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Health Care Guides

Health Care Guides. Introducing New Mexico Health Connections. New Mexico Health Connections. Affordable Care Act (ACA) – Section 1322 Consumer Operated and Oriented Health Plan (CO-OP) New Mexico’s only non-profit health plan

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Health Care Guides

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  1. Health Care Guides Introducing New Mexico Health Connections New Mexico Health Connections

  2. New Mexico Health Connections • Affordable Care Act (ACA) – Section 1322 • Consumer Operated and Oriented Health Plan (CO-OP) • New Mexico’s only non-profit health plan • February 2013 - Licensed as Certified Qualified Health Plan by NM Office of the Superintendent of Insurance • Required to hold 2.5 times the normal financial reserves needed for health plans • All brought about by Nandini Kuehn, PhD and other concerned New Mexicans

  3. NMHC - What Makes Us Different Non-profit health plan • Mission-driven, not profit-driven • Profits will be reinvested back to New Mexicans to improve quality of health care • Lower Premiums • Improve Benefits • Collaboration with Community Organizations • Investing in the community health infrastructure • Serving as connector between members and community resources

  4. NMHC - What Makes Us Different • Consumer Operated and Oriented Health Plan (CO-OP) • Governed with consumer control • By 2016, majority of our Board of Directors will be NMHC members • Members will help drive health plan direction and decisions

  5. NMHC - What Makes Us Different • NMHC is committed to a model of coordinated care • Focused on keeping members and their families healthy • Closely partnering with Clinicians, Community Health Workers and Promotoras • Incentivizing prevention, health, and wellness

  6. Philosophy of Benefit Plans • Less is more • Fewer plans = Less confusion • Our benefit plans on the Exchange are the same as those off the Exchange • Choice to use co-pay model • The cost the member pays is defined and clear • Encourages use of preventive care and wellness services

  7. Generic Medications • $0 Co-pay for these Chronic Conditions: • Hypertension • Depression • Bipolar Disorder • Diabetes • Hypercholesterolemia • Chronic Obstructive Pulmonary Disease • Coronary Artery Disease • Congestive Heart Failure • Asthma

  8. Behavioral Health Services • Behavioral Health Services are a key focus for NMHC • Addressing Behavioral Health issues leads to better overall health • Behavioral Health Provider network • $0 co-pay for the first 3 outpatient visits • $0co-pay for most generic Behavioral Health medicines

  9. NMHC State-Wide Provider Network • Nearly 5,500 practitioners, hospitals, and facilities • Primary Care and Specialty • Close partnerships with FQHCs • Centers of Excellence • Out of State Network • Community Health Worker program • Please refer to website for a more detailed list of providers

  10. NMHC Website: Easy to Navigate

  11. NMHC Website: Getting Started

  12. NMHC Website: Quote and Compare

  13. NMHC Website: Quote Comparison

  14. NMHC Website: Provider Network

  15. NMHC Website: Rx Formulary

  16. Questions to help guide your clients • How often do you /your family go to the doctor • How many times did you visit the emergency room last year • What prescription medications are taken on a regular basis • Who are your doctors • Do you have any chronic conditions • Are you eligible for subsidies

  17. Things to Consider • How much did you spend last year • The least expensive plan is not always the most cost effective • Consider deductibles, co-pays and coinsurance as well as the monthly premium Example: The story of Mr. Sanchez and his health plan selection journey

  18. Mr. Sanchez & His Health Plan Selection

  19. NMHC Summary • NMHC adds value to the insurance market • Member Driven • Community Focused • Co-pays clarify member costs • Easy to use website • Profits reinvested in New Mexico • Built by New Mexicans, for New Mexicans

  20. New Mexico Health Connections www.mynmhc.org info@mynmhc.org 1-855-7MY-NMHC 2440 Louisiana Blvd., NE, Suite 601 Albuquerque, NM 87110

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