Federal Employees Open Season 2013

Transcription

1 Federal Employees Open Season 2013

2 Attention Federal Employees Here are several reasons to Choose Coventry in Fitness club membership at no cost to you - Preventive dental at no cost to you - Preventive vision at no cost to you - $120 yearly Over-the-Counter (OTC) benefits - Dependent Passport Program - $3 Rx copayments for Select generics - 24-Hour Nurse Line To learn more about these programs please visit feds.chcflorida.com or call

3 Table of Contents Preventive Care Coverage...1 Knowing where to go can help you save on health care costs...2 Coventry WellBeing...3 Preventive Dental...4 Preventive Vision...4 My Online Services SM...5 Coventry Mobile App...5 WellBeing has its Rewards...6 Dependent Passport Program Hour Nurse Line...8 $120 Yearly Over-the-Counter (OTC) Benefit...8 Mail Order Benefit Manager...8 High Option Plan...9 Standard Option Plan...11 High Deductible Health Plan...13 Contact Numbers...16 feds.chcflorida.com

4 Preventive Care Coverage Preventive Care Helps Keep Members Healthy At Coventry Health Care, we encourage members to receive preventive care items and services. The Affordable Care Act (ACA) requires specific preventive services and drugs to be covered at 100 percent when they are received through participating providers. Members who use our network providers will receive preventive care services paid at 100 percent. Coverage for Preventive Services Here are some examples of the preventive services that are covered with no copay, coinsurance or deductible. Child Preventive Exams: Preventive office visits including well child care Immunizations: (vaccines for children, birth to age 18- doses, recommended ages and populations vary): Influenza (flu) Pneumonia Hepatitis A Hepatitis B Diphtheria, Tetanus, Pertussis (Td/Tdap) Varicella (chicken pox) Measles, Mumps, Rubella (MMR) Polio Rotavirus Meningococcal Human Papillomavirus (HPV) Screening Tests: hearing, vision, phenylketonuria (newborns), sickle cell disease (newborns) Newborn Preventive Treatment: ocular medication against gonorrhea for all newborns Adult Preventive Exams: Preventive office visits including well woman exam Immunizations: (vaccines for adults - doses, recommended ages and populations vary): Influenza (flu) Pneumonia Hepatitis A Hepatitis B Diphtheria, Tetanus, Pertussis (Td/Tdap) Varicella (chicken pox) Measles, Mumps, Rubella (MMR) Meningococcal Zoster Human Papillomavirus (HPV) Screening Tests: breast cancer, cervical cancer, colorectal cancer, prostate cancer, HIV, routine blood and urine, cholesterol, osteoporosis The list is subject to change as federal guidance is issued. The full list of covered preventive services issued with the Interim Final Rules can be found at Talking with Your Provider about Preventive Care We process claims based on your provider s clinical assessment of the office visit. If a preventive item or service is billed separately, cost-sharing may apply to the office visit. If the primary reason for your visit is seeking treatment for an illness or condition, and preventive care is administered during the same visit, cost-sharing may apply. This means your provider may ask you to pay your appropriate health plan copay, deductible or coinsurance. Certain screening services, such as a colonoscopy or mammogram, may identify health conditions that require further testing or treatment. If a condition is identified through a preventive screening, any subsequent testing, diagnosis, analysis or treatment are not considered preventive services and are subject to the appropriate cost-sharing. If you have questions about a claim or provider visit, please call the customer service number on your Member ID card or speak with your provider. Please regularly check our website for new information about preventive care coverage as the government agencies refine guidance and requirements. 1 feds.chcflorida.com

