Heartland Health Wellness Connections May 2008. Heartland Wellness Connections Participation.
Health Care Guides Introducing New Mexico Health Connections 11/6/2013New Mexico Health Connections.
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Transcript of Health Care Guides Introducing New Mexico Health Connections 11/6/2013New Mexico Health Connections.
![Page 1: Health Care Guides Introducing New Mexico Health Connections 11/6/2013New Mexico Health Connections.](https://reader035.fdocuments.us/reader035/viewer/2022070308/551c4e405503467b488b5154/html5/thumbnails/1.jpg)
Health Care GuidesIntroducing New Mexico Health Connections
11/6/2013 New Mexico Health Connections
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New Mexico Health Connections• Affordable Care Act (ACA) – Section 1322 • Consumer Operated and Oriented Health Plan (CO-OP)• New Mexico’s only non-profit health plan• February 2013 - Licensed as Certified Qualified Health
Plan by NM Office of the Superintendent of Insurance • Required to hold 2.5 times the normal financial
reserves needed for health plans• All brought about by Nandini Kuehn, PhD and other
concerned New Mexicans
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NMHC - What Makes Us DifferentNon-profit health plan• Mission-driven, not profit-driven– Profits will be reinvested back to New Mexicans to
improve quality of health care• Lower Premiums• Improve Benefits • Collaboration with Community Organizations
– Investing in the community health infrastructure• Serving as connector between members and
community resources
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NMHC - What Makes Us Different
• Consumer Operated and Oriented Health Plan (CO-OP)– Governed with consumer control– By 2016, majority of our Board of Directors will be
NMHC members– Members will help drive health plan direction and
decisions
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NMHC - What Makes Us Different
• NMHC is committed to a model of coordinated care– Focused on keeping members and their families
healthy– Closely partnering with Clinicians, Community
Health Workers and Promotoras – Incentivizing prevention, health, and wellness
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Philosophy of Benefit Plans
• Less is more– Fewer plans = Less confusion – Our benefit plans on the Exchange are the same as
those off the Exchange• Choice to use co-pay model– The cost the member pays is defined and clear– Encourages use of preventive care and wellness
services
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Individual Plans
Choice ConnectGold $500 PPO
Choice ConnectSilver $2,000 PPO
Care Connect Gold $750 HMO
CareConnect Silver $2,000 HMO
Care Connect Bronze HMO
UNM CareConnect $2,000 HMO (HIX ONLY)
Care Connect Catastrophic HMO(HIX ONLY)
In-Network
Out-of-Network
In-Network
Out-of-Network
Preventive Care Services(1) No Charge
50% after deductible
No Charge
50% after deductible
No Charge
No Charge
No Charge
No Charge No Charge
Primary Care $20/visit
50% after deductible
$30/visit
50% after deductible
$30/visit $25/visit
50% after deductible
$25/visit No Charge(2)
Specialist Care $40/visit
50% after deductible
$60/visit
50% after deductible
$60/visit $75/visit
50% after deductible
$75/visit0% after deductible
Behavioral Health Visits(2) No Charge
50% after deductible
No Charge
50% after deductible
No Charge
No Charge
No Charge
No Charge No Charge
Urgent Care $50/visit $50/visit $50/visit $50/visit $50/visit $50/visit
50% after deductible
$50/visit0% after deductible
Emergency Room Services $250/visit
$250/visit
$250/visit$250/visit
$250/visit
$250/visit
50% after deductible
$250/visit0% after deductible
Preferred Generic Drugs(3)
No ChargeNot Covered
No ChargeNot Covered
No Charge
No Charge
No Charge
No Charge No Charge
Generic Drugs $10/RxNot Covered
$25/RxNot Covered
$15/Rx $25/Rx
50% after deductible
$25/Rx0% after deductible
Brand Name Drugs $30/Rx
Not Covered
$75/RxNot Covered
$45/Rx $75/Rx
50% after deductible
$75/Rx0% after deductible
Non-Preferred Brand Drugs $60/Rx
Not Covered
$150/RxNot Covered
$75/Rx $150/Rx
50% after deductible
$150/Rx0% after deductible
Specialty Drugs30% to max of $250/Rx
Not Covered
$250/RxNot Covered
$150/Rx $250/Rx
50% after deductible
$250/Rx0% after deductible
