WI 2019 SG Guide
WI_2019_SG_Guide
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YOUR TIME MATTERS. So we’re making everything work harder for you. � � New, more affordable plan designs for your clients Simplified electronic process, from quoting through enrollment, for you Small Group product guide I Effective January 1, 2019 MAKING IT EASIER FOR YOU AND YOUR CLIENTS Your time should be focused on supporting your clients, consulting with them on the right health plan for their unique needs. What if it could be easier? Instead of paperwork, what if you could focus on building your business? WELCOME TO A BETTER WAY. HELPING CHOOSE THE RIGHT PLAN FOR YOUR CLIENTS SHOULDN’T KEEP YOU UP AT NIGHT Medical Pharmacy Dental Vision Life Disability Behavioral Health Your clients want their employees to have the right plan for their needs, while balancing the cost. We get it. We created a wider range of plan options with everything your clients and their employees need to make smarter health care choices, save time and manage costs. And our plans work together – medical, pharmacy, dental, vision, life, disability and behavioral health. You and your clients should feel good with that choice. � More plan choices to meet more budgets � A lower cost of care because of the strength and quality of our networks, so members can see doctors who deliver the most effective, efficient care � � — Members get whole-person coverage. Because our products are connected, doctors can work together behind the scenes to see a person’s overall health, leading to earlier detection of possible health issues Expanded medical and pharmacy portfolios: — ACA-compliant medical and pharmacy plans offering a wide range of member cost share options — Integrated Act Wise consumer-driven health plans that manage the medical benefits and the spending accounts A 5% discount on specialty premiums (dental, vision, life and disability) when clients purchase dental for the first time along with vision, life and/or disability � Better health and engagement for members – our digital health care platform integrates benefit information, clinical and claims data, and other digital tools to create a more personalized member experience MAKING IT ALL EASIER. YOU SPOKE, WE LISTENED. We know it hasn’t always been easy to work with us. From complicated and inconsistent processes to long implementation times, you’re frustrated and we hear you. We’ve been working hard to invest in, and develop, market-leading tools and technology with one goal in mind: to streamline, so you can save time and worry. The changes you’ll see: � Reimagined Producer Tool-box where you can do it all—in one place, no more going back and forth between portals � Full transparency on your clients’ status in the implementation process – no more guessing games � Simplified quoting so you can easily show your clients the cost of any combination of our medical, dental, vision, life and disability coverage � Integrated EmployerAccess makes it easier for you to perform maintenance on all of your clients with a single sign-on � Online enrollment submission for your clients and their employees that drastically reduces implementation times; no more paperwork But we didn’t change everything. You will continue to enjoy the support from the service teams you know and trust. And we’ve made their jobs easier with streamlined processes that are consistent across our company and technology that’s flexible so they can quickly answer your questions. It’s the best of both worlds so you can rest easy. WHAT’S NEW IN 2019 For employer groups with 1-50 employees Wisconsin SmartShopper Rewards Program SmartShopper is a program that rewards members for using lower-cost, high-quality locations for certain health care services and procedures. Because costs can vary by hundreds and even thousands of dollars, this program gives members a way to compare costs. If they choose a lower-cost location, they not only get a cash reward, but they save on out-of-pocket costs. Members just register with SmartShopper and go online or call to get help comparing costs and finding a lower-cost location nearby. After their procedure is complete and the claim is paid, they’ll get a check in the mail in about four to six weeks. LiveHealth Online Through LiveHealth Online, members can have video visits 24/7 with board-certified doctors using a mobile device or computer with a webcam. Doctors can assess common health issues like flu or allergies. They provide a treatment plan and send prescriptions to a pharmacy, if needed. Members can also talk with licensed therapists and psychiatrists. Therapists are usually available in four days or less. And, Spanish-speaking doctors take appointments 7 a.m. to 11 p.m., seven days a week using Cuidado Médico. 1 Prescription availability is defined by physician judgment. 