3910 S. Yellowstone Hwy. Idaho Falls, ID Melaleuca, Inc. Printed in the USA 02/08 ML02

Transcription

1 3910 S. Yellowstone Hwy. Idaho Falls, ID Melaleuca, Inc. Printed in the USA 02/08 ML02

2 Notes Choose from Three Great Plans* Basic Dental Total Care Care Care Monthly Preferred Plus Customer Price $3.95 $14.95 $24.95 Pharmacy Vision Hearing Dental Chiropractic Behavioral Counseling 24-Hour Nurse Line Health Club Network Long Term & Elder Care Diabetes Supplies Physicians Hospitals and Facilities Patient Assistance Program * For U.S. Customers only THIS IS NOT INSURANCE HealthCare Savings Program Member Services: (toll-free) HealthCare Savings Program Member Services: (toll-free) 22

3 Phone Directory Member Services: General Questions Request Replacement Card Recommend New Provider Comment on Provider Services Mail-Order Pharmacy Hour Nurse Line Speak with a Nurse Health Information Library Locate Providers Dental or visit Vision Prescriptions Chiropractic Patient Advocacy Long Term & Elder Care Health Clubs Behavioral Counseling Hearing Locate Hospitals and Healthcare Facilities, notify of ER or hospital/facility admission Diabetes Supplies, Durable Medical Equipment and Over the Counter Drug Welcome! Welcome to Melaleuca s HealthCare Savings Program. As Melaleuca: The Wellness Company SM, we are uniquely positioned to offer you the most extensive health care savings program in the country, with access to networks of hundreds of thousands of doctors, specialists, and facilities. The reason we are able to offer you such fantastic savings is simple: physicians, dentists, and other providers have substantial costs associated with insurance paperwork, patient billing, accounting staff, and collections. Please keep in mind your membership is NOT insurance which makes the HealthCare Savings Program so easy to use! Just present your membership card to a participating provider and you ll receive your savings when you pay at the time of service. This Member Guide gives you the information you need to effectively use all of our providers and maximize the savings for you and your family. We know your family s health is your number one priority. That s why, with Melaleuca s HealthCare Savings Program, your entire household can use your membership card! For your convenience, a list of your closest participating providers is enclosed with your fulfillment kit. For additional listings or questions, our Member Services department will help you locate a provider in your area. The toll-free Member Services phone number is Please take time to carefully read the instructions in this Member Guide. Then enjoy all the outstanding savings, privileges, and benefits you ll receive with the HealthCare Savings Program! LASIK Services LASER6 21 HealthCare Savings Program Member Services: (toll-free) HealthCare Savings Program Member Services: (toll-free)

4 Table of Contents Notes General Instructions Pharmacy Vision Hearing Dental Chiropractic Behavioral Counseling Hour Nurse Line Health Club Network Long Term & Elder Care Diabetes Supplies, Durable Medical Equipment and Over the Counter Drugs Physicians Hospitals and Facilities Patient Assistance Program Provider Locations Phone Directory HealthCare Savings Program Member Services: (toll-free) HealthCare Savings Program Member Services: (toll-free) 20

5 Provider Locations For your convenience and based on your zip code, we have enclosed a sheet with the providers that are closest to your home. For additional providers, please call Member Services or visit the Services Center at Participating providers are subject to change without notice. Melaleuca has been very selective in building its networks for this program. We know there are many qualified providers we have not yet contacted. We appreciate referrals from members like you. Call Member Services and give the name and address of your provider and we will extend an offer to that provider to join the network. Unfortunately, we cannot guarantee acceptance by either the program administrator or the provider. General Instructions 1. Read the description for each HealthCare Savings Program benefit. 2. There are several network logos and instructions for our providers on the back of your membership card. Be sure to present your membership card each time you use one of these services. This helps ensure the providers give you the full savings to which you are entitled. 3. To determine which services are available for each plan, refer to the chart on page 2. Also, next to the service heading on each page you will see the names of the three plans. If the plan name is blue with a red circle, the service is included in that plan. If the plan name and circle are gray, that service is not included. For example: In this example, the service would NOT be available on Basic Care, but would be available for Dental Care Plus and Total Care. Please call Member Services if you have any questions about your plan benefits. 4. Remember, your membership covers you, your spouse, and any children living in your household. 5. To locate participating providers in your local area, check the list in your fulfillment kit. For additional provider locations, call Member Services at or visit the Services Center at 6. Payment must be made in full at the time of service. 7. You may see providers as often as needed. 8. If you have any questions, call Member Services for prompt, friendly assistance. The Member Services representative has the most up-to-date information regarding current providers, new services that have been added to the program, and more information about using your membership card. 9. Member Services hours are Monday through Friday 8:00 a.m. to 8:00 p.m. Eastern Time. 10. Additional information and answers to some of the frequently asked questions about this program can be found in our Services Center at HealthCare Savings Program Member Services: (toll-free) 4

