Small Group Benefit Comparison

Transcription

1 Small Group Benefit Comparison effective January 1, 2015 A guide to choosing the right plan for your business

2 We re Proud to Be a Top 100 Health Plan 1 At Sharp Health Plan, we believe in making life better. We are honored to be one of the best health plans in the nation. TOP 100 TOP 3 Top 100 US health plan 1 Top 3 California health plan 1 Highest rated customer service and satisfaction among reporting California health plans 2 Highest level Excellent Accreditation 4 out of 4 star quality rating Additional Benefits Included with Every Plan We know that excellent health care is not enough; it must also be easy to access. The convenience of Sharp Health Plan extends beyond San Diego and beyond standard business hours. All Sharp Health Plan members receive the following value added benefits: Best Health is one of only eight health plan wellness programs to be accredited nationally. The program provides Sharp Health Plan members with a variety of resources from meal plans to exercise routines to one-on-one personalized health coaching. Sharp Nurse Connection We offer after-hours nurse advice telephone service for Sharp Health Plan members. When you have a health question or concern after regular business hours, a single phone call puts you in touch with a registered nurse. As the walk-in medical clinic located inside select CVS/pharmacy stores, MinuteClinic provides convenient access to basic care 3, without an appointment. Assist America connects Sharp Health Plan members to doctors, hospitals, pharmacies and other services when faced with a medical emergency while traveling 100 miles or more away from home, or out of the country. ¹ Based on NCQA s Private Health Insurance Rankings ² Based on the 2014 California Assessment of Healthcare Providers and Systems (CAHPS ) results, Sharp Health Plan received an overall summary rating of 86% satisfaction compared to the statewide average of 76%. For customer service, Sharp Health Plan received a 90% satisfaction rating and the statewide average was not reported. The source for data contained in this publication is Quality Compass 2014 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2014 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). 3 Member copayment may differ from in-network costs.

3 San Diegans Choose Sharp Health Plan With a range of plans and provider networks, we have the right plan to meet your unique small business needs. Sharp Health Plan is your first choice in San Diego for access to quality health care for a healthy workforce. Local Focus As the only San Diego-based commercial health plan, all of our services, from account management to customer care, are provided locally. Award-Winning Care Sharp Health Plan is a subsidiary of Sharp HealthCare, a recipient of the 2007 Malcolm Baldrige National Quality Award, the nation s highest Presidential honor for quality and organizational performance excellence. Customizable With a multitude of plan designs, four provider networks and a broad range of pricing options, you have the ability to tailor your plan design to your business needs.

4 Sharp Health Plan Benefit Comparison effective January 1, 2015 Deductibles Calendar year deductible (per individual/per family) (applies only to those covered benefits indicated) Calendar year deductible (per member) for covered drugs (applies only to those covered drugs indicated) Maximums There are no lifetime maximums for this plan Annual Out of Pocket Maximum, including deductible (per individual/per family) 1 Professional Services Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. Preventive services 2 Prenatal and postpartum office visits Allergy injections Allergy testing Outpatient Services Outpatient surgery Radiology, pathology, hemodialysis, etc. Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) Physical, occupational and speech therapy Hospitalization Services Inpatient Emergency/Urgent Care Services Emergency room (waived if admitted for inpatient hospital stay) Urgent care Ambulance Services Ambulance in connection with hospital admission or emergency services Prescription Drug Coverage 8 Drugs administered in a practitioner s office, hospital or outpatient facility Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary medications up to a 30-day supply Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary medications up to a 90-day supply by mail order Generic Formulary and prescribed over-the-counter contraceptives for women Durable Medical Equipment Durable medical equipment Diabetics supplies Prosthetics, orthotics Mental Health Services Inpatient Outpatient Home-based applied behavioral analysis for treatment of pervasive developmental disorder or autism Chemical Dependency Services Inpatient Outpatient Emergency services for acute drug or alcohol detoxification Other Skilled nursing facility services (100 days per benefit period) Home health services (100 days per calendar year) Hospice care Inpatient Hospice care Outpatient 1 Copayments and deductibles for supplemental benefits (Assisted Reproductive Technologies, Chiropractic Services, Adult Vision) do not apply to the annual out of pocket maximum. 2 Includes preventive services with rating of A or B from the US Preventive Services Task Force; immunizations for children, adolescents and adults recommended by the Centers for Disease Control and Prevention; and preventive care and screenings supported by the Health Resources and Services Administration for infants, children, adolescents and women. If preventive care is received at the time of other services, the applicable copayment for such services other than preventive care may apply.

