Improving the health of individuals, families and communities

Presbyterian Health Plan Open Enrollment 2008

Improving the health of individuals, families and communities

Our Purpose

Presbyterian serves to

improve the health of individuals, families and communities.

Improving the health of individuals, families and communities

Presbyterian Health Plan

Founded in 1908, Presbyterian Healthcare Services has served New Mexicans for nearly a century.

Presbyterian Health Plan was established in 1986.

We’re the largest health plan in New Mexico with over 430,000 members.

We are New Mexicans serving New Mexicans because we are the only local owned and operated health delivery system.

Improving the health of individuals, families and communities

• Eight hospitals in seven communities

• Nineteen primary care clinics

• Seven urgent care clinics

• Clinics in over twenty-five specialties

• Two Healthplex facilities

• Employ nearly 500 physicians• seven

An Integrated System – Healthcare Delivery

Improving the health of individuals, families and communities

Statewide Network

• Over 1,300 Primary Care Physicians

• Over 5,400 Specialists

• Over 600 hospitals and

other facilities

Improving the health of individuals, families and communities

• M.D. Anderson began providing radiation cancer treatment at Kaseman Hospital in the Spring of 2007

• Cancer Center at Presbyterian now provides medical oncology and hematology, surgical oncology, and radiation oncology

• Medical oncology team includes three board-certified hematology/medical oncologists

Developments in Our System – Oncology

Improving the health of individuals, families and communities

MultiPlan and PHCS Nationwide Network

Please note:

• The Multiplan/PHCS network only applies outside of New Mexico.

• For State of New Mexico members (effective 07/01/08), Multiplan/PHCS network providers are considered “in-network,” therefore copayments or co-insurance apply.

Improving the health of individuals, families and communities

MultiPlan and PHCS Nationwide Network

• Over 450,000 Providers• Over 4,000 Facilities

• New logos for the MultiPlan and PHCS healthcare provider networks will be on the back of your ID card and can help you save money when you need to be treated when traveling outside of New Mexico.

Improving the health of individuals, families and communities

Las Cruces Network

• Presbyterian is contracted with 95 % of Las Cruces Physicians

• Presbyterian is contracted with both Las Cruces Hospitals – Memorial Medical

Center– Mountain View Regional

Medical Center

Improving the health of individuals, families and communities

El Paso Network

• Presbyterian is contracted with 96 % of physicians

• Presbyterian is contracted with 7 El Paso Hospitals – Del Sol Medical Center in El Paso, Texas– Las Palmas Medical Centers in El Paso, Texas– Physicians Specialty Hospital of El Paso in El Paso, Texas– Providence Memorial Hospital in El Paso, Texas– R E Thomason General Hospital in El Paso, Texas– Sierra Medical Center in El Paso, Texas & Scci Hospital

El Paso– Southwestern General Hospital in El Paso, Texas

Improving the health of individuals, families and communities

Plan Highlights

• One of the plans with Lowest Premium

• Lowest Deductible

• No Referrals Needed

• Urgent and Emergent Care Nationwide

• Value-Added Benefits

• Multiplan/PHCS Network as in-network providers

Improving the health of individuals, families and communities

Benefit Highlights

Deductible $50

Office Visit/Gyn Care $10*Specialist $25(no referral)Preventive Care $ 0*Lab Work $ 0*X-Rays $ 0Hospital Inpatient $300MRI-PET-CT scans 10% up

to $200.00

*Deductible not applicable

Maternity Care $10

(Pre & Post-Natal)

one time co-pay

Delivery $300

Emergency $150

In/Out of Network

Urgent Care $35

Improving the health of individuals, families and communities

Plan Benefit Example

Billed Allowed You Owe

Preventive $154 $116 $ 0

PCP/GYN $ 90 $ 58 $10

Specialist $190 $120 $25

(deductible) $50

X-Ray $50 $30 $0

Out-Patient Surgery $5,000 $2,500 $250

$5,484 $2,824 $335

Improving the health of individuals, families and communities

Care Coordination and Disease Management

Care Coordination for Acute Conditions

- Transplant services

- High-risk Pregnancy management

Disease Management for Chronic Conditions

- Diabetes

- Coronary Artery Disease

- Asthma

Improving the health of individuals, families and communities

Transition of Care

• Transition of members from previous carriers to PHP

• Pertains to certain services, procedures, or specialty care including:

- Chronic or catastrophic medical conditions/transplants

- Coordinated through Case Management

- Second/third trimester of pregnancy

- Limited time period

Improving the health of individuals, families and communities

Helpful Resources

Nurse Advice Line

1-866-221-9679• Direct access to a Registered Nurse• 24 hours a day/ 365 days a year• Free, confidential medical advice• General health information• Audio health library

Tobacco Quit Line1-888-840-5445• Confidential and convenient support• Enroll to receive up to five coaching sessions• Free nicotine replacement therapy products

Improving the health of individuals, families and communities

Prevention and Wellness

• Member Education• Web-based preventive health information and resources:

www.phs.org, A.D.A.M, LifeMasters OnLineTM

• Statewide educational classes for various diseases, as well as special courses (e.g., healthy cooking/diet, meditation, smoking cessation, anti-stress)

• Quarterly newsletters on health and wellness topics for all members; specific newsletters for Asthma, Diabetes, and Coronary Artery Disease

Improving the health of individuals, families and communities

Member Services

Dedicated Member Service Unit

– Welcome calls and member surveys

– Bilingual services

– Order ID cards

– Check status of claims

– Details on covered benefits

(505) 923-5600 or 1-888-ASK PRES

Improving the health of individuals, families and communities

www.phs.org

Improving the health of individuals, families and communities

My Pres Online

Online services include:

– Look up your benefit plan

– Change PCP (effective the next day!)

– View the status of your claims

– Request replacement ID Cards

– Update address and other information

– Send Member Services questions online

– Access to A.D.A.M. Health Information Site

Improving the health of individuals, families and communities

REASONS TO CHOOSE PRESBYTERIAN

• One of the plans with the Lowest Premiums

• Lowest deductible• NM Based / Not for profit• Contracted with 95% of

physicians in Las Cruces• Contracted with both LC

hospitals• Contracted with 96% of

physicians in El Paso• Contracted with 7 El Paso

Hospitals

Improving the health of individuals, families and communities

People helping People. It’s our tradition.