Agent Update

Care Choices Update
Dependent Audit
Patient Safety Hospital Survey
Grievance Process
Helping Members Get the Care They Need
Helping Members Understand Their Benefits Information
Maximum Contribution Levels for Health Savings Accounts (HSAs)
Meeting Members' Medical Needs
Reminder About the Use of the HIPAA Member Authorization Form
Care Choices WOW Program Comes to a Close

Care Choices Update

As you know, Care Choices HMO, Care Choices PPO and Preferred Choices PPO health plans are being sold to Priority Health, a Grand Rapids, Michigan based health plan owned by three Michigan health systems. Below is an update regarding the sale.

We filed the paper with the State of Michigan (OFIS) on December 27, 2006. Pending State approval, we hope to close no later than April 1, 2007.
Priority Health will staff an Eastern Office. They will lease the current offices of Care Choices in Farmington Hills. Priority Health, headquartered in Grand Rapids, staffs regional offices in Kalamazoo, Holland, Traverse City and Saginaw.
We’ve named our senior management team. Priority Health confirmed their support of Care Choices when they retained current management employees to serve as the Eastern Office leadership team.
- Michael Koziara, Vice President of the Eastern Region
- Jelka Petrovic, Associate Vice President of Sales and Product Strategy
- Gilbert Burgos MD, Associate Vice President of Medical Affairs
- Barry Coffield, Director of Operations and Claims
- Miriam Bielski, Director of Customer Service.
The Eastern Office will be a full-service regional center. We continue to be dedicated to meeting the needs of all our customers and therefore, this office will include sales and client services, provider contracting, medical management, claims, and customer service operations.
We will maintain our Agent Advisory Council. We’ve been working closely with the Agent Advisory Council to determine product needs in the east Michigan region. Based upon the input received, we have almost finalized the product portfolio and will be unveiling it shortly. We are proud to announce that the product portfolio and supporting tools that will be available in the region will be second to none. You and your customers will not only have more choices, but better ones than ever before. We are also working with the Agent Advisory Council on other improvements and we’ll keep you posted on the progress. If you have any ideas or suggestions, please feel free to share them with Jelka Petrovic.
Your Care Choices contact may change. We are reorganizing the sales department and the individual assigned to your account will contact you in the near future to learn how we can serve you better. If you have any questions, please contact Jelka Petrovic via email at petrovij@trinity-health.org or at (248) 489-6218.
The bottom line: Care Choices has been working very closely with the executive team from Priority Health and here is why we are excited for the future:
- They share Care Choices commitment to customer service.
- They enjoy strong partnerships with agents in West and Northern Michigan.
- 93 percent of their current new business sales are through the agents, a model they plan to replicate in this market.
- They bring a diverse product portfolio with a commitment to new product introductions.
- They have the resources necessary to invest in our future.

Thank you for your support of Care Choices. We are counting on your support to make 2007 the best in our history.

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Dependent Audit

Care Choices will be conducting its annual dependent validation throughout the month of
April. In March, we sent a letter and form to all Care Choices HMO subscribers with dependents age 19 or older asking them to verify that their dependent meets the tests for a “qualifying dependent” according to the Internal Revenue Service (visit www.irs.gov for more information). We are only sending one communication to subscribers, no reminder letter will be sent.

Care Choices must receive completed forms by April 30, 2007. If a completed form is not received by that date, the dependent’s coverage will be terminated. By mid-May, we will notify employers of the dependents whose coverage has been terminated as of April 30, 2007.

Important: Care Choices is unable to make retroactive reinstatements for any late validation submissions. We recommend you remind your clients of the importance of completing and returning this form to us.
If you have any questions, please contact Business Support at (800) 261-3452.

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Patient Safety Hospital Survey

For the past five years, most Michigan hospitals have participated in the Michigan Health and Safety Coalition (MH&SC) Joint Hospital Survey. This is the fourth year that this survey is a joint effort between MH&SC and The Leapfrog Group. Results for the 2006 survey can be found on www.mihealthandsafety.org and leapfroggroup.org.

The MH&SC is a non-profit corporation focused on improving patient safety in Michigan. The Leapfrog Group is a voluntary program, driven by purchasers of health care to initiate breakthrough improvements in health care safety, quality and affordability of health care and to recognize and reward these efforts.

