Here for you. Here for your health.

Transcription

1 Here for you. Here for your health. A guide to your plan

2 Contact information This guide to your plan can help you make the most of your health care and Assurant Health s Customer Care Center can do the same. We re here for you. Assurant Health Customer Care Center CVS Caremark pharmacy locator caremark.com us [email protected] Our website assuranthealth.com Your plan s effective date Remember that your plan has an effective date. This is the exact date when your benefits begin. It s important to know this date, to keep your contract and complete plan information in a safe place, and to always keep your insurance plan ID card with you. For money-saving opportunities, look for this symbol. 2

3 Understanding health insurance Few individuals could handle a large financial loss due to a catastrophic illness or injury on their own. However, when you purchased health insurance from Assurant Health, you took an important step in reducing this risk for you and your family. To further reduce your personal liability, it s important you understand how your health insurance coverage works before you or your family needs to use it. For example, should you require an inpatient hospital stay, the handling of your covered expenses could flow like this: Deductible Out-of-pocket limit DEDUCTIBLE (YOU PAY) CALENDAR YEAR COINSURANCE (YOU PAY) COINSURANCE (WE PAY) REMAINING ELIGIBLE MEDICAL EXPENSES (WE PAY 100%) DEDUCTIBLE: Amount you pay each calendar year before we pay benefits for non-preventive services. COINSURANCE: The dollar amount or percentage of covered charges you pay for the calendar year after your deductible has been met. For example, with 80/20 coinsurance, we pay 80% of the covered expenses and you pay 20%. OUT-OF-POCKET LIMIT: The amounts you pay in copays, deductible and coinsurance accumulate toward your chosen total out-of-pocket cost for the calendar year. BENEFITS PAID AT 100%: We pay 100% of remaining eligible expenses for the calendar year once all your out-of-pocket costs have been met. You ll find your plan copay, deductible, coinsurance and out-of-pocket limit in the Benefit Summary section of your insurance contract. Network discounts Certain health care providers (doctors and hospitals in your network) offer reduced charges to Assurant Health policyholders. Assurant Health subtracts the appropriate discount amount from the provider s billed amount. 3

4 Find a network provider before using your plan Using network providers saves you money. With your PPO (participating provider organization) network plan, choosing providers (doctors and hospitals) in your network gives you the most value for your health care dollar. Network providers have agreed to reduce the amount they will charge patients in the network meaning you re eligible to receive discounts. Your copay (if you have one), deductible, coinsurance and out-of-pocket limit are at their lowest when you use network providers.* * For emergency services, your deductible, coinsurance and out-of-pocket limit will be paid in-network even if your emergency care providers are not in your PPO network. Reasonable and customary charges may apply. FIND A DOCTOR To find a network doctor, choose any of these methods. 1. Go to assuranthealth.com/doctors. 2. Contact the network directly using the contact information listed on the front of your insurance card. Avoid emergency rooms for nonemergencies. Know in advance the locations of the nearest urgent care, retail health and after-hours clinics. See page 9 for more information. What happens if you go out of your network? In the event your doctor or hospital is not in your primary network, you can still save money on services by choosing one that participates in Assurant Health s secondary networks. It s important to know that eligible claims will be processed at your out-of-network benefit level. Visit assuranthealth.com/doctors or look on the back of your ID card to see the secondary network providers you may choose from. You may also contact us to find providers in your plan s secondary network. 4