5 Platinum 90 Plans Sharp 0/10/100 Sharp 0/15/250 Sharp 0/20/500 Sharp 0/20/1000 C Sharp 0/20/10% C Sharp 0/20/250 None None None None None None None None None None None None N / A N / A N / A N / A N / A N / A $2,000 1 / $4,000 1 $2,000 1 / $4,000 1 $2,000 1 / $4,000 1 $2,000 1 / $4,000 1 $4,0001 / $8,000 1 $4,000 1 / $8,000 1 $10 / visit $15 / visit $20 / visit $20 / visit $20 / visit $20 / visit $10 / visit $15 / visit $30 / visit $40 / visit $40 / visit $40 / visit $0 / visit 2 $0 / visit 2 $0 / visit 2 $0 / visit 2 $0 / visit 2 $0 / visit 2 $10 / visit $15 / visit $30 / visit $40 / visit $0 / visit 2 $0 / visit 2 $10 / visit $10 / visit $10 / visit $10 / visit $20 / visit $20 / visit $10 / visit $15 / visit $30 / visit $40 / visit $40 / visit $40 / visit $100 / procedure $250 / procedure $500 / procedure $500 / procedure 10% coinsurance 3 $250 / procedure $0 / visit $0 / visit $0 / visit $0 / visit $40 / visit $40 / visit $100 / procedure $100 / procedure $100 / procedure $100 / procedure 10% coinsurance 3 $150 / procedure $10 / visit $15 / visit $30 / visit $40 / visit $20 / visit $20 / visit $100 / day (3-day max) $250 / day (3-day max) $500 / day (3-day max) $1,000 / admission 10% coinsurance 3 $250 / day (5-day max) $100 / visit $100 / visit $100 / visit $150 / visit $150 / visit $150 / visit $10 / visit $ 15 / visit $30 / visit $40 / visit $40 / visit $40 / visit $100 $100 $100 $150 $150 $150 $10 / $20 / $40 $15 / $35 / $50 $19 / $35 / $70 $15 / $35 / $50 $5 / $15 / $25 / 10% $5 / $15 / $25 / 10% $20 / $40 / $80 $30 / $70 / $100 $38 / $70 / $140 $30 / $70 / $100 $10 / $30 / $50 / 10% $10 / $30 / $50 / 10% 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 10% coinsurance 3 10% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 10% coinsurance 3 10% coinsurance 3 $10 / visit $15 / visit $30 / visit $30 / visit $40 / visit $40 / visit $100 / day (3-day max) $250 / day (3-day max) $500 / day (3-day max) $1,000 / admission 10% coinsurance 3 $250 / day (5-day max) $10 / visit $15 / visit $30 / visit $40 / visit $20 / visit $20 / visit $10 / visit $15 / visit $30 / visit $40 / visit 10% coinsurance 3 $20 / visit $100 / day (3-day max) $250 / day (3-day max) $500 / day (3-day max) $1,000 / admission 10% coinsurance 3 $250 / day (5-day max) $10 / visit $15 / visit $30 / visit $40 / visit $20 / visit $20 / visit $100 / visit $100 / visit $100 / visit $150 / visit $150 / visit $150 / visit $100 / day (3-day max) $200 / day (3-day max) $200 / day (3-day max) $200 / admission 10% coinsurance 3 $150 / day (5-day max) $10 / visit $15 / visit $30 / visit $40 / visit 10% coinsurance 3 $20 / visit $100 / day (3-day max) $250 / day (3-day max) $500 / day (3-day max) $200 / admission $0 / admission $0 / admission $0 / visit $0 / visit $0 / visit $0 / visit $0 / visit $0 / visit 3 Of contracted rates 4 In high deductible health plans (HDHPs) linked to Health Savings Accounts (HSAs), each individual in a family plan must meet an amount of either $2,600 or the individual deductible, whichever is higher, until the family deductible is met. 5 Deductible applies. 6 Individuals enrolled in a family plan will reach the annual deductible maximum if the Member meets the individual deductible maximum amount or if any combination of enrolled family members meets the family deductible maximum amount, whichever comes first. 7 Deductible applies after the first 3 non-preventive visits.

