Offering Employer Options & Value from UNICARE of Arkansas

Offering Employer Options & Value from UNICARE of Arkansas
BusinessFlex for Small Groups Offering Employer Options & Value from UNICARE of Arkansas This summary of benefits provides a very brief description of the important features of our plans. This is not the insurance contract and only the actual Certificate of Coverage provisions will apply. The Certificate set forth, in detail, the benefits, limitations, and exclusions. If there are any conflicts between the terms of the Certificate of Coverage and the information in this presentation, the terms of the Certificate of Coverage will prevail.

BusinessFlex for Small Groups
Offering Employer Options & Value from UNICARE of Arkansas

Today's Agenda Part A: Part B: Introduction to BusinessFlex
Why BusinessFlex? What we’ve learned What makes a successful health plan Recent innovations Product strategy BusinessFlex Benefit overview BusinessFlex Plan overview Part B: BusinessFlex Plan detail

Introducing BusinessFlex
Taking innovation to a higher level: Defined Contribution options for both medical and dental coverage Section 125 Premium-Only Plan administered by Ceridian Benefits Services

Choices that Matter The BusinessFlex program represents a new approach to the small group market. Defined Contribution options Section 125 Premium-Only Plan MemberFlex Six PPO Plans

Why BusinessFlex?

The Underwriting Cycle
14% I. II. III. IV. Premiums 12% 10% 8% 6% Medical Inflation 4% 2% 0% -2% 1990 1992 1994 1996 1998 Source: Bureau of Labor Statistics, 1999

Small Group Average Price per Member
III. II. AVG PREMIUM PMPM I.

Growing demand for choice by employers
Increasing Costs

Successful Health Plans
Price/Cost vs Creative Plan Structures Allow for financial risk sharing with members Focus on Direct Access (PPO) plans vs. Managed Care

The Challenge How to continue our recent rate of success as the economy slows. How to better meet the needs of Arkansas businesses and employees.

Our Answer is BusinessFlex
Objectives: Help Employers successfully manage the current challenges of today’s business climate Ensure that Employees have improved choices and options

Our Answer is BusinessFlex
Objectives: Expand opportunities for Uninsured Groups to acquire coverage Contribute to WellPoint vision of market redefinition

BusinessFlex for Small Groups
High Premier 500 Broad Range of Products and Premium Options Medium $500 Deductible Premier 1000 Low Saver $1000 $2000 Deductible $1000 Deductible

BusinessFlex Core Features
MemberFlex Defined Contribution Premium Only Plan (POP) Expanded Coverage Options

BusinessFlex Plan Overview
UNICARE Saver 1000 UNICARE 2000 UNICARE 1000 UNICARE 500 UNICARE Premier 1000 UNICARE Premier 500

BusinessFlex Plan Detail
Part B: BusinessFlex Plan Detail

BusinessFlex Features
Defined Contribution MemberFlex Premium Only Plan (P.O.P.)

BusinessFlex Plan Detail
UNICARE Saver 1000 UNICARE 2000 UNICARE 1000 UNICARE 500 PREMIER 1000 PREMIER 500

Defined Contribution Options
Four financing options for Medical plans: Defined Contribution 100: Limits employer’s monthly contribution to no more than $100 per covered employee. Defined Contribution 80: Limits employer’s monthly contribution to no more than $80 per covered employee. Employer may choose from the low and medium medical plan options? Back to Main Menu

Four financing options for Medical plans: Defined Contribution Select: Allows employer to pay any fixed monthly amount in excess of $100 per covered employee in increments of $5. Traditional Contribution: Enables employers to contribute a minimum of 50% of employee’s monthly premium. Back to Main Menu

Options for Dental: Defined Contribution options are also available for dental. Defined Contribution 15: $15 per employee Defined Contribution Select: Set any fixed amount in excess of $15 per employee Traditional Contribution: 50% or more of total employee premium Back to Main Menu

What is MemberFlex? Enables employers to empower employees with
control of their own medical and dental needs Allows the employer the flexibility to offer one, several or all plans to his/her employees Employees control their costs by choosing from plans of varying costs Back to Main Menu

The Premium Only Plan (P.O.P.)
Employers can: Generate company tax savings through a reduction in taxable payroll Receive P.O.P. for only $125 per year Apply tax savings toward the purchase of enhanced employee benefits, increasing employee satisfaction Back to Main Menu

The Premium Only Plan (P.O.P.)
Employees can: Increase take-home pay Defray part of the cost of their premium with associated tax savings Reduce FICA, federal or, where applicable, state or local taxes on their portion of employer-sponsored plan insurance premiums Back to Main Menu