5 Pre-authorization might be required Pre-authorization advanced review of planned treatment is required before inpatient treatment, outpatient surgery and other types of outpatient treatment listed under Utilization Review in your insurance contract. When pre-authorization is required, ask your health care provider to initiate the process IMPORTANT: as soon These as are possible your insurance prior IDto Cards the beginning of treatment. Dear Suzanne M Sample: Suzanne M Sample 921 Sample Way Somewhere IN CA Thank you for choosing an Assurant Health insurance plan. Here are your new insurance identification cards. Remove them, fold them at the center and carry them with you. Please replace old cards with these. To ensure proper claims handling, please show your card to your providers. Thank you for your business. If you have questions about your new cards, please call Customer Service at the number on the back panel. PRE-AUTHORIZATION Effective: October 01, 2012 The contact number for pre-authorization is on the back of your insurance card. If you are viewing this information online, you'll receive your permanent insurance identification cards in the mail shortly. Use this side for Medical Benefits Suzanne M Sample POLICY: PPO HOSPITAL / MD PLAN ER ACCESS FEE $75 For network provider information visit This card does not guarantee coverage or benefits. To receive maximum medical benefits, authorization is required. Failure to call may result in reduced benefits. For authorization, call For verification of patient coverage, call Customer Service at Providers: Send your electronic claims to Assurant Health/ASA via HealthSmart Clearinghouse, payor #58730, or mail a standard form to Assurant Health/ASA, P.O. Box 91604, Lubbock, TX, Assurant Health is the brand name for products underwritten and issued by Time Insurance Company. Visit us at Aetna Participating doctors and hospitals are independent providers and are neither agents nor employees of Aetna or Assurant Health. SAMPLE Emergency surgery or hospital admission should never be delayed for pre-authorization. However, your health care Use this side for Prescription Drug Benefits provider should call the pre-authorization contact number as RxBIN: RxGRP: FORJALA soon as possible during/following ID #: FMKZ such emergency care. DEP ID# Sample Suzanne M 01 To maximize your retail prescription drug benefit, present this card and your prescription(s) to a participating pharmacy. To locate a participating pharmacy, please visit our web site at or call At the time of service you must pay the pharmacy any copayment and/or other charges required by your plan. Only eligible person(s) named on this card may obtain covered prescription drug benefits. Pharmacy: Please obtain positive identification of the person presenting this card. THIS CARD DOES NOT GUARANTEE COVERAGE OR BENEFITS For Assistance: Pharmacists can call or visit the Pharmacist Resource Center at Insureds can call Medco Health Solutions, Inc. PO Box Lexington, KY No referrals necessary No referrals are needed to obtain health care services, even for specialists. However, remember that you ll receive discounts from network providers. 5

6 Assurant Health plans offer preventive benefits to help you stay healthy Your plan pays 100% of preventive services recommended under the Affordable Care Act (health care reform) when you use innetwork doctors. Go to assuranthealth.com/wellness to find information and a detailed guide on which preventive services are paid at 100%, plus preventive services procedure codes. Maximize your benefits by using a provider who participates in your network. When you do, you won t be responsible for the copays, deductibles and coinsurance. Please note that certain preventive services are paid at 100%, and other charges related to those services, such as office visits and physician fees, may not be. Assurant Health will need to review what the provider submits as the purpose of the visit, as well as the type of services received, to determine how related office visits and physician fees will be covered. Services intended to diagnose, treat or monitor an illness or injury are not considered preventive, so your plan deductible, coinsurance and copays may apply. 6 6

7 Using your medical benefits In general, the following procedure outlines what to expect or do each time you use a medical service (e.g., at a doctor s office, emergency room or hospital): You select a network provider (see page 4) and present your medical insurance card at the time of service. Remember: network providers offer discounts on covered services. COPAY: Your plan may require you to pay a copay, which is a set amount you pay each time you visit a doctor or hospital. The provider bills Assurant Health using the instructions on the back of your insurance card. Assurant Health processes your medical claim and sends an Explanation of Benefits (EOB) to you and to your provider. Always be sure to review and verify the accuracy of the billed charges. If Assurant Health pays the provider, it will be indicated on the EOB. If the provider is going to bill you, it will be indicated on the EOB. You pay the provider based on your bill, if you receive one. The first covered amounts you pay to your providers apply toward your deductible. Once your deductible is met, Assurant Health begins to pay providers a percentage of covered expenses and you pay the balance your coinsurance Once the copays, deductibles and coinsurance you have paid meet your out-of-pocket maximum, Assurant Health pays all other covered expenses for the remainder of the calendar year Go paperless Receive information about your plan and claims (EOBs) on our secure website. You ll never have to keep track of those paper documents again. 1. Register/log in at members.assuranthealth.com. 2. Go to Update My & Preferences and indicate your communication preferences with a few easy clicks 7

8 CVS Caremark is your pharmacy benefit manager As your pharmacy benefit manager, CVS Caremark brings you discounts on prescriptions and processes prescription claims. Their nationwide network has more than 65,000 independent and chain pharmacies, including CVS, Target, Walgreens, Walmart and Rite Aid stores. Save an average of 30-40% on prescription drugs When you pick up your prescription at a CVS Caremark participating pharmacy, any drug discount will already be applied. Your pharmacist will charge you the amount you re responsible for paying (such as any applicable copay, coinsurance or deductible). Make sure it s covered by reviewing the Prescription Drug Card Program information in your insurance contract, or contact us. The convenience of CVS Caremark mail order In most states, CVS Caremark will deliver to your home any prescription drugs you re using on a long-term basis. It s convenient, and you may even save money. Call CVS Caremark or visit caremark.com for more information. Assurant Health Specialty Pharmacy Program If you have a complex condition that requires a specialty pharmaceutical, you can maximize the benefits of your plan by using our designated provider, CVS Caremark Specialty Pharmacy. If you do not fill your prescription through CVS Caremark Specialty Pharmacy, you may have limited or no coverage depending on your plan. Call us to find out if a medication you re taking is a specialty pharmaceutical or to see if it requires pre-authorization. You can learn more about the Assurant Health Specialty Pharmacy Program by visiting our Current Customers Web page at assuranthealth.com. IMPORTANT: Have your insurance card with you when you visit the pharmacy. Without it, the pharmacy will charge you the retail price for your prescription drugs. However, you can submit your receipt and a claim form to CVS Caremark to have the claim applied to your plan. Ask your doctor to prescribe FDA-approved generic prescription drugs, when available, instead of more expensive brand name drugs. 8

