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2012 Healthy Living Plan Comparisons - HMO ... - UWUA Local 223

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					                           Healthy Living Plan Comparison - HMO Plans vs. PPO Plans (2012)
Carrier                    Priority Health                                                           HAP                                                                       BCN                                                                       BCBSM and Aetna

Plan Name                  Priority Healthby Incentives HMO                                          HAP Health Engagement HMO                                                 BCN Healthy Blue Living HMO                                               Community Blue PPO and Aetna Open Choice PPO

Access                     Priority Health is available in the Western and Northern Michigan area.   HAP is limited to Southeast Michigan. Not all doctors                     BCN is available throughout Michigan. Not all doctors                     BCBSM is available throughout Michigan. Virtually all doctors and
                           Virtually all doctors (97% of all Doctors and Hospitals particpate) in    and hospitals participate.                                                and hospitals participate.                                                hospitals participate.
                           Northern and Westen Michigan.                                                                                                                                                                                                 Aetna is available throughout Michigan. Not all Doctors and
                                                                                                                                                                                                                                                         hospitals participate.

General                    Choice Level/Standard Level                                               Enhanced Level/Standard Level                                             Enhanced Level/Standard Level                                             Enhanced Level/Standard Level
                           First 90 days: Everyone is at the Choice Level.                           First 90 days: Everyone is at the Enhanced Level.                         First 90 days: New members begin in the Enhanced Level. Remaining         First 90 days: Everyone is at the Enhanced Level.
                           Within first 90 days: You and your covered spouse                         Within first 90 days: You and your covered spouse                         members retain the benefit level they had at the end of the plan year.    Within first 90 days: You and your covered spouse
                           or same sex domestic partner (SSDP) must meet                             or same sex domestic partner (SSDP) must meet                             Within first 90 days: You and your covered spouse or same sex             or same sex domestic partner (SSDP) must meet
                           two (2) requirements.                                                     three (3) requirements.                                                   domestic partner (SSDP) must meet three requirements.                     three (3) requirements.
                           Dependent children do not have to meet requirements.                      Dependent children do not have to meet requirements.                      Dependent children do not have to meet requirements.                      Dependent children do not have to meet requirements.

