Your health plan 2022 Open Enrollment - Yourmedicalplanbenefits .3 - HealthPartners
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Your health plan 2022 Open Enrollment Your medical plan benefits . . . . . . . . . . . . . . 3 Extra support . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3M
Getting started
The more you know about your plan, the easier it is to make
good decisions for your health and wallet. We’re happy
you’re trusting HealthPartners. Here are some tips.
Understand your costs Check out your extras
You’ll likely see these terms during Your health plan does more than just
enrollment and throughout the year. process claims. Read on to learn more
Knowing how these costs work about some of the services, resources
with your plan will help you avoid and discounts you have available to
unexpected charges. help you live your best life.
• Premium – how much you pay for
your plan, usually taken out of Use your online account
your paycheck.
With an online account, you can
• Deductible – the amount you’re
get up-to-date personal health plan
What to do next responsible to pay for care before
information in one simple place.
your plan helps cover costs, not
• Call us with questions at including your premium. • See claims and how much you
952-883-5144 or 877-435-7613 could owe.
• Coinsurance – a percent of the bill
you pay. Your plan covers the rest. • Search for doctors in your network.
• Sign in or create an account at
healthpartners.com/3M • Out-of-pocket maximum – the • Check your deductible or
most you’ll pay for covered care out-of-pocket maximum spending.
We can help you make choices you'll each year.
• View your member ID card.
feel good about.
• Summary of Benefits and Coverage
• Get cost estimates for care.
(SBC) – lists out the specific benefit
costs for your plan. • Manage your health on the go with
the myHP mobile app.
I'm thankful I had someone to help me understand my own health
insurance. I can walk you through your plan now, so you're prepared
when you use it later.
Lauren, Member Services
21-1122153-1129248
3
Skip the clinic trip
with online care
Save time and money by getting treated right from
your smartphone, tablet or computer. Your plan covers
two options.
Virtuwell® Doctor On Demand
(online questionnaire) (video chat)
• Easy. In fact, 99% of Virtuwell • Convenient. Get started when
users say it's simple and 98% and where it works for you at
highly recommend it. Answer a doctorondemand.com. Video
few questions at virtuwell.com capabilities are required.
anytime, anywhere.*
• Quick. See a doctor in minutes.
• Fast. Get a treatment plan Live video visits include
Questions about benefits? and prescription from a nurse assessment, diagnosis and
practitioner. They can help with prescriptions when necessary.
Member Services can answer your more than 60 common conditions,
benefits and coverage questions. • Affordable. A visit to treat conditions
and it usually takes just one hour.
Call us at 952-883-5144 or like colds, the flu and allergies**
877-435-7613 • Guaranteed. You’re only charged costs less than a clinic visit. It’s
if Virtuwell can treat you. Plus free to sign up and easy to check
follow-up calls about your your coverage when you register.
treatment are free. If you need to
be seen in person, we'll let you
know – but it's not usually needed.
The next time you’re
• Affordable. Virtuwell visits are a
sick, your health plan has
fraction of the cost of walk-in, urgent
affordable options to help
or primary care visits. Use your
you get better, faster.
member ID card to check your cost at
virtuwell.com/cost/healthpartners. Julie, RN, Nurse Navigator
*Available anywhere in the U.S. to residents of AZ, CA, CO, CT, IA, MI, MN, NY, ND, PA, SD, VA and WI.
**The cost for behavioral health services varies depending on the services provided and duration of service.
21-1148109-1148244
4
Care today for a
healthy tomorrow
Prevent problems before they start so you can enjoy the
things you love. Your health plan covers in-network
preventive care at 100%; you don't pay anything.
Protect your health with Preventive care includes
routine visits • Blood pressure, diabetes and
Even if you’re not sick, it’s smart cholesterol tests
for you and your family to go in for • Colorectal, breast and cervical
regular checkups, screenings and cancer screenings
well-child visits. If there are any
• Routine pre- and post-natal care
issues, you can catch them early –
when treatment is most effective. • Vaccines
Questions about benefits? • Weight, alcohol and tobacco
screenings
Member Services can answer your
benefits and coverage questions. • And more!
Call us at 952-883-5144 or
Visit healthpartners.com/preventive to
877-435-7613
find out what care is recommended
for you.
I always encourage members to go in for their screenings.
If you’re ever wondering whether a service counts as routine
preventive care, give us a call.
