WELCOME TO GROUPADMINISTRATOR TRAINING
CLIENT MANAGEMENTJOY SHELBY
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AGENDA
• Welcome
• Account Management
• Service Center
• Group Administration
• Enrollment Procedures
• Billing Procedures
• Employer eServices
• Communications Support
• Medica CallLink®
• Employee Assistance Program
• Wellness Programs and Resources
• My Health Rewards by Medica®
• Healthy Savings
• Fit Choices® by Medica
• Take Action Calendar and Onsite Resources
• ROC Tour or My Health Rewards Demonstration
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ACCOUNT MANAGEMENT
ACCOUNT MANAGEMENT
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Group set-up
Pre- and post-enrollment meetings
Health and wellness events
Broker assistance
Account Managers
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SERVICE CENTER TOTAL SERVICE TEAM
SERVICE CENTER
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One Call Does It All!!
Phone Numbers
952-992-2200
1-800-936-6880
SERVICE CENTER
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My Plan Total Service Team – One Stop Shop
Phone Numbers
1-855-2MY-PLAN
1-855-269-7526
SERVICE TEAM AND TOTAL SERVICE TEAM
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Clarify benefit information
Address enrollment and eligibility concerns
Check billing, claims and provider status
Check on the status of an enrollment
Order materials for you on behalf of your customers
Answer questions about mymedica.com and the My Plan portal
Capabilities
SERVICE TEAM AND TOTAL SERVICE TEAM
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Dedicated team
Committed to quality
Extensive plan knowledge
−All representatives have customer service experience
−Core competency assessments completed annually; refresher training provided weekly
−Monthly quality audit average score: 98%
Excellence
GROUP ADMINISTRATIONBRENT PETERSON
GROUP ADMINISTRATION
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Enrollment Procedures
Billing Procedures
Employer eServices
Communications Support
Topics
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ENROLLMENT PROCEDURES
ENROLLMENT PROCEDURES
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When Can Employees Enroll?
EMPLOYEES CAN ENROLL… FORM TO USE…
WHEN NEWLY HIRED
THE MEDICA ENROLLMENT/
CHANGE/CANCELLATION FORM
FOLLOWING A CHANGE IN FAMILY
STATUS:
a) LOSS OF OTHER COVERAGE
b) BIRTH
c) ADOPTION
d) MARRIAGE
e) DIVORCE
DURING OPEN ENROLLMENT
ENROLLMENT PROCEDURES
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Enrollment / Change / Cancellation Form
Submit within 31 days of event
Use to:− Add employee
− Add dependent (i.e. spouse, child)
− Waive coverage
− Change information (i.e. name and address)
− Remove employee from plan (termination date: end of month)
ENROLLMENT PROCEDURES
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Plan Selection Change Form
Submit within 31 days of event or plan change
Use to:− Move already enrolled employee from one plan
to another
ENROLLMENT PROCEDURES
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Continuation Eligibility
To Determine Eligibility:
COBRA/Continuation laws and requirements are the responsibility of the employer (contact your legal counsel)
For more information on Minnesota State Continuation:
• MN Department of Commerce 651-539-1500 or 1-800-657-3602 https://mn.gov/commerce
• MN Department of Health651-201-5000 or 888-345-0823 http://www.health.state.mn.us/
Federal COBRA questions: US Department of Labor at 1-866-487-2365 or www.dol.gov
ENROLLMENT PROCEDURES
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Continuation Eligibility
To Re-enroll Members Who Have Elected Continuation
Terminate coverage using the Enrollment/Change/Cancellation Form
Notify members of continuation rights
Re-enroll using the Enrollment/Change/Cancellation Form
ENROLLMENT PROCEDURES
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Employee Enrollment Information or Changes
Send Enrollment Information or Changes to:
Medica
PO Box 30986
Salt Lake City, UT 84130-0986
Fax# 248-733-6064
ENROLLMENT PROCEDURES
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Material Orders
Forms may be found online at Medica.com or requested from the Medica Service Center at 952-992-2200
ENROLLMENT PROCEDURES
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Master Group Contract
Many questions can be answered by referring to your Master Group Contract (MGC). The MGC is a legal contract between your company and Medica that lists the following:
- Term of contract
- Grace Period
- Acceptance of contract
- Eligibility
- Rates
