Consumer Choice Health Plan Model
Administered by MMSI
www.healthtradition.com
PLAN
»
We provide Mayo Clinic Health System expertise and programs to help
members make smart health care decisions
Overuse of services, high prescription drug prices and an increase in chronic conditions fuel
escalating medical plan costs. As health care costs spiral upward, employers need innovative
solutions. The Consumer Choice health plan model offers an integrated solution that provides
cost controls for employers by actively involving employees in the health care decisionmaking process.
Our unique approach helps control health
plan costs by providing the right care at
the right time at the right place through the
integration of:
» Medical plan options
Health Tradition benefit experts are involved in all
phases of the plan design, using tools to help meet
your overall goals while meeting the needs of your
plan members.
The Consumer Choice health plan model is available
with two core medical options. A traditional Health
Maintenance Organization (HMO) plan allows your
members access to a primary care physician who
cares for and meets the medical needs of the patient.
The Point of Service (POS) plan offers the HMO plan
with the addition of an out-of-network benefit.
» Wellness programs incorporating
Mayo Clinic expertise
A variety of tools ranging from health assessments
and 24-hour nurse lines to disease management
programs may be added into your overall plan design.
This allows medical experts to proactively identify
and work closely with plan members that have highrisk and high-cost conditions.
» Telephone, online and print resources
Consumer Choice provides access to a variety of
financial tools and health resources, including
Mayo Clinic books and online information. Registered
nurses and counselors serve as advisors to members
to help them determine the right care at the right time
at the right place. These resources work together to
help control health plan costs by providing tools to
empower employees.
To help your organization improve cost controls and educate employees on
health care expenses, our Consumer Choice health plan model utilizes:
Quality clinical programs incorporating
Mayo Clinic expertise into our model plan
design provides both short- and longterm savings by proactively educating
members on how to choose the right
care at the right time at the right place,
increasing your return on investment.
Deductible
Health and Wellness Programs
Choosing the right care
Medical Coverage
The Consumer Choice Health Plan Model
Full Coverage – LEVEL 4
Coinsurance – LEVEL 3
Deductible Gap – LEVEL 2
HRA/FSA – LEVEL 1
Allocation
Core – Health and Wellness Programs
Wellness programs support plan members throughout the decision-making
process. These programs educate members on how to choose the right care
at the right time at the right place.
Level 1 – HRA/FSA Allocation
A Health Reimbursement Account (HRA) is funded by your organization
on a pre-tax basis and is used by employees to pay for eligible services.
Depending on the plan design you set up, all or part of the unused HRA
balance can be rolled over to cover future expenses. Our benefits experts
can help you determine the appropriate allocation amounts and services
eligible for coverage.
A Flexible Spending Account (FSA) is a financial tool your organization
can provide to employees at little to no cost. Employers can save on social
security taxes for every dollar employees put into the plan while employees
can use pre-tax dollars to pay eligible expenses not covered by the benefit
plan.
Level 2 – Deductible Gap
The deductible gap is the difference between the HRA and deductible
amount. For example, in a plan with a $2,000 deductible and $1,000 HRA,
employees would be responsible for the $1,000 “gap” if their medical
expenses exceed the HRA allocation. Members can use funds from an FSA
or pay out-of-pocket to bridge this gap.
Level 3 – Coinsurance
When members meet the deductible, a coinsurance amount applies for
medical expenses. This includes employer-determined cost sharing
amounts for in- and out-of-network services.
Level 4 – Full Coverage
When members reach the out-of-pocket maximum, covered benefits are
paid at 100%. Preventive care services are also included in the plan design,
and are paid through the medical coverage. These expenses are not subject
to the deductible and are not deducted from an employee’s HRA.
Health Tradition will help you decide
what provider network works best for
your organization. It is our goal to provide
networks that offer your members stateof-the-art technology, medical expertise
and compassionate care.
Engaging employees
Health Tradition continues to develop
various strategies to engage employees
in taking an ownership role in the
management of their health.
Educating employees on the true cost
of health care is a core strategy of our
plan. Print communication materials,
online tools that help members track their
health care dollars and telephone-based
registered nurses and counselors engage
plan members at all points in the decisionmaking process.