5 Knowing where to go can help you save on health care costs Your Primary Care Physician (PCP) should be your first source for health care. He or she knows you best and can guide you to other services as needed. If you can t get to see your PCP right away, you have other choices including an urgent care center, a convenient care center and the emergency room. The following table can help you decide where to go. Convenient Care Center Urgent Care Center (UCC) Emergency Room (ER) What is it Health centers, located in pharmacies, grocery stores and other retail stores, which treat common illnesses and are usually open evenings and weekends Facilities that offer quality medical care for illnesses and injuries and are often open evenings and weekends A group of rooms in a hospital created to treat emergency conditions, usually open 24 hours a day, seven days a week When to go, in general For small problems when you can t see your family doctor right away When you can t get in to see your doctor and you need care for an unexpected illness or injury that does not pose a serious danger to your health When a sudden accident or medical condition causes severe symptoms or pain and not receiving immediate medical attention places your health in serious jeopardy. Examples of when to go Minor sicknesses, such as rashes, ear aches, sore throats, stomach aches and other problems Flu shots, vaccinations and other shots An injury, and it s after your doctor s office hours You need stitches for a non-critical injury You have a chronic problem, such as a sore throat or back pain, that isn t improving and can t wait until your doctor is available You re away from home but need medical care in the area you re visiting Poisoning or drug overdose Difficulty breathing or shortness of breath Chest or upper abdominal pain or pressure Fainting, sudden dizziness, weakness, loss of consciousness Changes in vision Confusion or changes in mental status or difficulty speaking Uncontrolled bleeding or severe pain Coughing or vomiting blood Suicidal feelings Advantages Convenience when you can t get in to see your doctor for a small problem Save time and money compared to visiting the ER The ER is the only place to go for treatment in a true emergency How to find a provider Visit the Web address shown on your ID card and choose Find a Doctor. You can also call Customer Service at the number listed on the back of your member ID card. In case of emergency If you find yourself in need of emergency care, dial 911 or go to the nearest emergency room. feds.chcflorida.com 2

6 Coventry Health Care of Florida believes member health and wellbeing is our top priority. As part of our commitment, we offer discount programs and online tools designed to promote healthy living. WellBeing Online Members have access to Coventry's WellBeing online health and wellness portal, including a Health Risk Assessment questionnaire, online coaching programs such as tobacco cessation, blood pressure management, cholesterol management and others. To help members with their program and track progress, we offer additional tools such as a step tracker, a restaurant guide, and BMI calculator. WellBeing Fitness Membership Program* at no cost to you The Coventry WellBeing Covered Fitness Program is designed to empower our members to take a more active role in improving their personal health. Members can choose from participating centers and receive a monthly membership at no cost. To find a participating fitness center visit chcflorida.com or call * The fitness centers are not credentialed or contracted through Coventry. Healthways, Inc. is the exclusive vendor contracted by Coventry to administer covered fitness services. WellBeing Complementary Alternative Medicine (CAM) Program With Coventry WellBeing CAM Program, our members can make meaningful lifestyle changes to improve their diet, fitness level, emotional wellbeing, and more. With the CAM Program, members and their covered dependents have access to discounts of up to 30% for various alternative therapies through American WholeHealth Network (AWHN) including: Guided Imagery, Massage, Tai Chi, Pilates, Acupuncture, Yoga and Nutrition. For more information call WellBeing Weight Loss Discount Program Jenny Craig is all about eating well, moving more and living life! Jenny Craig offers Coventry members a FREE 30-Day Trial Program and a 25% discount off a Premium Program.* For more information call 877-JENNY-70. * Plans do not include a weekly food discount. Weight Watchers Online discount program offers Coventry members a savings of $10 off a 3-month subscription. Members have access to Weight Watchers Online for only $55 - less than $5 per week. Weight Watchers offers our members exciting weight management options at a discount. The program features a $15 registration fee and a $10 weekly Membership Fee. For more information visit feds.chcflorida.com or call QualSight LASIK Savings Coventry members have access to savings on the Nation s most popular and successful elective procedure - LASIK eye surgery! Coventry has partnered with QualSight LASIK to bring members savings of 40% to 50% off the national average price for Traditional LASIK. QualSight s network of the nation s most experienced LASIK surgeons has collectively performed over 2.5 million procedures. Choose from over 800 locations nationwide for your free LASIK consultation to find out if you are a candidate for this life changing procedure. For more information call Hearing Exam & Hearing Aid Discount Program Through HearUSA, our members receive a 20% discount on a variety of products and services, including hearing aids, exams and educational classes at convenient locations across Florida. For more information call feds.chcflorida.com

