Delta s Healthy Rewards Program. Administration Services

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1 Delta s Healthy Rewards Program Administration Services

2 Helping You Navigate the Winding Road of Healthcare Reform The crisis is real. Chronic diseases, such as diabetes and heart disease, are steering healthcare costs over the cliff. It is estimated that healthcare costs for chronic disease treatment account for over 75% of health expenditures; an expense shared by employers and employees. These common and extremely costly diseases are often treatable, or completely preventable, when people pursue a healthy lifestyle. Cost Control Delta manages plan cost by encouraging health awareness and individual responsibility.

3 Administration Services INTRODUCING HEALTHY REWARDS Delta Health Systems has designed a new benefit plan that combines health-conscious programs with the administration needed to produce results. Healthy Rewards emphasizes and rewards impactful consumerism, raises health awareness, and meets the demands of the Patient Protection and Affordable Care Act. Key components of the plan are: Programs that provide a clinical benchmark and annual results for each member Care management tools to assist with positive behavior change The first step is an annual health evaluation for plan members. These can be conducted at employer sites or contracted lab facilities. The comprehensive evaluation includes the following: blood panel Blood pressure test Abbreviated health risk assessment Participants receive a concise, easy-to-understand health report that outlines evaluation results, reviews potential health problems, and lists personalized strategies that promote better long-term health. Delta handles the administration of Healthy Rewards in conjunction with the client and broker. Delta will: Schedule, promote, and market the evaluations to plan members. Provide a participant report to the client within two weeks of the evaluation period s closure during year one. Provide a participant report within four weeks in year two and beyond.

4 Important Elements of Healthy Rewards PERSONAL HEALTH SCORE Participants receive a Personal Health Score that is calculated based on: Blood Pressure Glucose Tobacco Use LDL Cholesterol Triglycerides HIPAA- COMPLIANT GOALS The member s Personal Health Score is used to produce a 12-month, HIPAA-compliant personal health goal. The goal can be achieved through a combination of direct physician supervision and lifestyle changes. By meeting or exceeding goals, participants can reduce the risk of heart disease, diabetes, stroke and other conditions. CUSTOMIZABLE PROGRAMS Clients have the option to customize their own program with additional compliance levels, including: Mandatory care management engagement programs for at-risk members Preventive care compliance for all plan members over 18 years of age, including annual screenings and other clinical tests Customization also includes compliance for specific conditions that utilize evidence-based guidelines. For example, specific guidelines for diabetics include: Eye exam in last 12 months HbA1c test in last 12 months LDL test in last 12 months (18 75 yrs. old) (HEDIS) Lipid profile in last 12 months Influenza immunization Healthy Rewards incents members to participate by reducing their contribution levels up to 30% of the benefit value.

5 Healthy Rewards includes components of TeamCare, Delta s comprehensive wellness and care management solution. TeamCare empowers individuals to improve their health, while helping to reduce utilization and lower healthcare spending. An employer can design its benefit plan to take advantage of any or all of the programs available from TeamCare. While these programs are not required, they are highly recommended to achieve the best results. Choose the TeamCare programs that are right for your organization. They include: Utilization Review/Case Management URAC-accredited programs that involve our specialized team of doctors and nurses who produce favorable patient outcomes at the lowest possible costs. And, our master s degree-level educators develop lifestyle management programs that help members make healthier choices, thus reducing the incidence of complications and future medical costs. Wellness Programs Support participants in maintaining healthy habits and help those at risk to set goals that reduce the chances of a future disease. Wellness coaches are available for one-on-one counseling in areas of weight management, stress, nutrition, exercise, and tobacco cessation. Various online services are available through our web portal. Disease Management Targets chronic conditions, such as diabetes and asthma; evidence-based guidelines are used to impact health and measure improvements. Maternity Management Provide education and support to expectant mothers in order to reduce instances of complications and subsequent high claims costs. and more!

