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10/1/19 Open Enrollment June 11, 2019 Through August 31,2019 June 2019 Meetings. Proprietary + Confidential. Who is Optima Health?. Virginia-based, not-for-profit health plan; owned by Sentara Healthcare, consistently ranked as one of Modern Healthcare’s top ten Integrated Delivery Systems
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10/1/19 Open Enrollment June 11, 2019 Through August 31,2019 June 2019 Meetings Proprietary + Confidential
Who is Optima Health? • Virginia-based, not-for-profit health plan; owned by Sentara Healthcare, consistently ranked as one of Modern Healthcare’s top ten Integrated Delivery Systems • Offering plans in Hampton Roads for 30 years, in Central VA since 2005, and in Roanoke/Lynchburg region since 2011 • Covering 500,000+ commercial and government program members • Highest-ranked health plan serving central/eastern Virginia by NCQA • Market leader in integrated Consumer Directed Health Plan solutions (HSA, HRA) • Consistently exceeds industry standards for claims accuracy, speed of answer, first call resolution, member and provider satisfaction Proprietary + Confidential
Optima Health Network Overview • 98% of physicians in Hampton Roads / NE North Carolina • 100% of inpatient facilities • All Sentara, Riverside, and Bon Secours facilities, Chesapeake Regional • Level 1 Trauma Center (Sentara Norfolk General) • Pediatric specialty hospital (Children’s Hospital of the King’s Daughters) • Three teaching facilities for tertiary care: • Virginia Commonwealth University - Richmond • University of Virginia - Charlottesville • Duke University – Durham Proprietary + Confidential
Provider Network PenetrationUpdated January 2019 All Optima Health networks include Duke University Hospitals and their affiliated physicians Proprietary + Confidential
Features in Your Plan • No Pre-existing Condition exclusions or waiting periods • No cost for preventive services, including annual vision exam • PCP relationships will be established, to help manage your care, but…. • No referrals required to see a specialist (“open access”) • After Hours Nurse – Toll Free number on ID card • Emergency Travel Assistance included • Convenience & Savings with MDLIVE telehealth • Employee Assistance Plan built in • Pharmacy and Medical Transition • wellness services Proprietary + Confidential
Benefit Summaries Proprietary + Confidential
MDLIVE = Telehealth services • Affordable (cost = PCP copay or $39) • 24/7/365 Anytime, Anywhere consultations • Online with webcam, telephone, or secure email with Board Certified physicians • MDLIVE physicians can diagnose, treat, and call in prescriptions for routine medical conditions • Register for MDLIVE by going to optimahealth.com • For added convenience, register all family members up front so that the account/profile is set up and ready to use when needed • Access MDLIVE via Optimahealth.com • Provides medical excuse notes for work and/or school • See Benefit Information Guide (BIG) for more details Proprietary + Confidential
Equity Vantage Preventive Rx Benefit Equity Vantage plan members are eligible to receive medications that are considered by Optima Health to be preventive at $0 copayment • Examples: • Montelukast Sodium for members with allergies or asthma • Metoprolol Succinate ER for members with high blood pressure • Please note: • If a generic equivalent drug is available, the brand-name drug is excluded from this benefit • You or your doctor may be asked to prove that the drug is used for prevention Proprietary + Confidential
OptumRx Mail Order Home Delivery Mail order home delivery from OptumRx is a convenient and cost-effective way to receive maintenance or long-term medications • Have your doctor write a mail order prescription; write your member ID number, name, and DOB on back* • Complete a New Prescription Mail-In Order Form and mail along with prescription and copayment to OptumRx • For refills, you can request via Optimahealth.com, by calling OptumRx, or by mail using the provided medication refill slip *Doctors can also place prescriptions over the phone or by fax directly to OptumRx; they must provide required member information Proprietary + Confidential
Additional Pharmacy Notes • Standard/Closed Formulary • Drugs must be on the Formulary to be covered • A number of high-cost brand name drugs with proven alternatives are not included • Brand Buy-Up • Member pays difference between cost of generic and cost of brand, if generic is available but brand is obtained • Specialty Pharmacy: • Our specialty pharmacy is Proprium. They will fill all specialty prescriptions, via delivery to your home or physician’s office. Your retail pharmacist will alert you if your prescription must be filled by Proprium. Contact Proprium at 855-553-3568. • Compare Drug Costs for a chance to save! • At optimahealth.com – find drug prices and see alternatives to share with doctor Proprietary + Confidential
