Health Enhancement Plan

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Vitals SmartShopper

SmartShopper is a new part of our healthcare cost savings and is a program run by a company called “Vitals”.  The goal is to find high-quality, low-cost locations for a host of medical procedures/screenings.  Medical procedures can fluxuate in pricing by hundreds or thousands of dollars for the same procedure from one location to another.  If you use SmartShopper to find the more cost efficient locations/doctors, then you will be sent a cash reward. 

As consumers of medical services, we typically don’t know (and don’t ask) what is the actual cost of the procedure/service/test.  We simply want to know the cost of our co-pay, not the cost to the insurance plan.  The healthcare industry is complex and equipment and specialties vary greatly in price, even for the same procedures.  Our Health plan currently addresses the issue of vastly different prices through Site of Service and Preferred Providers.  Through Site of Service, preferred locations for Lab/Pathology/Radiology carry a low co-pay while non-preferred locations carry a hefty 20% to 40% co-pay.   The Preferred Providers is an incentive program which could lead to the co-pay being waived.  In the same way, SmartShopper provides a “reward” if you utilize their service in selecting a location for medical services.

The process is fairly simply, create an account either by phone (1-844-328-1579) or visit VitalsSmartShopper.com.   When you need a medical procedure or screening, contact SmartShopper.  A SmartShopper “Personal Assistant” will help you select a location and set up the appointment.  This process will generate a “code” which will prompt a reward to be mailed out once the claim is paid by the insurance company.

The SmartShopper plan is an optional piece of our Healthcare plan.  It is there if you want to earn rewards for the procedures and screenings you may need and can provide a large cost savings to the State’s overall healthcare expenses.  More explanation on SmartShopper.


Site Of Service and Preferred Provider Lists

Locate a qualifying Site-of-Service Facility/Doctor and Prefered Provider
          Site of Service Explained,/ Q&A
          Site of Service Qualified Facilities
          Anthem Preferred Provider search-page 
          United Healthcare Preferred Provider search-page

NOTE:
Prefered Provider just means that some doctors will have the $15 co-pay waived.

Site-of-Service locations is also a method of preferred providers but refers to the facility for outpatient labs and diagnostic imaging.  A preferred site means that they are in-network and there is no cost for the visit.  A non-preferred, in-network site carries a 20% co-pay.  Those with out-of-network coverage (POS plans only) will pay 40% coinsurance for tests performed at out-of-network lab or imaging centers.

Site-of-service is designed to exclude lab/imaging work from being performed at a hospital facility unless you are actively under the care of the hospital.  This is important b/c these locations typically involve very expensive procedures, so ensure that you visit a preferred, in-network  facility or the 20% co-pay could be a bit shocking (an out-of-network facility carries a 40% co-pay if you have POS and a 100% patient-cost if you have POE).

HEP Requirements at a glance

 

 

Check your compliance at www.cthep.com
(as a reminder, the password requires at least 8 characters, at least 1 capital letter, and at least 1 number)

Drug Co-Pay Rates:

Preferred Generic                      $5 co-pay
Non-Preferred Generic              $10 co-pay
Preferred Brand Name              $25 co-pay
Non-Preferred Brand Name      $40 co-pay