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CoverageFirst® PPOThe easy first step toward consumer choice plans. Now with more options for your smaller clients!
April 2005
GHC-17612 4/05
The Easy First Step Toward Consumer-Choice Plans
A simple solution-no complicated banking arrangements
All the benefits of a full PPO plus an up-front allowance
Motivates employees to use their benefits wisely - and to consider costs
Guides employees in becominginformed consumers of health care
A Quick Review• CoverageFirst is a PPO plan that can help
members save money. Members change their behavior by becoming more involved in their health spending decisions.
• Unique four-phase design:– Annual allowance of $500 per member
promotes consumerism: member must manage allowance up-front before paying toward deductible
– Annual deductible after eligible expenses total $500
– Coinsurance goes into effect after member meets the deductible
– Safety net ensures 100% coverage for all eligible expenses after the member reaches the out-of-pocket maximum
CoverageFirst: How it works
that applies after a member spends the allowance for the year.
in which CoverageFirst pays all or most additional eligible medical expenses until the member satisfies the annual out-of-pocket maximum
CoverageFirst 100/70 plan – new options (for 2-50 case size)
Current Additional options
Deductible $2,500$3,000/$4,000/$5,000
Copayment $25 $40 – office visit – office visit $100 – ER
$50 – outpatient facility
CoverageFirst 80/60 plan – new options (for 2-50 case size)
Current Additional options
Deductible $1,000 $1,500/$2,000/$2,500/$3,000/$4,000/$5,000
Copayment $25 – $40 – office visitoffice visit $100 – ER
$50 – outpatient facility
Out-of-pocket $2,000 $3,000/$4,000 (Available with allMaximum deductible options)
Rate reduction!For groups with 2-50 employees,
CoverageFirst 100/70 plan rates
will be reduced by 7.5 percent
Reduced rates start with 4/1/05 effective dates
Lower rates are available on our new product options
Rate reduction helps nudge your clients toward consumer-choice plans
Humana’s Consumer Choice Continuum Today
CoverageFirst
New Options Benefit AllowanceFully insured fund
SmartExpressCoins PPO w/ PCA
Employer Funded
Traditional Products
PPO, HMO
Consumer Choice Continuum
Health SavingsAccount
Employee Funded
• Introduces the concept of consumer choice• Appropriate for groups at any point on the continuum• Good strategy for employers: Offer CoverageFirst at a low employee premium as a dual choice strategy to encourage high participation. Consider adding “buy-up” options to encourage engagement.
Dual Choice Strategy
$500 $625
$375 $375
$125 $250
Example
Standard copayment plan 90/60 with $500 deductible
With a dual choice strategy, the employer can encourage consumer engagement by contributing at the same level for both plans.
Premium
Employer contribution
Employee contribution
Example
CoverageFirst 80/60 with $1,500 deductible
Dual Choice
Wrap-up
CoverageFirst PPO – an easy first step for employers not ready to dive into more complicated consumer-choice plans
Broad choice of deductible and copayment options
Changes employees’ behaviors and attitudes about health care costs – spending allowance encourages planning, cost-comparing, and budgeting
For 2-50 groups, reduced ratesfor 100/70 plans with 4/1/05 effective dates
Great option for dual-choice strategy
Thanks for your interest in the“new and improved” CoverageFirst PPO plan!
What else would you like to know about CoverageFirst?