Transcript What are my 2010 Health Net Medical benefits?

Your 2010 Health Net Benefits
University of California Faculty & Staff
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Topics Covered
Why Health Net? – an introduction
How does my Health Net HMO plan work?
What are my 2010 Health Net Medical benefits?
What are my NEW 2010 Health Net Prescription Drug benefits?
What is Decision PowerSM?
What extras are available to me as a Health Net member?
What information can I find on the web?
How can I maximize my benefits?
Where do I go for more information?
Please consult the UC Evidence of Coverage booklet for complete benefit details.
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Why Health Net?
Health Net has a proven track record of providing UC employees
with a quality health plan that offers excellent value.
• Health Net plans have been offered continuously for the past 27 years
to University of California Faculty & Staff
• Health Net received an “Excellent” accreditation rating - the highest
level - from the National Committee for Quality Assurance (NCQA)
• 2007 and 2008 California Office of the Patient Advocate (OPA)
survey ranked Health Net the number one major network-model
carrier in clinical quality and service.
• UC members are increasingly satisfied with Health Net
• More UC members are enrolled in Health Net than any other health
plan!
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Introduction to Health Net
Health Net is working in collaboration with the University of California with
the following goals in mind:
Sustainable – being eco-friendly in the resources we choose
and use
Savings – providing quality benefits at a good value
Smart – giving you the coverage and tools to take charge and make
the most of your health
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Introduction to Health Net (cont’d)
IF YOU NEED A HEADLINE, THIS IS IT.
Reasons why Health Net is a Better Decision
A California leader in managed health care, Health Net offers:
• One of the largest networks of doctors and hospitals in California,
including all the UC Medical Centers and Pharmacies.
• Predictable costs with fixed copayments for services. Preventive
care and immunizations are covered at 100% for all covered members.
• Financially sound, Health Net is ranked #165 in the 2009 Fortune
500 list of companies.
• Decision PowerSM, a program that brings together the information,
resources and personal support that fit you, your health and your life.
• Dedicated support for UC members at www.healthnet.com/uc and
1-800-539-4072.
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How does my Health Net HMO plan work?
IF YOU NEED A HEADLINE, THIS IS IT.
1.
Each covered family member selects a Primary Care Physician (PCP)
2.
Each Primary Care Physician is affiliated with a Participating Physician
Group (PPG)
3.
Your PCP will coordinate your care and access to any needed specialty
care with the PPG.*
4.
Generally, all your care will be handled within the PPG.
 Logon to www.healthnet.com/uc and click “Where do I Start”?” to access
the ProviderSearch tool.
*
For annual OB/GYN visits, no referral is needed. Rapid Access allows your physician to
refer you directly to certain specialists within your PPG.
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University of California 2010 Benefits-At-AGlance
IF
YOU NEED A HEADLINE, THIS IS IT.
Health Net HMO – Medical Benefits
Copayment
Doctor office visit
$15 per visit
Specialist office visits
$15 per visit
Periodic health evaluations/immunizations
Covered in full
X-rays and lab procedures
Covered in full
Maternity care
Covered in full
Urgent care
$50 per visit
$15 (if owned and operated by your PPG)
Hospitalization
$250 per admission
Emergency Care
$50 per visit – waived if admitted
Please consult the UC Evidence of Coverage booklet for complete benefit details.
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University of California 2010 Benefits-At-A-Glance
(cont’d)
Health Net HMO – Medical Benefits
Copayment
Deductible
None
Calendar year out-of-pocket maximum (one
member)*
$1,000
Out-of-pocket maximum (two members)*
$2,000
Out-of-pocket maximum (family – three or
more members)*
$3,000
Lifetime maximum
None
* Benefits that do not apply to the out-of-pocket maximum include: prescription drug copays and
services not covered by the plan. Please consult the UC Evidence of Coverage booklet for complete
benefit details.
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University of California 2010 Benefits-At-A-Glance
(cont’d)
IF YOU NEED A HEADLINE, THIS IS IT.
