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Anthem HIP 2.0Indiana Primary Health Care Association Annual
Conference2015
Product
Mbrs
Mbr %Plan 1
Plan 2
Plan 3
Plan 4
Plan 6
Plan 7
Plan 9
Plan 10
Plan 12
Plan 13
Plan 14
Plan 15
Plan 16
Plan 17
Basic 4,492 5% 154,47
7
State Basic
22,024
24% 307 1 19,521 18 2,177
Plus 43,384
48% 86 2 43,296
State Plus
21,201
23% 80 17,200 7 3,914
Totals 91,101
100% 86 2 43,296 15 4,477 80 17,200 7 3,914 307 1 19,521 18 2,177
HIP 2.0 Members Update
As of 4/22/15, please see below the HIP Membership breakdown:•29% of current total population are Basic/State Basic Members (5% Basic + 24% State Basic)•71% of current total population are Plus/State Plus Members (48% Plus + 23% State Plus)
Power account increases to $2,500Plan Options: HIP Plus, HIP Basic, HIP State Plan plus HIP Link (available summer 2015)Dental and Vision now covered in HIP Plus and HIP State PlanCost sharing: PACs, PAC penalties, Co-paysHHW/HCC rates increased by 25%, BH 85% of MC and Prenatal/Maternity 100% of MC
HIP 2.0 Changes
Emergency Care:Member will have a co-pay if they do not have an emergency health condition. $8 first time and $25 each time after.Power account funds cannot be used to pay ER co-pays. Co-pays will be collected by the hospital.Native Americans and Pregnant Members do not have a co-pay for an actual emergency.
Member Information/Cost Sharing
POWER Account (Personal Wellness and Responsibility)
Monthly contribution based on income No co-pays, except for ER usage for non-
emergent events Health plan will bill the member each month Member and PMP choose preventative care
services
Member Information
Non-profits organizations can pay for member power account contributions. All non-profit organizations can participate.
One-time contribution or monthly contributions.
PACs can be paid through payroll deduction through an employer.
Employers may also pay for PACs, partial or full.
Power Account Contributions
Mail Check: Anthem BC/BS IN HIPP.O. Box 105674Atlanta, GA 30348-5674
Credit/Debit cards: phone or onlineAutomatic bank draftPayroll deductionElectronic funds transferWal-Mart- cash only
Power Account Contributions
HIP Plus members who do not make contribution payments will lose their HIP Plus coverage. Payments that are 60 days late will be termed from HIP Plus.
Income less than $973 for an individual or $1,988 for a family of four per month will receive HIP Basic benefits If income is more member will be termed from HIP.
Member Information
HIP Basic requires a member to make a payment every time they receive a health care services. (Co-payments)
Physician or OP co-pay $4 Prescriptions $4 -$8 Hospital $75 If you are moved to the HIP Basic Plan due to
non-payment you cannot move back to HIP Plus until a new 12 month benefit period begins
Member Information
Changing your PMP: Members can change physicians at any time
as long as the physician is in network. A member who sees a physician who is not
their PMP and without authorization from Anthem may have to pay for those services.
Self-referral services: these services can be received without seeing your PMP to get a referral.
Member Information
Self-referral Services
Behavioral health Chiropractic care Diabetes self-care training Emergency services Eye and vision care Family planning HIV/AIDS care management Podiatry services Immunizations
Member Information
Individuals with certain complex medical or behavioral health conditions can qualify for State Plan Benefits under HIP.Anthem will work with members who claimed to have a medical condition upon initial application to see if they qualify for MF- initial 60 days of coverage.Health Needs Assessment to be completed.
Medically Frail
Provided under the HHW benefit if you qualify for HIP and you are already pregnant when you enrolled or re-enrolled. HIP Maternity plan only continues through two months post partum. You should apply for regular HIP as soon as you begin your post partum period.
HIP Maternity
HIP 2.0 builds on the successes of the original HIP program which included lower ER usage by members, increasing use of preventative services, proven consumer-directed model (HSA) thus leading to increased savings of health care dollars and better health outcomes for Indiana.
Empowerment of members.
Member Information
Anthem Clinic Days Co-Branding Sponsoring Events (Back to School events,
National Health Center Week, Outreach Activities)
Webinars (Smoking Cessation)
Working with IPHCA members
Transportation to physician visits, WIC appointments, and redetermination appointments.
Anthem has also added pharmacy visits as a third leg of a visit.
Cellphones with 250 minutes per month and a one time bonus of 200 minutes.
Subscriptions to Eating Well and Parenting Magazine
Enhanced Benefits
Gift cards to Walmart for completing health survey and certain preventative care visits as outlined in the member handbook.
New Baby, New Life maternity program (replaces Future Moms program) (prenatal program)
Sports physicals for children with their assigned member
Local classes and programs dedicated to healthy living.
Enhanced Benefits
LCP Transportation: Value add benefit and Anthem has added pharmacy as third leg of a trip.
Schedule appointments: 1.800.508.7230 Monday to Friday, 8am-5pm After hours service 1.866.408.6131 (24 hours
a day, 7 days a week) www.icptransportation.com
Enhanced Benefits/Transportation
Anthem BCBS Member HandbookCustomer Care Center- 1.866.408.6131HIP Pharmacy Member Hotline: 1.866.408.613124/7 Nurseline: 1.866.800.8780Transportation: 1.800.508.7230Vision: VSP 1.866.866.5641Dental: 1.888.291.3762www.anthem.com (member website)
Member Resources
