uams smart care medical network slides (for sept...
TRANSCRIPT
“I wish UAMS gave a cost break to employees for coming here for healthcare.”
It’s here!
Started January 1, 2012 Updated for Jan 2014, Human Resources
What is UAMS SmartCare?
• Incentive for you to come to a UAMS facility for your healthcare
• New benefit under our medical insurance starting January 2012
• Applies to UAMS employees and family covered under our medical insurance
• Reduces what you pay out of pocket after insurance pays
Come home to UAMS.
facilities include:
UAMS Hospital UAMS Outpatient Clinics UAMS clinic in WLR AHEC Family Medical
Centers UAMS Psychiatric Providers
(including Child Study Center, NWA Outpatient & STRIVE)
University Women’s Health Center
UAMS physicians who bill through UAMS MCPG but are located at Freeway Medical or Baptist Inpatient Rehab (which are not SmartCare facilities)
Ark. Children’s Hospital Dennis Development Center
Pediatricians (unless practice at a UAMS SmartCare facility)
PET Scan at UAMS (outsourced)
Baptist Rehab Institute for Outpatient Therapy
Baptist Psychiatric Facility
Freeway Dialysis Services
VA and NLR VA Hospitals
NW Ark Centers for Children (located in Lowell)
Not SmartCare:
How well do you understand how our medical insurance benefits
work?
Let’s review so you see how
SmartCare will save you money.
Following slides show benefits as of January 2014.
What’s the name of our medical insurance plan?
QualChoice (through 12-31-2012)
or UMR (starting 1-1-2013)
“University of Arkansas Health Plan” Remember, we’re self-insured and self-funded.
We contract with a third party administrator to pay claims.
What’s the difference between Classic and Point of Service?
Classic... You must go in-network, similar to an HMO. Only exception are true emergencies. Or for medical services not available in-network and UMR has authorized, in advance, for you to go out-of-network.
POS…
Same in-network benefits as Classic. But also have coverage if you go out-of-network. (although your share of costs will be higher if you go out-of-network))
What does “in-network” mean?
A doctor, hospital or other health care provider listed in the network for U of A Members
Go to http://www.umr.com/oss/cms/UMR/UAS Note the disclaimer that Baptist and Heart Hospital are
not in network. Next click “University of Arkansas System Provider
Network” link.
Which LR hospitals are in-network?
UAMS
St. Vincent
Ark. Children’s Hospital
Baptist
Heart Hospital
What do you pay if you go in-network for preventive care?
Annual physical
Well baby/child visits & immunizations through age 18
Flu immunizations
Routine screening mammograms (age 40)
Pap smears
Prostate antigen
testing (PSAT)
Colorectal cancer screening
Bone density screening (age 65)
Diabetic supplies
Hypertension meds (selected generics)
Blood pressure monitor
smoking cessation
Rest of your covered medical care falls into two “what I pay” categories
Your share of the cost is a COPAY
and/or
Your share of the cost is subject to annual DEDUCTIBLE and COINSURANCE
Out of Pocket Maximum
OLD DEFINITION through 12-31-2013
It applied to only your coinsurance 20%. Meaning… once you satisfied your deductible
and were paying 20% coinsurance, that coinsurance maxed out at a specific rate, at
which point insurance picked up 100% of anything subject to coinsurance. But you still
had copays.
Out of Pocket Maximum
NEW DEFINITION/BENEFIT starting 1-1-2014
Easier to understand and could result in significant savings for you!
Includes your deductible and copays (except prescription drug copays are separate, not
included). Meaning… once your share of the cost hits the out of pocket max, insurance picks up 100% of covered expenses the rest of the calendar year.
You only keep paying your rx copays.
Q: What is your cost for in-network doctor office visit?
PCP Specialist
$25
$45
$10
$30
Save $15
A: Copay
PCP = Primary Care Physician. Includes Family Medicine, Internal Medicine and Geriatric doctors. Same lower copay for women’s routine Gyn visits, routine eye exams and outpatient mental health visits.
