individual and family health insurance plans

Transcription

1 CALL TODAY: (800) MercyCare has a plan for you. individual and family health insurance plans Live well. We ll insure you do.

2 page 1

3 About us MercyCare s individual 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. We are proud to say that MercyCare, as part of Mercy Health System, received the Malcolm Baldrige National Quality Award, the nation s highest presidential honor for quality and organizational performance excellence. Did you know that MercyCare: 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? Manages over 40,000 members? Is one of the largest HMO plan providers in the area? To see more of what MercyCare Health Plans has to offer, visit MercyCareHealthPlans.com. 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) Daily, 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 Quality, affordable health care close to home 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 it. 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 frequently asked questions Why should I have health insurance? No one plans to get sick or hurt, but most people need medical care at some point. MercyCare Health Plans individual plans cover many of your expected and unexpected health care costs, and protect you from very high expenses. Health insurance is a contract between you and MercyCare Health Plans. You buy a plan that best meets your needs, and MercyCare Health Plans pays part of your medical costs when you get sick or hurt. There are other important benefits of health insurance. MercyCare s individual plans provide free preventive care, vaccinations, screenings and check-ups. We also provide prescription drug coverage. Do I have to have health insurance? If you don t have coverage in 2015, you ll pay the higher of these two amounts: 2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan. $325 per person for the year ($ per child under 18). The maximum penalty per family using this method is $975. Can I keep my doctor? If you currently see a Mercy doctor, you can continue to see him/her by choosing a MercyCare plan. Please note that different plans have different networks and providers. Networks include health care providers that a plan contracts with to take care of the plan s members. Depending on the type of policy you buy, care may be covered only when you get it from a network provider. When comparing MercyCare plans in the Marketplace, you will see a link to the list of providers in each plan s network. What if I have a pre-existing condition? Whether you need health coverage or have it already, the health care law offers new rights and protections that make coverage fairer and easier to understand. Essential health benefits for pre-existing medical conditions are covered under all Marketplace plans. No insurer can reject you, charge you more, or refuse to pay for essential health benefits for any medical condition you had before your coverage started. MercyCare plans do not contain exclusions for any pre-existing conditions. You ll pay the fee on the federal income tax return you file for the year you don t have coverage. page 7

9 What do essential health benefits include? Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services Hospitalization Maternity and newborn care (care before and after your baby is born) Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) Prescription drugs Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills) Laboratory services Preventive and wellness services and chronic disease management Pediatric services Essential health benefits are minimum requirements for all MercyCare plans. What is the health insurance marketplace? Also sometimes called the Exchange, the Marketplace is a new way to find health coverage that fits your budget and meets your needs. With one application, you can see all your MercyCare options and enroll. When you use the Marketplace, you ll fill out an application and find out if you can get lower costs on your monthly premiums for private MercyCare insurance plans. You ll find out if you qualify for lower out-of-pocket costs through Medicaid or the Children s Health Insurance Program (CHIP). Find out more and apply at MercyCareHealthPlans.com. How do I find out if I qualify for assistance? When you buy health insurance coverage in the Marketplace, you may be able to get a premium tax credit that lowers what you pay in monthly premiums. This will depend on your 2015 household size and income. You can apply part or all of this tax credit each month to your premium payments. The Marketplace will send your tax credit directly to your insurance company, so you pay less for your premiums each month. The Federal Poverty Level (FPL) is the measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits. If your 2015 income falls within the following ranges you ll generally qualify for a premium tax credit. The lower your income is within these ranges, the bigger your credit. To see the ranges turn to page 10. Call a MercyCare sales representative at (800) to see if you qualify for additional premium assistance. What is Cost Sharing Reduction (CSR)? A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. You can get this reduction if you get health insurance through the Marketplace, your income is below a certain level, and you choose a health plan from the Silver plan category If your income is at least 100 percent and not more than 250 percent of the Federal Poverty Level, you are eligible for special plans with Cost Sharing Reductions to lower your out-of-pocket costs, in addition to the Advanced Premium Tax Credits. Only the Marketplace can determine if you are eligible for, and how much you can receive in, Cost Sharing Reductions. page 8

