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Individual Member Guide Individual Member Guide UTAH 2018 SELECTHEALTH HEALTHSAVE® 2 CHOOSE A PLAN Most HealthSaveSM plans are designed to be paired with a Health Savings Account (HSA). With a HealthSave plan, We offer plans by metal tiers—Bronze, Silver, or Gold. you have more control over your healthcare dollars. Some These levels are defined onhealthcare.gov and indicate HealthSave plans are cost-share reduction plans; however, how much you’ll spend on benefits. We also offer a not all cost-share reduction plans are eligible for an HSA. Catastrophic plan. WHAT IS AN HSA? Choosing a Plan That’s Right for You BRONZE An HSA is similar to a personal savings account, with a few differences. For HSA-eligible individuals, The health plan pays 60% on average. money contributed to an HSA is tax-exempt and You pay about 40%. can be used for certain medical expenses (as EXPANDED BRONZE defined by the IRS) such as deductibles, copays, We offer a variety of plan designs and networks to fit your needs and budget. As you The health plan pays 65% on average. and coinsurance. Our preferred HSA vendor is You pay about 35%. HealthEquity®. Please visit healthequity.com for shop, it’s important to understand how our plans are categorized. Follow these four more information about an HSA. SILVER steps to help you enroll on the plan that's right for you. The health plan pays 70% on average. You pay about 30%. New! GOLD The health plan pays 80% on average. SELECTHEALTH HEALTHSAVE REWARDS Follow these four steps 1 FIND OUT IF YOU QUALIFY You pay about 20%. We believe that engaged members live their healthiest lives to find the perfect plan: possible, and healthy members help us keep insurance FOR A TAX CREDIT OR Catastrophic coverage plans pay CATASTROPHIC: premiums low. If you are looking for a plan that rewards COST-SHARE REDUCTION less than 60% of the total average cost of care. FIND OUT IF YOU QUALIFY you for making healthy choices, our HealthSave Rewards 1 FOR A TAX CREDIT ADVANCED PREMIUM TAX CREDIT ESTIMATOR plan (on the Select Value® network) may be just the right fit. The plan subscriber can receive an annual payment of If you qualify for a subsidy, the federal government $100—in the form of a Visa gift card—for fulfilling a few CHOOSE A PLAN will pay a portion of your monthly premium. Visit TRADITIONAL PLANS 2 commitments, such as creating a My Health account, selecthealth.org/applyonline and enter some simple Traditional plans are a popular choice for those who'd choosing a Primary Care Physician (PCP), and filling out an information, including family size and household income, CHOOSE A NETWORK like a traditional or "classic" plan, including coverage for online health assessment.* Members who enroll on this plan 3 to see if you qualify and get an estimate. medical services, preventive care, and prescription drugs. must earn and redeem their reward by December 31, 2018. Choose a deductible and benefits that work for you. MAKE YOUR FIRST PAYMENT COST-SHARE REDUCTION *Rewards made available subject to program terms Some of these plans have a deductible waiver or a 4 In addition to a tax credit, you may be eligible for cost- and conditions. limited deductible waiver for Primary Care, Mental sharing reduction plans that lower the amount you pay Health, and Specialty Care office visits. On these plans, out of pocket for deductibles, coinsurance, and copays. the deductible only applies for some or a limited number Members of a federally recognized American Indian tribe CATASTROPHIC PLAN of office visits. may also qualify for additional cost-sharing benefits. If you are younger than age 30, or if you qualify for a hardship exemption, you may consider purchasing a catastrophic health plan. These plans have lower premiums, higher deductibles and out-of-pocket maximums, making them ideal for those who only want protection from very high medical costs. These plans are not eligible for a premium subsidy. 2 selecthealth.org selecthealth.org 3 PARTICIPATING HOSPITALS AND CLINICS VALUE MED Alta View Hospital* American Fork Hospital* 10 PARTICIPATING HOSPITALS Intermountain Medical Center* 5,100+ PARTICIPATING PHYSICIANS & PROVIDERS LDS Hospital* McKay-Dee Hospital* Orem Community Hospital* Primary Children’s Hospital* Riverton Hospital* TOSH - The Orthopedic Specialty Hospital* Utah Valley Hospital* Bear River Valley Hospital* Delta Community Hospital* Dixie Regional Medical Center* Choosing a Network That’s Right for You River Road Campus Dixie Regional Medical Center* Fillmore Community Hospital* Garfield Memorial Hospital* Heber Valley Medical Center* Logan Regional Hospital* Park City Hospital* 3 CHOOSE A NETWORK Sanpete Valley Hospital* Sevier Valley Hospital* Our integration with Intermountain Healthcare® gives you access to high-quality hospitals, clinics, and doctors in the Cedar City Hospital* state. We offer two provider networks: Select Value and Select Med®. With Select Value, you generally enjoy lower Ashley Valley Medical Center premiums, but with Select Med you will have a larger network, giving you access to more providers. You can search for Beaver Valley Hospital participating providers at selecthealth.org/find-a-doctor, where you can also find patient satisfaction and quality 35 PARTICIPATING HOSPITALS Central Valley Medical Center ratings for many providers and clinics. 