Employer Plan Brochure - Prevea360 Health Plan

P7217_0215_B2B_Brochure_Cover.pdf
1
7/16/15
12:50 PM
A better kind of health plan
Health Plan Benefits for Businesses
(Fully-funded Options – HMO, PPO, POS)
Looking for more information
about Prevea360 Health Plan
employer group plans?
Please visit
prevea360.com
Contact our sales team or your agent for more information
about Prevea360's approach to health insurance for your
business and how you can be a part of it.
C
M
Y
CM
MY
CY
CMY
K
Questions?
Our Prevea360 sales representatives are here to help.
[email protected] | 877.230.7555
Prevea360 Health Plan does not discriminate on the basis of disability in the provisions of programs, services or activities. If you need
this printed material interpreted or in an alternate format, or need assistance in using any of our services, please contact a Customer
Care Specialist at 877.230.7555 or TTY: 711.
PREVEA360 HEALTH PLAN
PO Box 28467
Green Bay, WI 54324-0467
prevea360.com
877.230.7555
TTY: 711
Prevea360 is underwritten by Dean Health Plan, Inc.
© 2015 Prevea360 Heatlh Plan
P7217_0215
Health Plan Benefits
for Businesses
Background Information
4–5
Integrated Care, Coordinated Network
6
Keeping Health Care Local
7
LeadWell® Employee Wellness Program
8–9
Plan Options
10–11
New Member Transition
12–13
Employer Tools
14
3
prevea360.com
P7217_0215_B2B_Brochure_Interior.indd 3
7/16/15 12:52 PM
Health coverage
centered around health care
Prevea360 Health Plan is a true collaboration between employers, health care experts, hospital partners
and insurance providers, leading to a more affordable and beneficial experience for your employees and
their families — one that is truly centered around them. And because Prevea360 was developed
right here by local health care and insurance professionals, the plan is designed specifically to help
our communities flourish.
Joining Prevea360 means your employees have access to 39 health centers, 6 premier hospitals and
local experts in more than 60 specialties and services. You can sleep better knowing you have a trusted
insurance team at your side.
We have you covered.
4
Prevea360 Health Plan for Businesses
P7217_0215_B2B_Brochure_Interior.indd 4
7/16/15 12:52 PM
Homegrown
Wisconsin health care providers working with a Wisconsin health plan
to form an integrated health insurance organization in Green Bay.
Green Bay
Prevea Health
is known for providing a high
caliber of care. With a strong
network, members can rely
on a wide variety of providers
from which to choose.
Green Bay
Prevea360, an insurance
company developed to serve
people in our communities
by people who live and work
in our communities, reinvests
resources locally to continue
to grow better health care right
here at home.
Madison
Dean Health Plan
is the largest managed care
organization in Wisconsin
and has revolutionized the
model of providers in
partnership with insurance.
5
prevea360.com
P7217_0215_B2B_Brochure_Interior.indd 5
7/16/15 12:52 PM
Integrated, physician-led
coverage and care
Prevea360 Health Plan addresses the challenge of creating a long-term, sustainable health care solution
by transforming the health care model. With its integrated approach of physicians, hospitals and
insurance being combined into one company, the focus can be on the doctor-patient-payer relationship.
Unlike other companies, Prevea360 brings a new standard of care and coverage to northeast Wisconsin
and the Lakeshore, one that your employees both deserve and expect.
Simply put, primary care physicians and specialists across Prevea360’s network collaborate
to provide the best possible care at an affordable price for you and your team.
It’s insurance that you can feel great about
providing to your employees.
Coordinated Network
Prevea360 Health Plan emphasizes
a proactive approach to care in which
primary care providers oversee all
aspects of a patient’s health needs,
from preventive to complex care.
This keeps your employees well,
decreases duplication of costly
services and provides better health
care value for your investment.
Insurance
Physicians
Employee
Hospitals
6
Prevea360 Health Plan for Businesses
P7217_0215_B2B_Brochure_Interior.indd 6
7/16/15 12:52 PM
Keeping health care local
The Prevea360 Provider Network includes more than 60 specialty offerings, such as:
Cardiology
• Surpassing the nation’s benchmarks in heart attack “door-to-balloon” survival rates.
• The heart teams at Prevea Health, HSHS St. Vincent and St. Mary’s Hospitals lead the region
in heart and vascular care.
Cancer
• Region’s LARGEST group of oncologists, working together to deliver the most comprehensive care
in a personalized manner.
