VALLEY HEALTH PLAN

Covered California Plan & Individual & Family Plan

© 2014 Valley Health Plan

WELCOME

Goal: To share information about Valley Health Plan (VHP) and

establish a relationship with trusted organizations to work

together to reach communities in need of health coverage.

– About Valley Health Plan

– HMO vs PPO

– Why Choose Valley Health Plan?

– Steps to Navigate: VHP Provider Search

– Steps to Navigate: Covered California Shop and Compare Tool

– How to Enroll

– Member Materials

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Agenda

ABOUT VALLEY HEALTH PLAN

• As the only locally based health plan in Santa Clara

County, we understand the community’s health

coverage needs.

• VHP, is a HMO that has been providing health insurance

coverage to employer groups since 1985.

• VHP is now publically available, where ANY resident of

Santa Clara County can choose quality, affordable

health coverage.

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For Residents of Santa Clara County

ABOUT VALLEY HEALTH PLAN

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Region 7 Service Area – County of Santa Clara

Northern Area

• Los Altos

• Los Altos Hills

• Mountain View

• Palo Alto

• Sunnyvale

Western Area

• Campbell

• Cupertino

• Los Gatos

• Monte Sereno

• Saratoga

Central /Eastern Area

• Milpitas

• San Jose

• Santa Clara

Southern Area

• Gilroy

• Morgan Hill

KEY DIFFERENCES BETWEEN HMO VS. PPO

• Health Maintenance Organization (HMO)

– All your health care services go coordinated by a Primary Care

Physician

– Need a referral to see a specialist (except in an emergency)

– Visits to out-of-network providers are not typically covered

• Preferred Provider Organization (PPO)

– No need for a referral to see a specialist

– Can access care both inside and outside the provider network

– Typically pay a higher percentage of cost for out-of-network care

– Choice = Higher Cost Share

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Valley Health Plan is an HMO

WHY CHOOSE VALLEY HEALTH PLAN?

• Covered California Plan

– Subsidies may be available based on age, family size and income

– Proof of legal status, residency, and income required

– VHP does not offer Small Business Health Options Plan (SHOP) at this time

• VHP Individual & Family Plan

– The applicant only needs to sign the application which attests that everything on the application is true

– Subsidies are not available

– Mirrored product for rates, copays, provider network, and benefits

All plans include Pediatric Dental (Liberty) & Vision (VSP) benefits

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Products Offered

WHY CHOOSE VALLEY HEALTH PLAN?

• Every HMO Qualified Health Plan offers the same essential health benefits and co-pay/coinsurance.

• Multilingual staff and member materials

• Lowest HMO prices for the most popular Exchange plans

• Quality network of primary and specialty care providers

– Primary Care: Community Clinics, Independent Providers, and Santa Clara Valley Medical Center (SCVMC)

– Hospitals: Lucile Packard Children’s, Saint Louise Regional, SCVMC, and Stanford

– Safeway and Walgreens pharmacies (Nationwide)

– Quest Labs (Statewide locations)

• Free health & wellness services

• Easy process for non-subsidy eligible applicants to enroll into mirrored VHP Individual & Family Plan

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Connecting the coverage you need with the care you deserve

PROVIDER NETWORK

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Covered California Plan and VHP Individual & Family Plan

FREE HEALTH AND WELLNESS SERVICES

• Chronic Disease Prevention & Management Classes

– Diabetes prevention, nutrition, tobacco cessation, Weight Watchers

• Prenatal Classes

– Childbirth, Breastfeeding, Labor & Delivery, Infant CPR

• Fitness Classes

– Aquatic, Jazzercise, Pilates, Total Body Fitness, Tai Chi, Yoga, Zumba

• Online Wellness Tools

– Personal Health Assessment, workshops, recipes, nutrition tracking

• Care Management Program

– Disease Management and Complex Case Management

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For All VHP Members

STEPS TO NAVIGATE: PROVIDER SEARCH

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Step 1: Visit www.valleyhealthplan.org

STEPS TO NAVIGATE: PROVIDER SEARCH

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Step 2: Click on Provider Search

STEPS TO NAVIGATE: PROVIDER SEARCH

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Step 3: Click Provider

STEPS TO NAVIGATE: PROVIDER SEARCH

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Step 4: Filter Results

STEPS TO NAVIGATE: PROVIDER SEARCH

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Compare Providers

STEPS TO NAVIGATE: PROVIDER SEARCH

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Provider Profile

STEPS TO NAVIGATE: PROVIDER SEARCH

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Provider Profile

STEPS TO NAVIGATE: SHOP AND COMPARE TOOL

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Step 1: Visit www.coveredca.com

FIND THE PLAN THAT MEETS YOUR NEEDS

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Step 2: Input your information

COVERED CALIFORNIA: VALLEY HEALTH PLAN

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Step 3: Plan Options (HMO vs. PPO)

Highlights

• You can toggle

metal options

• Tax credits same

for all

• Total monthly

premium

payments differ

by Plan choice

PLAN PREMIUM COMPARISON

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Example for a 25 year old

PLAN PREMIUM COMPARISON

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Example for a 40 year old

HOW TO ENROLL

• Buying through Covered California

– Visit coveredca.com

– Call 1.800.300.1506 (toll-free)

• Buying Directly From VHP

– Visit valleyhealthplan.org

– Call 1.888.421.8444 (toll-free)

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Individuals and Families

MEMBER MATERIALS

• “We Speak the Language of Health”

– Covered California Plan (English, Spanish & Vietnamese)

– Individual & Family Plan (English, Spanish & Vietnamese)

• “Compare and Save”

– Example of premiums for 25-year olds

– Example of premiums for 40-year olds

• Summary of Benefits and Coverage (SBC)

– All Metal Tiers

• Premium Rates by Age

• How to Read Your VHP ID Card

Folder Contents

Thank You!