6 Healthy Rewards Plan Example HOSPITAL BENEFITS Inpatient and Outpatient Admissions Emergency Room Surgi-Centers Skilled Nursing Facility Mandatory Centers of Excellence Requires use of PPO Network Facilities 100% Benefit at PPO Facilities (no Deductible) No Benefit at Non-PPO Facilities (except as noted below*) $100 ER Co-Pay (Waived if admitted) 100% Benefit at PPO Facilities (no Deductible) No Benefit at Non-PPO Facilities (except as noted below*) 100% to a maximum of 120 days per stay 100% at PPO Facilities No Benefit at Non-PPO Facilities (except as noted below*) MEDICAL BENEFITS Deductible Benefits Doctor Visits X-rays and Lab Ambulance Surgeon and Related Services Chiropractic Physical Therapy Speech Therapy Occupational Therapy Hearing Aid and Testing Preventive Care, Routine Physicals and Immunizations This is the maximum you will pay in out-of-pocket expenses; once you have reached this amount, the plan will cover 100% per person per calendar year Requires use of PPO Network Providers No Deductible 70% Coinsurance for PPO Providers No Benefit for Non-PPO Providers (except as noted below*) $1,500 calendar year maximum 24 visit maximum 24 visit maximum 24 visit maximum $800 maximum benefit 100% Benefit for PPO Providers Only No Benefit for Non-PPO Providers $5,000 Per Year Maximum Out of Pocket for Individuals $10,000 Per Year Maximum Out of Pocket for Families *In the case of an emergency admission to a Non-PPO Hospital, the PPO Percentage rate will continue only until the doctor verifies that you or your dependent s condition is stable, recovering and is no longer life threatening. If there are no PPO Providers within a thirty mile radius of your residence, or if you or your dependent requires services only available at a Non-PPO Provider, the PPO Percentage rate will apply.

7 MENTAL HEALTH Inpatient Inpatient / Residential Alcohol & Substance Abuse Outpatient Day Care Program Office Visit 30 day maximum per lifetime 100% PPO Facility 90% at TARP Contracted Facility 50 visits per calendar year 80% PPO Provider 80% PPO Provider PRESCRIPTION DRUGS Through designated PBM Generic Drugs mandatory when available. DAW (Dispensed as Written if preauthorized) Retail: (30 day supply) 10% Co-Pay for Generic Drugs 20% Co-Pay for Preferred (Formulary) Brand Name Drugs 40% Co-Pay for Non-Preferred (Non-Formulary) Brand Drugs Mail Order: (up to 90 days) 10% Co-Pay for Generic Drugs 20% Co-Pay for Preferred (Formulary) Brand Name Drugs 40% Co-Pay for Non-Preferred (Non-Formulary) Brand Drugs 20% Co-Pay Specialty Pharmacy Program Co-Pay Max per prescription $250 Maintenance Medications (specific drugs only): No Co-Pay 2 TIER MONTHLY CONTRIBUTIONS Sample Contributions Single Contribution Single Incentive Contribution** Family Contribution Family Incentive Contribution** January 2013 to December 2013 $100 $50 $200 $100 **Rates for Compliance 1) Incentive Rates apply with completed annual health evaluation. New enrollees have 60 days to complete initial evaluation (Applies to adults over age 18). 2) Incentive rates apply in future years based on compliance with recommended health management program; base rates apply first of month after second annual health evaluation if non-compliant (Applies to adults over age 18). Compliance will be determined by the personal health score and goal. The score is comprised of five lifestyle risk factors: glucose, LDL cholesterol, triglycerides, blood pressure and smoking. The member s ability to improve (or maintain) this score is an indicator of their personal engagement and commitment to health. The personal health score is calculated using the following criteria: 1) Blood Pressure: 1 point per BP unit above 139/89 (Systolic/ Diastolic). A 5-point credit against the IHI score can be earned if both systolic and diastolic blood pressure values are below 140/90. 2) LDL Cholesterol: 1 point per unit above the personal LDL target level of 99, 129 or 159 mg/dl. A 5-point credit against the IHI score can be earned if value is at or below the participant s LDL target level. 3) Glucose: 1 point per Glucose unit above 99. A 5-point credit against the IHI score can be earned if glucose is at or below target of 99. 4) Triglycerides: 1 point per 10 Triglyceride units above 149. A 5-point credit against the IHI score can be earned if triglycerides are at or below target of ) Tobacco Use: 40 points for using tobacco.

8 Built to stand the test of time, Delta Health Systems has delivered as promised to its clients for more than 45 years. By partnering with Delta, you can expect: Self-funded health plan expertise that transcends many different vendors we have the flexibility to customize a plan that is right for you. Complete transparency of costs one administrative fee and no nickel and diming for support/ troubleshooting calls. Total accountability for adhering to the highest of standards we are an SSAE 16 audit-approved business. Cost control as a result of strong network relationships and TeamCare, our population health management solution. Administration Services SNAPSHOT DELTA HEALTH SYSTEMS Founded in 1968 Independent and privately held More than 250 employees Offices in Stockton, CA; Fresno, CA; and Salt Lake City, UT To find out more about the many advantages Delta has to offer, contact Delta Health Systems at DELIVER AS PROMISED Settle all accounts promptly and accurately Be a knowledgeable intermediary Provide cost-effective benefit plans