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BILLING PROCEDURES
BILLING PROCEDURES
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Billing
Pay as billed, wait for adjustments
Payment due by first of the month
Bills run on or around 11th of the month
Do not terminate employees on billing statement
Changes are due a full 30 days prior to reflect on billing statement
Automatic Clearing House (ACH), an automated payment option, is available upon request
Questions? Call Service Center at 952-992-2200
BILLING PROCEDURES
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Invoices
Invoice reflects:
Account’s summary
Current invoice summary
Invoice detail at subscribers level
Applicable adjustments
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EMPLOYER eSERVICES®
EMPLOYER eSERVICES®
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Employer eServices®
Real time online administration
Secure internet connection 24/7
EMPLOYERESERVICES.COM
EMPLOYER eSERVICES®
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Features
Manage access
Enrollment
ID Cards
Billing
Pay online
EMPLOYER eSERVICES®
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Manage Access with Registered CMA
Client Master Administrator (CMA)- Manages access of users
- Activate or inactivate access
- Assign functional permissions, such as enrollment or billing
EMPLOYER eSERVICES®
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IF YOU... CONTACT…
Want to register for
Employer eServices®
Medica Service Center at
952-992-2200 or 1-800-936-6880
Email the Service Center at
Have a general question about Employer
eServices® or experience a technical
issue while using eServices®
Employer eServices® customer
support at 1-800-651-5465
QUESTIONS
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COMMUNICATIONS SUPPORT
COMMUNICATIONS SUPPORT
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Member Newsletters
Biannual distribution
Mailed to all enrolled employees
HEALTHY ATTITUDES
Monthly distribution
Emailed to members registered on mymedica.com; available as PDF for employers to distribute
4MEMBERS
COMMUNICATIONS SUPPORT
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Employer Update E-Newsletter
Monthly employer newsletter
Employer events
Policy changes
Product, network and service changes
Ideas for helping you manage your health care costs and engage your employees in healthy lifestyles
If you aren’t receiving it, visit medica.com/employer and provide your email address
COMMUNICATIONS SUPPORT
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Medica.com Employers
Plan information
Employer and member information resources
Valuable health and wellness programs and resources for employers and members
Find A Doctor
Online versions of our publications
Recent Medica news
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EMPLOYEE ASSISTANCE PROGRAM
EMPLOYEE ASSISTANCE PROGRAM (EAP)
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Services and Resources
Adult/elder services
Child/parenting services
Chronic condition support services
Convenience services
Life learning
Legal mediation services
Communication resources
Financial services
Management critical incident
response preparation and response
Management consultation
Training services
CATEGORIES CORE SERVICES AND BENEFITS
Masters-Level Associates 24/7 to talk
about personal, financial or legal
worries
Three in-person counseling sessions
covered at 100%
Critical Incident Response and Worksite
Trainings: 150 onsite hours
30-minute legal consultation at no cost
(in person or over the phone)
Promotional postcard mailings to
employees’ homes
EMPLOYEE ASSISTANCE PROGRAM (EAP)
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Offering Help with Life Events
Buying a
new homeGetting married
or divorced
Financial
stress
Work
stressHaving
children
Childcare or
eldercare issues
Retirement
issues
Moving or
relocation
Starting
a new job
Returning
to work
FOR 24/7 ASSISTANCE: 1-800-626-7944
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MEDICA CallLink® NURSE LINE
MEDICA CallLINK®
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Nurse Line
Answer health questions and help with decisions
Educate on treatment options and condition management
Guide to appropriate level of care and advice on provider selection
Locate network physicians and pharmacies
Available 24-7
Call 1.800.962.9497 to talk to a registered nurseChat live with a nurse online at mymedica.com
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Q & A
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MEDICA HEALTH AND WELLNESS OVERVIEW
WHY THE NEED?
