2017 plan preview - the brokerage · pdf fileplan option. goals for benefit changes. network...
Post on 06-Feb-2018
218 Views
Preview:
TRANSCRIPT
2017 Plan Preview
℠
HealthTeam Advantage 2017
• Who is HealthTeam Advantage – A Quick Refresher• Goal for Benefit Changes• Network Additions• What’s New for 2017• HealthTeam Advantage Plan I Changes• HealthTeam Advantage Plan II Changes• HealthTeam Advantage Plan I Overview• HealthTeam Advantage Plan II Overview
℠
Who is HealthTeam Advantage?• Medicare Option for consumers in the Piedmont Triad area
• Alamance, Guilford, Randolph and Rockingham Counties
• Partnership between Cone Health and Care N’ Care Insurance Company, Inc.
• Care N’ Care Health Insurance Company, Inc.• Started in 2009 by local doctors to fill a need in the market for a better health
plan option
Goals for Benefit Changes
Network Additions
• Now over 2,800 contracted physicians and facilities• New Additions
• Morehead Hospital and Physician Group• Cornerstone Imaging• Asheboro Family Physicians• Alliance Urology Specialists• Carolina Cardiology• Triangle Orthopaedic Associates• Eden Internal Medicine• White Oak Family Physicians
• Annual Physical Exam at $0 copay in-network
• Annual Hearing Exam at $0 copay in-network
• Annual Eye Exam at $0 copay in-network
• 90-Day Prescription Copays reduced to only 2 times the 30 day copay
• Reimbursement Schedule for Out-Of-Network Dental Rider Benefits
Changes to Plan I
• Inpatient Hospital Coverage: • 2016: Days 1-7 - $275 per day; Inpatient stay covered to 90 days• 2017: Days 1-6 - $225 per day; Unlimited number of days covered
• Skilled Nursing Facility Coverage:• 2016: Unlimited number of days covered• 2017: Coverage limited to 100 days
• Doctor Visits:• 2016: Primary Care Physician - $15 Specialist - $30 • 2017: Primary Care Physician - $10 Specialist - $20
• X-Rays:• 2016: $10• 2017: $5
Changes to Plan II
• Premium:• 2016: $57 per month• 2017: $49 per month
• Inpatient Hospital Coverage: • 2016: Inpatient stay covered to 90 days• 2017: Unlimited number of days covered
• Skilled Nursing Facility Coverage:• 2016: Unlimited number of days covered• 2017: Coverage limited to 100 days
• Doctor Visits:• 2016: Primary Care Physician - $10 Specialist - $20 • 2017: Primary Care Physician - $5 Specialist - $15
HealthTeam Advantage Plan IBenefit In-Network Out-of-Network
Maximum Out-of-Pocket $3,400 $5,100
Primary Care Physician $10 $40
Specialist Visit $20 $50
Inpatient Hospital $225 (days 1-6) $400 (days 1-7)
X-Rays $5 $10-$25
Laboratory Tests $0-$5 $10-$25
Outpatient Surgery- Ambulatory Surgical Center- Hospital Facility
$150$170
$200$250
Skilled Nursing Facility $0 (days 1-20) $150 (days 21-100)
$40 (days 1-20) $160 (days 21-100)
HealthTeam Advantage Plan I - ContinuedBenefit In-Network Out-of-Network
Urgently Needed Care $30 $30
Outpatient Rehab Services $15 $40
Prescription Drugs – 30 day supply- Tier One (Preferred Generics)- Tier Two (Generics)- Tier Three (Preferred Brands)- Tier Four (Non-Preferred Drugs)- Tier Five (Specialty)
$4$15$45$8533%
Prescription Drugs – 90 day supply- Tier One (Preferred Generics)- Tier Two (Generics)- Tier Three (Preferred Brands)- Tier Four (Non-Preferred Drugs)- Tier Five (Specialty)
$8$30$90
$17033%
HealthTeam Advantage Plan IIBenefit In-Network Out-of-Network
Maximum Out-of-Pocket $3,100 $5,100
Primary Care Physician $5 $30
Specialist Visit $15 $50
Inpatient Hospital $225 (day 1) $75 (days 2-5) $425 (days 1-6)
X-Rays $0 $10-$25
Laboratory Tests $0-$5 $10-$25
Outpatient Surgery- Ambulatory Surgical Center- Hospital Facility
$100$125
$175$225
Skilled Nursing Facility $0 (days 1-20) $140(days 21-100)
$40 (days 1-20) $160 (days 21-100)
HealthTeam Advantage Plan II - ContinuedBenefit In-Network Out-of-Network
Urgently Needed Care $30 $30
Outpatient Rehab Services $10 $30
Prescription Drugs – 30 day supply- Tier One (Preferred Generics)- Tier Two (Generics)- Tier Three (Preferred Brands)- Tier Four (Non-Preferred Drugs)- Tier Five (Specialty)
$0$12$40$7533%
Prescription Drugs – 90 day supply- Tier One (Preferred Generics)- Tier Two (Generics)- Tier Three (Preferred Brands)- Tier Four (Non-Preferred Drugs)- Tier Five (Specialty)
$0$24$80
$15033%
top related