The Healthcare Consortium for Virginia Private Colleges

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The Healthcare Consortium for Virginia Private Colleges Powered By Docstoc
					      Roanoke College
      Medical Plan Open
              Enrollment
October/November, 2009
    The Consortium
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       12 of Virginia’s Private Colleges have joined forces
        to purchase health care as a group
       Along with “purchasing power” comes:
             More flexibility in plan design
             More effective cost controls
             Greater presence in the marketplace
             Negotiating power with the carrier community
    Founding Members
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       Bluefield College        Lynchburg College
       Bridgewater College      Mary Baldwin College
       Emory & Henry            Randolph-Macon College
        College                  Roanoke College
       Ferrum College           Sweet Briar College
       Hampden-Sydney           Virginia Intermont
        College                   College
       Hollins University
    Consortium Benefits – The Basics
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       Continued partnership with Anthem Blue Cross Blue
        Shield

       All Consortium members have adopted a “January 1”
        Plan Year. All current medical benefits end on
        12/31/09.

       This is the first “Open Enrollment” for the founding
        members.
    Medical Plan Details
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    Medical Plan Options


• Overview of Plans Offered



• Benefit Plan Summaries




6                             Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc.
                                                 An independent licensee of the Blue Cross and Blue Shield Association.
                                                            Registered marks Blue Cross and Blue Shield Association.
    KeyCare Provider Network

• PPO – Preferred Provider network

• 95% of available physicians in
  Western Virginia are in our PPO
  network and 100% of all acute care
  hospitals

• Any provider can be accessed, NO
  referrals are necessary

• Provides in and out-of-network
  benefits
7                                      Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc.
                                                          An independent licensee of the Blue Cross and Blue Shield Association.
                                                                     Registered marks Blue Cross and Blue Shield Association.
    HealthKeepers Provider Network

• HMO Provider network

• 92% of available physicians in
  Western Virginia are in our HMO
  network, and 97% of all acute care
  hospitals

• Referrals are required

• Provides in-network benefits; with the
  exception of qualified medical
  emergencies
8                                      Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc.
                                                          An independent licensee of the Blue Cross and Blue Shield Association.
                                                                     Registered marks Blue Cross and Blue Shield Association.
      Network Providers
• Contact your provider’s office (ask if
  they participate in the KeyCare PPO/
  HealthKeepers HMO network)

• Check on-line at www.anthem.com

• Refer to Provider Directories

• Call Anthem’s “Pre-Enrollment”
  Customer Service Hotline (866-263-
  0361) or Anthem Customer Service
  (after 11/30/09)
9                                          Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc.
                                                              An independent licensee of the Blue Cross and Blue Shield Association.
                                                                         Registered marks Blue Cross and Blue Shield Association.
     Coverage While Traveling


     • With Anthem Blue Cross and Blue
      Shield PPO programs, you and your
      covered dependents have coverage
      nationally and internationally.


     • To access providers in the U.S. or
       internationally

        www.anthem.com or 1-800-810-
        BLUE

10
                                            Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc.
                                                               An independent licensee of the Blue Cross and Blue Shield Association.
                                                                          Registered marks Blue Cross and Blue Shield Association.
 Visit us at Anthem.com

     •Our Member Self Service tool is
       easily accessible through anthem.com
       and provides our members with the
       ability to manage their benefits and
       health care needs.
     • Find a participating physician,
       hospital, or other healthcare
       provider including directions
     • Print a customized directory
     • View claims status
     • Get personalized health information
       through MyHealth@Anthem
     • Request an identification card
                                       Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc.
11                                                        An independent licensee of the Blue Cross and Blue Shield Association.
                                                                     Registered marks Blue Cross and Blue Shield Association.
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     •   Provider Directory
     •   Multiple Providers
     •   Multiple Search parameters
     •   Personalized PDF directory (print or e-mail)
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        After Log-in
            Member Self Service
            Secure communications
            Member Empowerment Tools
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                                               For Individual
                                             Users – Online Bill
                                                 Payment



        Member Self Service
            Claims status
            View Authorizations
            Request ID card
            View and update personal info
            Secure communications
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        Claims Status
            Same info as EOB
            24 months history
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     •   Special Offers @ Anthem
         – Discounts on health products and services, health clubs,
           weight loss, acupuncture, Lasik surgery, vitamins
            360º Health Extras
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        MyHealth@Anthem
         Members who register on
           MyHealth@Anthem have
           access to a WebMD-
           powered personalized
           health center with
           interactive resources like:
              Condition Centers
              Physician Pre-Visit
               Questionnaire
              Symptom Checker
              Child Health Manager
              LEAP Fitness Program      Our Symptom Checker uses a 3-D graphic
                                           of the human body to help members
              Nutrition Center                   convey their symptoms
             360º Health Extras
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        SpecialOffers@Anthem
         Discounts on Health and
           Wellness Products and
           Services from leading
           national vendors
         –Just for Anthem Members