2 Appointments subject to availability 1 2 Site of Service Cost of Care Program Where you go for your care matters. With the Site of Service program, members can use our provider search tools on anthem.com to find locations of independent providers that offer the same top-quality care at lower costs. Members can compare costs and choose how they want to save. Options for savings include lab services, ambulatory surgery, radiology and advanced diagnostic imagery and physical therapy. Care and Cost Finder Online Tool Members can use this quick and easy tool to make smart health care choices. Once they register at anthem.com they can compare provider costs and look up quality ratings — all in one place. The tools lets them search for doctors, facilities and pharmacies, and then gives cost estimates for over 400 common medical procedures (based on their health plan) for those providers. They can also rate a provider’s service and review ratings from other members. Anthem Health Guide This combination of customer service and health support offers members access to highly trained professionals (health guides) who consult with them and provide comprehensive help. Backed by smart technology and analytics, guides are closely linked to health professionals, such as nurses, health coaches, educators and social workers. Together, they can help members stay on top of their heath, get more value from their benefits and navigate the health care system more efficiently. Members can call, request a scheduled call back, email or have an online chat on a computer or through our app. If you'd like to know more contact your Anthem sales representative. ANTHEM AND YOU Working together to make health care easier for everyone, everywhere 1 in 3 Americans are covered by a Blue Cross and Blue Shield plan 1 More than 106 million members 96% of hospitals in the U.S. are in our plans 95% of providers in the U.S. are in our plans Local focus in 14 states Our local networks offer access to 95% of in-network doctors and 99% of in-network hospitals. When using network doctors members save big! And we reward our doctors for the quality of care they give not the number of patients they see. So members get more attention and better care. Benefits that travel Members have access to medically necessary emergency and urgent care across the country, and around the world, with the BlueCard® and Blue Cross Blue Shield Global Core program. 1 Blue Cross and Blue Shield Association website: About Blue Cross and Blue Shield Association (accessed May 2018): bcbs.com. 2 PERSONALIZED, EASY-TO-USE CARE MOBILE ANTHEM ANYWHERE APP Our innovative approach helps provide one of the best consumer experiences in the industry. The Anthem Anywhere app is better and faster than ever, making it easy for members to manage their care and coverage right from their smartphone. Enhanced Personal Health Care: Team-based approach for personalized, proactive, quality care. LiveHealth Online: 24/7 doctor care, right from a computer or mobile device. Easy online tools: Members can compare provider costs and quality, review/rate providers and get estimates on procedures. Cancer Care Quality Program: Helps doctors provide evidence-based care for members with fewer side effects Quick care options: Helps members understand their options when they need care right away. With a quick tap, members can: Access at-a-glance account information through My Summary1. Log in with their fingerprint via touch authentication2. Quickly find providers or urgent care centers. Save their ID card to their phone or share, fax or email an ID card directly to their provider. Chat confidentially with our Member Services team. Receive push alerts when there are changes to claims or other updates. 1 Not available on all plans. 2 Available for iOs 9 and above and for Android versions 6 and above. 3 BLUECARD MAKES GETTING CARE EASY ALMOST ANYWHERE CARE & COST FINDER: BETTER CARE AT A BETTER COST Members take health care benefits with them across the country and around the world. Anthem’s Care & Cost Finder tool gives members what they need to make smart health care choices. The BlueCard® program gives members access to doctors and hospitals almost everywhere, giving them peace of mind that they can find the health care provider they need no matter where they are in the world. And it’s easy! They can find a doctor, compare costs and look up quality ratings — all in one place. This online tool lets them: ® Within the United States Members are covered for medically necessary emergency and urgent care in all 50 states, whether care is needed in a rural or urban area. Search for doctors, specialists, hospitals, urgent care centers and other providers in their plan. Search for pharmacies or link to Anthem pharmacy benefits information. When you see a network provider there are: No claims forms to complete No payment upfront for medical services except for the usual out-of-pocket expenses. Explanation of benefits received from the }members’ plan. See cost estimates for over 400 common medical procedures (based on their health plan) to know how much they may pay. Rate a doctor’s service and review ratings from other members. Outside of the United States Members have coverage for urgent and emergency care. The Blue Cross Blue Shield Global Core Program makes it easy for members to locate a preferred provider through online tools and 24/7 Customer Service. Our PPO plans also include coverage for nonemergency care across the U.S. and while traveling abroad. 