Q: What do you pay for outpatient procedure in-network (e.g. MRI)?
Deductible 20% Coinsurance (Not to exceed annual out of pocket max)
$ 750
$ depends
$2,000
$ 250
$ depends
$1,000
Save up to $1,000
A: Ded + Coins
Q: What do you pay for outpatient surgery in-network?
Copay Deductible 20% Coinsurance
(not to exceed annual max)
$ 150 $ 750
$ depends $2,000
$ 0 $ 250
$ depends $1,000
Save up to $1,000
A: Copay + Ded + Coins
Q: What do you pay for hospital admission?
Inpatient copay
Deductible
20% Coinsurance
(not to exceed annual max)
$ 300
$ 750
$ depends
$2,000
$ 150
$ 250
$depends
$1,000
Save up to $1,000
A: Copay + Ded + Coins
Q: What do you pay for maternity?
Deductible
20% Coinsurance
(not to exceed annual max)
$ 0 $ 300
$ 750
$depends $2,000
$ 0 $ 150
$ 250
$depends $1,000 Save up to
$1,000
Inpatient copay
prenatal office visits
Call UMR your first trimester, complete Maternity Management program, and knock $300 off your cost!
A: Copays + Ded + Coins
More on the Deductible
You have one in-network deductible … not a separate one under UAMS SmartCare. Think of it as one bucket. What you’ve paid on your SmartCare deductible applies to your regular in-network deductible, and vice versa. How much deductible you have to pay into the bucket depends on where you’re receiving care at that moment. UAMS SmartCare = lower deductible to satisfy Elsewhere in the network = higher deductible to satisfy
It’s easy!
• Nothing to sign up to access SmartCare… as long as you’re enrolled in UA medical plan
• Simply choose to come to UAMS for your care. You’ll automatically pay less out of your pocket.
• You maintain the choice of where you want to go for your care. But now there’s an extra incentive to come home to UAMS.
• Be sure to show your UMR medical card showing you’re in the UAMS group and have SmartCare
Other things to consider
• If my PCP is not at UAMS, do I have to switch? No. You’ll still enjoy SmartCare savings when you see a SmartCare PCP
at UAMS, even if your regular PCP is elsewhere.
• If I have other coverage, should I/can I switch to UA health plan to enjoy SmartCare savings?
Not until open enrollment is offered. Or you may enroll within 30 days of a “qualifying event” such as marriage, birth of child, or loss of coverage through spouse due to job loss or divorce.
SmartCare is just for UAMS employees. Not available to UALR, UAF or employees at other UA campuses.
• How much to put in my healthcare FSA? May need to put in less at next open enrollment, to account for the SmartCare savings.
But wait… there’s more to
SmartCare Concierge for UAMS Employees
(501) 686-8749
Make appointments, coordinate multiple appointments. Priority access to available appointments.
Facilitate communication between participants and clinic staff/ physicians regarding test results and special needs while maintaining complete confidentiality
Collaborate with clinic management and staff to enhance the patient experience and eliminate barriers to care
Address access and billing issues
How can I facilitate your UAMS SmartCare appointment?
Email your request to: [email protected]
(“Smart Care Appointments” under Global)
Please include: • Patient’s Name • Date of Birth • Address and phone number • Insurance Policy Number • Clinic Name • Physician Name
Or call
(501) 686-8749
This is a dedicated number
just for UAMS employees.
Meet your SmartCare Concierges
Debra Martin
Patre Allen Redonia
“Reesie” Louden
More resources
• For more information about SmartCare, visit the Human Resources web site, www.hr.uams.edu . Click on the SmartCare link.
• Specific questions or concerns about SmartCare? Call 686-5660 or email [email protected].
• Benefit questions? Contact HR Employee Services. • 4th floor, C wing, Central Building, • 686-5650, [email protected]
• Please be aware that the flexibility to move in and out of SmartCare by selecting
your provider and place of service also adds complexity to the billing process. If you receive services at UAMS and your bill does not appear to reflect the SmartCart savings, please first contact UMR at 1-888-438-6105.