Contact Information NeededIn the coming months, Physicians Health Plan of South Michigan will begin requesting email addresses from agents and employers. In an effort to communicate to our employers and agents in a more timely fashion, we will be pushing toward a paper-free communication system. This is not only more cost effective, but it also increases the rate at which information is received. Thank you, in advance, for your cooperation.Internet RedesignPHPSM is in the process of redesigning our web site to be more user friendly. The redesigned site will include separate sections for agents, employers, physicians, and members and prospective members. The redesign is scheduled to be complete by late summer. Please excuse our dust while we are remodeling.New Group DeadlinesPaperwork for new groups must be received by PHPSM a minimum of 15 days prior to the effective date. Required documentation includes:
Customer ServiceFor questions regarding current member benefits, eligibility, physicians, member ID cards, pharmacy, claims, and conversion, please contact the Customer Service Department at 517-787-6865 or 1-800-394-7569. Since we are local, you may also stop by Monday through Friday between 8 a.m. and 5 p.m. One of our service representatives will be happy to help you.Broker Bonus ProgramWe are proud to inform you that the broker bonus program will remain in effect through December 31, 2006. To be eligible for the quarterly bonus, each broker must have at least four employer groups or 25+ subscribers that have a renewal/new effective date within the quarter. Bonuses will be paid out within 45 days of the end of each quarter. What's changed? Since Advantage is now part of the standard benefit plan, the Advantage bonus program will no longer be applicable. For more information regarding the Broker Bonus Program, please contact Stacey McCluer at 517-782-7154 ext 6717.Sales Department Contact Information
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Advantage product now offered to all groups
Effective April 1, upon renewal, all employers will have as part of their standard benefit package coverage for:
- It's Your Life health management program
- Smoking Cessation Support program including prescription medication
- Weight reduction program currently offered through Weight Watchers®
- Health risk appraisal (HRA)
- Venous blood draw
- Body mass index (height and weight measurements)
- Blood pressure reading
Due to the demand of this product, we have decided to remove the Advantage requirements for employers. This adds significant value to our program, differentiating PHPSM from the rest. Brochures are available upon request. Please call Kim in the Sales Department at 517-782-7154 ext. 6720 for brochure requests.
High Deductible Health Plan Update
PHPSM has filed six new High Deductible Health Plans with the State of Michigan Office of Insurance Services and are awaiting final approval. There is one prescription rider option of $10/25/50 included with these plans. Pending approval from the State and negotiations with an HSA trustee, the target sell date of these plans is July 1, 2005. Agent training sessions will begin in May or June so be watching for your invitation.New Member ID Card
Physicians Health Plan of South Michigan (PHPSM) has always focused on finding new ways to improve both the efficiency and quality of health care delivery. We just did it again with our new PHPSM medical ID card, shown below.
The new medical ID card is:
- More durable - The card is printed on heavier paper, making it more durable and long lasting.
- Easy - There's nothing to it; use this card as you use your old card when visiting physicians and other health care professionals.
- Complete - The card carries all of the information needed to verify the cardholder's eligibility under their plan of coverage.
Going Above and Beyond
At PHPSM, quality is critical. Because we are local, our quality initiatives have a large impact on our community. Quality initiatives for 2005 include NCQA accreditation and Evalue8 participation. The National Committee for Quality Assurance (NCQA) is an organization dedicated to assessing and reporting on the quality of managed care plans and is the industry standard for Fortune 500 employers, federal and state governments, and consumers. It is designed to help members and purchasers make more informed health care choices when comparing health plans. In fourth quarter 2003, PHPSM made a decision to seek NCQA accreditation as the best use of valuable resources for complying with regulatory obligations while demonstrating our commitment to quality to our current customers and attracting new business. Document Submission is scheduled for May 9, 2005 and the onsite visit is July 11-12, 2005. We expect an accreditation decision as early as August 2005.EValue8 was created by Watson Wyatt and the National Business Coalition on Health (NBCH). It is used to assess performance and establish quality improvement goals within the participating health plans. The motivation behind eValue8 is the evidence-based belief that improved quality, outcomes, processes of care, and administration will optimize and enhance overall value for the purchaser and consumer. Participation in eValue8 provides employers and groups a way to compare different health plans before selecting a health plan to partner with for their employees' care. Participation in eVaule8 is optional. PHPSM submitted the electronic collection tool on March 16, 2005. The final report, which compares PHPSM to all other participating health plans, will be available to employers and groups.
Preferred Drug List Changes
Some important changes will be made in our Preferred Drug List on May 1, adding value for our employers and members. Freestyle and Precision brand diabetic test strips, as well as Novolin and Novolog insulin pens and cartridges, will be made available for a 2nd tier co-payment rather than a 3rd tier co-payment. We believe that this change will enhance care for our diabetic members.In the non-sedating antihistamine drug class, Allegra will move to a tier-2 co-payment from tier-3, while Clarinex will no longer be covered under the pharmacy benefit. In the gastrointestinal drug class, Prevacid soluble tablets (they melt in your mouth!) and oral suspension will continue to be covered on tier-3, while Prevacid capsules will no longer be covered under the pharmacy benefit. Three other similar drugs (Aciphex, Nexium, Protonix) remain available at the tier-2 co-payment level.