How P.O.P. Works... Made possible through provisions of Section 125 of the Internal Revenue Code Total taxable payroll of company is reduced by amount of employees’ premium contributions Savings to employer depend on total company payroll and dollars that employees contribute Employees use pre-tax dollars to pay their share of monthly premiums, reducing their taxable income Back to Main Menu

UNICARE Saver 1000 Annual medical deductible and Out of Pocket:
Low Price Options UNICARE Saver 1000 Annual medical deductible and Out of Pocket: Deductible, Participating: $1,000 two-deductible family maximum (Non-Participating: $2000 two-deductible family maximum) Out of Pocket: Participating Provider (does not include deductible & copayments) $3,000 plus deductible per member $6,000 plus deductible for family Out of Pocket: Non-Participating Providers $10,000 plus deductible per member $20,000 plus deductible per family Back to Main Menu

UNICARE Saver 1000 Office Visits Participating Provider -
Low Price Options UNICARE Saver 1000 Office Visits (4 office visit maximum is participating and non-participating providers combined, per member, per year and is also inclusive of preventative care office visits) Participating Provider - $30 copay for 4 visits per member per year with deductible waived. Non-participating Provider - 50% of covered expenses for 4 visits with deductible waived. Limited to 4 office visits Back to Main Menu

Participating Provider
Low Price Options UNICARE Saver 1000 Preventive Care: Participating Provider $30 copay for 4 visits per member per year with deductible waived. Non-participating Provider 50% of covered expense Back to Main Menu

Low Price Options UNICARE Saver 1000 Professional Services Participating Provider 60% of negotiated fee, in hospital only with limited exceptions Non-participating Provider 50% of covered expense, in hospital only with limited exceptions Back to Main Menu

Maternity provided for groups of 15-50
Low Price Options UNICARE Saver 1000 Maternity provided for groups of 15-50 (coverage is available through the purchase of a Rider for groups of 2-14) Participating Provider - 60% of negotiated fee Non-participating Provider - 50% of covered expense Back to Main Menu

Outpatient Medical Care
Low Price Options UNICARE Saver 1000 Outpatient Medical Care Participating Provider 60% of negotiated fee Eligible outpatient hospital services only Non-participating Provider 50% of covered expense Back to Main Menu

Low Price Options UNICARE Saver 1000 Inpatient Hospital Services Participating Provider 60% of negotiated fee Non-participating Provider 50% of covered expense, plus a $500 penalty for non-emergency stays Emergency Room visits that do not result in inpatient admissions will be subject to a $60 penalty Back to Main Menu

Retail Pharmacies/Mail Order Per prescription (up to a 30-day supply)
Low Price Options UNICARE Saver 1000 Prescription Drugs, PARTICIPATING Retail Pharmacies/Mail Order Per prescription (up to a 30-day supply) Generic Drugs - $10 copay, with a maximum payment by UNICARE of $500 per member per year Brand Name (formulary) Drugs – $30 copay plus a separate $250 deductible, with a maximum Payment by UNICARE of $500 per member per year Brand Name (non-formulary) Drugs – $50 copay plus a separate $250 deductible, with a maximum payment by UNICARE of $500 per member per year (SAVER 1000 PLAN $500 MAXIMUM IS FOR GENERIC, BRAND NAME FORMULARY AND NON-FORMULARY COMBINED) Back to Main Menu

Non-PARTICIPATING – No Mail Order
Low Price Options UNICARE Saver 1000 Prescription Drugs, Non-PARTICIPATING – No Mail Order Non-Participating Retail Pharmacies Only Per prescription (up to a 30-day supply) Generic Drugs – 60% up to a maximum of $500 per member, per year, of the average wholesale price Brand Name (formulary) Drugs – 50% up to a maximum of $500 per member, per year, of the average wholesale price Brand Name (non-formulary) Drugs – 40% up to a maximum of $500 per member, per year, of the average wholesale price (SAVER 1000 PLAN $500 MAXIMUM IS FOR GENERIC, BRAND NAME FORMULARY AND NON-FORMULARY COMBINED) Back to Main Menu

UNICARE 2000 Annual medical deductible and Out of Pocket:
Low Price Options UNICARE 2000 Annual medical deductible and Out of Pocket: Deductible: $2,000 two-deductible family maximum (Non-Participating: $4,000 two-deductible family maximum) Out of Pocket: Participating Provider (does not include deductible and copayments) $3,000 plus deductible per member $6,000 plus deductible for family Out of Pocket: Non-Participating Providers (does not include deductible & copayments) $10,000 plus deductible per member $20,000 plus deductible per family Back to Main Menu

