HAP Products
Product Lines
Product Line Detail

Why HAP?
Why Health Alliance Plan?

Product Definitions
Product Definitions

HAP Product Line
HAP Product Line
HAP Service Area
HAP HMO
HAP POS
HAP Senior Plus HMO
Medicare Complementary

Alliance Health & Life
Alliance Health & Life (AHL)
AHL Service Area
AHL EPA
AHL POS
AHL PPO
Alliance Medicare PPO

HAP Preferred
HAP Preferred (Formerly HealthChoice)
HAP Preferred Service Area
HAP Preferred EPA
HAP Preferred POS
HAP Preferred PPO

Product Lines

Product Line Detail

	HAP	Alliance Health & Life	HAP Preferred
Products	HMO POS HAP Senior Plus HMO	EPA POS PPO Alliance Medicare PPO	EPA POS PPO
Funding Arrangement	Fully Insured	Fully Insured	Self-funded, External and Internal TPA
Rating System	Community-rated	Experience-rated (except Alliance Medicare PPO)	Self-funded
Target Market	Groups under 50 or over 250 eligible employees	Groups between 50 and 250 eligible employees	Groups over 250 eligible employees
Service Area	SE Michigan	SE Michigan	SE Michigan (Statewide with ChoiceNet)

Why Health Alliance Plan?

• A broad portfolio of products and a large network of contracted providers
• Financially sound (Weiss “A” Rating)
• Recognized (NCQA, GM Benchmark) as a company that helps ensure that quality medical care is delivered to its members
• A stable base of clients through excellent service and continued innovation
• Open access products and a national provider network for employers located in multiple states available through the HAP-CIGNA marketing affiliation

We have multiple solutions designed to fit most every need:

• A product line called HAP for employers looking to minimize risk and maximize the use of proven managed care quality and cost containment tools
• A product line called Alliance Health & Life that offers employers a chance to assume partial risk
• A product line called HAP Preferred for employers looking to take all of the risk
• Open access products and a national provider network for employers located in multiple states available through the HAP-CIGNA marketing affiliation

We offer employers, members and providers practical tools through the Internet that simplify their transactions.

We offer members and providers the “HAP Advantage,” which entitles them to preferred rates on a variety of services by showing their ID card:

• LASIK services at a preferred rate from HFHS Optimeyes
• HAP Advantage rates on Computers and Internet access from PeoplePC
• Preferred rates from Weight Watchers

Product Definitions

• Health Maintenance Organization (HMO): Groups pre-pay a premium for all health services and providers are generally paid a fixed fee or “capitation” for each assigned member. For the patient, it means no deductible, no paperwork, and small copayments as long as they access care though their designated Primary Care Physician (PCP)
• Exclusive Provider Arrangement (EPA): HMO-like design: PCP required, preventative care, no self-referred benefits
• Point of Service (POS): Combines Indemnity and HMO concepts into one plan design. Members choose a PCP and get the highest level of benefits when they receive care by, or under direction of their PCP. Members have the additional freedom to go to any provider for an additional out-of-pocket expense
• Preferred Provider Organization (PPO): Members have the freedom of choice of providers, but have lower out-of-pocket costs when they use the preferred provider network
• Medicare Advantage Plans (HMO and PPO): Employers choose affordable premiums and benefits through HAP Medicare Advantage Programs. HAP Senior Plus HMO features the Henry Ford Health System three county network and a nine county, expanded provider network with optional Medicare Prescription Drug Benefits. Alliance Health & Life offers Alliance Medicare PPO with in-and-out-of-network coverage and optional Medicare Prescription Drug Benefits. Also available to individual Medicare beneficiaries.
• Medicare Complementary: An insurance option that coordinates with Medicare as the secondary insurance. This plan covers deductibles and coinsurance for the services that are eligible under Medicare but are not completely covered

HAP Product Line

• The oldest and most popular product line of Health Alliance Plan
• Three fully-insured, community rated products: HMO, POS, HAP Senior Plus HMO
• Target market: Groups under 50 and over 250
• All plans allow for cost sharing options with a range of benefit designs and copayments available
• Groups pay a fixed premium based on the benefits selected and the type of business (SIC code)

HAP Service Area

HAP HMO
Fully-insured, community-rated product
Target market: Groups under 50 or over 250 employees
FEATURES:

• Members choose a PCP for routine care: PCP manages and coordinates all medical care needs, referral to specialists and for admissions to hospitals
• Emergency and urgent care coverage worldwide
• Flexible cost sharing: a range of benefit designs and copayment options available
• Community rated: all members pooled together for rating purposes, resulting in relatively consistent rates from year-to-year
• Disease management and prevention programs including asthma, cancer screening, smoking cessation, diabetes, congestive heart failure, depression, etc.
• Affinity discounts: access to complementary services through HAP Advantage

HAP POS
Fully-insured, community-rated product
Target market: Groups under 50 or over 250 employees
FEATURES:

• Members choose a PCP who manages or coordinates all care. Under this scenario, members receive the highest level of benefits
• Members may also self-refer to out-of-network or out-of-plan providers and still receive benefits for covered expenses but are subject to higher deductibles and coinsurance
• Community rated: all members pooled together for rating purposes, resulting in relatively consistent rates from year-to-year
• Low out-of-pocket cost: preventative services for a small copayment
• Emergency and urgent care coverage worldwide
• Flexible cost sharing: a range of benefit designs and copayment options available
• Affinity discounts: access to complementary services through HAP Advantage

HAP Senior Plus HMO – Medicare Advantage Plans

• Three county HFHS network is open to Medicare beneficiaries who live in Oakland, Wayne, or Macomb county
• Nine county expanded network is open to Medicare beneficiaries who live in Oakland, Wayne, Macomb, Monroe, Livingston, Washtenaw, St. Clair, Genesee, or Lapeer county
• Also available to individual Medicare beneficiaries.