9 Retail health clinics Save time and money on basic treatment Don t spend your money on urgent care when a retail health clinic can treat certain conditions more affordably. Visit one of these convenient health care facilities for affordable, accessible, nonemergency care and prescriptions. Your network benefits apply when you use one of our contracted clinics listed below. Most are open 7 days a week No appointments necessary Located in major retail stores Visits average 15 minutes FIND A LOCATION Healthcare Clinic MinuteClinic RediClinic (Texas only) In select Walgreens pharmacy locations or assuranthealth.com/retailclinics In select CVS pharmacy locations or assuranthealth.com/retailclinics In select H-E-B store locations REDI (7334) or assuranthealth.com/retailclinics 9

10 Travel The unexpected can happen even when you travel be prepared. Always keep your insurance card with you when traveling it contains valuable information should you need health care services. Emergency services are covered when you travel outside the United States. To submit a claim, obtain an itemized bill from each health care provider, have the bill(s) translated into English, if necessary, and submit them to Assurant Health for your reimbursement. Call Assurant Health s Customer Care Center at if you need additional assistance with submitting these claims. 10

11 Online tools and resources Evaluate your health risks with a Health Risk Assessment The Health Risk Assessment evaluates your health behaviors and health history in areas like nutrition, weight, tobacco use, injury prevention and health screenings. You receive a personalized plan with recommended actions to take on your top four health risks. If you choose, an Assurant Health nurse will provide additional coaching and assistance. To take the Health Risk Assessment, register online: members.assuranthealth.com. Estimate your out-of-pocket costs Use the online Treatment Cost Estimator to research pricing for local medical procedures, compare network versus out-ofnetwork costs and more. Know your options to help manage your health care dollars and make informed choices. Go to members.assuranthealth.com. View your plan documents Find your insurance contract, and view your original policy packet documents and Explanations of Benefits at our website. Register and log in at members.assuranthealth.com. Once you ve registered, supply us with your address for updates and future access to additional documents. Just go to the Update My & Preferences page, located under My Profile. The Assurant Health website offers educational insurance information, resource links, free tips and health care reform information. Go to assuranthealth.com and select Current Customers. Thank you for choosing Assurant Health. 11

12 About Assurant Health Assurant Health is the brand name for products underwritten and issued by Time Insurance Company (est. 1892), John Alden Life Insurance Company (est. 1961) and Union Security Insurance Company (est. 1910) ( Assurant Health ). Together, these three underwriting companies provide health insurance coverage for people nationwide. Each underwriting company is financially responsible for its own insurance products. Primary products include individual, small employer group and short-term limited-duration health insurance products, as well as non-insurance products and consumer-choice products such as Health Savings Accounts and Health Reimbursement Arrangements. Assurant Health is headquartered in Milwaukee, Wisconsin, with operations offices in Minnesota, Idaho and Florida, as well as sales offices across the country. The Assurant Health website is assuranthealth.com. Assurant is a premier provider of specialized insurance products and related services in North America and select worldwide markets. The four key businesses Assurant Solutions, Assurant Specialty Property, Assurant Health and Assurant Employee Benefits partner with clients who are leaders in their industries and build leadership positions in a number of specialty insurance market segments. Assurant provides debt protection administration; credit-related insurance; warranties and service contracts; pre-funded funeral insurance; solar project insurance; lender-placed homeowners insurance; manufactured housing homeowners insurance; individual health and small employer group health insurance; group dental insurance; group disability insurance; and group life insurance. Assurant, a Fortune 500 company and a member of the S&P 500, is traded on the New York Stock Exchange under the symbol AIZ. Assurant has approximately $27 billion in assets and $8 billion in annual revenue. Assurant has approximately 14,000 employees worldwide and is headquartered in New York s financial district. Assurant Health is the brand name for products underwritten and issued by Time Insurance Company and John Alden Life Insurance Company. Form (Rev. 08/2014) 2014 Assurant, Inc. and CVS Caremark. All rights reserved.