         •   Fitness clubs
         •   Weight management
         •   Smoking cessation
         •   Books and videos
         •   Alternative medicine
         •   Vitamins, minerals, and
         •     herbal supplements
         •   Laser Vision Correction   •Members can save 20-40% on over
                      Surgery          2,500 products through our extensive
                                                discount programs
             360º Health Guidance
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        Anthem 24/7 Nurseline
        Our information hotline
         provides access to a
         registered nurse over the
         phone anytime, anywhere,
         24 hours a day, 7 days a
         week. Call for assistance or
         just to hear a reassuring
         voice.
         •   Helps members assess
             symptoms
         •   Increases understanding
             of medical condition or
             prescribed course of
             treatment
                                           29% of PPO callers were directed to the
         •   Ensures members have                   emergency room.
             the right care in the right
             setting
          360º Health Guidance
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        Condition Care                     Includes the followingconditions:
                                              Includes              conditions
                                             Includes the following conditions
                                           Includes the following conditions: ::

         Our programs provide                Pediatric or Adult Asthma
           personalized support
           tailored to the needs of          Chronic Obstructive Pulmonary
           each member to improve                   Disease (COPD)
           their health while reducing
           medical costs.                    Heart Failure (HF)
              Multi-specialty team
               approach that includes        Coronary Artery Disease (CD)
               registered dieticians,
               clinical social workers,      Pediatric or Adult Diabetes – Types I
               pharmacists, and                      and II
               exercise physiologists
              Dedicated care managers
               provide a wide variety of
               educational tools to help
               members manage their
               health.
         360º Health Guidance
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                                             Includes the following conditions:
           Future Moms
     • Helps expectant women
         establish a healthy lifestyle for
         a healthy pregnancy.
     •    Follows progress from the
         first trimester through delivery
     •   Helps identify at-risk
         pregnancies and provides the
         care and support needed for
         full-term healthy births
     •    Obstetrical nursing support for
          both high-risk and non-high-
          risk expectant mothers
     •    Post-delivery follow-up,
         including postpartum
         depression, assessment,
                                                Future Moms is a HERA Award Winner for
         and education
                                             improvements in Women’s and Children’s Health
     •    Members have 24/7 phone                              Outcomes
         access to obstetrical nurse
      Pre-Authorization

 •   Required for the following services/procedures to avoid
     penalties:

     • All scheduled hospital admissions
     • Certain maternity admissions
     • Emergency hospital admissions (within 48 hours)
     • Skilled Nursing Facility admissions
     • All confinements of newborn dependents which
       extend beyond the mother’s discharge date
     • All proposed CT scans, MRIs and related diagnostic
       procedures

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                                         Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc.
                                                            An independent licensee of the Blue Cross and Blue Shield Association.
                                                                       Registered marks Blue Cross and Blue Shield Association.
      Mail Order Rx Drugs


 For those who currently take maintenance
   medications:
 • Contact Wellpoint Next Rx at 888-613-6091.
 • Next Rx representatives will contact your
   physician to establish Mail Order Service.
 • Allow approximately 2 weeks for set-up process.
 • To prevent interruption of current mail order
   service, obtain script from physician and fill
   prescription before January 1st, 2010.
 • Next Rx envelopes and contact information are
   included in Anthem enrollment packets.

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                                         Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc.
                                                            An independent licensee of the Blue Cross and Blue Shield Association.
                                                                       Registered marks Blue Cross and Blue Shield Association.
     Rx – Pre-Authorization

 If you are taking a specialty medication that
    requires pre-authorization (e.g., most
    non-insulin injectables):
 • Contact the Specialty Drug Unit at 800-870-
   6419. (A complete list of Specialty Drugs can
   be provided.)

 If you are taking a non-specialty medication
    that requires pre-authorization:
 • Coordinate with your physician. Have physician
    contact Anthem/Wellpoint. Physicians have a
    special provider contact number.

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                                          Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc.
                                                             An independent licensee of the Blue Cross and Blue Shield Association.
                                                                        Registered marks Blue Cross and Blue Shield Association.
 Customer Service Contacts

 •       Pre-enrollment line is available October 26 –
         November 30
                       1-866-263-0361
          Hours are 9 am to 5 pm, Monday - Friday

 •       Customer Service is available to answer your
         questions once you are enrolled
               KeyCare PPO Customer Service
                       1-800-445-7490
           HealthKeepers HMO Customer Service
                       1-800-421-1880
               Lumenos HSA Customer Service
                       1-800-582-6941

     •    CS Hours - Monday through Friday 8 am to 6 pm
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                                                   Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc.
                                                                      An independent licensee of the Blue Cross and Blue Shield Association.
                                                                                 Registered marks Blue Cross and Blue Shield Association.
                                     We thank you for this opportunity to provide
                                health insurance coverage for you and your family!




     Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. An independent licensee of the Blue Cross and Blue Shield Association. Registered marks Blue Cross and Blue Shield Association.

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     Uniview Vision Plan
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     Ameritas Dental Plan
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     Flexible Spending/Premium Conversion
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     Open Enrollment
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     Requirements/Deadline
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        Forms:
          Anthem  PPO/KeyCare Application OR
           Anthem HMO/Healthkeepers Application
          Dental Election Form

          Flexible Benefit Election Form

          Vision Enrollment Form (if electing voluntary coverage)


        Enrollment materials must be returned to Human
         Resources no later than Friday, November 20th.
     Roanoke College Open Enrollment
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