4 Use it anywhere! Members can register or log in at anthem.com or use our Anthem Anywhere app to start using the Care & Cost Finder tool. SMARTSHOPPER OFFERS MEMBERS CASH REWARDS When members shop smart for certain health services, they’ll get rewarded Prices for the same quality health services, like health screenings and surgeries can vary by hundreds to thousands of dollars depending on the location. With SmartShopper, members can get help finding lower-cost options when their doctor recommends a medical procedure so they can save money and earn cash rewards! Here’s all they need to do: Register with SmartShopper by calling or going to vitalssmartshopper.com. Compare prices at different locations. Choose from the list of lower-cost locations and book the appointment. Get cash back (in about 4-6 weeks), once the procedure is complete and the claim is paid. Here’s just some of the health services that qualify for rewards: Health service Reward Colonoscopy Up to $150 CT scan Up to $150 Gallbladder removal Up to $250 May not be available on all plans. Check with your Anthem Sales representative for details. 5 MEET ANTHEM HEALTH GUIDE Personalized customer service and care support With Anthem Health Guide, members have access to highly-trained professionals, backed by smart technology and analytics. This helps them stay involved in their health, get more value from their benefits and navigate the health care system more efficiently. Members can call, request a scheduled call back, email or have an online chat on a computer or through our app. Our guides work closely with health care professionals and offer support needed like: Cancer support for members, family members and caregivers through treatment Behavioral health support for members or family members with mental health, drug and alcohol abuse or other personal issues Reminders for preventive and follow-up care Resources for comparing costs, finding in-network doctors and more Clinical alerts for care gaps and savings on services and medications. 6 HELP MEMBERS BE THEIR HEALTHY BEST LIVEHEALTH ONLINE: ACCESS TO CARE ANYTIME, ANYWHERE These resources help members get support for every life stage. Members can use LiveHealth Online to have video visits with board-certified doctors from a computer with a webcam or mobile device. In minutes, doctors can address common health issues such as colds, allergies and headaches. They’ll then assess conditions, provide a treatment plan and send prescriptions to a pharmacy, if needed. Spanish-speaking doctors are available by appointment from 7 a.m. to 11 p.m., 7 days a week using Cuidado Médico. 24/7 NurseLine Round-the-clock answers to health questions Help deciding where to go for care Future Moms Education and support during pregnancy Assessments to help find risks Nurses on call for questions and follow-up throughout pregnancy Breastfeeding support through LiveHealth Online MyHealth Advantage Claims reviewed for gaps in care and health risks Confidential MyHealth Note sent to members offering suggestions to improve health Condition Care Support for members with a chronic condition Personalized plan from a nurse coach and team of specialists Case Management Proactive outreach to members who are hospitalized or have a serious illness Support from a nurse care manager and other health professionals LiveHealth Online also has professionals available to address mental health, allergies, wellness, and some that specialize in kids’ health. Members can see a licensed therapist or board certified psychiatrist in just a few days.1 Why LiveHealth Online? Convenience. Access to care right from the home or office. Choice. Members can select from a range of doctors and therapists. Cost. Depending on the health plan, members pay $49 or less per visit1 to see a doctor, and visits with a therapist or psychiatrist cost about the same as an office therapy visit. Members can register at livehealthonline.com or download the free mobile app. 1 Appointments subject to availabiity of the mental health professional. 7 PRESCRIPTION DRUG PLANS VISION AND DENTAL BENEFITS FOR WHOLEPERSON HEALTH Select Drug List — Offers cost-effective drugs and meets or exceeds the Affordable Care Act (ACA) requirement. Anthem Blue View VisionSM offers members access to one of the largest networks in the nation — along with significant savings. Searchable Drug Lists — Members can log in to anthem.com to connect to their benefitspecific drug list and search up-to-date information. 38,000 doctors and 27,000 locations ACA Preventive Drug List — Under the Affordable Care Act (ACA), pharmacy plans must cover 100% of the cost of certain preventive care drugs and products. 