7 Benefit Highlights Preventive Dental Dental is something to smile about Your Coventry health benefit plan offers preventive dental benefits. Choose a participating dentist and schedule routine cleanings and x-rays, covered with just a copayment. Additional services are also covered at discounted pricing when using a participating dental provider. Just present your membership identification card when you arrive at your appointment. For more information please refer to your dental schedule of benefits or visit us online at feds.chcflorida.com. Exclusion and limitations apply. If you have question or need to obtain a participating provider please contact Member Services at , Monday - Friday from 8 a.m. - 6 p.m. Preventive Vision As a member, enjoy these valuable benefits Comprehensive, routine eye examination, including refraction for eyeglasses, once per calendar year by a participating optometrist. $19 Frame and Plastic Single Vision Lenses $20 Frame and Plastic Bifocal Vision Lenses $25 Frame and Plastic Trifocal Vision Lenses $30 Contact lens examination to include fitting for regular daily wear, extended wear and disposable lenses, 3 months of follow-up care, and starter kit* Daily Wear Lenses Extended Wear Lenses Extended Wear Replacement Lenses No charge $10 per pair $15 per pair $48 per lens * Contact Lens Examination is available only after member has received a comprehensive eye examination and refraction from a participating optometrist. If you have question or To obtain a participating provider for your next exam call Primary Plus Customer Service at Monday - Friday from 8 a.m. to 6 p.m. Exclusion and limitations apply. Please see your Member Contract or Vision Endorsement for further details. feds.chcflorida.com 4

8 My Online Services feds.chcflorida.com Coventry offers online resources designed to help members get the information they need. Coventry members can register on our website and access their health benefits information in a safe and secure environment. The following capabilities and many more are just a click away. View or print detailed benefit information Search for participating providers Access the Provider Comparison Tool, which offers quality ratings for hospitals, pricing information for procedures and detailed profiles on doctors and hospitals Search for prescription drug pricing and research drugs by generic or brand names Learn about costs, uses, precautions and side effects Access educational resources through the National Institutes of Health Print ID cards SM Going Places? Take Coventry along. Download Coventry s Mobile App Stay connected to your benefit information while on the go. With Coventry Mobile, you have secure access to the following: Medical claims status with detailed summaries Allergy & immunization details Benefit usage details Family history HRA/FSA balances Surgery and procedure history ID cards Authorized dependents accounts Current medications Emergency contact information Plus, use the provider search feature to obtain a list of participating network doctors, hospitals and urgent care centers within a few easy steps and without having to log in. TM Coventry Mobile is compatible with smartphones such as Android, BlackBerry and iphone, and devices such as ipod touch and tablets. Provider search is not available for Blackberry smartphones. 5 feds.chcflorida.com

9 WellBeing has its Rewards Nothing is more important to Coventry than the health of our members. To begin your journey to better health we encourage you to take advantage of Coventry WellBeing, our online health and wellness program. Better health isn t the only benefit Coventry WellBeing provides, a $50 wellness reward card or WellBeing merchandise is waiting for you, and it s simple to earn. All journeys have a beginning. The first step to your successful wellness journey begins at feds.chcflorida.com. Login or register at My Online Services, and click on Take Your Personal Health Risk Assessment (HRA) today. The HRA is a completely confidential, online questionnaire. It is designed to provide you a better understanding of your current health status and engagement levels. After completing the questionnaire, you will receive an assessment report and personalized digital coaching programs guiding you through the steps to better health and wellness. Upon completion of one of your recommended digital coaching programs you will have earned enough points to redeem your $50 wellness reward card or WellBeing merchandise, and you re on your way to a healthier you! It s simple: Visit feds.chcflorida.com and login or register at My Online Services Click on and complete the Health Risk Assessment - Earn 20 points Complete the consultation for a digital coaching program - Earn 25 points Complete the coaching program by responding to your 90-day check-in - Earn 5 points Redeem your points toward a $50 wellness reward card or WellBeing merchandise. Here s wishing you all the best on the road to better health. Enjoy your journey and its many rewards. The $50 WellBeing reward is available to eligible members age 18 and above once each calendar year. feds.chcflorida.com 6