Members may have access to a wide
range of tools:
» Mayo Clinic health information
through healthtradition.com
» Mayo Clinic Health Risk Assessment
» Financial tools to track expense
and payment information through
MMSIservices.com
» Consumer focused member plan
materials
Additional materials, such as the
Mayo Clinic Guide to Self-Care book,
Healthwise U video workshops, Mayo
Clinic EmbodyHealth newsletter and
other resources are available to enhance
your organization’s consumer strategy.
Choose the PLAN level right for you
Mayo Clinic Health System
primary and specialty care
1. PLAN well
When employers choose Health Tradition Health Plan,
employees benefit from the excellent, compassionate
care of Mayo Clinic Health System physicians in their
own communities.
Included with the Health Tradition Health Plan
Health Tradition Health Plan members select an innetwork primary care provider (PCP), which includes
Mayo Clinic Health System physicians, in their own
communities. The local PCP knows each patient’s history
and preferences and helps to ensure they are receiving
the most personalized, cost effective and highest quality
care possible. The PCP has the unique ability to directly
consult with and make medically indicated referrals to
Mayo Clinic Health System colleagues.
Required specialty care referrals to Mayo Clinic in
La Crosse and Rochester
Many tests and services can be provided by Mayo Clinic
specialists practicing locally. However, there may be
instances when the local Mayo Clinic Health System
specialist believes specialty care at Mayo Clinic in
Rochester or another out-of-network provider is clinically
indicated. The PCP and local Mayo Clinic Health System
specialist will work closely with Health Tradition Health
Plan to ensure the patient receives the most appropriate
care at the most appropriate facility. Health Tradition
Health Plan will send a letter to the patient explaining
exactly what services have been considered and approved
at Mayo Clinic in Rochester or another out-of-network
provider.
Plan Well is the foundation for developing better health
care consumers among your employees and their family
members. Franciscan Health Solutions Health Promotion
provides you with the education, support and resources
your employees and their families need to take a more
active role in their health at no extra charge.
2. WORK well
Lifestyle improvement
Paid services offered to employer groups
Work Well helps you create a culture of wellness by actively
supporting your workforce in making healthy life changes.
You can provide your employees and their families with
tremendous opportunities, tools and programs for change
and gather meaningful data to help develop future
programming needs.
3. LIVE well
Tailored to each company
Comprehensive paid services offered to employer groups
Live Well provides employers with customized long-term
strategies that will take your wellness program to the
optimal level. Our health promotion consultants provide
guidance in program design, communication and incentive
strategies, goal setting and outcomes measurement. Our
customized reporting and analysis of aggregate data allows
us to provide the specific recommendations you need to
affect improvements in support of your health goals and
objectives.
Increase your investment in wellness programming and
see health care costs decrease.
Health care costs
Primary care provider
Education, support & resources
3
1
2
Wellness and preventive care investment
Making health care affordable
An advantage of the Consumer Choice health plan model is control.
Our approach, with the clinical programs at the core of the plan design,
provides:
» Control over costs for chronic conditions through personalized sessions
with registered nurses and counselors
» Control over member utilization through employee education and financial
participation
» Control over prescription drug prices through the use of the Health
Tradition Formulary and pharmacy benefit management services
These combine to help reduce costs for the health care coverage provided to
your employees.
Another advantage of the Consumer Choice health plan model is flexibility. Our
benefit experts can advise how to fund the HRA and set up “rollover” amounts,
help you determine whether a flexible spending account is appropriate and
identify other tools that are right for your organization.
Your integrated solution for health care benefits
Whether you provide the Consumer Choice health plan model as one of your
organization’s plan offerings or as the only option, Health Tradition experts will
help tailor a health plan that meets your organization’s specific needs.
For more information
Health Tradition currently provides health benefits administration for
more than 30,000 members. Call 1-888-459-3020 or visit our web site at
www.healthtradition.com to learn more about Health Tradition.
1808 East Main Street | Onalaska, Wisconsin 54650
P.O. Box 188 | La Crosse, Wisconsin 54602
www.healthtradition.com
© 2011 Health Tradition Health Plan
HTHP-V432 (09/11)