MotivHealth New Member Booklet

Iron County School District MEMBER BENEFITS GUIDE

TO DO:

10421 S Jordan Gateway Ste. 300 South Jordan, UT 84095 (844) 234-4472 INSURANCE COMPANY

MotivHealth.com

THE SMARTER APPROACH TO HEALTH INSURANCE

MotivHealth is the insurance company creatively solving the high cost of healthcare, with an average increase in annual premium of less than <1% for our clients as opposed to the industry average of an 8% increase.

COMPANY FACTS •

BASED IN SALT LAKE CITY, UT

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BEGAN OPERATIONS JANUARY 2016

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OVER 30,000 MEMBERS & GROWING FAST

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110 EMPLOYEES

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PROFITABLE SINCE YEAR 2 OF OPERATIONS

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ONLY INSURANCE COMPANY WITH A SEAMLESS: —HEALTH PLAN, —HSA and —HSA INVESTMENT EXPERIENCE

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PROPRIETARY API BASED HSA PLATFORM (with potential to license or white label to other companies)

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MotivHealth.com

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(844) 234-4472

CARVE-OUT PBM SERVICES

Copyright © 2020 MotivHealth Insurance Company. All Rights Reserved

Engage, Educate, & Inform It starts with engaging people so they can see the ‘how.’ As they become educated they understand the ‘why.’ Finally, they are informed, so they can ‘act.’ It is through this methodology that we, at MotivHealth, begin to affect claim costs that translate into lower premiums.

ENGAGE

+

We engage our members through rewarding them with money in their HSA if they walk 8,000 steps a day. We educate our members with a full ‘university’ platform— MotivU—complete with courses, quizzes and earned incentives.

EDUCATE

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Finally, we inform our members by giving them access to a robust, price transparency tool to allow them to KNOW THE

COST OF CARE BEFORE RECEIVING CARE so they can get best care at the best price.

INFORM

Average Savings when care is optimized.

= $3700/claim

MotivHealth.com

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(844) 234-4472

Copyright © 2020 MotivHealth Insurance Company. All Rights Reserved

OUT OF NETWORK

$1,350/$2,700 Non-Embedded 10% After Deductible $3,000/$6,000 Embedded

$2,700/$5,400 Non-Embedded 30% After Deductible (AD) $6,000/$12,000 Non-Embedded

Inpatient ER

Inpatient Inpatient Copay Limit Emergency Room Skill Nursing Facility

10%AD N/A 10%AD 10%AD

30%AD 30%AD 30%AD 30%AD

Professional Visits

Preventive Care Primary Care Physician Specialist Behavioral Health Visits Rehab/Physical Therapy/OT

Covered 100% 10%AD 10%AD 10%AD 10%AD

No Cost (up to allowed amount) 30%AD 30%AD 30%AD 30%AD

Imaging & Diagnostics

CT/PET Scan/MRI Lab & X-Ray Services Outpatient Facility Other Outpatient Professional

10%AD 10%AD 10%AD 10%AD

30%AD 30%AD 30%AD 30%AD

Prescription (RX)

Generic - Retail Preferred Brand - Retail Non-Preferred Brand - Retail Specialty Drugs

10%AD 10%AD 10%AD 10%AD

30%AD 30%AD 30%AD 30%AD

Urgent Care Ambulance Home Health/Private Duty Nursing

10%AD 10%AD 10%AD

30%AD 30%AD 30%AD

TERMS

COVERAGE

THE PLAN

IN NETWORK

Other Services

BENEFIT SUMMARY

Deductible (Single/Family) Deductible* Embedded/Non-Embedded Coinsurance (Paid by Member) OOP Max (Single/Family) OOPM Embedded/Non-Embedded

*Deductible: The amount you pay before your health

Embedded: Each individual has their own deductible.

insurance starts paying for covered medical expenses.

When any one person reaches their individual deductible, the plan begins paying co-insurance for that individual.

Co-Insurance: The portion you pay once your deductible has been met. You will pay this percentage until you have hit your out-of-pocket maximum.

Out-of-pocket maximum: This is the most you wil I need to pay towards healthcare expenses in a given year.

