2011 US Benefits - HealthSCOPE Benefits

Transcription

WHIRLPOOL CORPORATION:
2011 U.S. Benefits
Susan Pavlopoulos
Senior Manager//
Global Benefits
November 17, 2010
WHIRLPOOL CORPORTATION  CONFIDENTIAL
2011 ACTIVE & RETIREE MEDICAL PLANS
2011 ACTIVE REWARDS AND SAVINGS PLANS
2011 ACTIVE AMANA HOURLY PLANS
Presentation title 4
2011 ACTIVE FT SMITH HOURLY PLANS
Presentation title 5
ACTIVE FLEXFORCE LIMITED PLAN
WHIRLPOOL PAYS
EMPLOYEE
PAYS
in-network
Deductible
Per Person3
Out-of-Pocket Limit
Per Person
Benefit Description
Primary Care Physician (PCP) Ofﬁce
Visits
Specialist Office Visits
Hospital (Inpatient & Outpatient)2
Surgery (Inpatient & Outpatient) 2
Adult Routine Wellness
Well Child Care
Emergency Room
Mental and Nervous (inpatient &
outpatient)
Chiropractic Care
Home Health Care
Annual Maximum
Lifetime Maximum
Prescription Benefit Highlights
Retail or Mail Order
Limited Plan
out-of-network
$1800
$3,600
none
none
70%
50%
70%
50%
70%
50%
70%
50%
100% *
Not covered
100% *
Not covered
70%
70%
50% if non-emergency
70%
50%
70%
50%
limited to 20 visits per calendar year (combined
limit)
70%
50%
limited to 120 visits per calendar year (combined
limit)
n/a
n/a
70% coinsurance*
* Indicates no deductible applies
Corporate Standard//Sample PowerPoint  6
WHIRLPOOL WELLNESS PREVENTIVE CARE BENEFITS
Preventive Care
Adults
Actives & Pre
Medicare Retirees
• 100% no deductible
in network!
•Bill with
routine/preventive
V-code
Well-adult care includes one routine office visit and examination each
Plan Year after age 18 years and one OB/GYN office visit and
examination after age 18 years of age each Plan Year.
Included immunizations and screenings associated with the above
routine office visits are as follows:
• Immunizations
1.Tetanus / Diphtheria (Td) Booster once every 10 years,
2.Influenza Vaccination (flu shot), one shot each Plan Year,
3.Pneumococcal Vaccination (Pneumovaz) one dose for persons
65
years and over,
4.Meningococcal conjugated vaccine (MCV4), one dose for college
freshmen living in dormitories
5.• Screenings
6.Cholesterol screening including triglycerides, LDL, HDL, or lipid
panel once every 5 years beginning at age 20 years
7.Baseline Mammogram, one between 30 and 40 years of age,
and one Mammogram each Plan Year starting at age 40 years of
age
8.Pap Smear and Routine Pelvic Exam, one each Plan Year
beginning at age 18 years,
9.Bone density test for osteoporosis every two years for women
age 50 years and over,
Colorectal Cancer Screenings,
􀂃 Fecal occult blood test (FOBT) or Colonoscopy or Double contrast
barium enema
􀂃 Digital rectal examination (DRE) and prostate specific antigen (PSA)
test.
• Pathologies, labs, chest x-rays, and EKGs that are ordered as part of
your preventive care visit due to age and/or family history, and are
considered preventive care by your Physician.
WHIRLPOOL WELLNESS PREVENTIVE CARE BENEFITS
Preventive Care
Children
• 100% no
deductible in
network!
•Bill with
routine/preventive
V-code
Well-child care includes routine office visits and examination, as follows:
1.
Six visits 0 – 12 months,
2.
Three visits 12 – 24 months,
3.
Annual visits from 24 months through age 18 years of age,
4.
GYN exam for children at age 18.
When associated with routine office visits, the following immunizations and
screenings are covered:
• Immunizations o Two doses of Hepatitis A, Three doses of Hepatitis B,
o Six doses of Diphtheria, Tetanus, Pertussis (DtaP), Four doses of Haemophilus
Influenza type b, Four doses of Polio, Four doses of Pnuemococcal Conjugate,
Two doses of Varicella, wo doses of Measles, Mumps, Rubella,
o One dose of Influenza vaccine (flu shot) one dose each Plan Year for children over
the age of 8 years; two doses (administered separately by at least 4 weeks)
each Plan Year for children up through 8 years of age.
o Human papilloma virus (HPV) vaccine for girls ages 9 through 18 years of age at the
following intervals:
􀂃 One complete dosage per lifetime consisting of 3 shots given within a 6 month
timeframe.
􀂃 Women over the age of 18 years but under the age of 26 years who have not yet
received the HPV may also receive the vaccine.
• Meningococcal conjugated vaccine (MCV4) at the following intervals:
One dose between the ages of 11 and 12 years; or
One dose before high school entry or at age 15 years, whichever
occurs first, for children who have not previously received the
MCV4 vaccine.
• Screenings and Exams
Lead level testing, one between ages 9 to 12 months and one at 24 months or after,
Vision screening conducted as part of Well-child care visit at ages 3, 4, 5, 6, 8, 10,
12, 15, and 18 years,
Hearing screening conducted as part of Well-Child care Visit at ages 4, 5, 6, 8, 10, 12,
15, and 18 years,
Pap smear and routine pelvic exam, one each Plan Year beginning at age 18 years or
the onset of sexual activity, whichever comes first
Pathologies, labs, chest x-rays, and EKGs that are ordered as part of your preventive
care visit and are considered preventive care by your Physician.
WHAT’S CHANGING?
Active Medical:
 Dependents up to age 26 may be added to plans, student and
marital status no longer apply
 Lifetime maximums on active plans have been removed
 Over the counter medications will no longer be reimbursable
through an FSA (or HSA) without a prescription
Retiree Medical:
 Most Pre-65 retirees moving to Rewards and Savings plans
 No I-account for pre-65 Rewards and Savings plans
 Most Post-65 retirees moving to stipend as of 1/1/11
 Pre and post-65 plans offered thru Whirlpool have LTM
2011 PHARMACY BENEFIT
2011 PHARMACY BENEFIT FOR ACTIVES
& PRE-65 RETIREES
*90-day supply available thru
Walgreens network
pharmacies or mail order only
Tier 0:
Tier 1:
Tier 2:
Tier 3:
Tier 4:
$0 or 0% Coinsurance
10% Coinsurance
30-day supply:
Min: $5 , Max: $12
90-day supply*:
Min: $12.50 , Max: $30
20% Coinsurance
30-day supply
Min: $20 , Max: $100
90-day supply*:
Min $50 , Max: $250
50% Coinsurance
30-day supply
Min: $50, Max: $250
90-day supply*:
Min: $125, Max: $625
100% Coinsurance
Encourage the
utilization of cost
effective therapies
relative to other agents
/ therapies
Products that are not as
clinically or cost
effective relative to
other available agents /
therapies
Products
considered to have
minimal or no
clinical or cost
effectiveness
relative to other
available agents /
therapies
Primarily Preferred
Brands
Primarily Non-Preferred
Brands
Encourage the
utilization of clinically
and cost effective
therapies
Encourage the
utilization of cost
effective therapies that
don’t qualify for $0 tier
Primarily Generics
Primarily Generics
INCREASED VALUE TO MEMBERS & PLAN
Primarily NonPreferred Brands
WHAT’S CHANGING?
Active & Pre-65 Pharmacy:
 Walgreens Health Initiatives (WHI) selected to replace Medco as
pharmacy benefit manager (PBM)