10 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 9

11 understanding income levels Household size Percent of federal poverty line (FPL) 100% 150% 200% 250% 300% 400% one $11,670 $17,505 $23,340 $29,175 $35,010 46,680 two 15,730 23,595 31,460 39,325 47,190 62,920 three 19,790 29,685 39,580 49,475 59,370 79,160 four 23,850 35,775 47,700 59,625 71,550 95,400 five 27,910 41,865 55,820 69,775 83, ,640 six 31,970 47,955 63,940 79,925 95, ,880 Individuals with a household income under 400% will receive a tax credit (subsidy) to help pay monthly premiums. Individuals with a household income under 250% will receive a cost share reduction which will reduce your deductible and maximum out-of-pocket. If you want to receive tax credit or cost share reduction, you need to purchase your individual MercyCare plan at healthcare.gov. (Please follow the steps on page 12.) If you don t qualify or don t want to receive a tax credit, you can purchase directly from MercyCare by calling (800) page 10

12 page 11

13 >> get health coverage in 4 steps How do I apply for Marketplace coverage? You can apply for health coverage, compare all your options and enroll in a plan in one streamlined application through the Marketplace. You can go to the Marketplace by visiting MercyCareHealthPlans.com and see the health coverage options available to you. Then you can compare plans side-by-side and choose a plan that meets your needs and fits your budget. 1 Set up an account. You ll provide some basic information to get started, like your name, address and address. 2 Fill out the online application. You ll provide information about you and your family, like income, household size, current health coverage information and more. This will help the Marketplace find options that meet your needs. 3 Compare your options. You ll be able to see all the options you qualify for, including private insurance plans and free and low-cost coverage through Medicaid and the Children s Health Insurance Program (CHIP). The Marketplace will tell you if you qualify for lower costs on your monthly premiums and out-of-pocket costs on deductibles, copayments and coinsurance. You ll see details on costs and benefits before you choose a plan. 4 Enroll. After you choose a plan, you can enroll online and decide how you pay your premiums to your insurance company. If you or a member of your family qualify for Medicaid or CHIP, a representative will contact you to enroll. If you have any questions, there s plenty of live and online help along the way. Ready to enroll? Call (800) or apply online at MercyCareHealthPlans.com. page 12

14 page 13

15 When does this new health care insurance program take place? Key dates you ll want to mark on your calendar: Marketplace open enrollment has started You can compare and select from the different insurance plans that MercyCare offers. After reviewing your options, you can enroll in a plan that fits your needs and budget. You ll also learn if you can get lower costs on your health insurance before you enroll in a plan through Medicaid or the Children s Health Insurance Program (CHIP). January 1, 2015: Health coverage can start If you enroll in a MercyCare plan before December 15, 2014, and make your first premium payment, your new health insurance starts January 1, During the rest of open enrollment, if you enroll between the 1st and 15th day of the month and pay your premium, your coverage begins the first day of the next month. So, if you enroll on January 10, 2015, your coverage begins February 1, If you enroll between the 16th and the last day of the month and pay your premium, your effective date of coverage will be the first day of the second following month. So, if you enroll on January 16, 2015, your coverage starts on March 1, February 15, 2015: Open enrollment for 2015 health insurance ends Be sure to visit MercyCareHealthPlans.com or the Marketplace and enroll in a plan before this date. page 14

16 page 15

17 MercyCare has a plan for you! We now have nine individual plans tailored to suit your needs and those of your family. The plans are laid out in metal tiers and detailed on pages Individual health 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* 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. **If your income level is between 100% to 250% FPL, you might qualify for Cost-sharing subsidies to reduce out-of-pocket costs. Must enroll in Silver plan for cost-sharing subsidies shown on pages page 16

18 Gold MercyCare HMO Gold Option A MercyCare plan details Deductible $2,000 single/$4,000 family Maximum out of Pocket $3,500 single/$7,000 family Coinsurance 20% after deductible Primary Care Visit $25 Specialist Visit $25 Preventive Services Covered at 100% ER Visit $100 Urgent Care $35 In-network Prescription Drug $20/$40/$60/25% Silver MercyCare HMO Silver Option A Deductible $5,000 single/$10,000 family Maximum out of Pocket $6,350 single/$12,700 family Coinsurance 30% after deductible Primary Care Visit $30 Specialist Visit $30 Preventive Services Covered at 100% ER Visit $100 Urgent Care $35 in-network Prescription Drug $20/$40/$60/25% Bronze MercyCare HMO Bronze Option A Deductible $5,000 single/$10,000 family Maximum out of Pocket $6,350 single/$12,700 family Coinsurance 30% Primary Care Visit 30% coinsurance after deductible Specialist Visit 30% coinsurance after deductible Preventive Services Covered at 100% ER Visit 30% coinsurance after deductible Urgent Care 30% coinsurance after deductible Prescription Drug $20/$40/$60/25% after deductible page 17