Both MH&SC and The Leapfrog Group are committed to improving patient safety in Michigan. They use a combined survey that collects data important to both organizations. The survey questions focus on the following areas of care:

Abdominal Aortic Aneurysm Repair

Carotid Endarterectomy Surgery

Esophagectomy Surgery

Infants with Congenital Anomalies

Low Birthweight Infants

Open heart surgery

Percutaneous Coronary Interventions

The Leapfrog Group focuses on the following quality practices:

Computer Physician Order Entry (CPOE)

ICU Physician Staffing (IPS)

Evidence-Based Hospital Referral (EBHR)

National Quality Forum (NQF) measures (27 procedures that are in place to reduce preventable medical mistakes.)

Patient safety continues to be a quality priority for Care Choices. We partner with multiple health plans and employers in Michigan to endorse the Leapfrog Group patient safety standards and the MH&SC guidelines. Participation in the joint hospital survey is voluntary. However, we require all of our participating hospitals to complete the survey and in addition:

Comply with the patient safety guidelines developed by the MH&SC.

Adhere to the additional national patient safety measure established by the National Quality Forum.

Adhere to The Joint Commission’s patient safety’s goals.

Take a few minutes and visit www.mihealthandsafety.org and www.leapfropgroup.org to see how hospitals rate.

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Grievance Process

There two ways a member can have the Care Choices HMO decision to deny payment for care or services reconsidered are outlined below.

1. Standard Grievance Process

Step 1: Members call our Customer Call Center and request a Grievance Filing Form, which will be sent to them within five business days.

Step 2: After receipt of the form, the Care Choices Member Reconsideration Committee reviews the grievance within the thirtieth (30) calendar day for pre-service and post-service grievances. Members are advised of the Committee’s decision, by phone and then a letter is sent within three calendar days after the Committee’s decision.

2. Independent External Review

If the member still disagrees with our final decision, then they can request an independent external review with the Michigan Office of Financial and Insurance Services (OFIS). They can only do this after they have followed our Standard Grievance Process.

Expedited grievance process

Members can also request an expedited grievance before the care or service is provided or while the care or services are being provided. If the member’s physician thinks this adverse determination will seriously jeopardize the member’s health, the entire process can be completed in 72 hours.

Members should refer to the Care Choices Member Handbook, our website, or call Customer Service for more information.

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Helping Members Get the Care They Need

Care Choices is committed to providing high-quality health care services. Our goal is to promote optimum health for our members. We want to make sure they get the right service in the right place at the right time. There are a number of ways we ensure our members receive information and education to help manage their medical conditions and improve their quality of life.

Health Management Programs

We offer comprehensive disease management programs in the following areas:

Asthma

Cardiac

Chronic obstructive pulmonary disease (COPD)

Diabetes Depression

Quitting tobacco

Weight management

We track certain types of health care services we provide for our members such as:

Preventive health care services - how many of our members get the immunizations and screening tests they need based on age, gender, and level of risk. Disease specific services - whether our members with cardiac disease, asthma, diabetes, or depression obtain the recommended tests and examinations they need for their specific condition(s).

We provide the following educational resources and tools:

Preventive Health Care Guidelines – recommendations for early detection tests, immunizations, and self-care for men, women and children are provided to members when they join the plan. These guidelines are posted on our website and updated on an annual basis.

Screening and Risk Tools

Behavioral Health (alcohol, depression/manic-depression, anxiety/post traumatic stress disorder, and eating disorders)

Cancer screening

Cardiac disease

“How’s Your Health” – interactive questionnaire that can help you identify health risks

Women and Children’s Health - reminders for certain screening tests, immunizations, and examinations are sent to women and children who are in need of these health services.

Health education classes and support groups - listings of health education classes and support groups at participating hospitals and facilities. A complete list appears in our printed provider directories and on our website.

For more information, please call us at (877) 890-2045.

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Helping Members Understand Their Benefits Information

It is important that members understand their health care benefits to ensure their satisfaction. The documents outlined below help explain benefits.

Member Handbook – explains how to receive covered services and also how to: Choose a primary care physician.

Receive care.
Change primary care physicians.
Obtain referrals to specialists.
Receive emergency care. Report changes that will affect coverage.
Resolve health care claims.
Report coverage under coordination of benefits.
Obtain services for students away from home.

Subscriber Certificate – describes the specific benefits members receive under their group policy with Care Choices. It includes general provisions, covered benefits, exclusions and limitations. It also provides definitions of coverage terms. A subscriber is the person who signs up for coverage on the Care Choices enrollment form. We issue coverage in the subscriber’s name and possibly for his or her dependents. A dependent is a member of the subscriber’s family who is eligible for enrollment.