Your deductible and coinsurance are all applied towards your out-of-pocket maximum.

844-234-4472

Non Embedded: You do not have individual deductibles. Co-insurance begins when the combined family medical costs reach the family deductible.

| PO BOX 709718 SANDY, UT 84070 |

MOTIVHEALTH.COM

Your Member Card MotivHealth is pleased to provide you with personalized identification cards. You will present this card to your provider each time you receive services. All correspondence from MotivHealth, including your Explanations of Benefits (EOBs), will reference your Member ID Number.

Enclosed is a sample of the health insurance ID card which you will receive in the mail.

WELCOME {MOTIVHEALTH MEMBER NAME}

******************************SNGLP 840 B1 33-P1 TZ |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| { MOTIVHEALTH MEMBER NAME} { 7777 Motivnation Rd } { Alpine, UT 84004-7077 }

Thanks for partnering with MotivHealth Insurance Company. MotivHealth believes in challenging the status quo by lowering costs and providing better benefits. MotivHealth excels at providing members with excellent service and education, total price transparency, and an integrated health experience centered on quality and value.

Enclosed is your health insurance ID card. We’re available 24/7 to answer any questions. Call us any time at 844-234-4472. Please go to MotivHealth.com to register and view your benefit information.

You're COVERED. We CARE. Better BENEFITS.

Call Us 24/7 - 844-234-4472

E L MP

MEMBER NAME NAME MEMBER

MemberID ID: : 000012345 000012345 Member GroupID ID:: 12345 Group 12345 Coverage:: Family Coverage Family MEDICAL MEDICAL

RXBin Bin: :015202 015202 RX PCN : :SGRX SGRX PCN

SA PHARMACY PHARMACY

$25--Office OfficeVisits Visits $25 $50--Specialist SpecialistVisits Visits $50 $50--Urgent UrgentCare Care $50 NNOOTT SSTTAATTEE RREEGGUULLAATTE EDD

$10- Generic - Generic $10 $30- Preferred - Preferred Brand $30 Brand $60- Non-Preferred - Non-Preferred Brand $60 Brand $150- Specialty - Specialty $150

24/7 Customer CustomerSupport Support 844-234-4472 844-234-4472 motivhealth.com motivhealth.com 24/7

NAME ThisMEMBER card does not guarantee eligibility or coverage. For services thatMember may cost more $500 call us to get the right care at the ID : than 000012345 bestGroup price. Out providers could result in balance billing.

IDof: network 12345 RX Bin : 015202

Coverage : IS REQUIRED Family – PRE-CERTIFICATION

PCN : SGRX SEND CLAIMS TO

- Within 48 hours of emergency admission.

- Before any non-emergent hospital admission, MEDICAL ACCOUNT SAVINGS HEALTH outpatient services or diagnostic testing. $25 - Office Visits

Electronic Claims— PHARMACY

$50 - Specialist Visitsat: PHARMACISTS call SGRx

MOTIVHEALTH

Payer ID#: U7632

$10 - Generic Paper Claims send to: $30 - Preferred PO Box 709718 Brand $60 - Non-Preferred Sandy, UT 84070-9718 Brand $150 - Specialty

4000 1234 5678 9010

$50 - Urgent Care 855-367-7479 (855-FOR-SGRX) N O T S TAT E R E G U L AT E D

UTAH NETWORK

m tivhealth 09/23 24/7 Customer Support 844-234-4472

I N S U R A N C E C O M PA N Y

JOHN DOE

OUTSIDE UTAH

motivhealth.com

© MOTIVHEALTH INSURANCE COMPANY. ALL RIGHTS RESERVED. © MOTIVHEALTH INSURANCE COMPANY. ALL RIGHTS RESERVED.

