iron county school district...the amount you pay before your health insurance starts paying for...

TO DO:

Iron County School DistrictMEMBER BENEFITS GUIDE

INSURANCE COMPANY

10421 S Jordan Gateway Ste. 300 South Jordan, UT 84095

(844) 234-4472

MotivHealth.com

MotivHealth believes in challenging the status quo. We believe in lowering costs, providing better benefits and incentivizing the growth of your health savings. Everything we do focuses on overcoming traditional or outdated notions of health insurance through relentless innovation, creativity, and engagement. We believe that our unique member-centered approach and powerful value-driven partnerships will empower and motivate you as we find the best care at the best price.

COMPANY FOCUS

The biggest issue in healthcare is that, as consumers, we don’t control

healthcare decisions. Few know what medical care costs until months

after a procedure, and when the bill comes, it’s too complex. It’s very

difficult to make smart healthcare decisions, resulting in unmanageable

expenses. We’re putting control back into your hands.

Copyright © 2020 MotivHealth Insurance Company. All Rights ReservedMotivHealth.com | (844) 234-4472

THE SMARTER APPROACH TO HEALTH INSURANCE

Copyright © 2020 MotivHealth Insurance Company. All Rights Reserved

ENGAGE + EDUCATE + INFORM

The MotivHealth Mission

$3700/claimAverage Savings when care is optimized.

=

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.

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 withcourses, quizzes and earned incentives.

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.


*Deductible: The amount you pay before your health insurance starts paying for covered medical expenses.

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 wilI need to pay towards healthcare expenses in a given year. Your deductible and coinsurance are all applied towards your out-of-pocket maximum.

Embedded OOPM: Each individual has their own max out of pocket. When any one person reaches their individual max out of pocket, the plan begins paying for the full cost of covered medical services for that individual.

Non Embedded Deductible: If you are enrolled with at least one other dependent, you do not have an individual deductible. Meaning, co-insurance begins when the combined family medical costs reach the family deductible.

844-234-4472 | PO BOX 709718 SANDY, UT 84070 | MOTIVHEALTH.COM

BENEFIT SUMMARY TE

RM

STH

E PL

AN

CO

VER

AG

E

IN NETWORK

$1,750/$3,500

Non-Embedded

20% After Deductible

$3,500/$7,000

Embedded

20% AD

N/A

20% AD

20% AD

Covered 100%

$35 AD

$45 AD

$35 AD

$45 AD

20% AD

20% AD

20% AD

20% AD

20% AD

30% AD

50% AD

20% AD

20% AD

20% AD

20% AD

Deductible (Single/Family) Deductible*

Embedded/Non-Embedded

Coinsurance (Paid by Member)

OOP Max (Single/Family)

OOPM Embedded/Non-Embedded

Inpatient

Inpatient Copay Limit

Emergency Room

Skill Nursing Facility

Preventive Care

Primary Care Physician

Specialist

Behavioral Health Visits

Rehab/Physical Therapy/OT

CT/PET Scan/MRI

Lab & X-Ray Services

Outpatient Facility

Other Outpatient Professional

Generic - Retail

Preferred Brand - Retail

Non-Preferred Brand - Retail

Specialty Drugs

Urgent Care

Ambulance

Home Health/Private Duty NursingOth

er

Serv

ices

Pres

crip

tion

(R

X)

Imag

ing

&

Dia

gnos

tics

Prof

essi

onal

Vis

its

Inpa

tien

t ER

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.

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

WELCOME {MOTIVHEALTH MEMBER NAME}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.comto register and view your benefit information.

© MOTIVHEALTH INSURANCE COMPANY. ALL RIGHTS RESERVED.

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

MEMBER NAMEMember ID : 000012345Group ID : 12345Coverage : Family

RX Bin : 015202PCN : SGRX

MEDICAL $25 - Office Visits

$50 - Specialist Visits $50 - Urgent Care

PHARMACY $10 - Generic $30 - Preferred Brand $60 - Non-Preferred Brand

N O T S T A T E R E G U L A T E D $150 - Specialty




MEDICAL $25 - Office Visits

$50 - Specialist Visits $50 - Urgent Care



© MOTIVHEALTH INSURANCE COMPANY. ALL RIGHTS RESERVED.




MEDICAL $25 - Office Visits $50 - Specialist Visits $50 - Urgent Care



Call Us 24/7 - 844-234-4472 This card does not guarantee eligibility or coverage. For services that may cost more than $500 call us to get the right care at the best price. Out of network providers could result in balance billing.

