1 university of california faculty & staff your 2010 health net benefits
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University of California Faculty & Staff
Your 2010 Health Net Benefits
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Please consult the UC Evidence of Coverage booklet for complete benefit details.
Why Health Net? – an introduction
How does my Health Net HMO plan work?
What are my 2010 Health Net Medical benefits?
What are my NEW 2010 Health Net Prescription Drug benefits?
What is Decision PowerSM?
What extras are available to me as a Health Net member?
What information can I find on the web?
How can I maximize my benefits?
Where do I go for more information?
Topics Covered
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Health Net has a proven track record of providing UC employees with a quality health plan that offers excellent value.
• Health Net plans have been offered continuously for the past 27 years to University of California Faculty & Staff
• Health Net received an “Excellent” accreditation rating - the highest level - from the National Committee for Quality Assurance (NCQA)
• 2007 and 2008 California Office of the Patient Advocate (OPA) survey ranked Health Net the number one major network-model carrier in clinical quality and service.
• UC members are increasingly satisfied with Health Net
• More UC members are enrolled in Health Net than any other health plan!
Why Health Net?
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Health Net is working in collaboration with the University of California with the following goals in mind:
Sustainable – being eco-friendly in the resources we choose and use
Savings – providing quality benefits at a good value
Smart – giving you the coverage and tools to take charge and make the most of your health
Introduction to Health Net
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IF YOU NEED A HEADLINE, THIS IS IT.
Reasons why Health Net is a Better Decision
A California leader in managed health care, Health Net offers:
•One of the largest networks of doctors and hospitals in California, including all the UC Medical Centers and Pharmacies.
• Predictable costs with fixed copayments for services. Preventive care and immunizations are covered at 100% for all covered members.
• Financially sound, Health Net is ranked #165 in the 2009 Fortune 500 list of companies.
• Decision PowerSM, a program that brings together the information, resources and personal support that fit you, your health and your life.
• Dedicated support for UC members at www.healthnet.com/uc and 1-800-539-4072.
Introduction to Health Net (cont’d)
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IF YOU NEED A HEADLINE, THIS IS IT.
1. Each covered family member selects a Primary Care Physician (PCP)
2. Each Primary Care Physician is affiliated with a Participating Physician Group (PPG)
3. Your PCP will coordinate your care and access to any needed specialty care with the PPG.*
4. Generally, all your care will be handled within the PPG.
Logon to www.healthnet.com/uc and click “Where do I Start”?” to access the ProviderSearch tool.
* For annual OB/GYN visits, no referral is needed. Rapid Access allows your physician to refer you directly to certain specialists within your PPG.
How does my Health Net HMO plan work?
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IF YOU NEED A HEADLINE, THIS IS IT.
Health Net HMO – Medical Benefits
Copayment
Doctor office visit $15 per visit
Specialist office visits $15 per visit
Periodic health evaluations/immunizations
Covered in full
X-rays and lab procedures Covered in full
Maternity care Covered in full
Urgent care $50 per visit$15 (if owned and operated by your PPG)
Hospitalization $250 per admission
Emergency Care $50 per visit – waived if admitted
Please consult the UC Evidence of Coverage booklet for complete benefit details.
University of California 2010 Benefits-At-A-Glance
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Health Net HMO – Medical Benefits
Copayment
Deductible None
Calendar year out-of-pocket maximum (one member)*
$1,000
Out-of-pocket maximum (two members)*
$2,000
Out-of-pocket maximum (family – three or more members)*
$3,000
Lifetime maximum None
* Benefits that do not apply to the out-of-pocket maximum include:
prescription drug copays and services not covered by the plan. Please consult
the UC Evidence of Coverage booklet for complete benefit details.
University of California 2010 Benefits-At-A-Glance (cont’d)
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IF YOU NEED A HEADLINE, THIS IS IT.
Health Net HMO – Prescription Drug Benefits
Copayment
Retail (up to a 30-day supply)
NEW! $5 Generic$20 Brand Formulary$35 Non-formulary
Mail order program or UC walk-up services at designated UC Pharmacies (up to a 90-day supply for maintenance drugs )
NEW! $10 Generic$40 Brand Formulary$70 Non-formularyNew benefits for 2010! Generic drug copay reduced from
$10 to $5 at retail; from $20 to $10 for mail order.