Pediatrics
• Region’s LARGEST group of pediatricians and pediatric specialists, including pediatric hematologists-oncologists,
cardiologists, gastroenterologists, hospitalists, intensivists, neurologists, orthopedic surgeons, plastic surgeons
and rheumatologists.
• Region’s ONLY Pediatric Intensive Care Unit, one of only five in the state of Wisconsin.
• Only area provider to offer Child Life services for hospitalized children and their families.
Orthopedics
• The region’s MOST COMPREHENSIVE specialty-trained orthopedic group, consisting of
fellowship-trained orthopedic surgeons for hip and knee, spine, hand, sports medicine,
pediatric and trauma.
• Continually in the top 10% nationwide for overall orthopedic patient satisfaction.
Obstetrics/Gynecology
• Wisconsin’s FIRST breast surgeon certified in Stereotactic Breast Procedures
by the American Society of Breast Surgeons (ASBS).
• Expertise in Maternal Fetal Medicine, plus the region’s FIRST Level III Neonatal Intensive Care Unit (NICU).
Emergency/Trauma
• ACS Level II Trauma Center, the highest ranking a non-university-affiliated
emergency center can attain.
• Advanced diagnostic services including CT, MRI, PET, nuclear medicine,
sonography, angiography, EEG, EKG and DMG.
• Emergency air and ground transportation.
Visit prevea360.com for a full list of specialties.
7
prevea360.com
P7217_0215_B2B_Brochure_Interior.indd 7
7/16/15 12:52 PM
The importance of wellness
Greater productivity, increased employee morale and lower absenteeism
are just a few outcomes of a comprehensive wellness program, contributing
to the overall success of your organization. With Prevea360 Health
Plan, you have access to Prevea Health’s LeadWell® Corporate Health &
Wellness program, featuring workplace education, fitness programming,
medical programming and dedicated wellness centers.
No matter your organization’s health and wellness needs, Prevea360 and
the LeadWell® team will work with you to develop a custom program that
delivers results.
It’s your employees’ health.
Your bottom line. Let’s get after it.
WORKPLACE EDUCATION
Seminars covering nutrition, fitness and health
topics focused on your employees’ needs
FITNESS PROGRAMMING
On-site health and fitness coaches
get your employees up and moving
MEDICAL PROGRAMMING
Motivate your employees toward a healthy
lifestyle with assessments and ongoing programs
WELLNESS CENTERS
A Prevea Health & Wellness on-site or near-site
wellness center will provide accessible, affordable,
quality health care for your employees
8
Prevea360 Health Plan for Businesses
P7217_0215_B2B_Brochure_Interior.indd 8
7/16/15 12:53 PM
High-quality health care right
at your workplace
Just like your company,
our people make us great
Whether onsite (at your workplace) or near-site
(near your location), access to a Prevea wellness
center makes quality health care highly affordable
and convenient for your employees and their
dependents. A dedicated nurse practitioner
provides many primary care services, including:
» Treatment of minor illnesses and injuries
»Management of chronic conditions,
such as diabetes and high blood pressure
» Physical exams
An organization is only as good as its people,
and the same holds true for LeadWell®.
Prevea Health is on the leading edge of health
and wellness programming thanks to its amazing
people. The LeadWell® team is comprised of
unrivaled professionals in general health care,
fitness, nutrition, physical therapy and all related
specialties. Prevea Health’s experts are nationally
recognized for delivering both health care quality
and demonstrated results of the highest level.
» Medical referrals
»Lab services at 40 to 60 percent less than
traditional rates, a savings for both you
and your employees
The option to incorporate wellness centers in your
health plan is part of the package for Prevea360
employer groups that have more than 100 employees.
Groups participating in a wellness center receive
a monthly activity report of utilization.
9
prevea360.com
P7217_0215_B2B_Brochure_Interior.indd 9
7/16/15 12:53 PM
Plan options
HMO
Health Maintenance Organization (HMO) Plan
• Lowest cost option
• Best choice when members live in the service area
The Prevea360 HMO Plan focuses on coordinated care from trusted providers
in our 11-county service area. Prevea Health primary care physicians serve as the
contact for many aspects of care, in addition to a range of specialists who can serve
more complex needs. This means health insurance and health care providers work
together to provide a comprehensive benefit plan that’s easy to use.
POS
Point of Service (POS) Plan
• Option if you want to offer out-of-network services
at the member’s choice
The POS plan offers the benefits of an HMO (lower costs at network providers),
with options to see out-of-network providers if necessary. This is a good choice
for employers who want to offer their employees the freedom to choose their
own doctors.
