Understanding Your Healthcare Options

Transcription

1 Understanding Your Healthcare Options To join the audio portion, please dial with the passcode This session will begin shortly.

2 Tips For Participating Submit questions to the presenter at any time using the Q & A feature. Share tips, resources, and ideas with other attendees using the Chat feature. The phone line will be open later in the presentation for Questions and Answers.

3 Welcome to Understanding Your Healthcare Options VISTA Webinar

4 Today s Team Dan Veale AmeriCorps VISTA Leader Bridging Health and Human Services Kim A. Judy AmeriCorps VISTA Training Coordinator CNCS Jory Camosy Account Manager Seven Corners

5 Today s Agenda The Affordable Care Act and what it means for you Steps for researching and making decisions about your healthcare Your AmeriCorps VISTA Healthcare Benefit What s included How to Access it Resources Question and Answers

6 Presenter Dan Veale Dan Veale AmeriCorps VISTA Leader Bridging Health and Human Services

7 Poll One Do you know how to find which healthcare choice is best for you? I know what my options are and what I need to do. I know some of my options or some of the things I need to do. I am confused or need more information. I need to make healthcare choices?

8 The Affordable Care Act (ACA) Fundamental changes to healthcare Changes implemented Affects all health insurance plans in different ways The roll-out of the Act is complex

9 How Does the ACA Affect Me as a VISTA? We all have to make a decision it s an individual choice Step 1 Determine what health coverage you have Step 2 Research your options and complete an application at Step 3 Shop for coverage and seek financial assistance

10 Step 1: What Kind of Health Coverage Do I Have? Do I have insurance that meets the minimum criteria of the law (aka: Minimum Essential Coverage MEC or compliant )? Yes No further steps are required No I only have the VISTA health coverage from Seven Corners I have health insurance/coverage from other sources which is not ACA compliant and is not considered a Grandfathered Plan If no, go to step two

11 Step 2: What Are My Health Insurance Options? Fill out application with the Health Insurance Marketplace Online Phone Paper With in-person assistance A Navigator, CAC, or IPA Shop for and buy a plan from an agent or broker. Tax credits and subsidies will not be available.

12 Step 3: Shop For Coverage and Seek Financial Assistance You will be given an affordability assessment. Nearly all VISTAs will end up in one of the following categories: You are deemed eligible for Medicaid. You may now shop for a compliant rated Health Insurance plan. Tax credits and tax subsidies may be available. You are deemed eligible for an exemption. All of the assessments will give you a detailed report of what you need to do next. Know that you may file an appeal if you disagree with the assessment. Individual Responsibility Mandate $95 or 1% of your income (whichever is greater) Update Seven Corners Other Healthcare Coverage Questionnaire

13 What Resources are Available? Official Health Insurance Marketplace resources s-and-articles/publications-and-articles.html Glossary An application checklist Brochures, fact sheets, and articles Paper applications Eligibility appeal forms

14 What Resources are Available? Cost Calculator Estimate the monthly cost of your health insurance premium: Kaiser Family Foundation Calculator Pros: shows expected actuarial value of plan and several other details Cons: no mention of tax credits nor tax subsidies Get Covered America Calculator Pros: shows cost with and without subsidies Cons: very few additional details

15 What Resources are Available? Non-partisan organizations Enroll America and Get Covered America FamiliesUSA Doctors For America Kaiser Family Foundation Robert Wood Johnson Foundation National Immigration Law Center

16 What Resources are Available? Additional organizations Navigators Certified Application Counselors (CACs) In-Person Assisters (IPAs) Find local in-person assistance by going to

17 My Personal HealthCare.Gov Story I went to October, November, December Called In January, I started over was able to pick a plan the same day. I picked a Silver Plan. After tax subsidies and tax credits, my initial monthly premium cost of $240 was reduced to $18.

18 Important Dates March 15, 2014 Last day to have chosen and paid for a plan starting on April 1 st March 31, 2014 Last day of Open Enrollment November 15, 2014 The start of the Open Enrollment period for health insurance in 2015

19 Poll Two I plan to: (check all that apply) Visit healthcare.gov to research my options Use an online calculator to estimate costs of insurance Contact a navigator or counselor for in person assistance Stick with the coverage I have and do nothing Other

20 AmeriCorps VISTA Healthcare Benefit Seven Corners We will continue to offer the AmeriCorps Healthcare Benefit to all AmeriCorps VISTA members We will maintain the current range of benefit as administered by Seven Corners through September 30, 2014 (end of fiscal year). We are continuing to explore additional options for how to equitably administer Healthcare for VISTAs in the future

21 Your Healthcare Plan Cost-share is limited to $5 for medical office visits and prescriptions ($0 co-pay for generics) and no cost-share for emergency hospitalizations No premium or annual or lifetime limits on coverage Catastrophic healthcare (e.g. appendicitis) incurs no cost to you Access to highly requested services

22 Presenter Jody Camosy Jory Camosy Account Manager Seven Corners

23 What We ll Cover Overview of the AmeriCorps Health Benefit Plan What s Covered What s Not Seven Corners and the Plan Network How to Use Your Benefits

24 Your AmeriCorps Health Plan AmeriCorps offers a limited health care plan The Plan is free for VISTA members individual coverage (dependents are not covered) self-funded through CNCS (not an insurance policy) designed to reduce your out-of-pocket costs not full major medical coverage administered by Seven Corners, Inc.