Please consult the UC Evidence of Coverage booklet for complete benefit details.
University of California 2010 Benefits-At-A-Glance (cont’d)
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IF YOU NEED A HEADLINE, THIS IS IT.
Getting started is easier than you may think. There are many options for you to get signed up for the program:
1. Call CVS Caremark directly at 1-888-624-1139. They will contact your doctor to get your prescription information. When you call, be sure to have the medication name and your doctor's information.
2. Order online. You will be prompted to enter your Healthnet.com username & password or to Register. Next, click on "New Mail Order Prescriptions" and then go to Fast Track.
3. Download, print and mail in the order form. If you do not have access online, call 1-800-539-4072 and Customer Service will mail you a form.
4. Use the Walk-Up Service available at UC designated UC Medical Center Pharmacies.
New! CVS Caremark may also be contacting you during the year to help you get started with the Mail Order Program.
With mail order pharmacy you get 3 months of medication for the price of two – that is 4 months of medication free each year or a savings of $20-140 per prescription per year!
Health Net Mail Order Program for Maintenance Drugs - Save $20-$140 per year per prescription!
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IF YOU NEED A HEADLINE, THIS IS IT.
It’s a list of medications that are generally accepted by a health plan also referred to as the Recommended Drug List (RDL).
Health Net’s Pharmaceutical & Therapeutic (P&T) committee designs and maintains the RDL:
•Committee includes community physicians representing different specialties
•Therapeutic evaluation•Evidence based medicine•Best practices•Develop policies on medication use•Outcomes
You can access Health Net’s most up-to-date Recommended Drug List online at
www.healthnet.com/uc, click Pharmacy Benefits
What is a Formulary?
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For every 100 people in the United States …
•60 are sedentary•25 smoke•20 are at least 20% overweight•27 have heart disease•10 have diabetes•50 have high cholesterol•24 have high blood pressure•50 feel distressed
…Decision PowerSM is the bridge to action.
Source: “Stress at Work,” National Institute for Occupational Safety & Health
Did you know?
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When it comes to your health, there’s more than one right answer. When you choose Health Net, you get more than health care coverage. You get Decision Power to help you…
• boost your health • identify potential risks • learn about treatment options • help prevent chronic problems • address serious medical concerns • and so much more
Use Decision Power online. Or by calling a Health Coach. Try multiple resources at once,
or one at a time. 24 hours-a-day, seven days-a-week, Decision Power helps you protect
your health in the way that works best for you.
Decision Power: Your Health, Your Time, Your Choice
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Staying healthy is just as important as getting well. Making the most of your health is what Decision Power is all about. Throughout every stage of health, Decision Power is here for you:
•Wellness & Prevention for healthier living – learn how to improve blood sugar levels to minimize diabetes risk, boost fitness levels, eat heart-healthy foods, & more.
•Preference Sensitive Conditions – guidance and options where multiple treatment approaches exist and the right one depends on your specific condition, personal preference and values for conditions such as chronic back pain, migraines, arthritis, & more.
•Chronic Conditions – support and resources for people living with ongoing health challenges such as diabetes, asthma, depression, heart disease, & more.
•Severe Illness – support and care options when a medical condition takes center stage, requiring in-depth support (e.g., home care, skilled nursing, behavior health care)
Decision Power: Support
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We've all heard the news, seen the magazine covers. Americans are getting bigger and the resulting health issues are growing. In fact, 20-25% of the U.S. population has Cardiometabolic Syndrome - a combination of three or more of six risk factors that predict diabetes, heart disease and colon cancer:
•Waist > 40” for men or > 35” for women•Blood pressure > 130/85•Fasting blood sugar > 100•Triglycerides > 150•HDL (good) cholesterol <40 men or <50 women•Smoking
If unchecked, these factors can lead to a serious disease. Decision Power can help you reduce your risk. Call anytime to talk with a Health Coach and find out what steps you can take to avoid Cardiometabolic Syndrome.