Renae, Member Services
21-1149037-1149553
5
Save on surgery
If you need surgery, save money by choosing a Top Value
location. Top Value locations provide the highest quality
care at the best possible price.
What ‘Top Value’ means How it works
Hospitals and clinics earn a Top Value Generally, your plan covers 80 percent
label for how well they treat conditions, of your care costs after you hit your
including how long it takes to get better deductible. You pay the other 20
and what kinds of complications might percent. But when you go to a Top
show up later. Top Value locations are Value facility, your plan pays for more
also rated highly by patients. of your surgery. Instead of paying 20
percent, you only pay 5 percent of the
facility bill.
Your plan pays more
Call Member Services at Your health plan will pay a higher At a Top At a
Value different
952-883-5144 or 877-435-7613 percentage of costs when you go to a
facility facility
Top Value location for certain surgeries.
for help figuring out how your Cost of $26,500 $35,000
These surgeries are part of your Top
arthroscopic
benefits work or finding a Top Value benefit: knee surgery
Value facility. • Arthroscopic knee* Your 5% 20%
coinsurance
• Arthroscopic shoulder* amount
• Cardiac ablation* What $3,000 $3,000
you pay deductible deductible
• Cardiac catheterization
+ $1,175 + $3,600
• Carpal tunnel* coinsurance coinsurance
(OOP max)
• Cataract*
Your total $4,175 $6,600
• Ear tubes* cost
• Gallbladder Your savings $2,425 $0
• Hernia* This is an example. Your costs and savings may vary.
• Rotator cuff*
• Tonsils* Find a Top Value facility
To find a Top Value location, log on to
healthpartners.com/3m and search
by procedure. Look for a symbol.
*Available at facilities in MN.
20-900614-904805 (9/20) © 2020 HealthPartners
6
Health advocates at
your service
Navigating health care can be difficult. But you don’t
have to do it alone.
Help from a nurse when you need it most
Your nurse health advocate helps you understand and manage your health
care and plan benefits. They are specially trained to work with 3M members
and can connect you to other 3M resources. You’ll get help seeing the big
picture while they manage all the little details.
Your nurse health advocate gives you personal, confidential support for real
life challenges like:
Understanding • What’s covered?
your benefits • How much will I pay?
To reach your nurse health • Can you help me find a provider in my network?
advocate, call 877-435-7613 Getting care and • What type of doctor do I need to see for my pain?
treatment • How do I coordinate care with multiple providers?
(toll free), Monday – Friday,
• What preventive care is appropriate for my age, gender and
7 a.m. – 6 p.m. CT. Once you health status?
begin a relationship, you'll talk Managing your • How do I manage my health risks – like cholesterol, blood
health pressure, weight and diabetes – on a daily basis?
with the same person each
• I’d like support during my pregnancy, can you help?
time you call. • Should I continue working while I have chemotherapy?
Preparing for and • How do I prepare for a doctor visit or surgery?
recovering from • How do I find the surgeon or hospital that’s best for me?
hospital care • What if I have questions when I get home?
• How can I help prepare my caregivers for my return home?
This program made managing my family's health care needs easier than ever.
Talking to a real nurse gave me confidence to make decisions for my family.
Health advocate participant
20-900614-905366 (9/20) © 2020 HealthPartners
7
Here for you, 24/7
Call us at one of these numbers if you have questions
about your health or what your plan covers. We have
people ready to help.
Member Services
For questions about: Monday – Friday,
• Your coverage, claims or plan balances 7 a.m. to 6 p.m. CT
• Finding a doctor, dentist or specialist in your network Call the number on the back
• Finding care when you’re away from home of your member ID card,
• Health plan services, programs and discounts 952-883-5144 or 877-435-7613.
Interpreters are available if you
need one.
Español: 866-398-9119
healthpartners.com/3M
Member Services can help you reach:
Nurse For questions about: Monday – Friday,
NavigatorSM • Understanding your health care 7:30 a.m. to 5 p.m. CT
program and benefits
• How to choose a treatment
Behavioral For questions about: Monday – Friday,
Health • Finding a mental or chemical health 8 a.m. to 5 p.m. CT
Navigators care professional in your network
• Your behavioral health benefits
One thing I love about my job is how my team helps
people all day, every day.
Rachel, Registered Nurse
20-900614-905367 (9/20) © 2020 HealthPartners
8Get the right care
at the right price
Your health plan covers lots of options when you need care.
Knowing the differences between the options can help you
choose where to get care at the best cost.
