“To be a leader in transforming the health of Maine
people and positively affecting the Maine economy”
Located in Maine; Centered Around You
Accessible
Member
Directed
Local
Supporting the Maine Economy
Partner with
Maine People
Your Voice is
Our Voice
Transparent
No Shareholders
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COOP
You
MaineBased
Understanding
the Needs of
Maine People
Focused on Maine
Provider Network
NonProfit
Statewide
Care Management
Account Management
Broad Network PPO (Preferred
Provider Organization)
 All Maine Hospitals
 Border Facilities & Providers
 National Network (First Health)
 PCPs, NPs& Specialists
 MH & SA Providers
 Hospitals, Clinics, Pharmacies & Others
 No Referrals Required
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Driving forces:
Competitive Pricing & Comprehensive Benefits




Lower Base Rate Than Competition
More Robust Benefits for Small Groups
More Value for Your Premium Dollar
Pricing & Benefit Comparisons Encouraged
Response from Competition: Early Renewals
 Missed Premium Savings
 Change of Contract Year
 Migration to QHP for Most Employers
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Small Group Plans on & off SHOP
Our Approach to Benefit Design Sets Us Apart
 Integrated Behavioral and Medical Health
 PT/ST/OT at Primary Care Level Cost Sharing
 First 3 Mental Health Visits at No Cost
 VBID / CISP
 Tobacco Cessation
 Encourage Member Engagement
 Shared Decision Making
 Choosing Wisely
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More to Your Bottom Line
Lower Out of Pocket Costs
+
Healthier Employees
+
Less Absenteeism
+
Enhanced Productivity
=
More to Your Bottom Line
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Wellness Adds Value
24/7 Access to
Health Coaches
 Registered Nurses,
Dieticians, Respiratory
Therapists
 May call you to talk about
your condition
 Provide information
 Help you make important
medical decisions
Informed
Decisions
Healthy Options Online
Health and Wellness Portal
 Get facts on over 6,000 health
topics
 Use decision support tools and
videos
 Complete your wellbeing
assessment
 Join challenges to earn points
and get rewards. Create
personal goals and track
progress
Tobacco Cessation Treatment
Maine Community Health Options Will Cover:
 Nicotine Replacement Products Prescribed by a Plan Provider
 Products Approved by the FDA for Tobacco Cessation
 Tobacco Cessation Education and Counseling
Covered at No Out of Pocket Cost:
 Generic Nicotine Replacement Therapy (NRT)*: Gum, Lozenge, Patch
 Chantix (up to a 90 Day Supply)
*When prescribed by a Plan Provider
MCHO does not use the “Tobacco Rating Band”
to charge higher Premiums for smokers
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Chronic Illness Support Program
MCHO offers additional help to Members with certain chronic
medical conditions that can be managed for better health.
Asthma
COPD /
Emphysema
Diabetes
Hypertension
Saves Members money by lowering or eliminating Out of Pocket
Costs for Routine Care of a chronic illness.
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Supporting Management of Chronic Conditions
Lower out-of-pocket costs for meds and services
Diabetes
Asthma & COPD
Medications

$0 costing sharing for
Specific medications used to
treat diabetes, hypertension
and hyperlipidemiaGenerics, 50% cost-sharing
for preferred brand
Medications

$0 costing sharing for Specific
medications used to treat asthma
& COPD-Generics, 50% costsharing for preferred brand
Services - $0 cost sharing
Services -
$0 cost sharing when
done by Plan Provider
when done by Plan Provider

Offices Visits to PCP for routine
management asthma, COPD,
emphysema

Pulmonologist consultation;
Pulmonary function test (1/yr.),
Home oxygen therapy assessment

Lab services linked to
asthma/COPD primary diagnosis
code

Offices Visits to PCP for
routine management

Endocrinology consultation

Podiatry Consultation

Nutritional Counseling,
diabetes education,
modification counseling

Diabetic Eye Exam (1/yr.)


1 Glucometer/yr., up to 150
test strips every 90 days
Inhaler adjuncts; Peak flow meter
(1/yr.); Asthma education

Pulmonary rehab., ongoing
exercise program for COPD

Lab services linked to
diabetes primary
diagnosis code.

Home assessment (asthma
only) up to $75/yr.
Hypertension
Medications

$0 costing sharing for
Specific medications used to
treat hypertension and
hyperlipidemia-Generics,
50% cost-sharing for
preferred brand
Services -
$0 cost sharing
when done by Plan Provider

Offices Visits to PCP for
routine management

Cardiology or nephrology
consultation and
management of hypertension

Lab services linked to
hypertension primary
diagnosis code.
Impact of CISP as Seen Through SBC
(Silver Plan example)
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Getting a Quote
 Qualified Brokers are Our Primary Channel
 By Working with an MCHO Benefits Consultant
 7 Simple Steps
 Online Proposal, Application and Enrollment
 Manage Coverage Online Through the Employer Portal
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Step 1): Basic Information
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Step 2): Employee Census
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Step 3): Benefit Choices
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Step 4): Contribution Method
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Step 5): Employer Contribution Amounts
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Step 6): Compare Plans
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Step 7): Review
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Simple Online Enrollment
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Automated Process Keeps You in the Know
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Ongoing Administration Made Easy
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Summary of Attributes
Local, Accessible
Non-Profit
Comprehensive State-Wide Network
CO-OP; Your Voice is Our Voice
Value Based Insurance Design
Delivering More Value to Employers
Competitive Rates and Comprehensive Benefits
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MCHO Today: Growth
Over 39,400 Members
Over 150 Groups
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MCHO Today: Service
Service Delivery Lessons Learned
Member Services
ID Card
Website Enhancements
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MCHO Today: Business Development
Extensive Broker Network
Dedicated Business Development Team
North:
 Robert Guerette, Benefits Consultant
 Patrick Hamlin, Account Manager
South:
 Sharon Ware, Benefits Consultant
 Mari Whittaker, Account Manager
Inside Benefit Sales Consultants:
 Matthew Ellis
 Kristy Pendexter
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Thank you for your time and interest in
Maine Community Health Options.
Toll Free: 1-855-624-6463
www.maineoptions.org
Business Development
207-402-3353
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