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Reasons for Developing a Healthy, Supportive Culture
A culture will assist to help change behavior and risk. Costs follow risks!
Healthy culture happens by design! Find ways to make your culture healthier.
Habits are influenced by environment.
Goal: Create a culture where the healthy choice becomes the easy choice.
WHY IMPORTANT?
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AGENDA
2019 My Health Rewards
Healthy Savings
Health Club Reimbursement
2019 Take Action Calendar & Onsite Resources
Weaving Wellness into Your Workshop/Partnership
MY HEALTH REWARDS®
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MY HEALTH REWARDS®
MY HEALTH REWARDS BY MEDICA®
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Online Health and Wellness Programs
MY HEALTH REWARDS BY MEDICA® │ 2019
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MEMBERS 18 YEARS OLD + CAN EARN UP TO $100 IN GIFT CARDS FUNDED BY MEDICA
POINTS EARNED 100 200 300 400 500
REWARDFirst
$20 gift-cardSecond
$20 gift-cardThird
$20 gift-cardFourth
$20 gift-cardFifth
$20 gift-card
MY HEALTH REWARDS(STANDARD)
ENHANCED ADDS:
RESULTS ADDS:
ACTIONHealth
Assessment
Next Steps
ConsultT
M
JourneysTM TrackTMVirtual
Care Education
MonjCare
SupportBiometric Screening
Biometric Result*
POINTS PER
ACTION100 25 50 each 1 per day 25
25 for access,
1 per day 200 onceper year
(ifidentified)
100 25 per Result*
HEALTH ACTION
Once per year
Once per year
Up to 300 per year
Up to 200 per year
Once per year
Up to 200 per year
Once per year
Up to 100 per year
*RESULTS INCLUDE:
BMI non HDL cholesterol blood pressure blood sugar
MY HEALTH REWARDS BY MEDICA®
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Personalized Homepage
MY HEALTH REWARDS BY MEDICA®
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Compass Health Assessment Examples
MY HEALTH REWARDS BY MEDICA®
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Compass Health Assessment Results
MY HEALTH REWARDS BY MEDICA®
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Next-Steps Consult
Health guides provide education on compass health assessment and biometric screening results:
− Personalized phone consultation
− Raise health awareness and reinforce positive results
− Identify small steps toward healthier changes
− Recommend programs
MY HEALTH REWARDS BY MEDICA®
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Journey
MY HEALTH REWARDS BY MEDICA®
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Journey Example
MY HEALTH REWARDS BY MEDICA®
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Track
MY HEALTH REWARDS BY MEDICA®
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Track
My health rewards wellness member portal will feature enhancements to track
− A more intuitive and easy identification of activities
MY HEALTH REWARDS BY MEDICA®
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Track Options
MY HEALTH REWARDS BY MEDICA®
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Gift Card Redemption
NEW FOR 2019
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Virtual Care Education
Virtual Care Education: Awards
25 My Health Rewards points for
reviewing virtual care options
VIRTUAL CARE OPTIONS®
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Convenient and Cost Effective Online Treatment
CLINIC-BASED AMWELL VIRTUWELL CallLink NurseLine
Many clinics offer virtual care, online care or e-visits
24/7 online clinic available in every state
Includes coverage for medical and behavioral health care services
24/7 online clinic available in select states
Available 24/7
Prices varyMedical: Each visit is $49 or less
Behavioral health: Price varies by type of service
Medical: Each visit is $49 or less
FREE
Check with your clinic to see if they offer virtual care and how you can connect with
your provider online
Mobile, web and phone visits with a board-certified doctor
Online visits with a certified nurse practitioner
Phone visits with a certified nurse practitioner
Clinic’s website Amwell.com Virtuwell.comhttps://www.medica.com/we
llness/nurse-line
*Virtual care options can vary by your plan’s network. Check care options at medica.com/findadoctor.
