Transcript 2014_15 Aetna Presentation

TRS-ActiveCare Member Website
www.trsactivecareaetna.com
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Welcome to Aetna
Just a little about what we will do for you . . .
It’s all about the extras!
Not your average service!
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 Concierge Customer Service
 Enhanced Clinical Services
Dedicated Care Advocate Team
Disease Management Program
Beginning Right Maternity
Management Program
24-Hour Nurse Information Line
Teladoc
Online resources
Aetna Navigator member portal
Aetna mobile app
My iTriage
Personal health record
Simple Steps to a Healthier Life
Discount programs
We are here for you!
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Learn about our providers
ID cards
Transition of Care needs
What to expect
How to reach us
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TRS-ActiveCare Customer Service
Aetna Health Concierge
Aetna Concierge is a high-touch member service model delivering a simple, more
personalized and seamless experience for members. Every Concierge not only
takes member calls — they take member calls personally.
Highlights Include:
 Dedicated member service team trained on TRS-ActiveCare culture and goals
 First Impression Treatment offers first time callers an opportunity to review
plan benefits, programs, resources and even a guided tour of our online system
 Warm transfers to Aetna programs
 Clinical and other health-action alerts
 Appointment scheduling
Whether you need a quick answer, help to untangle a difficult issue, or someone
to explain your benefits - you have an advocate dedicated to your needs.
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Enhanced Clinical Programs
Care Advocate Team
A dedicated care advocate team supports everything from clinical precertification and concurrent
review - to acute care management. Through our predictive modeling tools, expanded triggers, and
monitoring of inpatient admissions on a daily basis, we find the individuals who need our help and
support them through a single-nurse approach. We help employees and their families take advantage
of the benefits available to them. This team also includes a social worker to ensure we can help
members with all of their needs.
Disease Management
The Aetna Health Connections program identifies and continually monitors members who have chronic
conditions. This team supports members while they reach their optimal health goals by using evidence
based clinical tools and delivering individualized actions. This is strictly a voluntary program and is
available both online and telephonically.
Beginning Right Maternity Management Program
The Beginning Right Maternity program is voluntary and designed to assist eligible female members
achieve a healthy term delivery. The program provides education and outreach focused on identified
risk factors including but not limited to: diabetes, hypertension, hyperemesis, smoking, a history of
preterm labor or delivery, and the timing of elective deliveries.
24-Hour Nurse Information Line
A 24/7 toll-free number that provides members with immediate access to a registered nurse for health
information. Member’s can also e-mail a nurse through a secure e-mail using Aetna Navigator.
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Teladoc is an affordable alternative to emergency room and urgent care. Many common
medical issues can be resolved through the convenience of just a phone call – 24/7/365
Highlights Include….
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Copays waived for ActiveCare 2 and ActiveCare Select plans; only $40 for ActiveCare 1-HD plan.
Board certified providers specializing in family practice, internal medicine, emergency medicine and
pediatrics.
Common diagnosis and treatment of sinusitis, upper respiratory infection, urinary tract infection,
bronchitis, otitis media, influenza and the common cold.
Consults available wherever the patient is - at home, at work, or travelling within the United States.
Guaranteed member call back within 60 minutes! The average call back time is 20-30 minutes.
Diagnosis, recommended treatment and prescriptions ordered when appropriate.
A copy of the consult record will be sent to the member's PCP upon request.
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Added Savings and Value with Quest Diagnostics
Take advantage of extra savings when you need a lab test. Quest Diagnostics has agreed
to lower rates for Aetna members. That helps save on out of pocket costs.
• TRS-ActiveCare 2 and TRS-Active Select Plans will have Quest lab services paid at
100%.
• TRS-ActiveCare HD-1 members will save on out of pocket costs for services from
Quest lab by having reduced rates.
• Request use of Quest Diagnostics to get these great savings!
New Plan Option - TRS-ActiveCare Select
ActiveCare Select is an affordable health plan option made available for the 20142015 plan year. With ActiveCare Select, you are free to see any network provider
without a referral. However, there is no coverage if you see a provider who is not in
the plan network. The only exception is for a true medical emergency.
There are two networks that make up the ActiveCare Select plan. Benefits are the
same regardless of where the employee lives.
Aetna Whole Health is an Accountable Care Organization (ACO) network. With Aetna Whole
Health, available to you is a health care team of doctors, nurses, therapists and other
providers whose goal is to work together with you to meet your unique needs and keep you
healthy.
