AultCare Sales Brochure

About Us AultCare is a highly service-oriented insurance company and third-party administrator. We create customized plans for employers and individuals, offer responsive service and empower people to make decisions about their health. We offer industry-leading claims turnaround. We are a team that believes in being an example in the community.

With our balanced approach to service and process, customers enjoy the capabilities of a large insurance company with the personal attention that sets us apart from our competitors. We are committed to accuracy and the technical aspects of health care, but we never lose sight of the fact that people are on the receiving end of that care.

Why AultCare AultCare offers many benefits to our members. AultCare is one of the largest regional provider-owned health plans in the nation. Our integrated health delivery system is like none you’ve seen. We provide the continuum of health services under one roof. We can support all your employees’ health care needs including pre-employment testing, health plan coverage, lab work, immediate care, outpatient and inpatient care needs.

We can help your employees stay healthy and productive at work.

What We Do:

• Promote the delivery of high-quality care and services, in a cost-effective manner, to our clients.

• Ensure continuous review, evaluation and improvement within our quality processes.

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Work within our integrated delivery system to manage costs to employers and members.

Our network of doctors and hospitals deliver high-value care following nationally accepted standards. These partnerships aim to ensure appropriate care in the appropriate setting with efficient navigation of the patient through the care process.

AultCare’s Achievements: One of AultCare’s founding principles that still holds true throughout the years is our commitment to ensuring a high standard of quality service, which is reflected through the variety of plans we offer.

The National Committee for Quality Assurance (NCQA) has awarded accreditation for our Commercial PPO, Commercial HMO, Medicare HMO, and Exchange PPO products. NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers, and researchers.

The standards are intended to help organizations achieve the highest level of performance possible, reduce patient risk for unfortunate outcomes and create an environment of continuous improvement.

Benefits to You as an Employer:

• Our knowledgeable staff is available to assist you with our multiple product lines: - Health - Dental and Vision - Wellness - Workers’ Compensation - Other Ancillary Products

> AD & D, STD, LTD > Life Insurance

- Medicare Plans > Medicare Advantage > Medicare Supplement

• Access to more than 33 hospitals, multiple urgent care facilities and 5,500 providers

Group Medical Benefits AultCare’s PPO plans offer you the best choice of health care benefits and providers, including group medical benefits to companies. AultCare has a wide variety of plan offerings to meet the individual needs and requirements of your organization. From standard plans to FSA and HSA compatible options, we have the solution for you. Your employees may select from our long list of providers to receive the plan’s very best benefits, or they would have the choice to use non-AultCare providers at a lesser benefit. The choice is up to them.

Consumer-Driven Health Plans AultCare has customized solutions to meet your company and employees’ health care needs:

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Plan designs HSA integration Defined contribution Customized networks Pharmacy programs Clinical management Population Health Management

AultCare and HealthEquity have partnered to enhance the consumer-driven health plan experience. The user-friendly website provides:

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Eligibility and claim integration Member cost comparison tools 24-hour customer service (live person) Strong investment options

Care Coordination Through a collaborative approach, AultCare’s Care Coordination Department combines Utilization Management, Population Health Management, Disease Management, Wellness and Pharmacy to provide a comprehensive approach to health care.

Our team offers management of individual complex cases, tracks and manages utilization of medical systems and coordinates disease and pharmacy management.

Our proactive approach toward patient-centered care utilizes available resources to promote quality and cost-effective outcomes.

The Care Coordinators are available to assist with:

Education & Support Services

• Cancer

• AultLine: 24/7 Nurse Hotline: 1-866-422-9603

• Chronic Care Improvement Program (CCIP)

• Chronic Obstructive Pulmonary Disease

• GlucoCom® and CardioCom® Programs

• Depression

• Diabetes

• Health Talks: Community educational sessions on a variety of topics

• Durable Medical Equipment (DME)

• Heart Disease

• Ongoing Care/Treatment

• Mental Health Conditions

• Surgery (Already planned or scheduled)

• Transplant (Organ or Bone Morrow)

• Self-help kits for stroke and home safety

• Tobacco cessation: Five weeks free “Give It Up” program at Aultman Hospital

Population Health Management The Population Health Management program is a model of health care that facilitates partnerships between patients and their primary care physicians. The program focuses on providing care that is patient centered, accessible, comprehensive and coordinated. Additionally, we strive to achieve high standards of quality and safety.

AultCare enrollees have access to a Population Health Management Nurse. This interaction can be over the phone or face-to-face and may be short or long term depending on individual needs. The nurse provides support and acts as a resource to assist with navigating the complex health care system.