6 Gold 80 Plans Sharp 0/30/1000 A Sharp 0/30/1000 B Sharp 0/40/1000 Sharp 1000/30/30% C Sharp 0/30/20% C Sharp 0/30/600 None None None $1,000 6 / $2,000 6 None None None None $150 $150 None None N / A N / A N / A N / A N / A N / A $5,000 1 / $10,000 1 $5,000 1 / $10,000 1 $5,0001 / $10,000 1 $3,400 1 / $6,800 1 $6,250 1 / $12,500 1 $6,250 1 / $12,500 1 $30 / visit $30 / visit $40 / visit $30 / visit $30 / visit $30 / visit $60 / visit $50 / visit $40 / visit $30 / visit $50 / visit $50 / visit $0 / visit 2 $0 / visit 2 $0 / visit 2 $0 / visit 2 $0 / visit 2 $0 / visit 2 $60 / visit $50 / visit $40 / visit $30 / visit $0 / visit $0 / visit $10 / visit $10 / visit $10 / visit $10 / visit $30 / visit $30 / visit $60 / visit $50 / visit $40 / visit $30 / visit $50 / visit $50 / visit $500 / procedure $750 / procedure $750 / procedure 30% coinsurance 3,5 20% coinsurance 3 $600 / procedure $0 / visit $0 / visit $0 / visit $0 / visit $50 / visit $50 / visit $150 / procedure $150 / procedure $150 / procedure $100 / procedure 20% coinsurance 3 $250 / procedure $60 / visit $50 / visit $40 / visit $30 / visit $30 / visit $30 / visit $1,000 / admission $1,000 / day $1,000 / day 30% coinsurance 3,5 20% coinsurance 3 $600 / day (5-day max) $100 / visit $100 / visit $150 / visit $150 / visit 5 $250 / visit $250 / visit $60 / visit $ 50 / visit $40 / visit $30 / visit $60 / visit $60 / visit $100 $100 $100 $100 5 $250 $250 $19 / $35 / $70 $19 / $35 / $70 $19 / $35 5 / $70 5 $19 / $35 5 / $70 5 $15 / $50 / $70 / 20% $15 / $50 / $70 / 20% $38 / $70 / $140 $38 / $70 / $140 $38 / $70 5 / $140 5 $38 / $70 5 / $140 5 $30 / $100 / $140 / 20% $30 / $100 / $140 / 20% 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3,5 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 $40 / visit $30 / visit $40 / visit $30 / visit $50 / visit $50 / visit $1,000 / admission $1,000 / day $1,000 / day 30% coinsurance 3,5 20% coinsurance 3 $600 / day (5-day max) $60 / visit $50 / visit $40 / visit $30 / visit $30 / visit $30 / visit $40 / visit $40 / visit $40 / visit $40 / visit 20% coinsurance 3 $30 / visit $1,000 / admission $1,000 / day $1,000 / day 30% coinsurance 3,5 20% coinsurance 3 $600 / day (5-day max) $60 / visit $50 / visit $40 / visit $30 / visit $30 / visit $30 / visit $100 / visit $100 / visit $150 / visit $150 / visit 5 $250 / visit $250 / visit $150 / admission $150 / admission $150 / day 30% coinsurance 3,5 20% coinsurance 3 $300 / day (5-day max) $40 / visit $40 / visit $40 / visit $40 / visit 20% coinsurance 3 $30 / visit $150 / admission $150 / admission $150 / day 30% coinsurance 3,5 $0 / admission $0 / admission $0 / visit $0 / visit $0 / visit $40 / visit $0 / visit $0 / visit C These plan designs are also available on Covered California.