VIRTUAL CARE OPTIONS®
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Treatment of Common Medical Conditions
Allergies
Bladder infections
Cold & Flu
Ear infections
Fevers
Migraines
Pinkeye
Stomach pain
Other, non-urgent common health conditions
VIRTUAL CARE OPTIONS®
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Behavioral Health Services
Some virtual care providers offer behavioral health services, including treatment for:
− Depression
− Anxiety
− Stress
− Mood disorders
− Insomnia
− Eating disorders
− Family (marriage, children)
− Grief and loss
− Coping with illness
Cost per visit varies by type of service. Eligible services are covered as a behavioral health office visit.
VIRTUAL CARE OPTIONS®
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Mobile, Web & Phone
Three easy options:
− Smartphone/tablet: Download the free Amwell app from the Apple Store or on Google Play
− Computer: Go to amwell.com
− Phone: Call 844-733-3627
Mobile Phone
VIRTUAL CARE OPTIONS®
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Overview
MY HEALTH REWARDS BY MEDICA®
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Introducing Monj
Monj is a company on a mission to reverse the obesity trend in America by addressing the largest cause of lifestyle-related diseases - people’s relationship to food.
They offer a skills-based behavioral curriculum centered on food, key lifestyle factors and social determinants including stress, social connection, mindset and movement.
MY HEALTH REWARDS BY MEDICA®
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Introducing Monj
Monj Rewards members 25 points for accessing the site, and 1 point per day up to 200 max for completion of daily missions.
MY HEALTH REWARDS BY MEDICA®
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Monj – Helpful Tools and ResourcesDaily Missions: Learn-by-doing missions are aimed at building healthy behaviors in small daily steps.
Power ups: Quick meals made by adding fresh ingredients that boost flavor (and nutrition). Great when eating out too.
Cooking Lessons: Monj cooking lessons vary in ingredient variety, skill level, and complexity.
Essentials: Content covering topics from how to store produce, to eating on the road, to hacking delicious snacks.
Shopping tools: Our smart shopping list enables members to buy the right amounts, avoiding waste by reducing extras bought in the store.
Team Ups: Connecting colleagues, friends and family for collaboration.
The Good Bite: Monj weekly emailed content addresses the whole person.
MY HEALTH REWARDS BY MEDICA®
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Monj – Helpful Tools and Resources
MY HEALTH REWARDS BY MEDICA®
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Monj – Helpful Tools and Resources
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HEALTHY SAVINGS OVERVIEW
Healthy Savings makes eating healthier
easier and more affordable.
The program is easy-to-use, members simply
shop, scan and save instantly!
Discounts on healthy foods of up to $250 per month
Foods qualified by a third party based on nutrient
density – only healthiest 1/3 qualify
No clipping or downloading coupons needed; all
promotions are automatically loaded onto barcode
Available to members within 30 miles of
participating retailer
HEALTHY SAVINGS | Discounts on Healthy Foods
Coming Soon:
Participating Retailers:
HEALTHY SAVINGS
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Branded Savings
200+ participating brands
Over $50 in member value
each week
Pre-qualified as healthy
Stackable with coupons
…and 195 more brands!
HEALTHY SAVINGS
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200+ Participating Brands
FRUITS VEGETABLES GRAINS PROTEIN DAIRY WHOLE PLATE
HEALTHY SAVINGS
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How it WorksMember accounts are pre-loaded with discounts each week
Shop for promoted items
Scan card or mobile app at checkout
Save instantly
1
2
3
HEALTHY SAVINGS
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Weekly Emails
Trending (Sundays)
Announces new benefit week & lists the top trending offers for the week with link to the full list.
Featured (Tuesdays)
Highlights four popular featured promotions and shows them as prepared foods.
Expiring (Thursdays) Opt-in
Reminds members of the promotions that are three days from expiration.
HEALTHY SAVINGS
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Mobile App & Website Portal
Members have two options to access their savings – the Healthy Savings mobile app and the website portal.
HEALTHY SAVINGS
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Mobile App & Website Portal
App users engage at a 150% higher rate and save 250% versus non-app users.
View Savings
Find Store Browse Offers Scan Products Scan Barcode
MY HEALTHY
SAVINGS:
$150.00
HEALTHY SAVINGS
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Available Offers
Members can use the Healthy Savings website portal or mobile app to view their available savings and browse all offers.