19 MercyCare HMO Gold Option B MercyCare HMO Gold Option C $1,000 single/$2,000 family $1,000 single/$2,000 family $3,500 single/$7,000 family $3,000 single/$6,000 family 20% after deductible 20% after deductible $30 $30 $60 $60 Covered at 100% Covered at 100% $500 $250 $35 In-network $35 In-network $20/$40/$60/25% $10/$25/$50/25% MercyCare HMO Silver Option B MercyCare HMO Silver Option C $2,000 single/$4,000 family $3,000 single/$6,000 family $6,600 single/$13,200 family $6,350 single/$12,700 family 30% after deductible 30% after deductible $30 30% coinsurance after deductible $60 30% coinsurance after deductible Covered at 100% Covered at 100% $250 $500 $35 In-network 30% coinsurance after deductible $20/$40/$60/25% $10/$25/$50/25% MercyCare HMO Bronze Option B MercyCare HMO Bronze Option C $4,000 single/$8,000 family $6,250 single/$12,500 family $6,600 single/$13,200 family $6,250 single/$12,500 family 20% 0% 20% coinsurance after deductible No charge after deductible 20% coinsurance after deductible No charge after deductible Covered at 100% Covered at 100% 20% coinsurance after deductible No charge after deductible 20% coinsurance after deductible No charge after deductible 20% coinsurance after deductible No charge after deductible page 18

20 MercyCare plan details Silver - Cost Share Reduction MercyCare HMO Silver Option A ( % FPL) Deductible $0 single/$0 family Maximum out of Pocket $500 single/$1,000 family Coinsurance 0% Primary Care Visit $15 Specialist Visit $15 Preventive Services Covered at 100% ER Visit $100 Urgent Care $35 in-network Prescription Drug $20/$40/$60/25% Silver - Cost Share Reduction MercyCare HMO Silver Option A ( % FPL) Deductible $750 single/$1,500 family Maximum out of Pocket $1,500 single/$3,000 family Coinsurance 20% after deductible Primary Care Visit $25 Specialist Visit $25 Preventive Services Covered at 100% ER Visit $100 Urgent Care $35 in-network Prescription Drug $20/$40/$60/25% Silver - Cost Share Reduction MercyCare HMO Silver Option A ( % FPL) Deductible $2,500 single/$5,000 family Maximum out of Pocket $5,200 single/$10,400 family Coinsurance 30% after deductible Primary Care Visit $30 Specialist Visit $30 Preventive Services Covered at 100% ER Visit $100 Urgent Care $35 in-network Prescription Drug $20/$40/$60/25% page 19

21 MercyCare HMO Silver Option B ( % FPL) MercyCare HMO Silver Option C ( % FPL) $50 single/$100 family $0 single/$0 family $750 single/$1,500 family $1,000 single/$2,000 family 0% 10% $15 10% coinsurance after deductible $15 10% coinsurance after deductible Covered at 100% Covered at 100% $100 $100 $35 In-network 10% coinsurance after deductible $10/$25/$50/25% $10/$25/$50/25% MercyCare HMO Silver Option B ( % FPL) MercyCare HMO Silver Option C ( % FPL) $250 single/$500 family $500 single/$1,000 family $1,500 single/$3,000 family $1,500 single/$3,000 family 10% after deductible 20% after deductible $30 20% coinsurance after deductible $60 20% coinsurance after deductible Covered at 100% Covered at 100% $250 $250 $35 in-network 20% coinsurance after deductible $20/$40/$60/25% $10/$25/$50/25% MercyCare HMO Silver Option B ( % FPL) MercyCare HMO Silver Option C ( % FPL) $2,000 single/$4,000 family $2,000 single/$4,000 family $5,200 single/$10,400 family $5,000 single/$10,000 family 20% after deductible 20% after deductible $30 20% coinsurance after deductible $60 20% coinsurance after deductible Covered at 100% Covered at 100% $250 $500 $35 in-network 20% coinsurance after deductible $20/$40/$60/25% $10/$25/$50/25% page 20

22 page 21

23 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 MercyCareHealthPlans.com or call us at (800) to find out future dates. page 22

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