Basic Requirements         The 2 requirements are: 1) Complete the Health                            The 3 requirements are: 1) Meet with your                                 The 3 requirements are: 1) Visit your BCN primary                         The 3 requirements are: 1) Get an Annual Physical Exam and have
                           Risk Assessment on-line at priorityhealth.com                             HAP personal care physician to fill out                                   care physician and complete a Health Qualification                        your physician complete all parts of the RedBrick Health Annual
                           and 2) Schedule a physical exam and have your                             and submit a completed Member Qualification form,                         form, 2) Meet all six health measurement targets                          Physical Screening form and return to Redbrick Health, must be posted
                           health care provider submit a completed                                   2) Complete the on-line Health Risk Assess-                               (Tobacco, Weight, Blood Pressure, Blood Sugar,                            no later than 3/31/2012: 2) Take the on-line Health Assessment at
                           qualification form indicating: Tobacco non-user,                          ment form at hap.org, and 3) Meet specific wellness                       Cholesterol, and Depression) scoring all As or Bs,                        www.redbrickhealth.com/login and 3) Particpate in a Health Coaching
                           Blood pressure under 140/90 and                                           targets or commit to participating in health                              and 3) Complete an on-line Health assessment                              Assessment must be completed no later than March 31, 2012, and
                           BMI (body mass index) under 30.                                           improvement programs or treatment plans.                                  at MiBCN.com annually.                                                    Call, if required. The Health Assessment must be completed no later
                                                                                                                                                                                                                                                         than March 31, 2012 and the Coach call completed by May 1, 2012.
                           As an alternative to requirement #2, if either                            Failure to return a completed Member                                      Depending on the results of your Qualification form,                      You can complete the confidential Health Assessment anytime
                           you or your spouse do not meet the                                        Qualification form with a score of 85 points                              within the first 120 days, you may also need to enroll                    between October 1, 2011 and March 31, 2012. Since lab test results
                           three health indicators, you can still maintain                           or above and/or the iStrive Health Risk                                   and actively participate in a free Quit the Nic smoking                   can sometimes take up to two weeks to receive, consider taking the
                           the Choice level by: 1) Completing cholersterol and                       Assessment within 90 days of coverage will                                cessation program until you quit using tobacco, or                        lab tests before your physical exam so you don't miss the deadline.
                           blood sugar tests, and 2) Agreeing to comply                              result in your benefits being transferred to the                          if your body mass index is 30 or above, participate in                    The annual physical exam and routine lab tests are fully covered by
                           with your provider's treatment program.                                   Standard Level with higher out-of-pocket costs.                           a free BCN-sponsored weight management program                            your plan (one per calendar year).
                                                                                                                                                                               until your BMI falls below 30.
                           On Day 91: If you and your spouse meet the                                The Member Qualification form focuses on seven                                                                                                      Healthy Living Normal Values for Health Meaures are: Blood Pressure:
                           qualifications, then you will keep the Choice Level                       health measures: Preventive Services,                                     If the other measures (Blood Pressure, Cholesterol,                       120/80; Cholesterol LDL: less than 160; Triglycerides: less than 200;
                           through the next year's 90-day qualifiication period.                     Tobacco Use, Weight Management, Blood                                     Blood Sugar and Depression) do not meet the                               Weight: Body Mass Index less than 30; Blood Sugar Fasting Glucose:
                                                                                                     Pressure, Cholesterol, Blood Sugar and                                    wellness targets, you would have to commit and                            Less than 100; HbA1c: Less than 8.0. and Tobacco Use.
                           If you and/or your covered spouse/SSDP do not complete the                Alcohol Use                                                               follow your doctor's treatment plan.
                           requirements by the deadlines, everyone under your contract                                                                                                                                                                   Be sure to have your Fasting Glucose tested since non-fasting Blood
                           will be moved to the Standard Level (which means you will be paying       Lab work completed in the last nine months                                The A, B, C grading system tracks your status on the                      Glucose results will likely put you out of the healthy range.
                           more for out-of-pocket maximums, coinsurance and prescriptions).          qualify, but your physician must complete                                 Qualification form. If you and your covered spouse
                           If you are moved to the Standard Level, your next opportunity to return   and sign the Member Qualification form.                                   earn all As or Bs you will receive the Enhanced Level.                    If you and/or your covered spouse/SSDP do not complete the
                           to the Choice Level will be no earlier than April 1, 2013.                                                                                          Earning one or more Cs on any of the health measures                      requirements by the deadlines, everyone under your contract
                                                                                                     It can take up to 10 days to process your                                 will move the entire contract to the Standard Level.                      will be moved to the Standard Level (which means you will be paying
                                                                                                     iStrive Health Risk Assessment and your                                                                                                             more for out-of-pocket maximums, coinsurance and prescriptions).
                                                                                                     Member Qualification form                                                 Status A: You are meeting the wellness target.                            If you are moved to the Standard Level, your next opportunity to return
                                                                                                                                                                               Status B: You have a health condition that may not                        to the Enhanced Level will be no earlier than April 1, 2013.
                                                                                                     If unable to meet program requirements                                    be controlled, but you are actively participating in
                                                                                                     due to extenuating circumstances, please                                  treatment to improve the condition.
                                                                                                     call Client Services toll-free at (888) 819-2540.                         Status C: You are not meeting the wellness target
                                                                                                                                                                               and you haven't committed to treatment to improve
                                                                                                     If you and/or your covered spouse/SSDP do not complete the                your condition.
                                                                                                     requirements by the deadlines, everyone under your contract
                                                                                                     will be moved to the Standard Level (which means you will be paying       If you and/or your covered spouse/SSDP do not complete the
                                                                                                     more for out-of-pocket maximums, coinsurance and prescriptions).          requirements by the deadlines, everyone under your contract
                                                                                                     If you are moved to the Standard Level, your next opportunity to return   will be moved to the Standard Level (which means you will be paying
                                                                                                     to the Enhanced Level will be no earlier than April 1, 2013.              more for out-of-pocket maximums, coinsurance and prescriptions).
                                                                                                                                                                               If you are moved to the Standard Level, your next opportunity to return
                                                                                                                                                                               to the Enhanced Level will be no earlier than April 1, 2013.

Forms                      Incomplete forms will not be accepted. Make a copy                        Incomplete forms will not be accepted. Make a copy                        Incomplete forms will not be accepted. Make a copy                        Incomplete forms will not be accepted. Make a copy
                           for your records.                                                         for your records.                                                         for your records.                                                         for your records.

Phone Number               (888) 389-6646 or (800) 446-5674                                          (888) 819-2540                                                            (800) 873-0509                                                            (866) 261-7144 (Redbrick) (866) 694-3258 (Aetna)

Fax Number                 (616) 942-0616 Attn: HealthbyChoice, MS2005                               (248) 552-9416                                                            (866) 637-4972                                                            (877) 543-2937
(for Qualification Form)

Website                    priorityhealth.com                                                        hap.org                                                                   mibcn.com                                                                 www.redbrickhealth.com/login healthinsurance@aetna.com

Your Contact Information   Important: Be sure to update your contact                                 Important: Be sure to update your contact                                 Important: Be sure to update your contact                                 Important: Be sure to update your contact
                           information. If your information is not up-                               information. If your information is not up-                               information. If your information is not up-                               information. If your information is not up-
                           to-date, it may affect your ability to meet                               to-date, it may affect your ability to meet                               to-date, it may affect your ability to meet                               to-date, it may affect your ability to meet
                           the requirements.                                                         the requirements.                                                         the requirements.                                                         the requirements.

				
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