UNICARE 2000 Office visits: Participating Provider
Low Price Options UNICARE 2000 Office visits: Participating Provider $30 copay for 10 visits per member per year with deductible waived; after 10 visits, once deductible is met, 60% of negotiated fee. Non-participating Provider 50% of covered expense Back to Main Menu

UNICARE 2000 Preventive Care: Participating Provider
Low Price Options UNICARE 2000 Preventive Care: Participating Provider $30 copay for first 10 visits per member per year with deductible waived; after 10 visits, once deductible is met, 60% of negotiated fee. Non-participating Provider 50% of covered expense Back to Main Menu

Low Price Options UNICARE 2000 Professional Services Participating Provider 60% of negotiated fee Non-participating Provider 50% of covered expense Back to Main Menu

Low Price Options UNICARE 2000 Maternity provided for groups of 15-50 (coverage is available through the purchase of a Rider for groups of 2-14) Participating Provider - 60% of negotiated fee Non-participating Provider - 50% of covered expense Back to Main Menu

Low Price Options UNICARE 2000 Outpatient Medical Care Participating Provider 60% of negotiated fee Non-participating Provider 50% of covered expense Back to Main Menu

Low Price Options UNICARE 2000 Inpatient Hospital Services Participating Provider 60% of negotiated fee Non-participating Provider 50% of covered expense plus $500 penalty for non-emergency stays Emergency Room visits that do not result in inpatient admissions will be subject to a $60 penalty Back to Main Menu

UNICARE 2000 Prescription Drugs, PARTICIPATING
Low Price Options UNICARE 2000 Prescription Drugs, PARTICIPATING Retail Pharmacies / Mail Order Per prescription (up to a 30-day supply) Generic Drugs - $10 Copay Brand Name Formulary - $30 copay plus a separate $250 Brand Name deductible, per member, per year Brand Name Non-Formulary - $50 copay plus a separate $250 Brand Name deductible, per member, per year Back to Main Menu

Low Price Options UNICARE 2000 Prescription Drugs, Non-PARTICIPATING – No Mail Order Non-Participating Retail Pharmacies only Per prescription (up to a 30-day supply) Generic Drugs – 60% of the average wholesale price, per member, per year Brand Name (formulary) Drugs – 50% of the average wholesale price, plus a separate $250 brand name deductible, per member, per year Brand Name (non-formulary) Drugs – 40% of the average wholesale price, plus a separate $250 brand name deductible, per member, per year

Low Price Options UNICARE 1000 Annual medical deductible and Out of Pocket: Deductible: $1,000 two-deductible family maximum (Non-Participating: $2,000 two-deductible family maximum) Out of Pocket: Participating Provider (does not include deductible or copayments) $3,000 plus deductible per member $6,000 plus deductible for family Out of Pocket: Non-Participating Providers $10,000 plus deductible per member $20,000 plus deductible per family Back to Main Menu

UNICARE 1000 Office visits: Participating Provider
Low Price Options UNICARE 1000 Office visits: Participating Provider $30 copay for 10 visits per member per year with deductible waived; after 10 visits, once deductible is met, 60% of negotiated fee. Non-participating Provider 50% of covered expense Back to Main Menu

UNICARE 1000 Preventive Care: Participating Provider
Low Price Options UNICARE 1000 Preventive Care: Participating Provider $30 copay for first 10 visits per member per year with deductible waived; after 10 visits, once deductible is met, 60% of negotiated fee. Non-participating Provider 50% of covered expense Back to Main Menu

Low Price Options UNICARE 1000 Professional Services Participating Provider 60% of negotiated fee Non-participating Provider 50% of covered expense Back to Main Menu

Low Price Options UNICARE 1000 Maternity provided for groups of 15-50 (coverage is available through the purchase of a Rider for groups of 2-14) Participating Provider - 60% of negotiated fee Non-participating Provider - 50% of covered expense Back to Main Menu

Low Price Options UNICARE 1000 Outpatient Medical Care Participating Provider 60% of negotiated fee Non-participating Provider 50% of covered expense Back to Main Menu

Low Price Options UNICARE 1000 Inpatient Hospital Services Participating Provider 60% of negotiated fee Non-participating Provider 50% of covered expense plus $500 penalty for non-emergency stays Emergency Room visits that do not result in inpatient admissions will be subject to a $60 penalty Back to Main Menu

Low Price Options UNICARE 1000 Prescription Drugs, PARTICIPATING Retail Pharmacies / Mail Order Per prescription (up to a 30-day supply) Generic Drugs - $10 Copay Brand Name Formulary - $30 copay plus a separate $250 Brand Name deductible, per member, per year Brand Name Non-Formulary - $50 copay plus a separate $250 Brand Name deductible, per member, per year Back to Main Menu