Treatment Cost CalculatorImproving Transparency for Members • Provides estimates for over 500 procedures and services • Compares providers and facilities • Uses real-time benefit information, deductible, and out-of-pocket maximum balances to calculate estimate • Provides HSA balances • Provides estimates of annual treatment costs by conditions Estimates are based on claims data Proprietary + Confidential
Winning with an Optima Health HSA Plan • Experienced market leader • No implementation or administration fees • Paperless for ease of administration • Direct claim feed from Optima to HealthEquity • Online Employee Portal • Permanent online database of eligible expenses • Easily pay providers for balance due or reimburse yourself • Wide breadth of investment options through low-cost Vanguard mutual funds • No transaction costs for trades • Easily transfer account balances and contributions from previous HSA • 24/7 US-based call center for questions, assistance, tax advice • Education available through: • Pamphlets/Books • Webinars/videos • HSA Contribution Calculator Proprietary + Confidential
Out-of-Area Dependent Program • For Vantage HMO and POS subscribers • Available to dependent children living out of the service area • Provides in-network coverage for use of PHCS providers • Must complete a confirmation document each year Proprietary + Confidential
Optima EAP • Helpful, flexible, and easy to use resources that can assist with: • Addressing life’s challenges • Solving problems • Tackling work-related issues • Health Plan includes 3 visits/virtual visits per new incident per person per year • Includes all enrolled employees AND household family members of enrolled employees • No cost for EAP visits • Confidential Proprietary + Confidential
Optima Health Mobile App Members can safely and securely access important health information whenever and wherever they need it. • Improved Access to Care with the touch of a screen • Find doctors and urgent care centers • Shop for health plans • Digital Engagement • Securely view benefit information • View and email member ID cards • Real-time access to deductibles, balances, and claims • View user profile and update email address • Access Optima Health contact information • Future enhancements and features to come Proprietary + Confidential
Health and Wellness Services Getting Started (No Charge) • Personal Health Assessments • Online; Confidential • How do I stack up? What are my risks? How can I address them? • Coaching – with Digital Health Assistant (telephonic option) • Robust Tools and Trackers • Staying Healthy • Award Winning Signature Programs • Healthy Habits/Healthy You • Guided Meditation • Tai Chi Qigong Shibashi • Eating for Life • Tobacco Cessation • Walkabout with Healthy Edge • Free Pedometer • Call 1-800-SENTARA – No charge Proprietary + Confidential
Gym Network 360 Discount Program • Effective April 2018, we have partnered with GlobalFit to provide a new discount program • Member discounts on fitness facilities, at-home exercise programs, nutrition, weight loss, and healthy-eating programs • 5-20% off retail rates at over 9,500 fitness facilities and programs • 24 Hour Fitness, Anytime Fitness, Curves, Gold’s Gym, etc. Proprietary + Confidential
Emergency Travel AssistanceWhen you are over 100 Miles from Home - Anywhere in the World • Complements Health Plan Benefits, for travelers • Medical Consultation, Evaluation, and Referral • Coordination between the health plan, attending physician/facility, and family members • Available 24/7, 365 days per year • Offers global access to Western-style health care • Coordinates logistics of care and repatriation of a seriously ill or injured member • Pays for full cost of evacuation (or return of remains) • Medical or non-medical escort if necessary • Foreign Hospital Admission Assistance • Advance of funds / guaranteed access • Separate ID card will come with regular Optima ID card Proprietary + Confidential
New Member Checklist This new checklist is designed to help navigate new enrollees to the services and tools available on Optimhealth.com • Getting registered • Complete Personal Health Assessment • Register with MDLIVE • Access HSA Information • Transition of care information Proprietary + Confidential
10/1/19 Open Enrollment June 11, 2019 Through August 31,2019 Better Health Easy to Use A Great Value Questions? Proprietary + Confidential