6 Pharmacy Save 15-25% off retail prices of brand name prescription drugs Save 15-60% or more off retail prices of many generic prescription drugs The retail pharmacy network includes more than 50,000 national and regional chain pharmacies such as: Albertsons Pharmacies Eckerd Kmart Pharmacies Rite Aid CVS Fred Meyer Stores Kroger Stores Safeway Dominick s Fry s Food and Drug Walgreens A&P Hy-Vee Pharmacies Phar-Mor BI-LO Duane Reade Costco Wal-Mart To determine if your pharmacy is part of the network, call Member Services. 1. A list of local providers is enclosed in your fulfillment kit. For additional providers in your area, contact Member Services or visit the Services Center at 2. Present your prescription and your membership card to the pharmacist. Please DO NOT call the pharmacy for prescription quotes they can t quote a price over the phone. You must handle prescriptions in person because the pharmacist s computer compares our contracted discount price with the pharmacy s retail price when your prescription is filled. With your HealthCare Savings Program membership, you ll always pay the lower of these two prices directly to the pharmacy at the time of the sale. 3. Be assured you ll always pay the lowest price for your prescriptions in a participating pharmacy on a given day. Some pharmacies may already be selling maintenance medications (to treat ongoing conditions like asthma and high blood pressure) and some short-term prescriptions at the lowest price available. In these cases, the HealthCare Savings Program contracted discount price may be higher than the pharmacy s lowest price. You pay whichever price is lower! 4. Your doctor can prescribe prescription drugs that have generic equivalents. Generic drugs have the same active ingredients as brand name drugs and often cost significantly less. You ll be amazed by your additional savings. 5 HealthCare Savings Program Member Services: (toll-free) Patient Assistance Program Even the best cash discounts are not able to help you when you don t have the cash available to pay the bill! Melaleuca is pleased to provide you with assistance in this situation. The program offers to step in at difficult times to provide you with personal attention exploring all reasonable means of helping you cope with the bill. Whether assisting with a Medicaid application, exploring a charity program, or negotiating a discount or an agreement to let you pay your bill over time, the program is there to help when it seems you are at the end of your rope. 1. There are only three requirements to be eligible for this program. You must be a member of the Total Care Plan You have, or expect to have, at least one bill or a collection of bills from a single provider that exceeds the fee schedule. Contact Member Services or go to for the current fee schedule. You are genuinely unable to pay the outstanding bill 2. If you meet these requirements, call Member Services to discuss your situation and the options available. HealthCare Savings Program Member Services: (toll-free) 18

7 Hospitals and Healthcare Facilities Access to savings at over 26,000 ancillary facilities (labs, radiology clinics, etc.) and over 1,400 hospitals nationwide. 1. Members may call Member Services toll-free at for assistance in locating a Specialty Network Facility or Hospital. 2. In the event emergency services are required after normal business hours, members should call within 48 hours after the emergency services or admittance to a Network Hospital or Facility to obtain instructions. 5. When you want the maximum savings on prescriptions used to treat ongoing conditions (maintenance drugs), you are guaranteed the lowest price by using the mail service pharmacy to purchase up to a 90-day supply of your prescription. To place your mail service pharmacy order, call Be prepared to provide the following information to receive a price quote for each prescription: Your member number from your card The name of the medication The strength and dosage form (tablets, capsules, etc.) The quantity you wish to purchase (up to a 90-day supply) You will need to provide an original signed prescription for your first mail order 6. If you have any questions about the pharmacy program, please call Member Services. (The pharmacist may make the call for you if he or she has questions.) 3. No savings will apply through the hospital network if a provider is asked to process a claim with member s insurance carrier. 17 HealthCare Savings Program Member Services: (toll-free) HealthCare Savings Program Member Services: (toll-free) 6