Low Price Options UNICARE 1000 Prescription Drugs, Non-PARTICIPATING – No Mail Order Non-Participating Retail Pharmacies Only Per prescription (up to a 30-day supply) Generic Drugs – 60% of the average wholesale price, per member, per year Brand Name (formulary) Drugs – 50% of the average wholesale price, plus a separate $250 brand name deductible, per member, per year Brand Name (non-formulary) Drugs – 40% of the average wholesale price, plus a separate $250 brand name deductible, per member, per year

Medium Price Options UNICARE 500 Annual medical deductible and Out of Pocket: Deductible: $500 two-deductible family maximum (Non-Participating: $1,000 two-deductible family maximum) Out of Pocket: Participating Provider (does not include deductible or copayments) $3,000 plus deductible per member $6,000 plus deductible for family Out of Pocket: Non-Participating Providers $10,000 plus deductible per member $20,000 plus deductible per family Back to Main Menu

Medium Price Options UNICARE 500 Office visits: Participating Provider $30 copay for 10 visits per member per year with deductible waived; after 10 visits, once deductible is met, 70% of negotiated fee. Non-participating Provider 50% of covered expense Back to Main Menu

Medium Price Options UNICARE 500 Preventive Care: Participating Provider $30 copay for 10 visits per member per year with deductible waived; after 10 visits, once deductible is met, 70% of negotiated fee. Non-participating Provider 50% of covered expense Back to Main Menu

Medium Price Options UNICARE 500 Professional Services Participating Provider 70% of negotiated fee Non-participating Provider 50% of covered expense Back to Main Menu

Medium Price Options UNICARE 500 Maternity provided for groups of 15-50 (coverage is available through the purchase of a Rider for groups of 2-14) Participating Provider - 70% of negotiated fee Non-participating Provider - 50% of covered expense Back to Main Menu

Medium Price Options UNICARE 500 Outpatient Medical Care Participating Provider 70% of negotiated fee Non-participating Provider 50% of covered expense Back to Main Menu

Medium Price Options UNICARE 500 Inpatient Hospital Services Participating Provider 70% of negotiated fee Non-participating Provider 50% of covered expense plus $500 penalty for non-emergency stays Emergency Room visits that do not result in inpatient admissions will be subject to a $60 penalty Back to Main Menu

Medium Price Options UNICARE 500 Prescription Drugs, PARTICIPATING Retail Pharmacies / Mail Order Per prescription (up to a 30-day supply) Generic Drugs - $10 Copay Brand Name Formulary - $30 copay plus a separate $250 Brand Name deductible, per member, per year Brand Name Non-Formulary - $50 copay plus a separate $250 Brand Name deductible, per member, per year Back to Main Menu

Medium Price Options UNICARE 500 Prescription Drugs, Non-PARTICIPATING – No Mail Order Non-participating Retail Pharmacies Only Per prescription (up to a 30-day supply) Generic Drugs – 60% of the average wholesale price, per member, per year Brand Name (formulary) Drugs – 50% of the average wholesale price, plus a separate $250 brand name deductible, per member, per year Brand Name (non-formulary) Drugs – 40% of the average wholesale price, plus a separate $250 brand name deductible, per member, per year

UNICARE Premier 1000 Annual medical deductible and Out of Pocket:
Medium Price Options UNICARE Premier 1000 Annual medical deductible and Out of Pocket: Deductible: $1,000 two-deductible family maximum (Non-Participating: $2,000 two-deductible family maximum) Out of Pocket: Participating Provider (does not include deductible or copayments) $2,000 plus deductible per member $6,000 plus deductible for family Out of Pocket: Non-Participating Providers $10,000 plus deductible per member $20,000 plus deductible per family Back to Main Menu

Medium Price Options UNICARE Premier 1000 Office visits: Participating Provider $30 copay for 10 visits per member per year with deductible waived; after 10 visits, once deductible is met, 80% of negotiated fee. Non-participating Provider 60% of covered expense Back to Main Menu

Medium Price Options UNICARE Premier 1000 Preventive Care: Participating Provider $30 copay for 10 visits per member per year with deductible waived; after 10 visits, once deductible is met, 80% of negotiated fee. Non-participating Provider 60% of covered expense Back to Main Menu

Medium Price Options UNICARE Premier 1000 Professional Services Participating Provider 80% of negotiated fee Non-participating Provider 60% of covered expense Back to Main Menu

