COLORADO HEALTHOP

A LITTLE BIT ABOUT US

• The Accountable Care Act included a provision to help create non-profit cooperative payers in each state through low interest loans.

• Rocky Mountain Farmer’s Union won the bid for Colorado and created the Colorado HealthOP.

• We are member governed.

WHAT IS A COOPERATIVE

A cooperative is a business that consists of a group of people working together for mutual economic, social and cultural benefit.

We are building the Colorado HealthOP with the belief that our members mutually want great healthcare at a great price.

PLANS OFFERED16 PLANS OFFERED OFF THE EXCHANGE

7 PPOS (STATEWIDE NETWORK)

3 HSA QUALIFIED HIGH DEDUCTIBLE HEALTH PLANS (BRONZE, SILVER, GOLD TIERS)

11 EPOS (KEY PROVIDER GROUPS ARE BANNER/CENTURA NETWORKS)

3 HSA QUALIFIED HIGH DEDUCTIBLE HEALTH PLANS

3 MOUNTAIN PLANS FOR SUMMIT, GRAND AND LAKE COUNTIES

 

18 PLANS OFFERED ON THE EXCHANGE

7 PPOS (STATEWIDE NETWORK)

2 MULTI-STATE PLANS

3 HSA QUALIFIED HIGH DEDUCTIBLE HEALTH PLANS (BRONZE, SILVER, GOLD TIERS)

11 EPOS (KEY PROVIDER GROUPS ARE BANNER/CENTURA NETWORKS)

3 HSA QUALIFIED HIGH DEDUCTIBLE HEALTH PLANS (BRONZE, SILVER, GOLD TIERS)

NEW EPO MOUNTAIN PLANS FOR SUMMIT, GRAND AND LAKE COUNTIES

2015 PLAN CHANGES

• Doctors visits changed to co-pays instead of co-insurance

• Physical Therapy and Mental Health are co-pays as well

• Chiropractic benefits are improved and we now cover acupuncture

(Example based on PPO Bison- Standard)

HEALTH ACTIONS

Members receive enhanced benefits by completing three health actions:

• Completing a health questionnaire• Completing a biometric screening (basic lab tests)• An annual checkup

Once these three free health actions are completed, Colorado HealthOP will upgrade the member to an enhanced version of their health insurance plan.

ENHANCED BENEFITS

• Free in-network behavioral health office visits

• Lower-cost or free primary care office visits

• A $900 HIA debit card as part of Colorado HealthOP’s new Flex Plan

• Coverage for acupuncture and chiropractic services with a co-pay

VALUE ADDED BENEFITS

• All plans (even bronze and catastrophic) include new 5-tier formulary which offers free generic medications for some chronic health conditions. Chronic conditions are:

• Asthma/COPD• High blood pressure• Cholesterol• Diabetes• Prenatal care• Depression

• 2015 pediatric dental benefits are embedded in all plans

FLEX PLANS

Brand new for 2015• Flex plans ($900 debit card available for completion

of health actions)• Available for PPO, EPO, and EPO mountain

EPO NETWORK

EXCLUSIVE PROVIDER ORGANIZATION

• ADAMS• ALAMOSA• ARAPAHOE• BOULDER• BROOMFIELD• CLEAR CREEK• CONEJOS• COSTILLA• DENVER• DOUGLAS• ELBERT• EL PASO• GILPIN• GRAND• JEFFERSON• LAKE• LA PLATA• LARIMER• LOGAN• MORGAN• PARK• SAGUACHE• SUMMIT• TELLER• WELD

• Avista Adventist Hospital • Boulder Community Hospital• Castle Rock Adventist Hospital• Conejos County Hospital• East Morgan County Hospital• Littleton Adventist Hospital• Longmont United Hospital• McKee Medical Center• Mercy Regional Medical Center• Middle Park Medical Center Granby• Middle Park Medical Center Kremmling• North Colorado Medical Center• OrthoColorado Hospital• Parker Adventist Hospital• Penrose-St. Francis Medical Center• Porter Adventist Hospital• San Luis Valley Regional Medical Center• St. Anthony Hospital• St. Anthony’s North Hospital• St. Mary-Corwin Medical Center• St. Thomas More• St. Vincent Hospital• Sterling Regional Med Center

Colorado HealthOP EPO Medical Facilities

PPO STATEWIDE NETWORK

OUT-OF-STATE CARE FOR CHRONIC CONDITIONS

For covered persons residing outside the service area, Colorado HealthOP provides coverage for the treatment of the chronic conditions listed below. Benefits will be considered at the in-network level when a pre-authorization is obtained prior to receiving services for these chronic conditions:

• Asthma/COPD• Anxiety• Diabetes• Depression• Hypertension• Hypercholesterolemia

Coverage for the treatment of other chronic conditions will be considered if upon a comprehensive review of the relevant medical information it is determined to be medically necessary.

GOALS• Achieve the Triple Aim• Get creative with payment models to

produce meaningful payment reform that works for members and providers

• Decrease admin cost to put premium dollars where they matter most

• Put members in control by providing accurate price transparency tools

QUESTIONS?