30-day fills: use the WHI network for discounted pricing
90-day fills: maintenance medications may be filled at Walgreens
retail or thru Walgreens mail order

WHI network includes independent pharmacies as well as chains such
as CVS, Rite Aid, Wal-Mart, & Target
Post-65 Retirees:
 Moving to stipend
WHI Q&A
Q: Will prescriptions automatically be transferred to Walgreens?
A: 30-day prescriptions will not be transferred to Walgreens.
 90-day mail maintenance medications will be automatically transferred to
Walgreens Mail Service as of January.
 NOTE: 90-day prescriptions not filled using mail service, any 30-day
prescription, as well as narcotics and compound medications will not be
transferred and will require a new prescription from your physician.
Q: Will the tier of drugs change?
A: No, the tiers in the benefit plan design are not changing.
 However, the price that members pay for medication may change due to the
special discount pricing being offered by WHI.
ID CARDS
Q: Will there be two ID cards for next year?
A: No, active and pre-65 members will continue to have one card for
medical and pharmacy.
 14
WHI Contact Information
PHONE:
1-877-WHIRL50 (877-944-1550)
FAX:
1-800-736-8270
WEB:
www.walgreenshealth.com
Click on Healthcare Professionals tab
 15
HEALTHSCOPE BENEFITS
HealthSCOPE Benefits
CUSTOMER CARE
REPRESENTATIVES
Whirlpool Service Line
1-800-660-6212
M-F 8:00 a.m. – 6:00 p.m. EST







1-800-660-6212
Pre-certification/Pre-authorization
Claim Status
Eligibility
Benefit Information
Provider Network verification
IVR- Available 24/7
1st Level Appeals
17
HSB Whirlpool Customer Care Web Tools
www.healthscopebenefits.com
 Click on Provider
o
Check on:
o Claim Status
o Eligibility
o Benefit Information
o Precert Information
o Copies of EOBs
18
HealthSCOPE Benefits
Copy of provider EOB
19
PRE-CERTIFICATION PROCEDURES
All members, along with their providers, will be required to precertify all:




Non-emergency inpatient admissions
Major outpatient surgical procedures
Non-stat MRI & CT Scans
Outpatient mental health facility admits or visits
Contact HealthSCOPE Benefits for pre-certification at
1-800-660-212
Member ID card has reminder statement regarding
pre-certification
20
 20
WHIRLPOOL PROVIDER UPDATES
COMMUNICATIONS THROUGHOUT THE YEAR

Quarterly Newsletters
Quarterly Teleconferences
Join the mailing list! Send an email to
susan_a_pavlopoulos@whirlpool.com

HealthSCOPE Benefits website
www.healthscopebenefits.com

Walgreens website
www.walgreenshealth.com
 21
QUESTIONS?

2011 US Benefits - HealthSCOPE Benefits

Transcription

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