Your MHSA Debit Card CDCPI714-10000

www.MOTIVHEALTH.com

1055362 09/16 cpi-co

AUTHORIZED SIGNATURE • NOT VALID UNLESS SIGNED

HEALTH SAVINGS ACCOUNT

4000 1234 5678 9010 09/23 JOHN DOE 24/7/365 • Member Services • 844.234.4472

CDCPI714-10000 www.MOTIVHEALTH.com MotivHealth.com | (844) 234-4472 1055362 09/16 cpi-co

123456789

Copyright © 2020 MotivHealth Insurance Company. All Rights Reserved

KNOW

Member Profile Setup

To get the most out of all of our programs and opportunities to grow your HSA, set up your Member Profile. Creating a MotivHealth profile is easy and will help you save and EARN money. Besides the basics, like viewing claims history, insurance benefits, and accessing your member ID card, your profile gives you access to unique tools and platforms that cut unnecessary insurance costs and grow health savings.

What You Can Do • • • •

View benefit descriptions Check claims status Manage your HSA Earn Incentives - Steps Program

• • • •

Earn $50 by completing MotivU Access the Cost-Comparison Tool Review eligibility/enrollment status Manage RX/prescription benefits

To access to your information, go to member.motivhealth.com.

Create an account.

You’ll be asked to enter personal information to identify you as the actual account holder.

LOG IN. Go to member.motivhealth.com, and type in the username and password you chose when creating your account.

QUESTIONS? MotivHealth’s personal healthcare assistants are available at 844-234-4472, every hour of every day to answer your health benefit questions.

MotivHealth.com

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(844) 234-4472

Copyright © 2020 MotivHealth Insurance Company. All Rights Reserved

Provider Search

Navigation

Click the down arrows next to “Doctor Search,” “Procedure Search,” or “Facility Search” to begin.

Or, you can use the links on the right to find telemedicine options, Onsite Care, and more.

Doctor Search

Search by name, or use the dropdown to search by specialty.

Procedure Search

Choose from a variety of procedures, select the member needing care, and a location.

Keys to Success

Get Started: MotivHealth.com

Contact Us: 844-234-4472

New Member Checklist At MotivHealth, success starts and ends with you taking full advantage of our unique member tools, resources, incentive programs and more.

1 2 3

4

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Create Your Member Account Visit www.MotivHealth.com and click “Log In” to create your member account.

Enroll In the Steps Incentive Program Simply sync your Garmin or preferred pedometer device to your member account.

Receive Free Prescription Assessment Contact a Prescription Benefit Analyst for a free review of your current prescriptions. We may be able to lower or eliminate your monthly medication expense.

Participate with Prompt Pay Contact a Personal Health Assistant prior to receiving a planned medical procedure. We may be able to reduce your out-of-pocket expense by as much as $3,000.

Contribute to Your HSA HSAs provide unique tax advantages, promote cost-awareness and encourage consumers to consider value in their healthcare decision making.

MotivHealth.com

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(844) 234-4472

Copyright © 2020 MotivHealth Insurance Company. All Rights Reserved

[ member incentives ]

M

otivHealth has achieved an industry record for a 5-year period. Our annual group premium renewal rate is <1% while the health insurance industry norm is an 8% increase. But we’re proud of our other industry-changing accomplishments as well.

STEPS INCENTIVES: Money Paid Out

2018 – 275.8k 2019 – 524.4k 2020 – 787k (Projected)

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PROMPT PAY SAVINGS: 2019 – $3.8 million 2020 – $4.7 million (Projected)

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RX SAVINGS:

MotivU ACTIVITY & INCENTIVES: 2020 – 1,250 Graduates (Projected) 2020 – $140,000 Paid Incentives (Projected)

24/7 365

OUR PERSONAL HEALTH ASSISTANTS ARE HERE FOR YOU—ALWAYS

80

$

HOW MUCH MEMBERS SAVE ON AVERAGE

BY CALLING A PHA BEFORE SCHEDULING A PROCEDURE.

Copyright © 2020 MotivHealth Insurance Company. All Rights Reserved

Our money-saving message is simple—Call us before scheduling a procedure .

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Our pharmacy 2016 – $ 10,836 programs continue 2017 – $ 661,656 to grow and save our 2018 – $ 3,313,756 members significantly on their medications.

2019 – $10, 018,475 2020 – $18.53 million (Projected)

MESSAGES

live motivated