25 The Network Plan is based on a network of preferred providers (PPO) physicians hospitals clinics pharmacies For best coverage, use providers in your network Choice Care Network PHCS Network (in NY, NJ only) Catamaran (pharmacy)

26 What s Covered Many routine services Visits to the doctor ($5 co-pay) Lab tests, x-rays Emergency services ($25 co-pay) Hospitalization Pharmacy* ($0-$5 co-pay) Pre-natal and maternity care Physical therapy, occupational therapy, speech therapy *not subject to pre-existing condition exclusion

27 Limited Coverage For Women Women One GYN health visit per service year Pap test Breast examination Routine lab work is not covered Birth control One mammogram per service year Women over 40 years of age One Bone Mineral Density (BMD) Women over 65 years of age

28 Limited Coverage For Men Men One prostate examination per service year Men over 50 years of age Includes PSA test

29 Limited Coverage for Dental and Vision Immunizations recommended by the CDC are covered Immunizations for travel outside the U.S. are not Dental Treatment for the emergency alleviation of dental pain is covered; routine dental care is not. Vision Eyeglasses/contacts damaged in the line of duty Limited to $25 for examination Limited to $50 for repair/replacement

30 Limited Coverage for mental health care Mental Health Care Outpatient 3 outpatient mental health visits per benefit year that are not subject to the pre-existing limitation Additional mental health visits are subject to the preexisting condition limitation Inpatient Covers inpatient hospital services only for conditions that are not pre-existing

31 What s Not Covered pre-existing conditions Pre-existing conditions are NOT covered. A pre-existing condition is any condition or illness for which medical treatment was given, or a diagnosis was made, on or before the effective date of the AmeriCorps Health Benefits Plan. However, prescriptions related to a pre-existing condition are covered, as long as they re not on the excluded list.

32 What s Not Covered for dental and vision Dental Care Routine dental care Vision care routine eye exams or glasses/contacts Routine examinations e.g., general physical exam See the AmeriCorps Member Health Care Guide for a complete list of exclusions

33 Seven Corners Administers the AmeriCorps Health Benefit Plan Website: Current information about health benefits Medical provider directory Pharmacy directory FAQs Forms Glossary Contact Information

34 Seven Corners My Plan myplan.sevencorners.com MyPlan (your claims and info) View your claims See customer service interactions Print your ID card Review online EOB (Explanation of Benefits) statements

35 Your ID Card Contains key info: Your ID# Plan contact information Precertification requirements Pharmacy information Keep it with you at all times Present it to physician, hospital or emergency room Printable ID card available in My Plan at myplan.sevencorners.com

36 How to Use Your Benefit Step 1 Coordination of Benefits Step 2 Find a preferred provider Step 3 Make an appointment and verify participation Step 4 If staying in the hospital, get pre-certification Step 5 Submit a claim (if needed)

37 Step 1: Coordination of Benefits Download, complete, and submit the Other Healthcare Coverage Questionnaire from americorps.sevencorners.com to indicate whether you have other coverage or not. If you have other health coverage, AmeriCorps is secondary to all other insurance AmeriCorps is primary to Medicare and Medicaid

38 Step 2: Find a Provider Visit americorps.sevencorners.com Use the directories to find doctors, pharmacies, etc. that participate in the network Check details of your coverage Choice Care Network PHCS Network (NY and NJ)

39 Step 3: Make an Appointment Verify that the provider participates in the network: Do you participate in the ChoiceCare network? Do you participate in the PHCS/MultiPlan network? (New York and New Jersey ) Be prepared to cover the co-pay

40 Co-Pay for office visits and emergency room Office Visits $5 co-pay Emergency Room $25 co-pay If admitted to the hospital, $0 co-pay

41 Co-Pay for prescriptions Pharmacy Network Prescription medicines are covered, not subject to pre-existing Prescription co-pays $0 copay for generic medications $5 copay for brand medications with a generic equivalent $0 copay for brand medications without a generic equivalent 30 day supply retail pharmacy 90 day supply through mail order See excluded drugs on page 9 of the Benefit Guide

42 Step 4: Get Pre-Certification Pre-certify an inpatient hospitalization by calling Seven Corners At least 1 business day prior to a planned hospitalization Within 2 business days after being hospitalized for an emergency admission Pre-certification is not a guarantee of payment. It is a way to certify medical necessity.

43 Step 5: Submit a Claim If your provider does not submit a claim for you: Download the form at americorps.sevencorners.com Fill out page 1 of the form Give it to your provider to complete page 2 Submit the form and receipts to Seven Corners

44 For Accidents If you are injured or become ill through the act or omission of another person, AmeriCorps has the right to seek payment from the other party. Claims for injuries cannot be paid until the Injury/Accident Details Request form is received at Seven Corners. AmeriCorps is not responsible for the member s attorney s fees or other costs.

45 americorps.sevencorners.com Benefit Guide Full overview of covered services Provider Directories My Plan Forms and Letters Claim Form Other Healthcare Coverage Questionnaire Injury/Accident Details Request form AmeriCorps Plan is Secondary letter

46 Customer Service Contact Seven Corners customer service (24/7) Questions about your benefits or medical bills For hospitalization/surgery For treatment of dental pain To get forms Find a doctor or hospital

47 How to Ask Questions To ask a question, call in using the number on this slide and press *1.

48 Evaluation Please take a few moments to share your feedback. How can we improve these sessions? What topics should we include in future webinars? Thank you very much for your time and participation!

49 Thank You for Your Participation! If you have further questions or for more information, contact us: Next webinar: Making Better Decisions Wednesday, February 26, 2:00 pm ET Visit the Ongoing Learning page on the VISTA Campus for a complete schedule of VISTA webinars