8 Vision 15% to 60% off retail prices on eyeglasses, contact lenses, and nonprescription sunglasses Access to a national network of more than 40,000 vision providers Your choice of independent optometrists, ophthalmologists, opticians, Pearle Vision, Target, Sears and Lenscrafters locations throughout the country Discounts on routine exams and contact lens exams 5% to 20% off retail prices for LASIK and PRK surgical procedures 1. A list of local providers is located in your fulfillment kit. For additional providers in your area, contact Member Services or visit the Services Center at 2. Present your membership card to the participating provider. 3. LASIK and PRK correction procedures are provided by the U.S. Laser Network. Members must first call Member Services for the nearest facility and to receive authorization for the discount. 4. You must pay the total bill, less the applicable discount, at the time service is given. Physicians Access to more than 360,000 physicians nationwide Save 15-40% for the following: Primary care physicians Family medicine Pediatrics OB/GYN Specialists Cardiology Neurology Podiatry Ophthalmology ENT Surgery Urology Internal medicine Orthopedics and more than 20 other specialties and subspecialties. Members simply locate a Participating PPO Provider by calling a Melaleuca HealthCare Savings Program Representative at and make an appointment. Members need to present their Membership Card at the time of service. Physicians will call a toll free number and enter the Member's information, the Physician's information, and procedure codes. The discounted amount is calculated via telephone, and the Physician collects the contracted amount, in full, from the Member. You must pay the total bill, less the applicable discount, at the time service is rendered. The discount applies to services provided by the physician and performed in the physician's office. To locate the providers most convenient for you, call Member Services toll-free at or visit Melaleuca has been very selective in building its networks. We know there are many qualified providers who we have not yet contacted. We appreciate referrals from members like you. If you will call your Member Services Representative at and give the name and address of your provider, we will extend an offer to that provider to join the network. Unfortunately, we cannot guarantee acceptance by either the program administrator or the provider. 7 HealthCare Savings Program Member Services: (toll-free) HealthCare Savings Program Member Services: (toll-free) 16

9 Hearing Diabetes Supplies, Durable Medical Equipment and Over the Counter Drugs Competitive prices on non-prescription, over the counter and Durable Medical Equipment items. Trained distribution staff delivers the patient's equipment and set it up for safe and easy use by the patient. Online catalog and ordering system. 1. Call or visit online at 2. Place your order for the diabetic supplies you will need based upon the testing schedule your physician has recommended. 3. Pay for your order from one of your multiple options available credit card, check, and money order. For individuals with Flexible Spending Accounts (FSA), the online store only contains items that are eligible to be purchased through your FSA. You will receive a receipt to give you your Human Resources Department or Flex Administrator for reimbursement. 4. Your package will be shipped to you based upon the delivery method you select. Free delivery when your order is $15 or more. At least 20% off the provider s charge for conventional hearing aids 10% off programmable/digital hearing aids 20% off custom earmolds, repairs, and related products Access to the largest national network of independent audiologists with over 1,500 locations Discounted charges for hearing evaluations No charge for annual follow-up, cleaning, and checking of hearing aids purchased through the plan 1. A list of local providers is located in your fulfillment kit. For additional providers in your area, contact Member Services or visit the Services Center at 2. Present your membership card to the participating provider. 3. You must pay the total bill, less the applicable discount, at the time service is given. 15 HealthCare Savings Program Member Services: (toll-free) HealthCare Savings Program Member Services: (toll-free) 8