When you need Go to Average cost Average time spent
Treatment and Virtuwell®* or $
prescriptions for minor Doctor On Demand
medical issues, like: 24/7 online care
• Bladder infection 15
minutes
• Pink eye Convenience clinics
• Upper respiratory (found in retail and
infections grocery stores)
A regular checkup or Primary care clinics $$
special care during the
day for things like: 30
Find in-network care
minutes
• Diabetes management
• Vaccines
Manage your health and your plan at
Care for urgent problems Urgent care clinics $$$
healthpartners.com/3M. when your doctor’s office
is closed, like: 45
Don't have an account yet? It's quick minutes
• Cuts that need stitches
and easy to sign up – you'll just need • Joint or muscle pain
your member ID card.
Help in an emergency, Emergency room $$$$
such as:
• Chest pain or 60
minutes
shortness of breath
• Head injury
*Available anywhere in the U.S. to residents of AZ, CA, CO, CT, IA,
MI, MN, NY, ND, PA, SD, VA and WI.
20-900614-905368 (09/20) © 2020 HealthPartners
9Living healthier just got
a little less expensive
Get special savings from handpicked retailers as a
HealthPartners member. There are lots of great products
and services available to you at a discounted rate –
all designed to help you live healthy every day.
Save money at your Get discounts at other places
favorite gym Save big by showing your member ID
Work out 12 or more days each month card to participating retailers.
and save up to $20 per person on your
Save money on:
monthly membership.*
• Eyewear
Participating gyms include:
Visit healthpartners.com/ • Exercise equipment
• Anytime Fitness
frequentfitness to find a gym • Fitness and well-being classes
• Curves
near you. • Healthy eating delivery services
• LA Fitness
• Healthy mom and baby products
Visit healthpartners.com/ • Life Time Fitness
• Hearing aids
discounts to see all participating • Snap Fitness
• Orthodontics
retailers and discounts. • And more!
• Pet insurance
• Swim lessons
• And more!
*Not all club locations apply. Some national clubs are owned by individual franchise owners and may not participate
in the program. Frequent Fitness is limited to members, age 18 years or older, of certain HealthPartners medical plans
and members of participating employer groups. Some restrictions apply. Termination of club membership may result
in forfeiture of any unpaid incentive. See participating club locations for program details. Workout requirements and
program eligibility may vary by employer. Please check with your employer or call Member Services to verify eligibility
and visits requirements. Program payments will not exceed club dues.
20-900614-905369 (9/20) © 2020 HealthPartners
10Take charge of your health plan
You go online to research, plan and follow up on big
decisions. A HealthPartners online account makes it just
as easy to stay on top of your health care and insurance.
Get personalized information when and where you
need it
With an online account, you have real-time access to your personal health plan
information in one simple place. No more guessing or waiting until business
hours to get answers to your questions.
Top 5 ways to use your online
account and mobile app
1. See recent claims, what your plan covered
Sign in to your account and how much you could owe.
2. NEW! Access your Living Well dashboard
Manage your health and your plan at
to check your program progress, take the 1
healthpartners.com/3M.
health assessment and complete activities.
2
Don't have an account yet? It's quick 3. View your HealthPartners member ID card
and easy to sign up– you'll just need and fax it to your doctor’s office. 3
your member ID card.
4. See recent claims, what your plan covered
4
and how much you could owe.
5. Get cost estimates for treatments and 5
procedures specific to your plan.
I love directing members to their online accounts and the mobile app.
You can easily get your health plan info, even when I’m not in the office.
Marissa, Member Services
21-1149037-1149564
11Assist America®
Travel anywhere, worry-free
Whether you’re traveling abroad or just out of town for
the weekend, you can feel confident you’re in good hands
when the unexpected happens.
Get 24/7 help
Assist America provides all the support you need when
you’re more than 100 miles from home.
• Coordinating transport to care facilities or back home
• Filling lost prescriptions
• Finding good doctors
• Getting admitted to the hospital
• Pre-trip info, like immunization and visa requirements
How to get started
• Tracking down lost luggage
• Download your Assist America
ID card at healthpartners.com/ • Translator referrals
getcareeverywhere • And more!
• Get the Assist America app and
enter HealthPartners reference
number 01-AA-HPT-05133 The Assist America mobile app makes traveling much easier.
You can make calls right from the app when you need support.
Jamie, Member Services
21-1149037-1149561
12Our approach to protecting personal information
HealthPartners® complies with all applicable laws regarding privacy of health and other information about our members and former members.