Health Net HMO – Prescription Drug Benefits
Copayment
Retail
(up to a 30-day supply)
NEW! $5 Generic
$20 Brand Formulary
$35 Non-formulary
Mail order program or UC walk-up services at
designated UC Pharmacies
(up to a 90-day supply for maintenance drugs )
NEW! $10 Generic
$40 Brand Formulary
$70 Non-formulary
New benefits for 2010! Generic drug copay reduced from $10 to $5 at retail;
from $20 to $10 for mail order.
Please consult the UC Evidence of Coverage booklet for complete benefit details.
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Health Net Mail Order Program for Maintenance Drugs
Save $20-$140 per year per prescription!
IF YOU -NEED
A HEADLINE, THIS IS IT.
With mail order pharmacy you get 3 months of medication for the price of
two – that is 4 months of medication free each year or a savings of $20140 per prescription per year!
Getting started is easier than you may think. There are many options
for you to get signed up for the program:
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Call CVS Caremark directly at 1-888-624-1139. They will contact your
doctor to get your prescription information. When you call, be sure to have
the medication name and your doctor's information.
Order online. You will be prompted to enter your Healthnet.com username
& password or to Register. Next, click on "New Mail Order Prescriptions" and
then go to Fast Track.
Download, print and mail in the order form. If you do not have access
online, call 1-800-539-4072 and Customer Service will mail you a form.
Use the Walk-Up Service available at UC designated UC Medical Center
Pharmacies.
New! CVS Caremark may also be contacting you during the year to
help you get started with the Mail Order Program.
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What is a Formulary?
IF YOU NEED A HEADLINE, THIS IS IT.
It’s a list of medications that are generally accepted by a health
plan also referred to as the Recommended Drug List (RDL).
Health Net’s Pharmaceutical & Therapeutic (P&T) committee designs
and maintains the RDL:
• Committee includes community physicians representing different
specialties
• Therapeutic evaluation
• Evidence based medicine
• Best practices
• Develop policies on medication use
• Outcomes
You can access Health Net’s most up-to-date Recommended Drug List online
at www.healthnet.com/uc, click Pharmacy Benefits
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Did you know?
For every 100 people in the United States …
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60 are sedentary
25 smoke
20 are at least 20% overweight
27 have heart disease
10 have diabetes
50 have high cholesterol
24 have high blood pressure
50 feel distressed
…Decision PowerSM is the bridge to action.
Source: “Stress at Work,” National Institute for Occupational Safety & Health
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Decision Power: Your Health, Your Time, Your Choice
When it comes to your health, there’s more than one right answer.
When you choose Health Net, you get more than health care coverage. You get Decision
Power to help you…
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boost your health
identify potential risks
learn about treatment options
help prevent chronic problems
address serious medical concerns
and so much more
Use Decision Power online. Or by calling a Health Coach. Try multiple resources at once,
or one at a time. 24 hours-a-day, seven days-a-week, Decision Power helps you protect
your health in the way that works best for you.
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Decision Power: Support
Staying healthy is just as important as getting well. Making the most
of your health is what Decision Power is all about. Throughout every
stage of health, Decision Power is here for you:
• Wellness & Prevention for healthier living – learn how to improve
blood sugar levels to minimize diabetes risk, boost fitness levels, eat
heart-healthy foods, & more.
• Preference Sensitive Conditions – guidance and options where
multiple treatment approaches exist and the right one depends on your
specific condition, personal preference and values for conditions such
as chronic back pain, migraines, arthritis, & more.
• Chronic Conditions – support and resources for people living with
ongoing health challenges such as diabetes, asthma, depression, heart
disease, & more.
• Severe Illness – support and care options when a medical condition
takes center stage, requiring in-depth support (e.g., home care, skilled
nursing, behavior health care)
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Decision Power Spotlight: Cardiometabolic Syndrome
We've all heard the news, seen the magazine covers. Americans are getting bigger and
the resulting health issues are growing. In fact, 20-25% of the U.S. population has
Cardiometabolic Syndrome - a combination of three or more of six risk factors that
predict diabetes, heart disease and colon cancer:
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Waist > 40” for men or > 35” for women
Blood pressure > 130/85
Fasting blood sugar > 100
Triglycerides > 150
HDL (good) cholesterol <40 men or <50 women
Smoking
If unchecked, these factors can lead to a serious disease. Decision Power can help you
reduce your risk. Call anytime to talk with a Health Coach and find out what steps you
can take to avoid Cardiometabolic Syndrome.