Decision Power Spotlight: Cardiometabolic Syndrome
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IF YOU NEED A HEADLINE, THIS IS IT.
Our Decision Power Healthy Discounts program rewards you for being a member. Save on these health-related products, services and more.
• Alternative Care Services through American Specialty Health Networks (ASH) such as acupuncture, chiropractic, and massage
• Fitness Club Discounts through ChooseHealthyTM
• Weight Management through Weight Watchers® or Jenny Craig®
• Emergency Medical Information Service through MedicAlert
• Kids Sport Gear through Sports4kids.com
• Eye Care discounts through EyeMed Vision Care®
• Health and Online Resources through beyou.tv/healthnet
• and more!
Health Net Extras: Decision PowerSM Healthy Discounts
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Custom Health Net website for UC – – www.healthnet.com/uc
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Custom Health Net website for UC – Post Login
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1. Order ID Card(s)2. Print a temporary ID
card(s)3. View address/phone on
file4. Search and/or change
your medical group (PPG)
5. View contact information for your medical group (PPG)
6. Change your PPG7. Search or view contact
information for your doctor (PCP)
8. Change your PCP9. Access all member
discounts
oh, let me count the ways…
10.Enroll in Mail Order (MO)
11.Search the Formulary12.Refill MO prescriptions13.Change MO billing info14.Check status of MO
prescription15.Create a Personal
Health Record (PHR)16.Obtain claim forms17.See some claims
history18.File an Appeal or
Grievance19.View your Rx claim
history20.View your medical
claim history
21.Access Decision Power22.Talk to a Health Coach23.Learn about different
diseases24.Start a quit smoking
program25.Get decision support26.Start an exercise
program27.Research the health
library28.Compare hospital
quality, price, mortality rates!
29.Compare medical groups30.Much, much,much
more!
Custom Health Net website for UC – Post Login (cont’d)
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1. Update your address and phone number with UC (http://atyourservice.ucop.edu)
2. Call your Primary Care Physician (PCP) and get a check up.
3. Know when your preventive screenings are due.
4. Register at www.healthnet.com/uc, find out about cost savings tips and more.
5. Use generics and take advantage of your new prescription drug benefits.
6. Use the Mail Order or UC Walk-up program for maintenance drugs and receive one month free (pay only 2 copays for a 90-day supply).
7. Call your PCP in an urgent situation. It may be more appropriate for you to go to an Urgent Care Center rather than an Emergency Room.
8. Take charge of your health - call Decision PowerSM today.
Health 101 Tips…to maximize your benefits
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• Log on to the Dedicated UC Custom website at www.healthnet.com/uc
• Talk to a Dedicated UC Customer Service representative (1-800-539-4072)– Dedicated team available 8 a.m. to 6 p.m. to answer
medical and prescription drug questions
• Talk to a Decision Power Health Coach (1-800-893-5597)– Personal coaching available 24/7– Nurses, registered dietitians, respiratory therapist– Ask to speak to the same Health Coach
• Talk to CVS Caremark’s Mail Order Pharmacy line (1-888-624-1139)– Representatives are available 24/7 to answer questions
about Mail Order Pharmacy
Where do I go for questions?
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Health Net Disclaimers
Decision PowerSM is not part of Health Net’s commercial medical benefit plans nor affiliated with Health Net’s provider network and it may be revised or withdrawn without notice. Decision Power is part of Health Net’s Medicare Advantage benefit plans but is not affiliated with Health Net’s provider network.
Decision Power services, including Health Coaches, are additional resources that Health Net makes available to enrollees of Health Net of California and Health Net Life Insurance Company. Decision Power Healthy Discounts is not part of your Health Net benefit program and is not intended to take the place of any covered benefits. Decision Power Healthy Discounts providers are independent businesses.
CA62548 (10/09) Health Net of California, Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, Inc. Health Net® is a registered service mark of Health Net, Inc. A Better DecisionSM and Decision PowerSM are service marks of Health Net, Inc. All other trademarks remain the property of their respective companies. All rights reserved.