Schedule of Benefits – specifies the copayments, benefit day limits, aggregate dollar limits and other financial limitations and member financial obligations applicable to the member’s specific benefit plan. Members receive this document with their Care Choices Member Information Kit or they can find a copy on our secure member portal.

Rider – lists additional or supplemental benefits that the member is entitled to based on their employer group. Members should keep their rider with their Subscriber Certificate.

Summary of Covered Services – provides a summary of what is and what is not covered. It is provided to most, but not all, of our employer group subscribers. It lists any copayment and benefit levels for covered services. Unlike the Subscriber Certificate, the Summary of Covered Services is not a complete description of benefits.

Each subscriber receives this information shortly after enrollment with Care Choices. The Member Handbook, Subscriber Certificate, and Schedule of Benefits can also be found on our secure member portal, Internet Self-Service (ISS). If you need a copy of any of these documents, please contact Business Support at 800-261-3452.

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Maximum Contribution Levels for Health Savings Accounts (HSAs)

The 2007 contribution levels for HSAs, according to the U.S. Department of Treasury are outlined below.

Minimum deductible amounts

$1,100 for individual-only or self-only coverage ($1,050 in 2006)

$2,200 for family coverage (two or more members) ($2,100 in 2006)

Maximum annual out-of-pocket costs (including deductibles and copayments)

$5,500 for individual-only or self-only coverage ($5,250 in 2006)

$11,000 for family coverage (two or more members) ($10,500 in 2006)

Maximum Annual HSA Contribution

$2,850 for self-only coverage ($2,700 in 2006)

$5,650 for family coverage (two or more members) ($5,450 in 2006)

Catch-up Contribution

For individuals, age 55 and older, the maximum annual catch-up contribution for 2007 is $800

For more information, please visit: www.ustreas.gov/offices/public-affairs/hsa/07IndexedAmounts.shtml

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Meeting Members' Medical Needs

We understand it’s important that your health plan make decisions based on your employees’ medical needs rather than the cost of their care. We have policies to ensure that decisions about coverage are based on care and service. In fact:

Utilization decisions are based only on the appropriateness of care, services and the existence of coverage.

Care Choices employees and providers are not compensated for issuing denials of coverage or service.

No incentives are offered to encourage barriers to care and service or decisions that result in underutilization.

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Reminder About the Use of the HIPAA Member Authorization Form

Care Choices Customer Service department must receive a signed Member Authorization for Release of Protected Information Form from the member (for anyone 18 years of age or older) before our Customer Service coordinators can discuss any Protected Health Information with you about the member.

A copy of this form, along with our Notice of Privacy Practices as well as other information about HIPAA, is located on our website at www.carechoices.com. You may also contact Business Support at 800-261-3452 to mail or fax you the information you need.

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Care Choices WOW Program Comes to a Close

Last fall, Care Choices introduced the WOW campaign - a program that was designed to reward you, our agent partner for:

Retention of Current Business

Quoting Activity

Here’s how the quoting bonus program worked

As an incentive for agent quoting activity, Care Choices held drawings for a flat screen LCD television once a month from November through February 2007. Agents received one entry for each Care Choices HMO, Care Choice PPO or Preferred Choices PPO quote for a group with 2-50 eligibles and two entries for each Care Choices HMO, Care Choices PPO or Preferred Choices PPO quote for groups with 51+ eligibles. Quotes generated by the Care Choices Sales and Business Support team were automatically entered into the drawing. Quotes generated externally using the Care Choices small group rate model were submitted using the Quoting Bonus Program Submission Sheet. And the lucky winners of the flat screen LCD television were:

Sherri Hansen, CSI Insurance

Karole Jensen, Michigan Chamber Services

Andrea Roberts, al Bourdeau Insurance Agency

Rocky Husaynu, Rocky Husaynu Agency

In addition, at the kickoff meeting in September, the were two winners:

Norm Roegner, TMR and Associates won a laptop computer

Donald Baslock, won a flat screen LCD television

Congratulations to all our winners and agent partners for a successful campaign!

Agent meeting on January 17

On January 17, agents attended an event in the luxurious Vito Anthony suites at the Palace of Auburn Hills. In addition to watching a great game, many had the opportunity to meet Kim Horn, President and Chief Executive Officer of Priority Health and Bill Alvin, President and Chief Executive Officer of Care Choices to learn more about the acquisition of Care Choices by Priority Health. Agents also provided feedback on what is important in the southeast Michigan market. We appreciate the input and advice we received and look forward to implementing many of these suggestions quickly.

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