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Health Net Extras: Decision PowerSM Healthy
Discounts
IF YOU NEED A HEADLINE, THIS IS IT.
Our Decision Power Healthy Discounts program rewards you for
being a member. Save on these health-related products, services and
more.
• Alternative Care Services through American Specialty Health
Networks (ASH) such as acupuncture, chiropractic, and massage
• Fitness Club Discounts through ChooseHealthyTM
• Weight Management through Weight Watchers® or Jenny Craig®
• Emergency Medical Information Service through MedicAlert
• Kids Sport Gear through Sports4kids.com
• Eye Care discounts through EyeMed Vision Care®
• Health and Online Resources through beyou.tv/healthnet
• and more!
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Custom Health Net website for UC – www.healthnet.com/uc
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Custom Health Net website for UC – Post Login
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Custom Health Net website for UC – Post Login (cont’d)
oh, let me count the ways…
1. Order ID Card(s)
2. Print a temporary ID
card(s)
3. View address/phone on
file
4. Search and/or change
your medical group (PPG)
5. View contact information
for your medical group
(PPG)
6. Change your PPG
7. Search or view contact
information for your doctor
(PCP)
8. Change your PCP
9. Access all member
discounts
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Enroll in Mail Order (MO)
Search the Formulary
Refill MO prescriptions
Change MO billing info
Check status of MO
prescription
Create a Personal Health
Record (PHR)
Obtain claim forms
See some claims history
File an Appeal or
Grievance
View your Rx claim
history
View your medical claim
history
21. Access Decision Power
22. Talk to a Health Coach
23. Learn about different
diseases
24. Start a quit smoking
program
25. Get decision support
26. Start an exercise
program
27. Research the health
library
28. Compare hospital quality,
price, mortality rates!
29. Compare medical groups
30. Much, much,much
more!
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Health 101 Tips…to maximize your benefits
1.
Update your address and phone number with UC
(http://atyourservice.ucop.edu)
2.
Call your Primary Care Physician (PCP) and get a check up.
3.
Know when your preventive screenings are due.
4.
Register at www.healthnet.com/uc, find out about cost savings tips and
more.
5.
Use generics and take advantage of your new prescription drug benefits.
6.
Use the Mail Order or UC Walk-up program for maintenance drugs and
receive one month free (pay only 2 copays for a 90-day supply).
7.
Call your PCP in an urgent situation. It may be more appropriate for
you to go to an Urgent Care Center rather than an Emergency Room.
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Take charge of your health - call Decision PowerSM today.
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Where do I go for questions?
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Log on to the Dedicated UC Custom website at www.healthnet.com/uc
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Talk to a Dedicated UC Customer Service representative
(1-800-539-4072)
– Dedicated team available 8 a.m. to 6 p.m. to answer medical and
prescription drug questions
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Talk to a Decision Power Health Coach (1-800-893-5597)
– Personal coaching available 24/7
– Nurses, registered dietitians, respiratory therapist
– Ask to speak to the same Health Coach
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Talk to CVS Caremark’s Mail Order Pharmacy line (1-888-624-1139)
– Representatives are available 24/7 to answer questions about
Mail Order Pharmacy
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Health Net Disclaimers
Decision PowerSM is not part of Health Net’s commercial medical benefit plans nor affiliated with Health Net’s
provider network and it may be revised or withdrawn without notice. Decision Power is part of Health Net’s
Medicare Advantage benefit plans but is not affiliated with Health Net’s provider network.
Decision Power services, including Health Coaches, are additional resources that Health Net makes available to
enrollees of Health Net of California and Health Net Life Insurance Company. Decision Power Healthy
Discounts is not part of your Health Net benefit program and is not intended to take the place of any covered
benefits. Decision Power Healthy Discounts providers are independent businesses.
CA62548 (10/09) Health Net of California, Inc. and Health Net Life Insurance Company are subsidiaries of
Health Net, Inc. Health Net® is a registered service mark of Health Net, Inc. A Better Decision SM and
Decision PowerSM are service marks of Health Net, Inc. All other trademarks remain the property of their
respective companies. All rights reserved.
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