Members can also favorite promotions by tapping on the open heart. ♥ They will get notified when the favorite offer is promoted.
HEALTHY SAVINGS
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Farmers Market
Members can save up to $3.00 on produce at participating Farmers Markets
HEALTHY SAVINGS
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Program FAQs - Card
How Do I Activate My Card?
− With your card, go to medica.com/healthysavings and click “Register” to access your weekly savings and manage your account.
Where Can I Use My Card?
− Any Healthy Savings retailer. Find stores nearest you on the “Store Finder” page or on the “Store” tab on the mobile app.
How Do I Use the Card in the Store?
1. We suggest using the app to help you locate products eligible for discounts
2. Present your card to the clerk before payment to scan the barcode
3. See “HS” discounts noted on the sales receipt
HEALTHY SAVINGS
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Program Awareness
Member Flyer
Member Video
Member Poster
FIT CHOICES BY MEDICASM
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Health Club Reimbursement
$20 8,000+ 2xCREDIT TOWARD MONTHLY DUES
HEALTH CLUBS TO CHOOSE FROM
THE FIT CHOICES BENEFIT CAN BE PAID
TWICE IN 2019
FIT CHOICES BY MEDICASM
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Health Club Reimbursement
NationalMany fitness facilities have locations nationwide, however not all locations may participate in the Fit Choices program. Contact the location you wish to visit to ensure they participate in the program
RegionalMany regional and local facilities in Minnesota, North Dakota, South Dakota, and western Wisconsin are in the Fit Choices program.
FIT CHOICES BY MEDICASM
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Health Club Reimbursement
Check medica.com for more information
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WELLNESS PARTNERSHIPS
WELLNESS PARTNERSHIPS
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Medica’s Online Wellness Resources – Medica.com
WELLNESS PARTNERSHIPS
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2019 Take Action Calendar
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WEAVING WELLNESS INTO YOUR WORKSITE
GUIDING PRINCIPLES
The wellness vision and strategy is grounded in the organization’s core vision and mission statement.
The formation of the wellness foundation is designed to offer support, motivation and engagement for employees to live a healthy lifestyle and to fulfill their passion and purpose.
The partnership will create a sustainable and supportive environment.
The partnership will create a cohesive wellness team.
Medica will collect and leverage data that matter most to your organization.
Medica’s partnership offers best practice consultation in building a sustainable wellness culture with a customized strategy that meets the needs and interests of each unique employee population. It is based upon the following guiding principles:
WHY – DEVELOP A WORKSITE STRATEGY
What gets measured gets done!
Builds the business case
It connects the dots with your wants
Makes engagement leaps
YOUR VISION IS THE GAS TANK
IT’S ALL ABOUT BABY STEPS!
90
STEP ONE STEP TWO STEP THREE
Well-being framework Well-being strategy & action plan
Well-being engagement dashboard
MEDICA’S HEALTH CONSULTATION MODEL | Best Practice
Goal: Create a sustainable, results-oriented worksite wellness approach that provides
awareness, motivation and support in addressing the unique health risks and interests of each
employer towards living a thriving lifestyle.
STEP ONE | Well-being Framework
Goal: Identify the uniqueness of each employer’s culture to assist with development of a wellness strategy that best meets the needs and interests of their employee population.
MEDICA’S DATA ANALYSIS SCOPE OF WELL-BEING CULTURE ANALYSIS
Demographics Population risk My Health Rewards by Medica® Preventive care utilization Chronic conditions – claims Employee engagement survey
Resources: Refer to Well-Being Framework Binder Section
Identify well-being pillars Identify existing programs/resources Cultivate supportive health promoting
environments, policies and practices
Resources: Refer to Well-Being Strategy & Action Plan Binder Section
Achieve leadership support Review environment structure related
to supportive health promoting environment, policies and practices
Effective communication channels Wellness Culture Champions
Resources: Refer to Well-Being Framework & Strategy & Action Plan Binder Sections
WHY IMPORTANT?
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QUESTIONS & ANSWERS
93
THANK YOU
94
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