When needed, we get consent or authorization from our members (or an authorized member representative when the member is unable to give
consent or authorization) for release of personal information. We give members access to their own information consistent with applicable law
and standards. Our policies and practices support compliant, appropriate and effective use of information, internally and externally, and enable us
to serve and improve the health of our members, our patients and the community, while being sensitive to privacy. For a copy of our Notice of
Privacy Practices, visit our website or call Member Services.
Summary of utilization management programs for medical plans
Our utilization management programs help ensure effective, accessible and high-quality health care. These programs are based on the most up-
to-date medical evidence to evaluate appropriate levels of care and establish guidelines for medical practices. Our programs include activities to
reduce the underuse, overuse and misuse of health services.
THESE PROGRAMS INCLUDE:
• Progression of care review and care coordination to support safe, • Evidence-based care guidelines for certain kinds of care.
timely care and transition from the hospital. • Prior authorization of select services – we require prior approval
• Outpatient case management to provide member support and for a small number of services and procedures. For a complete
coordination of care. list, visit our website or call Member Services.
Important information on provider reimbursement
Our goal in reimbursing providers is to provide affordable care for our members while encouraging quality care through best care practices and
rewarding providers for meeting the needs of our members. Several different types of reimbursement arrangements are used with providers. All
are designed to achieve that goal. Check with your individual provider to find out how they are paid.
ARRANGEMENTS USED FOR MEDICAL PLANS:
• Fee-for-service – the health plan pays the provider a certain set • Basis of the diagnosis/per diem – a set fee to treat certain kinds
amount that corresponds to each type of service furnished by the of conditions, sometimes based on the number of days the
provider. patient spent in the facility.
• Discount – the provider sends us a bill, and we’ve already • Ambulatory Payment Classifications (APCs) – for outpatient
negotiated a reduced rate on behalf of our members. We pay a services. We have a negotiated payment level based on the
predetermined percentage of the total bill for services. resources and intensity of the services provided. Hospitals are
• Case rate – the provider receives a set fee for a selected set of paid a set fee for certain kinds of services which is based on the
services, up to an agreed upon maximum amount of services, for resources utilized to provide that service.
a designated period of time. Alternatively, we may pay a case rate • Combination – more than one of the methods described are
to a provider for all of the selected set of services needed during used. For example, we may pay a case rate to a provider for a
an agreed upon period of time. selected set of services, up to an agreed upon maximum amount
• Withhold – a portion of the provider’s payment is set aside until of services, and pay that same provider on a fee-for-service basis
the end of the year. Withholds are sometimes used to pay for services not provided within the time period that exceed the
specialty, referral or hospital providers who furnish services to maximum amount of services. We may also pay a provider such
members. The provider usually receives all or a portion of the as a clinic using one type of reimbursement method, while that
withhold based on performance of agreed upon criteria, which clinic may pay its employed providers using another
may include patient satisfaction levels, quality of care and/or care reimbursement method.
management measures.
Conducting medical necessity reviews
HealthPartners conducts medical necessity reviews for select services. These reviews ensure our members receive safe and effective care that
aligns with the coverage outlined in the member’s contract. Medical necessity reviews can be conducted pre-service, before the service takes
place; post-service, after the service has happened; or concurrently, while the service is taking place. Contracted providers are responsible for
obtaining prior authorization from the health plan when it is required. Services that require prior authorization are listed on our website. Prior
authorization is not required for emergency services. HealthPartners will inform both you and your provider of the outcome of our review.
This plan may not cover all your health care expenses. Read your plan materials carefully to determine which expenses are covered. For details
about benefits and services, go to healthpartners.com/3M or call Member Services at 952-883-5144 or 877-435-7613.
The HealthPartners family of health plans is underwritten and/or administered by HealthPartners, Inc., Group Health, Inc., HealthPartners Insurance
21-1213441-1292016 (08/21) © 2021 HealthPartners Company or HealthPartners Administrators, Inc. Fully insured Wisconsin plans are underwritten by HealthPartners Insurance Company.
13Thanks for calling HealthPartners Our Member Services team loves to help and there’s no better time than now. Give us a call if you have questions about your plan or even if you just want to get to know your plan a little better. Making sure you understand your health plan is just the first way we help you stay healthy. Member Services 952-883-5144 or 877-435-7613 Monday – Friday, 7 a.m. to 6 p.m., CT healthpartners.com/3M 21-1213441-1292012 (07/21) © 2021 HealthPartners
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