6,900+ PARTICIPATING PHYSICIANS & PROVIDERS Davis Hospital & Medical Center Franklin County Medical Center* LOWER COST HIGHER COST Gunnison Valley Hospital Huntsman Cancer Hospital FEWER PROVIDERS MORE PROVIDERS (For Med: Cancer Treatment Only) Kane County Hospital Milford Valley Memorial Hospital Moab Regional Hospital Mountain West Medical Center San Juan Hospital Value – Serving the Wasatch Front, this network is highly Med – Our most popular network covers all of Utah Uintah Basin Medical Center integrated with Intermountain Healthcare and includes and includes 35 participating hospitals and more than Cassia Regional Hospital** 10 participating hospitals and more than 5,100 providers. 6,900 providers. Portneuf Medical Center* St. Luke’s Rehab Hospital - IP Acute Care Unit *Idaho Facility *Intermountain-owned Facility 4 selecthealth.org selecthealth.org 5 4 MAKE YOUR FIRST PAYMENT Visit selecthealth.org/applyonline to use our convenient MEMBER SERVICES QUESTIONS? online application. The application must be completed Our Member Services Call us. and signed electronically. If you need help with your representatives are application, call Individual Sales at 855-442-0220, or you available six days a week can call your agent. to answer questions about your benefits and claims. You’ll need to make your first month’s payment before To contact Member Services, call 800-538-5038 you will receive an ID card. Care Options weekdays, from 7:00 a.m. to 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. TTY ALL YOUR INFO IN ONE PLACE users, please call 711. Once enrolled, you’ll have access to My Health. Here you’ll NEED HELP SHOPPING FOR A PLAN? Before scheduling an appointment, consider the following care options. have important health and benefit information at your We’re happy to help you find the right plan. They could save you money and a trip to the doctor! fingertips—whenever and wherever you need it. We also Call your agent, or contact our Individual Sales provide a number of health resources, including LiVe Well team at 855-442-0220. INTERMOUNTAIN HEALTH ANSWERS® EMERGENCY CARE tools, to help you achieve your wellness goals. Call Intermountain Health Answers to speak to a In emergencies, you should call 911 or go to the nearest registered nurse who will listen to your concerns, answer hospital. Though copays are the same at all emergency any medical questions you may have, and help you rooms, you will save money by visiting participating decide what course of action to take. Call 844-501-6600. hospitals. View participating facilities on page 5 of this booklet or visit . Free! selecthealth.org/find-a-doctor See your benefits on the next page for more information. INTERMOUNTAIN CONNECT CARE® Intermountain Connect Care is a fast, convenient OUTSIDE THE STATE OF UTAH way to talk to a provider about urgent medical If you have an emergency or need urgent care outside of issues. Use your smartphone, tablet, or computer Utah, participating benefits apply to services received in a to connect to a provider within minutes. It’s easier doctor’s office, urgent care facility, or emergency room. than you may think—download the app or visit You may save money on out-of-area services by using intermountainconnectcare.org to get started. Multiplan or PHCS providers and facilities. To find one, call or visit . $10 copay before deductible for non-HealthSave 800-678-7427 multiplan.com plans; $10 copay after deductible for HealthSave See your benefits on the next page for more information. (HSA Qualified) plans. INTERMOUNTAIN INSTACARE®/KIDSCARE® SELECTHEALTH MEMBER ADVOCATES® They’re open late—and are a great choice for SelectHealth Member Advocates can help you find sore throats, broken bones, sprains, headaches, a doctor or schedule an appointment. stomachaches, earaches, and other urgent medical Call 800-515-2220 weekdays, from 7:00 a.m. to conditions. With nearly 40 locations, there’s a site near 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. you. Use our app to reserve your spot in line! See your benefits on the next page for more information. 6 selecthealth.org selecthealth.org 7 Preauthorization is required for certain services. This chart is not a complete list of benefits. If you have questions,
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