2019 NMRHCA SWITCH ENROLLMENT BENEFIT PRESENTATION - January 2019 through December 2019 - New Mexico Retiree ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2019 NMRHCA SWITCH ENROLLMENT
BENEFIT PRESENTATION
January 2019 through December 2019
Founded in 1908
758,518 INDIVIDUAL
CUSTOMERS served
474,624 Presbyterian Health Plan MEMBERS
The image cannot be
displayed. Your
computer may not
have enough
memory to open the
image, or the image
may have been
corrupted. Restart
your computer, and
then open the file
again. If the red x
9 981 100+ 9,000+
HOSPITALS HOSPITAL BEDS CLINICS HEALTHCARE
throughout PROFESSIONALS
New Mexico throughout
New Mexico
2
Award Winning Healthcare
Highest Level 3 $4.5M Grant Recipient Top Scoring Proposal
Recognition
for Central NM PMG ccccccMedicare Advantage HEDIS Reporting
Primary Care Clinics
ccccc
c
Ø Best Healthcare Organiza.on Ø Best Health Plan Ø Best ER
Ø Best Doctors Ø Best Hospital Ø Best Urgent Care
Sources: December 2017 Albuquerque Metro Consumer Survey, 2018 ABQ Journal Reader’s Choice
Awards
3
Extensive Statewide Network •Over 9,000 Providers in 554 Locations •2,200 Primary Care Physicians •7,000 Specialists No Referrals Required •Over 600 hospitals and other facilities • Hiring of providers to meet the increased healthcare needs of New Mexicans. • Ongoing facility investments that offer convenient and innovative care to New Mexicans.
Presbyterian Nationwide Network
• 900,000 Na=onal Providers
• 4,000 Facili=es Na=onwide
• Access to Centers of Excellence
Facili=es
– Mayo Clinic, MD Anderson
John Hopkins University, and
many more.
• Logos on the
back of your ID card
• Always In-Network
Nationwide PPO
www.mul=plan.com/presbyterian
Value HMO Plan
Benefit In-Network Out of Network
Annual
Value HMODeductible $1500/ Individual N/A
Out of Pocket $5500/ Individual N/A
Primary - $35
Office Visit N/A
Specialist - $55
Preventive Care (including 100%
mammograms, pap test, N/A
colonoscopy & immunizations) Deductible does not apply
100%
Lab, X-Ray, and
Deductible does not apply N/A
Pathology
Emergency Room $175 $175
Urgent Care $40 N/A
All other covered
services(including inpatient/
outpatient, rehab and MRI, PET & 30% N/A
CT)
Premier PPO Plan
Benefit In-Network Out of Network
Premier PPO
Annual Deductible $800/ Individual $800/ Individual
Out of Pocket $4500/ Individual $4500/ Individual
Primary - $30
Office Visit 50%
Specialist - $45
Preventive Care (including 100%
mammograms, pap test, 50%
colonoscopy & immunizations) Deductible does not apply
Lab, X-Ray, and 100%
50%
Pathology Deductible does not apply
Emergency Room $125 $125
Urgent Care $35 50%
All other covered services
(including inpatient/outpatient, 25% 50%
rehab and MRI, PET & CT)
New Options for 2019!
• Premier PPO Option • Value HMO
Deductible Waived Deductible Waived
$500 copay $650 copay
Outpatient Surgeries-
Presbyterian (Kaseman Hospital Albuquerque/ Rust Medical Center Rio
Rancho)
• Hernia
• Laparoscopic Cholecystectomy Surgery
New Mexico Orthopedics (Albuquerque)
• Shoulder Arthroscopy
• Knee Arthroscopy
8
Access To Care
Appropriate and Affordable Options for Care
9
PresRN
Your Nurse Advise Line
Speak to a registered nurse by phone 24/7, 365 days a year, even in Spanish.
With PresRN, members have: 866-221-9679 or 505-923-5570
} Direct access to Presbyterian nurses No fee for members to access this service.
} Minimum 10 years clinical experience.
} Use national protocol to triage, diagnose and treat.
} Nurses have access to your plan info and electronic
health record for past and current health conditions,
treatments and Rx.
} Navigate you to appropriate care based on your
diagnosis.
} Capture the details of your care in MyChart.
} Automatically message your PCP, Specialist or Care
Coordinator.
10Video Visits
Video Conference with a Healthcare Provider
“Skype” with a healthcare provider 24 hours a day, 365 days a year.
With Video Visits, members can:
• Schedule a Video Visit on any computer, tablet or smart phone.
• Use at home, work or when travelling.
• Get diagnosis and treatment for common health issues
like earaches, cold/flu symptoms and allergies within 1 hour.
• Receive prescriptions to the pharmacy of your choice.
• Receive a text or email summary of your visit.
• View the details of the Video Visit in MyChart. No fee for members
to access this service.
• Receive a doctor’s note for school or work via email.
11MyChart:
Be An Active Part of Your Care Team
Presbyterian Health Plan members have secure online access to their
Presbyterian electronic health records.
With MyChart, members can:
• Send and receive messages with their care team.
• Schedule primary care appointments, confirm
or cancel appointments.
• View lab and test results.
• Request prescription renewals.
• View visit summaries, health summary, care plan,
allergies and immunizations.
• Receive health reminders. No fee for members
to access this service.
• Pay doctor and hospital bills.
1213
Member Advocate Team:
Presbyterian Customer Service Center
Member Advocate Team
Ø Locate a Provider - within PMG or Contracted Network
including Specialists, Facilities, Behavioral Health and Multiplan.
Ø Contact and consult with the Provider for availability to ensure
a good fit for the member.
Ø Schedule an appointment using the members preference for dates, times
etc.
Integrated Dedicated Customer Service Team
Ø Located in New Mexico www.phs.org/sonm
Ø Claims, Benefits, General Questions (505) 923-5600 or
1-888-ASK PRES
Ø Patient Financial Services Email: info@phs.org
14Investments in Access
Presbyterian Santa Fe Medical Center
Coming 2018
Urgent Care Physical, Occupational and Speech Therapies
24/7 Emergency Services Lab and Imaging, including CT and MRI
General Surgery 30 Adult Inpatient Beds, some licensed ICU beds
Orthopedics 6-Bed Birthing Unit
Podiatry Telehealth Services
15Ambulatory
Surgical
Centers
Member
sa.sfac.on
Effec.ve
outcomes
Ambulatory Surgical Centers
Ø Lower Cost Setting: 30-50% Reduction
Cost Ø Increased Member Satisfaction
Ø Effective Services
Ø 3 Locations Albuquerque Metro Area
16Value of Presbyterian
Locally Owned and Operated New Mexicans
Non-Profit Organization serving New Mexicans
Investing in New Mexico
Emergency Care Nationwide
Serving 1 in 3 New Mexicans
Expanding Access and
Improving Outcomes for
Innovative Access to Care
New Mexicans Video Visits, PresRN, MyChart, UC Scheduling
17You can also read
