2020 Large Group Benefits Brochure
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20 Large Group Benefits 20 Health plans designed for flexibility and savings Health | Well-being | Prescription Drug | Dental | Vision | Additional Workplace Benefits Bringing you SMARTER, BETTER HEALTH CARE Improving care in every community Personalized member engagement with a robust portfolio that delivers programs that to help your employees make smart decisions drive higher-quality health care and lower costs. about their health care expenses. Purposeful innovation Tailored health plan solutions to change the way health care is designed, that are comprehensive and flexible to meet delivered, and experienced for our members. your business’ unique needs. Table of contents Smarter, Better Health Care........................................................................1 Improving care in every community...............................................................3 Personalized member engagement ................................................................5 Purposeful innovation ..................................................................................10 Tailored health plan solutions ........................................................................11 51 – 99 health plans ...................................................................................22 Copay Deductible/Copay Deductible/Coinsurance HSA-qualified Choice Advantage Tiered Network 100+ health plans .......................................................................................38 Copay Deductible/Copay Deductible/Coinsurance HSA-qualified Choice Advantage What’s not covered ......................................................................................49 Important plan details .................................................................................50 Underwriting summary................................................................................51 Prescription drug plans ................................................................................53 Dental plans ................................................................................................55 Vision plans .................................................................................................57 SMARTER, BETTER HEALTH CARE Keep your employees healthy and protect your bottom line with a tailored network and health plan solution from Independence Blue Cross (Independence). Whether you need medical and prescription drug coverage or want to add extra benefits, we have a health plan for you. The Power of Blue With the power of the Blues, we can deliver comprehensive health coverage solutions to you.* 1 in 3 Americans Largest provider network 106 million members carry a Blue Card (96% of hospitals, 95% of doctors) * Based on data from the Blue Cross Blue Shield Association. Health plans overview Quick guide to your benefits solutions Independence has everything you need to create a tailored health plan solution to keep your business and employees as healthy as possible. Build the plan that best meets your needs. 51 – 99 customers 100+ customers Protect employees' health • 58 plans • 168 plans • PPO, DPOS, POS • PPO, DPOS, POS • Tiered Network plans • Copay, deductible, and coinsurance plans • Copay, deductible, and coinsurance plans • Health Savings Account (HSA) • Health Savings Account (HSA) • Biotech/Specialty & Infusion Health plans — pg. 22 – 48 • Biotech/Specialty & Infusion Site of Service benefits Site of Service benefits • Choice Advantage plans with additional • Choice Advantage plans with additional Site of Service benefits Site of Service benefits • Preventive Plus colonoscopy benefit • Preventive Plus colonoscopy benefit • Lab Site of Service benefits (PPO plans only) • Lab Site of Service benefits (PPO plans only) • HSA available with qualified plans • HSA available with qualified plans • HRA option with all plans except HSA-qualified plans • HRA option with all plans except HSA-qualified plans Spending accounts — pg. 19 • FSA for medical or dependent care available with any plan* • Coverage is required • Coverage is optional • Value formulary • Value formulary Prescription drug — pg. 53 – 54 • 3 plans • 20 plans • HSA-qualified plans have built-in prescription • HSA-qualified plans have built-in prescription drug coverage drug coverage • Available to all customers • Available to all customers Dental — pg. 55 – 56 • Sample PPO plans included for comparison • Sample PPO plans included for comparison • Additional PPO plans available • Additional customizable PPO plans available • All DPOS/POS medical plans have built-in eye • All DPOS/POS medical plans have built-in eye exams and can be paired with vision plans to exams and can be paired with vision plans to Vision — pg. 57 – 58 cover glasses or contacts cover glasses or contacts • PPO medical plans can be paired with vision plans • PPO medical plans can be paired with vision plans that cover exams as well as glasses or contacts that cover exams as well as glasses or contacts • Included for all fully-insured customers • Included for all fully-insured customers Telemedicine — pg. 16 • Available to self-funded customers • Available to self-funded customers Employee assistance program — pg. 20 • Personal Life ManagementSM • Personal Life ManagementSM Protect employees' wealth • Life insurance • Life insurance Guardian supplemental • Disability insurance • Disability insurance insurance — pg. 20 • Accident, critical illness, and cancer insurance • Accident, critical illness, and cancer insurance • Hospital indemnity insurance • Hospital indemnity insurance Give employees peace of mind • Available to fully-insured customers at no cost • Available to fully-insured customers at no cost The College Tuition Benefit — pg. 16 upon renewal upon renewal • Available to self-funded customers • Available to self-funded customers International health • 2 plans to choose from (short- or long-term travel) • 2 plans to choose from (short- or long-term travel) insurance — pg. 21 Lower your financial risk Stop loss — pg. 21 • Not available • Available for self-funded customers * HSAs can only be paired with a limited-purpose FSA to cover eligible vision and dental expenses. 2020 Large Group Plans | Independence Blue Cross 2 Improving care in EVERY COMMUNITY Making health care work better in the communities we serve by working together with providers to improve the quality and affordability of the care delivered to your employees. Value-based programs provide quality and savings Independence is a leader in driving value-based health care through our Facilitated Health Networks (FHN). Instead of paying providers for volume, this approach rewards providers based on quality and outcomes. % % BETTER DECREASE 32 1 21 2 in pediatric prevention in avoidable ER visits per 1,000 % 18 MORE PROVIDERS in a value-based contract than the national average3 1 Based on 2017 HEDIS National Average 2 Based on internal data 3 Health Care Payment Learning & Action Network. Measuring Progress: Adoption of Alternative Payment Models in Commercial, Medicaid, Medicare Advantage, and Medicare Fee-for-Service Programs. October 22, 2018 Improving care in every community Health care value optimization Driving value in medical management As stewards of your dollar, we regularly review programs, In recent years, Independence has optimized our medical processes, and policies — using industry benchmarks and management savings to ensure members receive high-quality best practice standards — to identify and address outliers health care in the safest setting. As a result, we are: in health care costs and utilization. Once we identify new • Driving evidence-based care initiatives, we embed them into our utilization management and claim payment policies. • Reducing the number of unnecessary procedures and related costs from potential complications • Embedding pharmacy benefits with medical benefits to provide the safest, most appropriate care Network Management and reimbursement administration Medical/Pharmacy Policy Health Care Value Optimization Utilization Management Payment Optimization % FHN success story: Penn Medicine CUT We collaborate with the University of Pennsylvania Health System (Penn Medicine) 25 to ensure our members receive quality health care at an affordable price. in hospital readmissions rates after the first year Preventing readmissions Real-time data Face-to-face with doctors Payment models incentivize doctors Exchanging data helps give a We hold quarterly meetings with Penn to deliver quality care, preventing complete view of patients' health Medicine doctors to provide tools to unnecessary readmissions. and identify gaps in care. help them maximize cost efficiencies. 2020 Large Group Plans | Independence Blue Cross 4 Personalized MEMBER ENGAGEMENT A positive and engaging employee and member experience is about getting members to understand and use their benefits to make smart decisions about their health and care expenses. Engaging with members helps them: Better understand Improve their health Make informed health Use self-service tools and maximize their and well-being care decisions and resources health benefits Members can access the following tools anytime, anywhere on ibx.com or through the IBX mobile app. Tools for members' health Tools for members' wealth • Achieve Well-being • Healthy Lifestyles reimbursements • Telemedicine services • Care Cost Estimator • Find a Doctor tool • Price a Drug tool • Behavioral health resources • Blue 365® discount • Blue Insider SM savings • Spending accounts The IBX