40% off an additional pair of glasses from providers in the plan1 63% average retail savings for Blue View VisionSM members using network providers 2 Retail and online partners National Plus Retail Pharmacy Network — Includes nearly 70,000 pharmacies across the U.S. — 99% of all pharmacies. Rx Choice Tiered Retail Pharmacy Network — has two levels. Members pay the standard cost share at Level 1. In Level 2, they pay a higher cost share. Retail90 — Members can get up to a 90-day supply of drugs from participating local pharmacies. Preferred Generics — If a generic drug is available and members choose the brand name drug, they’ll pay the Tier 1 cost share plus the difference in cost. Home Delivery Choice — Members choose how prescriptions are filled for maintenance drugs, at their local or home delivery pharmacy. 8 Our Dental benefits offer members easy access to a large number of dentists. That includes discounts and services to help them keep up their dental health and prevent long-term problems. 127,000 dentists and 385,000 places to get care 35% average discount on covered dental services when using a dentist in the plan Extra cleaning or periodontal maintenance for members in one of our medical care management programs for certain conditions3 1 Except when discounting of non-covered services is prohibited by state law. 2 Based on the Blue View Vision plan with $10 lens copay and $130 frame allowance for glasses, or $130 contact lens allowance. 3 Applies to Anthem Dental Essential Choice members who are actively engaged in an Anthem Care Management program for the following conditions: cancer, pregnancy, diabetes, certain heart conditions, organ or bone marrow transplants, stroke, end stage renal disease (kidney disease), and suppressed immune systems (HIV/AIDS). ADDED PROTECTION FOR MEMBERS Life and disability benefits are easy to add, easy to manage. Here's a sample of what's included: Dedicated team of disability case managers, nurses and health coaches. Personalized claim support and stay-at-work programs help those with disability claims get back to work quickly and safely. Resource Advisor offers counseling on emotional, financial and legal concerns, and identity theft recovery. Travel assistance with emergency medical assistance covers members when traveling more than 100 miles from home.1 Beneficiary Companion offers support for handling estate details. Disability claims processing time is 7.3 days or less with 99.8% accuracy. These benefits can be offered on a voluntary basis to help your clients save on premium costs Your clients can offer 100% employee-paid voluntary dental, vision, life and disability plans. They pick the plan design and their employees pay premiums at affordable group rates.2 1 Travel assistance available to clients with life benefits. 2 Minimum voluntary participation requirements: dental/vision = 5 enrollees, life/disability = 10 enrollees. 9 SPECIALOFFERS@ ANTHEMSM FOR HEALTHY SAVINGS* With SpecialOffers@AnthemSM, members get discounts on products and services that promote better health and well-being. Here’s a peek at the perks: Vision and hearing 1-800 CONTACTS® Premier LASIK Fitness and health Jenny Craig® GlobalFit™ FitBit SelfHelp Works Family and home WINFertility® Safe Beginnings® ASPCA Pet Health Insurance Medicine and treatment Puritan’s Pride Allergy Control products See the discounts Members can log in to anthem.com and select Discounts. *All discounts are subject to change without notice. 10 MEMBERS CAN EARN CASH BACK WHEN THEY SHOP EMPLOYERACCESS MANAGING BENEFITS HAS NEVER BEEN EASIER Through our partnership with PayForward. EmployerAccess is a simple and secure tool on anthem.com that gives your clients everything they need to manage benefits easily and quickly - 24/7. They can: How does it work? Members can shop at 60,000 participating retailers and earn 3 - 15% cash back with each qualified purchase. They can shop online, swipe their card or buy and use an e-gift card. Is it free to join? Enroll and cancel members and dependents. Check eligibility. Yes! Members just need to have an Anthem medical plan. Request ID cards. How do members sign up? They can register at payforward.com, or download the PayForward app from the App Store or Google Play™. Change member personal information. Members can use incentives to: Spend any way they choose. View Summary of Benefits. Save to a Health Wallet, PayForward account or bank account. Share with friends, family and charities. View, pay and download bills. View transaction history. For more details: Check out payforward.com. Contact your Anthem account representative. To get started today, clients can sign up at employer.anthem.com. 11 LET’S DO THIS, TOGETHER Select the links below to view Anthem’s products for 2019. As you view our portfolio, you’ll see all types of plan designs that are as unique and different as your clients. Choosing a health plan isn’t easy, but we want it to be. The plans you’re about to see have been created to be easy for you to quote and administer and easy for your clients and their employees to use. Medical plan grid Vision plan grid Dental plan grid Life & Disability plan grid This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of coverage, contact your Anthem representative. * Non-ACA compliant plans may may not qualify for single bill when combined with other coverages. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 107469MUBENABS 05/18
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