plans in the Marketplace get a metal designation based on the level of cost-sharing. Cost-sharing refers to the costs that members share when they get medical care, such as a deductible and co-insurance. METAL LEVEL PREMIUMS OUT-OF-POCKET COSTS PLAN PAYS* PLATINUM Highest Lowest 90% GOLD Higher Lower 80% SILVER Moderate Moderate 70% BRONZE Lower Higher 60% *On average, the plan will pay this percentage of the total cost of the policy s benefits. page 12

14 2015 group plans Platinum Plans Medical RX EPO Plans EPO Full Pay $0 Ded. $1,250 OOPM $15 OV copay $50 E.R. copay $10/$25/$50 EPO CO-90 $0 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 EPO CO-90 $0 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 EPO CO-80 $0 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 EPO CO-80 $0 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 EPO CO-90 $500 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 EPO CO-90 $500 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 EPO CO-80 $500 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 EPO CO-80 $500 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 HMO Plans HMO Full Pay $0 Ded. $1,250 OOPM $15 OV copay $50 E.R. copay $10/$25/$50 HMO CO-90 $0 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 HMO CO-90 $0 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 HMO CO-80 $0 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 HMO CO-80 $0 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 HMO CO-90 $500 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 HMO CO-90 $500 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 HMO CO-80 $500 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 HMO CO-80 $500 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 PPO Plans PPO CO-90/70 $0 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 PPO CO-90/70 $0 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 PPO CO-80/60 $0 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 PPO CO-80/60 $0 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 PPO CO-90/70 $500 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 PPO CO-90/70 $500 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 PPO CO-80/60 $500 Ded. $1,000 OOPM $20 OV copay $100 E.R. copay $17/$40/$60 PPO CO-80/60 $500 Ded. $1,500 OOPM $20 OV copay $100 E.R. copay $10/$25/$50 page 13

15 Gold Plans Medical RX EPO Plans EPO CO-80 $1,250 Ded. $2,500 OOPM $25 OV copay $100 E.R. copay $20/$40/$60 EPO CO-80 $1,250 Ded. $3,250 OOPM $25 OV copay $100 E.R. copay $10/$25/$50 EPO CO-80 $2,000 Ded. $3,500 OOPM $25 OV copay $100 E.R. copay $20/$40/$60 EPO CO-80 $2,000 Ded. $4,000 OOPM $25 OV copay $100 E.R. copay $10/$25/$50 HMO Plans HMO CO-80 $1,250 Ded. $2,500 OOPM $25 OV copay $100 E.R. copay $20/$40/$60 HMO CO-80 $1,250 Ded. $3,250 OOPM $25 OV copay $100 E.R. copay $10/$25/$50 HMO CO-80 $2,000 Ded. $3,500 OOPM $25 OV copay $100 E.R. copay $20/$40/$60 HMO CO-80 $2,000 Ded. $4,000 OOPM $25 OV copay $100 E.R. copay $10/$25/$50 HMO H.S.A. $1,800 Ded. Integrated Ded. PPO Plans PPO CO-80/60 $1,250 Ded. $2,500 OOPM $25 OV copay $100 E.R. copay $20/$40/$60 PPO CO-80/60 $1,250 Ded. $3,250 OOPM $25 OV copay $100 E.R. copay $10/$25/$50 PPO CO-80/60 $2,000 Ded. $3,500 OOPM $25 OV copay $100 E.R. copay $20/$40/$60 PPO CO-80/60 $2,000 Ded. $4,000 OOPM $25 OV copay $100 E.R. copay $10/$25/$50 Silver Plans Medical RX EPO Plan EPO CO-60 $2,000 Ded. $6,350 OOPM $35 OV copay $150 E.R. copay $20/$40/$60 EPO CO-70 $2,500 Ded. $6,350 OOPM $35 OV copay $150 E.R. copay $20/$40/$60 HMO Plans HMO CO-60 $2,000 Ded. $6,350 OOPM $35 OV copay $150 E.R. copay $20/$40/$60 HMO CO-70 $2,500 Ded. $6,350 OOPM $35 OV copay $150 E.R. copay $20/$40/$60 HMO CO-70 $5,000 Ded., $6,600 OOPM, $35 OV copay, $150 E.R. copay $20/$40/$60 HMO H.S.A. $3,600 Ded. Integrated Ded. PPO Plan PPO CO-60/40 $2,000 Ded. $6,350 OOPM $35 OV copay $150 E.R. copay $20/$40/$60 PPO CO-70/50 $2,500 Ded. $6,350 OOPM $35 OV copay $150 E.R. copay $20/$40/$60 Bronze Plans Medical RX HMO Plans HMO CO-60 HDHP $3,200 Ded. $6,350 OOPM $20/$40/$60 after deductible HMO H.S.A. $5,500 Ded. Integrated Ded. page 14

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17 1 2 3 Call our office toll-free (800) , or TTY for the hearing impaired (800) , Monday-Friday, 8 am-4:30 pm, central time. Our sales representatives can answer your questions and make an appointment to discuss your individual needs. us at mcare@mhsjvl.org. Interested in attending a brief seminar? Visit our website at MercyCareHealthPlans.com or call us at (800) to find out future dates. page 16

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19 MercyCare Health Plans MercyCare Insurance Company MercyCare HMO, Inc. P.O. Box 550 Janesville, WI MercyCare Health Plans is a Qualified Health Plan issuer in the Health Insurance Marketplace.