Nurses educate on chronic and acute conditions and provide information on resources to ensure our enrollees’ needs are met.

Pharmacy Benefit Management Program (PBM) AultCare’s Pharmacy Management program goal is to provide a process for the timely and continual evaluation, selection and rational use of pharmaceuticals ensuring AultCare’s customers clinical effectiveness, safety and cost-efficient drug treatment.

Formulary Structure

Pharmacy Network

AultCare maintains a progressive formulary design consisting of different levels of covered or reimbursable drugs with established co-payments or co-insurance assigned at each level (tier). Physicians have the choice of prescribing generic, preferred brand or non-preferred brand-name products. Certain medications may require prior authorization and/or step therapy based on individual plan language. If prior authorization is required, a letter of medical necessity may be submitted to the AultCare Pharmacy Department. The letter may be faxed to AultCare Pharmacy at 330-363-3284 or mailed to P.O. Box 6910, Canton, Ohio 44706.

The AultCare PBM provides access to local and national retail pharmacies as well as, a mail order and a specialty network.

Medication Therapy Management AultCare’s PBM partners with community pharmacies and pharmacists to provide medication therapy management services to its applicable members.

Expected Value

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Maximized generic utilization Focused specialty drug management Pharmacist-driven interactions with members Year-over-year competitive pharmacy trends Lower than average administration fees

Wellness Program AultCare’s Wellness program is an advocate wellness model which focuses on prevention and care management.

Our Wellness program integrates with your health plan to provide greater engagement, improved health and better cost control.

AultCare Wellness is Supported by AultCare Integration

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Advocacy and Education Partnerships with Physicians and Hospitals Plan Design Control Integrated Systems

DATA AN A

AultCare integrates the sectors of Administrative Services, our Network of providers and hospitals, Consumerism and Care Coordination to provide our clients with the best patient-centered customized plans to meet their needs. AultCare Wellness is supported by our integration initiative through its own integration sectors:

T LY

ICS

e tiv re tion tra Ca ina nisvices i d m r r e o Ad S Co m s k eri or um tw ns Ne o C

Edge on Engagement The AultCare Wellness program is a part of our customized plan designs which results in a greater consumer engagement. Utilizing the experience of over 2,000 employer groups, our consulting services will work with your employees to ensure an ease of access to primary care.

A One-of-a-Kind, Personalized Experience Through our one-of-a-kind, personalized experience, our team of clinical and non-clinical staff includes professional consultants, a registered dietitian, a personal trainer, a tobacco-cessation specialist, and registered nurses. Our team will offer you an integrated program which will lead to better health outcomes at lower costs.

>>> Care Coordination • Population Health Management • Utilization Management • Disease Management • Pharmacy Management • Wellness

Educational Programs • • • • • • •

Diet, Exercise, Fitness Tobacco Cessation Disease States Substance Abuse Group Motivation Programs Individual Incentive Programs Health Risk Assessments

Coaching/ Consulting • Health Coaches • Health Fairs • RN Consultations • RX Consultations • Dietitian Consultations • Fitness Consultations

AultCare’s Wellness Program allows you to choose

the wellness options that are best for your company.

AultCare Products Small Cap Stop-Loss

Level Funding Option

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The Small Cap Stop-Loss Product is for those fully insured plans who want to take advantage of self-funding. With Small Cap Stop-Loss you have the protection of being fully insured with the advantages of self-funding.

• Key Points

A Level Funding Option is an innovative self-funded stop loss approach to maximize plan cost and simplify monthly payments while limiting your monthly expense, allowing you to budget more effectively.

• By choosing this funding option through the AultCare Corporation, we are able to offer you unique components for your company:

- Low-risk transition to self-funding

- Laser cap protection

- Budget your health care for 2 years

- Access to Multiple Carrier Markets

- Specific deductible down to 15K

- Varied Product Components by Carrier

- 25 employee minimum required

- Plan Design Flexibility

• We will design a plan to fit your company - Wellness Features

Medical Cost Estimator As the health care industry evolves, AultCare has developed a transparency tool to give members more power when making decisions about their health care.

The AultCare Medical Cost Estimator was designed to give members an estimate, with the consideration of their deductible/out-of-pocket expenses, as to what members can expect to pay for a wide variety of in-network services and procedures. Now, members have the ability to compare the costs between different physicians, hospitals and facility charges.

How it Works:

• AultCare members log into their account

• Select the member who will receive the procedure/treatment

• Select the procedure/treatment you want to inquire about

• Choose up to four providers for a cost comparison

• Review the provider estimates

Workers’ Compensation AultComp TPA AultCare has two product lines that work specifically with our workers’ compensation population. AultComp Administrators is a workers’ compensation third party administrator (TPA) that incorporates AultCare’s core principles of personalized customer service, quality and low cost. They represent group rated, state funded and self-insured employers.