7 Silver 70 Plans Bronze 60 Plans Sharp 1750/40/40% C Sharp 1500/45/20% A C Sharp1500/45/20% B C Sharp HSA*1500/20%/20% C Sharp 5000/60/30% C Sharp HSA* 4500/40%/40% $1,750 6 / $3,500 6 $1,500 6 / $3,000 6 $1,500 6 / $3,000 6 $1,500 4 / $3,000 4 Integrated $5,000 6 / $10,000 6 Integrated $4,500 4 / $9,000 4 Integrated $150 $500 / $1,000 $500 / $1,000 Integrated Integrated Integrated N / A N / A N / A N / A N / A N / A $5,750 1 / $11,500 1 $6,250 1 / $12,500 1 $6,250 1 / $12,500 1 $6,250 1 / $12,500 1 $6,250 1 / $12,500 1 $6,250 1 / $12,500 1 $40 / visit $45 / visit $45 / visit 20% coinsurance 3,5 $60 / visit 5,7 40% coinsurance 3,5 $40 / visit $65 / visit $65 / visit 20% coinsurance 3,5 $70 / visit 5 40% coinsurance 3,5 $0 / visit 2 $0 / visit $0 / visit $0 / visit $0 / visit $0 / visit $40 / visit $0 / visit $0 / visit $0 / visit $0 / visit $0 / visit $10 / visit $45 / visit $45 / visit 20% coinsurance 3,5 $60 / visit 5 40% coinsurance 3,5 $40 / visit $65 / visit $65 / visit 20% coinsurance 3,5 $70 / visit 5 40% coinsurance 3,5 40% coinsurance 3,5 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3,5 30% coinsurance 3,5 40% coinsurance 3,5 $0 / visit $65 / visit $65 / visit 20% coinsurance 3,5 30% coinsurance 3,5 40% coinsurance 3,5 $100 / procedure 20% coinsurance 3,5 $250 / procedure 20% coinsurance 3,5 30% coinsurance 3,5 40% coinsurance 3,5 $40 / visit $45 / visit $45 / visit 20% coinsurance 3,5 $60 / visit 5 40% coinsurance 3,5 40% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 30% coinsurance 3,5 40% coinsurance 3,5 $150 / visit 5 $250 / visit 5 $250 / visit 5 20% coinsurance 3,5 $300 / visit 5 40% coinsurance 3,5 $40 / visit $90 / visit $90 / visit 20% coinsurance 3,5 $120 / visit 5,7 40% coinsurance 3,5 $150 5 $250 5 $ % coinsurance 3,5 $300 / visit 5 40% coinsurance 3,5 $19 / $35 5 / $70 5 $15 / $50 5 / $70 5 / 20% 5 $15 / $50 5 / $70 5 / 20% 5 20% 5 / 20% 5 / 20% 5 / 20% 5 $15 5 / $50 5 / $75 5 / 30% 5 40% 5 / 40% 5 / 40% 5 / 40% 5 $38 / $70 5 / $140 5 $30 / $100 5 / $140 5 / 20% 5 $30 / $100 5 / $140 5 / 20% 5 20% 5 / 20% 5 / 20% 5 / 20% 5 $30 5 / $100 5 / $150 5 / 30% 5 40% 5 / 40% 5 / 40% 5 / 40% 5 50% coinsurance 3,5 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3,5 30% coinsurance 3,5 40% coinsurance 3,5 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3,5 30% coinsurance 3,5 40% coinsurance 3,5 $40 / visit $65 / visit $65 / visit 20% coinsurance 3,5 $70 / visit 5 40% coinsurance 3,5 40% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 30% coinsurance 3,5 40% coinsurance 3,5 $40 / visit $45 / visit $45 / visit 20% coinsurance 3,5 $60 / visit 5,7 40% coinsurance 3,5 $40 / visit 5 20% coinsurance 3 $45 / visit 20% coinsurance 3,5 30% coinsurance 3,5 40% coinsurance 3,5 40% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 30% coinsurance 3,5 40% coinsurance 3,5 $40 / visit $45 / visit $45 / visit 20% coinsurance 3,5 $60 / visit 5,7 40% coinsurance 3,5 $150 / visit 5 $250 / visit 5 $250 / visit 5 20% coinsurance 3,5 $300 / visit 5 40% coinsurance 3,5 40% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 30% coinsurance 3,5 40% coinsurance 3,5 $40 / visit 20% coinsurance 3 $45 / visit 20% coinsurance 3,5 30% coinsurance 3,5 40% coinsurance 3,5 40% coinsurance 3,5 $0 / admission $0 / admission $0 / admission $0 / admission $0 / admission 5 $40 / visit $0 / visit $0 / visit $0 / visit $0 / visit $0 / visit * Sharp Health Plan provides integrated HSA Plans with our preferred partner, HealthEquity. Please refer to HSA eligibility requirements when considering these plans. Members may elect to open an HSA account in conjunction with an HDHP HSA compatible plan. 8 Member cost-share will not exceed $200 per individual prescription of up to a 30 day supply of covered oral anti-cancer drug.