If you live in or around San Antonio, Dallas, Austin, or Houston (counties listed
below) and elect ActiveCare Select as your 2014-2015 plan option, you will be
required to use providers who belong to the Aetna Whole Health network. If you
do not live in one of the counties listed, you will be required to use providers listed
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in the Aetna Select (Open Access) network.
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Aetna Navigator®
The go-to resource for managing health
 Members access a secure, personalized website to:
 Find a doctor or facility
 View claims and Explanation of Benefits (EOBs)
 Compare costs for office visits, tests and procedures
 Complete a health risk assessment and participate in online wellness programs
 Store and share personal health history and access a Personal Health Record
 Track health goals
 Find forms and order ID cards
 Access information on discounts:
 Fitness memberships and equipment
 Vision services and products
 Natural products and services
 Hearing exams, hearing aids and batteries
 Weight-management programs
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Helpful On-line Tools and Resources
Personal Health Record (PHR) a secure, online
My iTriage stores health
information including insurance,
medications and dosages, conditions
and more, securely and conveniently
online. Assists with treatment
options and decision support.
Aetna Mobile this smartphone app can check
tool that connects people to their health
information, helping them take a more active role in
managing their health. It offers an easy, convenient,
and organized way to store health history and
information. When members share PHR information
with their health care providers, it can help decisionmaking with better access to patient data.
Simple Steps to A Healthier Life an online
symptoms, find a doctor, get a cost estimate or make health risk assessment and online coaching tool that
provides new and simple ways to manage health and
an appointment.
set goals. The online coaching sessions help
members meet health goals, at their own pace, with
their specific health and wellness needs in mind.
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Transition of Care
For employees in an active course of treatment with a non-par provider
 Examples of an active course of treatment include, but are not limited to:
 3rd trimester pregnancy
 Ongoing treatment plan such as chemotherapy or radiation therapy
 Terminal illness
 Conditions requiring multiple surgeries
 Recent surgery
 Outpatient treatment for mental illness or substance abuse
 Ongoing or disabling condition that worsens
 Organ or bone marrow transplant
 Members should contact the TRS Customer Service team to obtain a form
 Impacted members should submit their request to continue treatment with a nonpar provider 90 days before your effective date of coverage
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HMOs
FirstCare Health Plans
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Why Choose FirstCare?
•Local offices; Texas-based customer service
•Comprehensive network of quality physicians
•No referral to network specialists
•Coverage for dependents living outside service area
•Worldwide emergency care
•New wellness program & improved provider search
•In TRS-ActiveCare since 2003
•Now serving 10 new counties
ID Card Timing
• All covered employees will receive cards
beginning in mid-August
• Annual Enrollment changes received by Aetna
by August 15 will result in cards reflecting
coverage updates being issued by end of
August
• Those making changes later will receive
replacement cards as processed
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Important Information For Mail Service Pharmacy Users
Caremark is your new mail service prescription provider.
Starting 9/1/2014, Caremark will become your new prescription drug provider. Feel free to register at www.caremark.com
or call TRS-ActiveCare Customer Service toll-free at for more information after 9/1/2014.
Existing refills with Express Scripts
Caremark will not have access to your mail service refill information until 9/1/2104. To avoid any delay in processing during
this transition, we recommend you choose one of the following:
•Ask your doctor or other prescriber to write a new prescription for up to a 90-day supply, plus refills when appropriate.
Mail this prescription to Caremark using the enclosed mail service order form.
•Send your refill request after 9/1/2014.
Ordering a new prescription through mail service
Ask your doctor or other prescriber to write two prescriptions: one for immediate short-term use to be filled at a local
network pharmacy, and one for a 90-day supply plus refills to be filled through Caremark Mail Service Pharmacy. You can
send in a mail order form www.caremark.com, use the FastStart tool at ww.caremark.com, or call FastStart at 1-800-8750867.
How to order refills from Caremark in the future:
Once you have received your first prescription from Caremark Mail Service Pharmacy, you can choose one of the following
ways to request a refill:
•Online: Log on to www.caremark.com and register if you haven’t already done so. Then click on “Refill a Prescription”.
•Mail: Simply complete the enclosed mail service order form or find one online at www.caremark.com.
•Phone: Call TRS-ActiveCare Customer Service and speak to a Customer Care representative toll-free at 1-800-222-9205.
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ANY QUESTIONS?
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