Electronic Claims— Payer ID#: U7632

Paper Claims send to:PO Box 709718 Sandy, UT 84070-9718

SEND CLAIMS TO MOTIVHEALTH

UTAH NETWORK OUTSIDE UTAH

PRE-CERTIFICATION IS REQUIRED – - Within 48 hours of emergency admission.- Before any non-emergent hospital admission, outpatient services or diagnostic testing.

PHARMACISTS call SGRx at: 855-367-7479 (855-FOR-SGRX)

KNOW BEFORE YOU GO. CALL 24/7

m tivhealth I N S U R A N C E CO M PA N Y

You're COVERED. We CARE. Better BENEFITS.

SAMPLE

4000 1234 5678 901009/23

JOHN DOE

• NOT VALID UNLESS SIGNED

24/7/365 • Member Services • 844.234.4472

AUTHORIZED SIGNATURE

www.MOTIVHEALTH.com 1055362 09/16 cpi-co

123456789

CDCPI714-10000

HEALTH SAVINGS ACCOUNT

4000 1234 5678 901009/23

JOHN DOE

• NOT VALID UNLESS SIGNED

24/7/365 • Member Services • 844.234.4472

AUTHORIZED SIGNATURE

www.MOTIVHEALTH.com 1055362 09/16 cpi-co

123456789

CDCPI714-10000

HEALTH SAVINGS ACCOUNT

Your MHSA Debit Card



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 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.


Provider Search

NavigationClick 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 SearchSearch by name, or use the dropdown to search by specialty.

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


New Member Checklist

Get Started:MotivHealth.com

Contact Us:844-234-4472

Participate with Prompt Pay

1

3

4

Create Your Member Account

Receive Free Prescription Assessment

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

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.

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.

2Enroll In the Steps Incentive Program

Simply sync your Garmin or preferred pedometer device to your member account.

5Contribute to Your HSA

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

Keys to Success

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


Contact Us:844-234-4472

HOW MUCH MEMBERS SAVE ON AVERAGE BY CALLING A PHA BEFORE SCHEDULING A PROCEDURE.

$80

EVER DREAMED OF BEING A PAID ATHLETE? Now you can be! Our MotivHealth Members earn $1 for every day they walk 8,000 steps or more, up to 20 days per month towards their MHSA. That’s $20 per month, or $250 per year that you can earn (counting the extra $10 for December). Your spouse can also participate and together you earn $500!

MotivU - EARN & LEARN:We pay you $50 for completing our 1-hour MotivU curriculum! It’s fun, informative, and rewarding! Join the elite group of insurance intellectuals and get a nice incentive contribution to your HSA! Plus, it looks great on your resume!

Member Incentives

24/7365


OUR PERSONAL HEALTH ASSISTANTS ARE HERE FOR YOU—ALWAYS

|

WE HEAR A LOT OF TALK ABOUT

AFFORDABLE CARE AND

HOW TO CHANGE THE ENTIRE

HEALTHCARE MODEL. RATHER THAN

TALK, MOTIVHEALTH IS SIMPLY

DOING IT. AND, WE BELIEVE IN

MOTIVATING OUR MEMBERS WITH

KEY INCENTIVE PROGRAMS. WE

TRULY WANT TO HELP YOU GROW

YOUR HEALTH SAVINGS AND HAVE

FUN IN THE PROCESS!

Cost Comparison Tool—Ask yourself: Why don’t you know the cost of procedures before you have them? This is the fundamental flaw in the healthcare model. Healthcare decisions like where, when and what procedures are needed are typically made by healthcare professionals—with little input from the patient and with little consideration for cost. MotivHealth members have access to a robust, one-of-a-kind cost comparison / price transparency tool. This is innovative in terms of helping members take charge of their decisions and for the first time to KNOW THE COST OF CARE BEFORE RECEIVING CARE.

RX / Pharmaceutical Program—Getting medications is like paying for college—you can pay full price or you can learn about and apply for various qualifying programs, grants and discounts. Most people have no idea these exist or how to take advantage of them. MotivHealth has a dedicated team assisting our members to find discount and full-assistance pharmaceutical programs to save on high-cost medication. This is game-changing for members with financially debilitating issues from Diabetes to Multiple Sclerosis. We also help find co-pay cards that reduce the member’s responsibility at the point of sale.

Steps Incentives

MESSAGES

livemotivated

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