10 Dental Save 15-30% on routine dental procedures and specialty services like crowns, bridges, and orthodontics* Accepted by more than 63,000 dentists nationwide Final savings will depend upon the type of dental work performed as well as your geographic location 1. A list of local providers is located in your fulfillment kit. For additional providers in your area, contact Member Services or visit the Services center at 2. Present your membership card to the participating provider. 3. You must pay the total bill, less the applicable discount, at the time service is given. *Actual savings will vary based upon procedures, geographic location, and the dentist s contracted discount rate. Long Term & Elder Care Finding quality elder care providers and services isn t a problem anymore. The answers to these and countless other questions about elder care are as close as your telephone, including information about: Geriatric case management Home health care Retirement communities Assisted living facilities Homemaker services Adult daycare Counseling and support Transitional care Hospice Rehabilitation facilities Nursing homes These services are available for you or for your parents and inlaws. Simply call our toll-free hotline and one of our Elder Care Advocate professionals will access your needs, discuss your options, or assist in actual care planning. 1. Call Member Services and one of our health care professionals will assess your needs, discuss your options, or assist in actual care planning. 2. Once eligibility is established, you will be asked for information that will assist the representative in directing you to the appropriate specialist. 3. The trained and experienced specialist will help you understand the issues related to caring for an older person and assist in helping you make the right choices. 4. We offer knowledgeable, caring, and cost-effective solutions for your long-term care needs. 9 HealthCare Savings Program Member Services: (toll-free) HealthCare Savings Program Member Services: (toll-free) 14

11 Health Club Network There are 2,500 clubs in the nationwide network of high-quality fitness clubs and wellness centers Provides quality, value, access, and choice for members Participating health clubs have all met the American College of Sports Medicine s Health and Safety Standards As a HealthCare Savings Program member, you are guaranteed to receive the lowest membership rate for the type of health club membership selected. (This program may apply to new health club members only. Current health club members should check with the club s membership department to see if the lowest membership rate is applicable to them and their rates can be adjusted.) 1. For participating health clubs in your area, contact Member Services or visit the Services Center at 2. Present your membership card to the participating provider. 3. HealthCare Savings Program members receive an unlimited number of oneweek introductory membership certificates (not to be combined at the same club) free of charge. 4. You can try out several different clubs to make sure you re joining the one that offers the programs and amenities you want. 5. You will be able to use the facility giving you the opportunity to truly experience the club before committing to a membership. Chiropractic Save up to 25% off billed charges Access to discounts at more than 14,000 chiropractors nationwide Our extensive network of chiropractors has demonstrated high levels of professional expertise, education, and ethics in their practices Savings will vary based on your geographic location and the type of service given 1.A list of local providers is located in your fulfillment kit. For additional providers in your area, contact Member Services or visit the Services Center at 13 HealthCare Savings Program Member Services: (toll-free) HealthCare Savings Program Member Services: (toll-free) 10

12 Behavioral Counseling Save 10-30% or more off normal billed charges Access to a national, comprehensive network of more than 20,000 mental health care professionals At a time when Americans are under more stress than ever, both at home and on the job, individuals and families often require the care of professionally trained and certified mental health care providers At every stage of treatment, patients receive the appropriate counseling and problem solving required to return to more productive lives both at home and in the workplace Our network of counselors, MDs, and PhDs handles a multitude of issues, including the following: Conflicts at work or home Codependency Eating disorders Personal relationship issues Sexual/physical/emotional abuse Marital and family issues Chemical dependency Stress or anxiety Child or elderly care issues Depression or grief 1.For participating providers in your area, contact Member Services or visit the Services Center at 2. Contact Member Services to set up an appointment with a participating provider that best suits your needs. 3.You must pay the total bill, less the applicable discount, at the time service is given. 24-Hour Nurse Line Illnesses and medical emergencies can strike anytime, anywhere; for this reason, our 24-Hour Nurse Line is staffed 365 days a year by registered nurses ready to assist you Provides detailed information on a range of concerns, including diagnosis interpretation, suggestions for using area support groups, behavioral counseling, and appropriate treatment for minor emergencies or illnesses This valuable service is provided for you and your dependents 1.When you or someone in your family has a health-related question, call the tollfree number listed on the back of your membership card. You will speak with a registered nurse who will answer your questions and provide you with health and medical information over the phone. Of course, all interactions are kept strictly confidential. 2.You can get information about symptoms, medical terms, procedures, diseases, treatment options, and medications. You can receive referrals to support groups or other organizations related to the medical topic you are pursuing. 3.Our nurses are eager to help. Call the 24-Hour Nurse Line whenever you want, as often as you want. It s fast, it s convenient, and it s always confidential. Listen to Audio Messages By simply calling the toll-free number, you can listen to the health information library s recorded messages on a wide variety of health and well-being issues. VERY IMPORTANT! In life-threatening emergencies, call 911 or go directly to the nearest hospital emergency room for treatment. 11 HealthCare Savings Program Member Services: (toll-free) HealthCare Savings Program Member Services: (toll-free) 12