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Individual Plans
MRI/CT/PET $250/test
50% after deductible
$250/test
50% after deductible
$250/test
$250/test
50% after deductible
$250/test0% after deductible
PT/OT/ST $40/visit
50% after deductible
$60/visit
50% after deductible
$60/visit $75/visit
50% after deductible
$75/visit0% after deductible
Outpatient Hospital
30% after deductible
50% after deductible
40% after deductible
50% after deductible
20% after deductible
30% after deductible
50% after deductible
30% after deductible
0% after deductible
Inpatient Hospital
30% after deductible
50% after deductible
40% after deductible
50% after deductible
$1,000/admission
$2,500/ admission
50% after deductible
$2,500/ admission
0% after deductible
Lab & X-ray Services(4)
No Charge
50% after deductible
No Charge
50% after deductible
No Charge
No Charge
50% after deductible
No Charge0% after deductible
Annual In-Network Deductible(5)
$500 $1,000 $2,000 $4,000 $750 $2,000 $2,500 $2,000 $6,350
Coinsurance after deductible
30% 50% 40% 50% 20% 30% 50% 30% 0%
Annual Out-of-Pocket Maximum
$5,000 $10,000 $6,350 $12,700 $6,000 $6,350 $6,350 $6,350 $6,350
Choice ConnectGold $500 PPO
Choice ConnectSilver $2,000 PPO Care
Connect Gold $750 HMO
CareConnect Silver $2,000 HMO
Care Connect Bronze HMO
UNM CareConnect $2,000 HMO (HIX ONLY)
Care Connect Catastrophic HMO(HIX ONLY)In-
NetworkOut-of-Network
In-Network
Out-of-Network
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Generic Medications• $0 Co-pay for these Chronic Conditions:– Hypertension– Depression– Bipolar Disorder– Diabetes– Hypercholesterolemia– Chronic Obstructive Pulmonary Disease– Coronary Artery Disease– Congestive Heart Failure– Asthma
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Behavioral Health Services
• Behavioral Health Services are a key focus for NMHC
• Addressing Behavioral Health issues leads to better overall health– Behavioral Health Provider network– $0 co-pay for the first 3 outpatient visits– $0 co-pay for most generic Behavioral Health
medicines
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NMHC State-Wide Provider Network• Nearly 5,500 practitioners, hospitals, and facilities• Primary Care and Specialty • Close partnerships with FQHCs• Centers of Excellence• Out of State Network• Community Health Worker program• Please refer to website for a more detailed list of
providers
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NMHC Website: Easy to Navigate
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NMHC Website: Getting Started
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NMHC Website: Quote and Compare
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NMHC Website: Quote Comparison
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NMHC Website: Provider Network
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NMHC Website: Rx Formulary
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Questions to help guide your clients• How often do you / your family go to the doctor• How many times did you visit the emergency room
last year• What prescription medications are taken on a
regular basis• Who are your doctors• Do you have any chronic conditions• Are you eligible for subsidies
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Things to Consider
• How much did you spend last year– The least expensive plan is not always the most
cost effective– Consider deductibles, co-pays and coinsurance as
well as the monthly premium
Example: The story of Mr. Sanchez and his health plan selection journey
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Mr. Sanchez & His Health Plan Selection
Health Needs Things to Consider How NMHC Can Assist
Type I Diabetes Locate a PCP State-wide provider network
Doctor Visits Low co-pays
Medication Costs $0 co-pay for generic medications
Subsidy Eligible? Subsidy Calculator on website
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NMHC Summary
• NMHC adds value to the insurance market– Member Driven– Community Focused– Co-pays clarify member costs– Easy to use website– Profits reinvested in New Mexico– Built by New Mexicans, for New Mexicans
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New Mexico Health Connections
2440 Louisiana Blvd., NE, Suite 601Albuquerque, NM 87110