BROWN
CALUMET
DOOR
KEWAUNEE
MANITOWOC
MARINETTE
MENOMINEE
OCONTO
OUTAGAMIE
SHAWANO
SHEBOYGAN
10
Prevea360 Health Plan for Businesses
P7217_0215_B2B_Brochure_Interior.indd 10
7/16/15 12:53 PM
PPO
Preferred Provider Organization (PPO) Plan
• Option for members outside of the service area
• Uses PPO network based on location of member
The PPO plan gives organizations with employees who live outside
the Prevea360 Health Plan service area access to a larger footprint
of providers in their communities.
For more information on any of these plans above,
please contact [email protected].
Ask your Prevea360 Health Plan account
executive or agent
Some of our plans are compatible with Health Savings
Accounts (HSAs), providing even more flexibility on cost
for your employees. Ask your account executive or agent
for details.
ASO
Administrative Services Only (ASO) Plan
Our Administrative Services Only plan, delivers the
flexibility, efficiency and technology you need for selffunded plans. For more information on ASO options,
please visit prevea360.com/ASOsales and request
a brochure.
11
prevea360.com
P7217_0215_B2B_Brochure_Interior.indd 11
7/16/15 12:53 PM
The importance
of onboarding
We understand that transitioning care can be overwhelming to your employees.
To help make that switch as smooth as possible, we send all new members a
Member Guide upon enrollment. Filled with details like where to find benefit
documents, how to read their ID card and what “prior authorization” really means,
this resource helps introduce them to their new plan and health partner. New
members can also visit prevea360.com/newmember for links and information
that can help with the switch.
In addition, Prevea360 members receive our newsletter, Member News,
throughout the year. Each issue includes tips that help your employees use
their health plan and advice for a healthy lifestyle.
Online Member Tools
Prevea360 Health Plan’s online member tools, like the Member Profile
and MyPrevea, help your employees take an active role in their health care
and coverage by providing anytime-access and cost transparency.
MyPrevea
This free, online service provides Prevea Health patients anytime-access
to information in their personal and family health records. This secure
site allows your employees to easily view current medications
and test results, exchange messages with their medical providers,
request appointments and track their medical history.
Member Profile
This one-stop insurance portal allows Prevea360 Health Plan members
to check the status of claims, request ID cards, review Explanations
of Benefits and more.
Find a Provider
The Prevea360 Health Plan online provider and pharmacy directories
allow members to search by location or name and are easily accessed
on prevea360.com.
12
Prevea360 Health Plan for Businesses
P7217_0215_B2B_Brochure_Interior.indd 12
7/16/15 12:53 PM
Here When You Need Us
The Prevea360 Health Plan Customer Care
Center is staffed with experienced and
knowledgeable Customer Care Specialists,
ready to answer any questions and concerns
your employees might have about their care
and coverage.
Call Customer Care
877.230.7555 (TTY: 711)
Monday through Thursday
7:30 a.m. to 5 p.m.
Friday
8 a.m. to 4:30 p.m.
Go Online
Visit prevea360.com.
13
prevea360.com
P7217_0215_B2B_Brochure_Interior.indd 13
7/16/15 12:53 PM
Designed with you in mind:
prevea360.com For Employers
The information you need to administer your plan and answer employee questions
is organized in one convenient online location.
Employer Resource Guide
A manual designed to cover a variety of questions regarding the enrollment of newly eligible employees
and dependents, changes in coverage and handling the monthly billing, along with your annual renewal
process.
Online Employer Tools
Our web portal opens a world of online conveniences. Some of the most popular options include
enrolling new employees, adding or deleting an employee’s dependents, terminating existing members
as you experience employee turnover and printing temporary ID cards and ordering new ID cards.
FAQs
Quick answers to help you field common questions about ID cards, special enrollment, group
continuation, Medicare eligibility and more. We also provide billing FAQs to address invoicing
and other billing-related questions.
Prevea360 Employer Newsletter
A bi-monthly e-newsletter specifically for Prevea360 Health Plan employer groups.
Applications and Forms
Wellness Information
Group Certificate Review
Health Care Reform and Regulatory Updates
Questions?
Contact your agent or reach out to our sales team
at [email protected].
14
Prevea360 Health Plan for Businesses
P7217_0215_B2B_Brochure_Interior.indd 14
7/16/15 12:53 PM