AultComp Administrators self-insured clients include Stark County’s largest employers. Their services include claims management, indemnity processing, medical bill payment and government reporting. Their claims managers work diligently to contain costs.

For state funded employers, AultComp Administrators provides group rating and group retrospective rating programs. They also provide case management, hearing attendance and customized reporting. Their focus is on enabling their state-funded employers to become eligible for the largest discounts available.

AultComp MCO Since 1997, AultComp MCO has been committed to assisting employees with their workers’ compensation claims. AultComp MCO is a workers’ compensation managed care organization, contracted with the State of Ohio Bureau of Workers’ Compensation (BWC). Our statewide certification allows us to manage claims for employers located in all 88 Ohio counties, working with any provider that is enrolled as a BWC certified provider.

AultComp MCO received full accreditation from the Utilization Review Accreditation Commission (URAC) in Case Management version 4.0. This URAC accreditation confirms to our injured workers and employers that they are receiving the best standards of practices through their workers’ compensation claims.

Currently, AultComp MCO is in a reaccreditation process for URAC Case Management version 5.0.

AultComp MCO’s persistence and commitment to deliver excellent service was recognized by the annual BWC report card for 2015. AultComp MCO was recognized as the best managed care organization to assist injured employees in their return to work after an injury.1 Additionally, AultComp MCO was rated number one in First Report of Injury Timing (FROI).2 AultComp MCO

encouraged employers and injured workers to file claims quickly, which resulted in a quick turnaround time for the injured workers to receive medical treatment and focus on their safe return to work. This efficient turnaround process saved our employers money as we started the process quickly and completed it in an efficient manner.

Looking ahead to 2016, AultComp MCO’s recently completed system conversion for the claims management process will greatly enhance claims management and billing. As part of this conversion, AultComp MCO will have more efficient reporting and audit capabilities.

Additionally, AultComp MCO will be able to provide more proficiencies in the treatment pre-certification and bill payment processes.

2015 BWC Report Card

1

2015 BWC Report Card

2

Network Hospitals City

Phone

17 Salem Community Hospital

Salem

330-332-1551

330-344-6000

18 Samaritan Regional Health System*

Ashland

419-289-0491

Alliance

330-453-4755

19 Southeastern Ohio Regional Medical Center

Cambridge

740-439-3561

Canton

330-452-9911

20 St. Elizabeth Boardman Hospital

Youngstown

330-729-2929

Youngstown

330-480-7211

Facility Name

City

Phone

1

Akron Children’s Hospital

Akron

330-543-1000

2

Akron General Medical Center

Akron

3

Alliance Community Hospital

4

Aultman Hospital

Facility Name

5

Aultman Orrville Hospital

Orrville

330-682-3010

21 St. Elizabeth Youngstown Hospital

6

Barnesville Hospital*

Barnesville

740-425-3941

22 St. Joseph Warren Hospital

Warren

330-871-4000

7

Coshocton County Memorial Hospital* Coshocton

740-622-6411

23 Summa Akron City Hospital*

Akron

330-375-3000

8

Crystal Clinic Orthopaedic Center

Akron

330-668-4040

24 Summa St. Thomas Hospital*

Akron

330-996-8410

9

East Liverpool City Hospital*

E. Liverpool

330-385-7200

25 Trinity Health System

Steubenville

740-283-7761

10 Edwin Shaw Rehabilitation Institute

Cuyahoga Falls

330-436-0910

26 Trinity Hospital Twin City

Dennison

740-922-2800

11 Harrison Community Hospital

Cadiz

740-942-4631

27 Union Hospital

Dover

330-343-3311

12 Lodi Community Hospital

Lodi

330-948-1222

28 Western Reserve Hospital

Cuyahoga Falls 330-971-7000

13 Medina General Hospital*

Medina

330-725-1000

29 Wheeling Hospital*

Wheeling, WV

304-243-3000

14 OhioHealth Mansfield Hospital*

Mansfield

419-526-8000

30 Wooster Community Hospital

Wooster

330-263-8100

15 Pomerene Hospital

Millersburg

330-674-1015

31 Cleveland Clinic**

Cleveland

216-444-2200

16 Robinson Memorial Hospital

Ravenna

330-297-0811 * AultCare PPO Only ** Upon approved referral

Canton, OH 44710 330-363-6360 or toll-free 1-800-344-8858 TTY Line for the Hearing Impaired: 330-363-2393 or 1-866-633-4752 www.aultcare.com 2600 Sixth St. S.W.

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