Medium Price Options UNICARE Premier 1000 Maternity provided for groups of 15-50 (coverage is available through the purchase of a Rider for groups of 2-14) Participating Provider - 80% of negotiated fee Non-participating Provider - 60% of covered expense Back to Main Menu

Medium Price Options UNICARE Premier 1000 Outpatient Medical Care Participating Provider 80% of negotiated fee Non-participating Provider 60% of covered expense Back to Main Menu

Medium Price Options UNICARE Premier 1000 Inpatient Hospital Services Participating Provider 80% of negotiated fee Non-participating Provider 60% of covered expense plus $500 penalty for non-emergency stays Emergency Room visits that do not result in inpatient admissions will be subject to a $60 penalty Back to Main Menu

UNICARE Premier 1000 Prescription Drugs, PARTICIPATING
Medium Price Options UNICARE Premier 1000 Prescription Drugs, PARTICIPATING Retail Pharmacies / Mail Order Per prescription (up to a 30-day supply) Generic Drugs - $10 Copay Brand Name Formulary - $30 copay plus a separate $250 Brand Name deductible, per member, per year Brand Name Non-Formulary - $50 copay plus a separate $250 Brand Name deductible, per member, per year Back to Main Menu

Medium Price Options UNICARE Premier 1000 Prescription Drugs, Non-PARTICIPATING – No Mail Order Non-Participating Retail Pharmacies Only Per prescription (up to a 30-day supply) Generic Drugs – 60% of the average wholesale price, per member, per year Brand Name (formulary) Drugs – 50% of the average wholesale price, plus a separate $250 brand name deductible, per member, per year Brand Name (non-formulary) Drugs – 40% of the average wholesale price, plus a separate $250 brand name deductible, per member, per year

UNICARE Premier 500 Annual medical deductible and Out of Pocket:
High Price Options UNICARE Premier 500 Annual medical deductible and Out of Pocket: Deductible: $500 two-deductible family maximum (Non-Participating: $1,000 two-deductible family maximum) Out of Pocket: Participating Provider (does not include deductible or copayments) $2,500 plus deductible per member $6,000 plus deductible for family Out of Pocket: Non-Participating Providers $10,000 plus deductible per member $20,000 plus deductible per family Back to Main Menu

UNICARE Premier 500 High Price Options Office visits: Participating Provider $30 copay for 10 visits per member per year with deductible waived; after 10 visits, once deductible is met, 80% of negotiated fee. Non-participating Provider 60% of covered expense Back to Main Menu

High Price Options UNICARE Premier 500 Preventive Care: Participating Provider $30 copay for 10 visits per member per year with deductible waived; after 10 visits, once deductible is met, 80% of negotiated fee. Non-participating Provider 60% of covered expense Back to Main Menu

High Price Options UNICARE Premier 500 Professional Services Participating Provider 80% of negotiated fee Non-participating Provider 60% of covered expense Back to Main Menu

High Price Options UNICARE Premier 500 Maternity provided for groups of 15-50 (coverage is available through the purchase of a Rider for groups of 2-14) Participating Provider - 80% of negotiated fee Non-participating Provider - 60% of covered expense Back to Main Menu

High Price Options UNICARE Premier 500 Outpatient Medical Care Participating Provider 80% of negotiated fee Non-participating Provider 60% of covered expense Back to Main Menu

High Price Options UNICARE Premier 500 Inpatient Hospital Services Participating Provider 80% of negotiated fee Non-participating Provider 60% of covered expense plus $500 penalty for non-emergency stays Emergency Room visits that do not result in inpatient admissions will be subject to a $60 penalty Back to Main Menu

UNICARE Premier 500 Prescription Drugs, PARTICIPATING
High Price Options UNICARE Premier 500 Prescription Drugs, PARTICIPATING Retail Pharmacies / Mail Order Per prescription (up to a 30-day supply) Generic Drugs - $10 Copay Brand Name Formulary - $30 copay plus a separate $250 Brand Name deductible, per member, per year Brand Name Non-Formulary - $50 copay plus a separate $250 Brand Name deductible, per member, per year Back to Main Menu

High Price Options UNICARE Premier 500 Prescription Drugs, Non-PARTICIPATING – No Mail Order Non-Participating Retail Pharmacies Only Per prescription (up to a 30-day supply) Generic Drugs – 60% of the average wholesale price, per member, per year Brand Name (formulary) Drugs – 50% of the average wholesale price, plus a separate $250 brand name deductible, per member, per year Brand Name (non-formulary) Drugs – 40% of the average wholesale price, plus a separate $250 brand name deductible, per member, per year Back to Main Menu

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Offering Employer Options & Value from UNICARE of Arkansas

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Offering Employer Options & Value from UNICARE of Arkansas

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