8 Provider Networks Sharp Health Plan offers four provider networks to offer flexibility while delivering high-quality health services: Choice, Value, Performance and Premier. 2,000+ Doctors H 14 Hospitals 5 Medical Groups Supplemental Benefits Available with Every Plan Chiropractic Services American Specialty Health (ASH) Plans Plan AC34 Plan B Plan D $5 per visit / 40 visits per year $10 per visit / 30 visits per year $10 per visit / 20 visits per year Acupuncture Services American Specialty Health (ASH) Plans Plan AC23 $15 per visit / 20 visits per year Plan AC17 $10 per visit / 20 visits per year Plan AC21 $15 per visit / 15 visits per year Plan AC15 $10 per visit / 15 visits per year Plan AC19 $15 per visit / 12 visits per year Plan AC13 $10 per visit / 12 visits per year Chiropractic + Acupuncture Services American Specialty Health (ASH) Plans Plan AC33 $15 per visit / 20 visits per year Plan AC25 $10 per visit / 12 visits per year Plan AC31 $15 per visit / 15 visits per year Plan AC04 $10 per visit / 20 visits per year Plan AC29 $15 per visit / 12 visits per year Plan AC03 $10 per visit / 40 visits per year Plan AC27 $10 per visit / 15 visits per year Plan AC02 $5 per visit / 40 visits per year Vision Services Vision Service Plan (VSP) Eye exam Copayment Materials Advantage 1 every 12 months $10 per visit Frames: 1 every 24 months; Lenses: 1 every 12 months Assisted Reproductive Technologies (ART) for employers with 20+ employees Plan Art C Copayments equal to 50% coinsurance of covered infertility services All plans include pediatric vision and dental benefits for members up to age 19. A portfolio of dental HMO and PPO plans, provided through Premier Access Dental, is also available. We re here to help. Customer Care: (858) or customer.service@sharp.com Fax: (858) sharphealthplan.com Like us on Facebook facebook.com/sharphealthplan 8520 Tech Way, Ste. 200 San Diego, CA SHPA Z 2014 SHC