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Answers to some common questions about HealthbyChoice IncentivesSM.
General information Employer advantages Selling: the whys, hows and whos Member information General informationQ: HealthbyChoice Incentives resembles other products already on the market. What's the story?HealthbyChoice Incentives evolved from our award-winning HealthbyChoice wellness program (now known as HealthbyChoice Rewards). Since HealthbyChoice was introduced in 2004, competitors have launched similar programs. Also employer groups have continued to request easy-to-use, cost-effective products that encourage consumers to be more accountable for their own health status and health care costs. We knew we wanted to evolve the HealthbyChoice product line to meet customer needs. Recent changes in HIPAA and IRS guidelines for wellness program incentives provided the ideal opportunity. They also allowed us to develop a product that would work for small groups. So in addition to our powerful, proven, employer-driven wellness program, we now offer a health plan, combined with a wellness program, that is easy to use and easy to understand for employees and employers. Q: How is HealthbyChoice Incentives different from HealthbyChoice Rewards? HealthbyChoice Incentives is a health plan combined with a wellness program. It is a full replacement product and cannot be sold with other Priority Health products. HealthbyChoice Rewards is an employer-driven wellness program. It's sold as an add-on to other Priority Health products. Here's a more detailed comparison of the two products. Q: How is HealthbyChoice Incentives different from comparable plan products on the market? There are several things that set HealthbyChoice Incentives apart from comparable products, among them:
Employer advantages
Q: Why would a company be interested in a product like HealthbyChoice Incentives?
Because:
Q: How does HealthbyChoice Incentives save employers money? First, all HealthbyChoice Incentives plan options (HMO and PPO) are copay aligned, with higher copays for higher cost services. Second, the dual-benefit design means that people meeting certain health-related criteria have better benefits (lower costs) but use fewer services; those who don't meet the health-related criteria have benefits that aren't quite as "rich" so they pay a greater portion of their care. Therefore, the plan typically attracts a healthier mix of client groups. In addition, the plan encourages healthier lifestyle choices. This may translate into less absenteeism and increased productivity, which ultimately impacts an employer's bottom line. Selling: the whys, hows and whosQ: Can I sell HealthbyChoice Incentives to any size of company?No. HealthbyChoice Incentives is only available to fully insured groups with 2 or more members. Q: What other products can be sold with HealthbyChoice Incentives? HealthbyChoice Incentives is sold only as a full replacement policy. It cannot be sold with any of our other products. However, HealthbyChoice Rewards, our wellness program, is an add-on service that can be sold with other Priority Health products. Q: Can I quote HealthbyChoice Incentives and regular network, POS and PPO plans at the same time? Yes. Proposals may include both HealthbyChoice Incentives and our traditional plans. Plans can be compared side by side. Q: Who makes a good target customer? HealthbyChoice Incentives is ideal for any customer, especially groups that want to encourage healthier lifestyle choices for their employees but may not yet have a "wellness" culture in place. These groups want the rate relief associated with providing excellent benefits to employees who embrace healthier lifestyles. We think the groups attracted to this program will be smaller, relatively healthy and have employees who, along with their spouses, have Internet access. Q: What if my customer wants to do more than a health plan that encourages healthier lifestyle choices? HealthbyChoice Incentives is more than a health plan. Members have access to a wide range of wellness resources, including Web-based tools and free exercise classes which are held at Priority Health's offices. Priority Health also offers many wellness programs that coordinate seamlessly with HealthbyChoice Incentives. Contact Sales or Wellness for delivery details, requirements and fee schedules. Q: Will a company's employees need to have computers and Internet access in order to participate in this plan? Yes, especially if members want to main the Choice (or higher) level of benefits for the plan year. To meet requirements, members must complete an online health risk assessment form. Plus many Priority Health wellness resources and tools are available through priorityhealth.com. To make online access easier, Priority Health offers its members discounts on Dell computers. It's just one of the many value-added components of HealthbyChoice Incentives that gives members and employers much more for their money. Q: Do employers pay different rates based on how many of their employees are on the Choice or Standard level of benefits? No, employers pay a "combined" rate no matter how many employees are at either benefit level. In addition, employers never know who among their employees are on the different benefit levels. Q: What if I have a customer who wants a report regarding the breakdown of the number of employees on each benefit level? Priority Health will provide groups with a report indicating how many of their members are on each benefit level (Choice or Standard), but we can't tell them which employees are on each level. Groups of 51 or more may be eligible for additional HIPAA-protected aggregate reports based on data collected. We can work with groups to help with wellness program development. If groups/members have questions, they should be directed to customer service. Q: Are there other designs available besides the 4 HMO and 4 PPO options? Currently, other options are only available to groups sized 100+. See a large group sales executive for more details. Q: What coverage riders are available? Only the contraceptive rider is available. Non-coverage riders such as the domestic partner rider are available for groups of 51 or more, according to current rules. Q: Are small groups (under 50 employees) eligible for wellness services under the HealthbyChoice Incentives plan? Yes. All HealthbyChoice Incentives members, regardless of the size of their company, have access to a wide variety of free wellness resources. This includes wellness and disease management classes held at Priority Health's offices, tobacco cessation programs, web-based tools and more. On-site programs and consulting services are also available to groups of 51 and over. Contact Sales for delivery details, requirements and fee schedules. Q: Are mid-year changes allowed? No. HealthbyChoice Incentives is available to new business or at renewal only. Member information
Information to help explain the HealthbyChoice Incentives plan to members.