10 Dependent Passport Program Peace of mind while they re away With the Passport Program, dependents who are enrolled in one of our health plans and live outside the service area will now receive out-of-area coverage at the highest level of benefits for services that are obtained from providers that are in the Coventry National Network.* Using the Passport Program Always present your Coventry member ID card so that providers can contact Coventry to verify coverage. Just like your in-network benefit, certain services require pre-authorization. Failure to obtain necessary pre-authorization will result in a reduction of benefits. Find a Provider To find a participating provider, call Customer Service at the number listed on your Member ID Card. How to Participate Please contact your Benefit Administrator for instructions on how your dependents can participate in the Dependent Passport Program. Your dependent may be able to participate in the Passport Program if: Eligible for dependent coverage as explained in your Group Agreement. Resides outside your plan s designated service area to live with a parent or attend school. * Certain covered services, including Behavioral Health Services may not be provided through the Coventry National Network, therefore members may be required to return to the service area to obtain care. 7 feds.chcflorida.com

11 Fitness Club Membership at no cost to you! You pay nothing for your monthly membership The Coventry WellBeing Covered Fitness Program is designed to empower our members to take a more active role in improving their personal health. Members can choose from participating centers and receive a monthly membership at no cost. To find a participating fitness center visit chcflorida.com or call * The fitness centers are not credentialed or contracted through Coventry. Healthways, Inc. is the exclusive vendor contracted by Coventry to administer covered fitness services. 24-Hour Nurse Line Answers when you need them The nurse line is part of our member resource system that provides members with direct access to a registered nurse 24 hours a day, 365 days a year. This value added benefit is designed to support you during an urgent situation. The Nurse Line has registered nurses available to offer friendly, helpful advice on topics like fever, back and muscle pain, medication questions, minor burns, dizziness, headaches, colds and viruses, swelling or cuts and stomach pain. The nurse will ask you some questions about your problem and help you decide if you need to go to the hospital, see a physician or care for yourself at home. Take advantage of the 24-Hour Nurse Line anytime. Call anytime $120 Yearly Over-the-Counter (OTC) Benefit Receive up to $10 per month, per household Take advantage of the Coventry Health Care of Florida s $10 per month Over-the-Counter (OTC) benefit (one per household). You won t pay a penny when you choose from Coventry s extensive list of more than 60 items including sunscreen, cold/allergy remedies, vitamins, herbal supplements, antacids, bandages, skin cream, toothbrushes and more. Items are delivered directly to your home through Coventry s convenient, easy mail order service. To learn more about the the $120 Yearly OTC Benefit: Go to feds.chcflorida.com Scroll down to $120 OTC Benefit Click on more information and/or view order form Mail Order Pharmacy Benefit Manager Fast and convenient service delivered right to your door Convenience and savings are easy when you use Coventry s mail order service. Using our mail order service allows us to customize a cost-effective pharmacy solution that delivers the prescription care that our members need and complements the other services that we provide. Coventry s Mail Order Service offers secure, personalized services to help you save time and money. To learn more about the Coventry Mail Order Service: Go to feds.chcflorida.com Click on Prescription Drug Mail Order Savings feds.chcflorida.com 8

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19 Contact Numbers Customer Service :00 a.m. - 6:00 p.m. (Monday - Friday) Pharmacy :00 a.m. - 8:00 p.m. (Monday - Friday) WellBeing :00 a.m. - 6:00 p.m. (Monday - Friday) Solstice Dental :00 a.m. - 6:00 p.m. (Monday - Friday) Vision :00 a.m. - 6:00 p.m. (Monday - Friday) 24-Hour Nurse Line hours / 7 days Claims & Member Services PO Box 7807 London, KY feds.chcflorida.com 16

20 2013 Rate Information Non-Postal Premium Postal Premium Biweekly Monthly Biweekly Type of Enrollment Enrollment Code Gov t Share Your Share Gov t Share Your Share Gov t Share Your Share High Option Self Only High Option Self & Family Standard Option Self Only Standard Option Self & Family HDHP Option Self Only HDHP Option Self & Family 5E1 $ $71.80 $ $ $50.60 $ E2 $ $ $ $ $ $ E4 $ $60.18 $ $ $39.72 $ E5 $ $ $ $ $ $ J41 $ $59.90 $ $ $39.54 $44.93 J42 $ $ $ $ $ $ feds.chcflorida.com CHGF1115 (09/12)