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A New Approach to Health Insurance

A New Approach to Health Insurance. “To be a leader in transforming the health of Maine people and positively affecting the Maine economy”. Located in Maine; Centered Around You. Member Directed Partner with Maine People Your Voice is Our Voice. Accessible Supporting the Maine Economy.

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A New Approach to Health Insurance

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  1. A New Approach to Health Insurance “To be a leader in transforming the health of Maine people and positively affecting the Maine economy”
  2. Located in Maine; Centered Around You Member Directed Partner with Maine People Your Voice is Our Voice Accessible Supporting the Maine Economy Understanding the Needs of Maine People Focused on Maine Provider Network Care Management Account Management Transparent No Shareholders
  3. Broad Network PPO (Preferred Provider Organization) All Maine Hospitals Border Facilities & Providers National Network (First Health) PCPs, NPs& Specialists MH & SA Providers Hospitals, Clinics, Pharmacies & Others No Referrals Required
  4. Driving forces: Competitive Pricing & Comprehensive Benefits Lower Base Rate Than Competition More Robust Benefits for Small Groups More Value for Your Premium Dollar Pricing & Benefit Comparisons Encouraged Response from Competition: Early Renewals Missed Premium Savings Change of Contract Year Migration to QHP for Most Employers
  5. Small Group Plans on & off SHOP
  6. Our Approach to Benefit Design Sets Us Apart Integrated Behavioral and Medical Health PT/ST/OT at Primary Care Level Cost Sharing First 3 Mental Health Visits at No Cost VBID / CISP Tobacco Cessation Encourage Member Engagement Shared Decision Making Choosing Wisely
  7. More to Your Bottom Line Lower Out of Pocket Costs + Healthier Employees + Less Absenteeism + Enhanced Productivity = More to Your Bottom Line
  8. Wellness Adds Value 24/7 Access to Health Coaches Healthy Options Online Health and Wellness Portal Informed Decisions Registered Nurses, Dieticians, Respiratory Therapists May call you to talk about your condition Provide information Help you make important medical decisions Get facts on over 6,000 health topics Use decision support tools and videos Complete your wellbeing assessment Join challenges to earn points and get rewards. Create personal goals and track progress
  9. Tobacco Cessation Treatment Maine Community Health Options Will Cover: Nicotine Replacement Products Prescribed by a Plan Provider Products Approved by the FDA for Tobacco Cessation Tobacco Cessation Education and Counseling Covered at No Out of Pocket Cost: Generic Nicotine Replacement Therapy (NRT)*: Gum, Lozenge, Patch Chantix (up to a 90 Day Supply) *When prescribed by a Plan Provider MCHO does not use the “Tobacco Rating Band” to charge higher Premiums for smokers
  10. Chronic Illness Support Program MCHO offers additional help to Members with certain chronic medical conditions that can be managed for better health. Asthma COPD / Emphysema Diabetes Hypertension Saves Members money by lowering or eliminating Out of Pocket Costs for Routine Care of a chronic illness.
  11. Supporting Management of Chronic ConditionsLower out-of-pocket costs for meds and services Diabetes Asthma & COPD Hypertension Medications $0 costing sharing for Specific medications used to treat diabetes, hypertension and hyperlipidemia-Generics, 50% cost-sharing for preferred brand Services - $0 cost sharing when done by Plan Provider Offices Visits to PCP for routine management Endocrinology consultation Podiatry Consultation Nutritional Counseling, diabetes education, modification counseling Diabetic Eye Exam (1/yr.) 1 Glucometer/yr., up to 150 test strips every 90 days Lab services linked to diabetes primary diagnosis code. Medications $0 costing sharing for Specific medications used to treat asthma & COPD-Generics, 50% cost-sharing for preferred brand Services - $0 cost sharing when done by Plan Provider Offices Visits to PCP for routine management asthma, COPD, emphysema Pulmonologist consultation; Pulmonary function test (1/yr.), Home oxygen therapy assessment Lab services linked to asthma/COPD primary diagnosis code Inhaler adjuncts; Peak flow meter (1/yr.); Asthma education Pulmonary rehab., ongoing exercise program for COPD Home assessment (asthma only) up to $75/yr. Medications $0 costing sharing for Specific medications used to treat hypertension and hyperlipidemia-Generics, 50% cost-sharing for preferred brand Services - $0 cost sharing when done by Plan Provider Offices Visits to PCP for routine management Cardiology or nephrology consultation and management of hypertension Lab services linked to hypertension primary diagnosis code.
  12. Impact of CISP as Seen Through SBC(Silver Plan example)
  13. Getting a Quote Qualified Brokers are Our Primary Channel By Working with an MCHO Benefits Consultant 7 Simple Steps Online Proposal, Application and Enrollment Manage Coverage Online Through the Employer Portal
  14. Step 1): Basic Information
  15. Step 2): Employee Census
  16. Step 3): Benefit Choices
  17. Step 4): Contribution Method
  18. Step 5): Employer Contribution Amounts
  19. Step 6): Compare Plans
  20. Step 7): Review
  21. Simple Online Enrollment
  22. Automated Process Keeps You in the Know
  23. Ongoing Administration Made Easy
  24. Summary of Attributes Local, Accessible Non-Profit Comprehensive State-Wide Network CO-OP; Your Voice is Our Voice Value Based Insurance Design Delivering More Value to Employers Competitive Rates and Comprehensive Benefits
  25. MCHO Today: Growth Over 39,400 Members Over 150 Groups
  26. MCHO Today: Service Service Delivery Lessons Learned Member Services ID Card Website Enhancements
  27. MCHO Today: Business Development Extensive Broker Network Dedicated Business Development Team North: Robert Guerette, Benefits Consultant Patrick Hamlin, Account Manager South: Sharon Ware, Benefits Consultant Mari Whittaker, Account Manager Inside Benefit Sales Consultants: Matthew Ellis Kristy Pendexter
  28. Thank you for your time and interest in Maine Community Health Options. Toll Free: 1-855-624-6463 www.maineoptions.org Business Development 207-402-3353
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