Q: Why is HealthbyChoice Incentives positioned as "easy to understand" by members? There are only three differences between the two levels of benefits. With the Choice level of benefits, members pay less for copays, deductibles/out-of-pocket costs and coinsurance. With the Standard level of benefits, they still receive great benefits but pay more for their copays, deductibles/out-of-pocket costs and coinsurance. This is a much simpler design than that of many comparable products. Q: Why were the three health indicators chosen? The three health indicators represent controllable health behaviors commonly linked to chronic illness and other health issues. Q: Do plan members have to see their providers in order to complete the qualification form that's required in order to maintain the Choice level of benefits? No. If a member has seen the provider up to six months prior to the plan effective date, and if the provider has documented information about tobacco use, BMI and blood pressure, we can use that information on the form. A member only needs to see his provider if additional lab work or an action plan is required. Q: Why does a member's spouse have to meet the program requirements? Lower plan costs are currently based on employees and their spouses achieving healthier lifestyles. Plus, studies show couples working together have a better chance to successfully change their lifestyles. The goal of this plan is for members to successfully improve their lives, ultimately lowering their need for health care services and the employer's health care costs. In the future, we will look at the possibility of an employee-only program, but we need the health outcomes of the initial rollout to determine employee-only product pricing. Q: Do the husband and wife both have to qualify? Yes. If the spouse is covered through the entire 90-day qualification period, both must meet the program requirements to maintain the Choice level of benefits. Members on a contract can't have different benefit levels. If the spouse doesn't qualify, the members will be at the Standard level of benefits. Q: What if the member qualifies but his or her spouse doesn't? Since members on a contract can't have different benefit levels, the spouse joins at the member's benefit level. He or she does not have to meet the requirements for maintaining the Choice benefit level at this point. Both members will need to meet the requirements the following year. Q: What if a member cannot get in to see his or her provider? Priority Health's providers all have timely access requirements to ensure members can obtain an appointment if they are required to within the 90-day period. In addition, providers are being trained on the product's time sensitivity. Q: Are all members required to have a fasting glucose and cholesterol test? No. Only members who do not meet the criteria for the three health indicators listed on the qualification form must complete additional lab work. They also must agree to a physician action plan as a HIPAA-mandated "reasonable alternative" in order to maintain the Choice level of benefits. Q: What happens if a member is outside the Priority Health service area? Out-of-area members must still meet program requirements to continue on the Choice level of benefits. Providers can contact Provider Services for more information. Q: What does Priority Health do with the health indicator scores and any test results? All information obtained from either the provider or an outside lab (in the case of the additional tests) is stored in the member's Patient Profile record. It is available to the member and the member's provider. Only the scores for the three health indicators are used to determine whether someone qualifies for Choice level of benefits. Information will be used by Priority Health to develop Wellness programming and services relevant for members. Q: What if a provider does not submit the qualification form during the 90-day period? Priority Health monitors information to catch late submissions. If a member has been moved to a different benefit level, and we later receive documentation they met their requirements on-time, we will move members back to the previous level and claims will be adjusted. Q: Do members have to meet the Choice level of benefits requirements every year? Yes. Members are expected to maintain their healthy lifestyles for as long as they are in the program. Q: How will members be notified that they have another chance to qualify for the Choice level of benefits at renewal? In their member materials and at plan renewal time. Q: What happens if a group is set up after their effective date (retro enrollment)? This will not affect their 90-day qualification period, which will begin with their effective date of coverage. Q: What happens when someone is added to the plan? Members who enroll during the first eight months of the plan year are treated as any other member. They have the same 90 days from their effective date to meet requirements to maintain the Choice level of benefits. Members who enroll in the 120 days are placed on the Choice level of benefits and will re-qualify for them the next year. Contracts that lapse and are reinstated are placed into their previous level of benefits if they already were given a 90-day qualification period. If they did not complete a 90-day qualification period before the contract lapse, they'll have a new 90-day qualification period. Q: Would a member who enrolled in the third quarter have to turn around and re-qualify few months later? No. Data can be used up to six months prior to the effective/renewal date and can be re-used. Information submitted (including the completion of the online health risk assessment) for a late enrollee that falls within the last six months of the plan year will also meet the following year's requirements. Q: What happens when someone moves to COBRA? Members moving to COBRA are treated as though they are still enrolled in the HealthbyChoice Incentives plan. They remain on the same level of benefits they had at the date of their COBRA Qualifying Event. They will qualify/re-qualify for the HealthbyChoice Incentives benefit levels as if they were active employees, following the same plan rules and requirements. Spouses/ex-spouses who elect COBRA coverage are treated as the subscriber and must follow HealthbyChoice Incentives program guidelines. Dependents enrolled under a parent's COBRA policy will follow the benefit level assignment to the parent on the COBRA policy and do not have to meet program guidelines, regardless of age. Dependents that are under age 18 and elect their own COBRA contract (a single COBRA contract) will always automatically be assigned to the Choice benefit level and do not have to follow program guidelines to qualify for the Choice benefit level. Dependents who are age 18 or older and elect their own COBRA contract (a single COBRA contract) are treated as the subscriber and must follow HealthbyChoice Incentive program guidelines. Q: What happens when someone is added retroactively? Can they get an extension on the 90-day period? No. Employers are expected to submit additions in a timely manner. Extensions to the 90-day period will not be given.
Last modified
07/17/08
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