Alliance Health & Life (AHL)

• Three fully-insured, experience-rated products: EPA, POS, PPO
• Target market: Groups 50 to 250
• Plan design flexibility was the foundation of AHL, however we’re moving toward standardized plans
• Employers can offer more than one product to their employees
• All plans allow for cost sharing options with a range of benefit designs and copayments available
• Groups pay a fixed premium based on the benefits selected, the age/gender makeup of the group, the type of business (SIC code), and their claims experience

AHL Service Area

AHL EPA
Fully-insured, experience-rated products
Target market: Groups over 50 employees
FEATURES:

• Members choose a PCP for routine care. PCP manages and coordinates all medical care needs, authorizes referrals to specialists and admissions to hospitals
• Emergency and urgent care coverage worldwide
• Flexible cost sharing: a range of benefit designs and copayment options available
• Affinity discounts: access to complementary services through HAP Advantage

AHL POS
Fully-insured, experience rated product
Target market: Groups over 50 employees

• Members choose a PCP who manages or coordinates all care. Under this scenario, members receive the highest level of benefits
• Members may also self-refer to out-of-network or out-of-plan providers and still receive benefits for covered expenses but are subject to higher deductibles and coinsurance.
• Experience-rated: premiums based on groups’ claims experience
• Low out-of-pocket cost: preventative services for a small copayment
• Emergency and urgent care coverage worldwide
• Flexible cost sharing: a range of benefit designs and copayment options available
• Affinity discounts: access to complementary services through HAP Advantage

AHL PPO
Fully-insured, experience rated product
Target market: Groups over 50 employees
FEATURES:

• No PCP – all contracted AHL providers are available without referral
• Members use in-network ‘preferred providers’ through plan designs which offer incentives like preventative services
• Members may use out-of-network plan providers but are subject to higher deductibles and coinsurance
• Flexible cost sharing: a range of benefit designs and copayment options available
• Services including prior-authorization, case management and concurrent review processes are administered by HAP’s medical management team
• Emergency and urgent care coverage worldwide
• Affinity discounts: access to complementary services through HAP Advantage

AHL Alliance Medicare PPO – A Medicare Advantage Plan

• Federally funded program that reimburses private plans for each enrollee using historic average costs by county (AAPC)
• Typically offers Medicare eligible beneficiaries more benefits than Medicare
• Employers select from a range of benefits above Original Medicare to create a custom package
• Optional Medicare Prescription Drug Benefit (Medicare Part D) available
• Open to Medicare beneficiaries who live in Oakland, Wayne, Macomb, Monroe, Livingston, Washtenaw, St. Clair, Genesee, or Lapeer county
• Also available to individual Medicare beneficiaries.

HAP Preferred
(Formerly HealthChoice)

• Three self-insured products: EPA, POS, PPO
• Designed for New Business employers with 250 or more employees who are interested in self-funded option with managed care components
• Offers employers the benefits of managed care with flexible plan designs and a broad provider network
• Groups receive information detailing their utilization to help them better manage their plan costs
• HAP Preferred is administered through contract and internal and external TPA’s depending on the product
• The HAP Preferred network can be augmented through participation with ChoiceNet, a statewide affiliation of networks with more than 6,000 contracted providers and 48 hospitals

HAP Preferred Service Area

HAP Preferred EPA
Self-insured product
Target market: New Business groups over 250 employees
FEATURES:

• Members choose a PCP for routine care. PCP manages and coordinates all medical care needs, authorizes referrals to specialists and admissions to hospitals
• Internal TPA and administration only
• Emergency and urgent care coverage worldwide
• Flexible cost sharing: a range of benefit designs and copayment options available
• Affinity discounts: access to complementary services through HAP Advantage

HAP Preferred POS
Self-insured product
Target market: New Business groups over 250 employees
FEATURES:

• Members choose a PCP who manages or coordinates all care. Under this scenario, members receive the highest level of benefits
• Members may also self-refer to our of network or out of plan providers and still receive benefits for covered expenses but are subject to higher deductibles and coinsurance
• Low out-of-pocket cost: preventative services for a small copayment
• Internal TPA administration only
• Emergency and urgent care coverage worldwide
• Flexible cost sharing: a range of benefit designs and copayment options available
• Affinity Discounts: access to complementary services through HAP Advantage

HAP Preferred PPO
Self-insured product
Target market: New Business groups over 250 employees
FEATURES:

• No PCP - all contracted HAP Preferred providers are available without referral
• Members use in-network 'preferred providers' though plan designs which offer incentives like preventative services
• Members may use out-of-network plan providers but are subject to higher deductibles and coinsurance
• Flexible cost sharing: a range of benefit designs and copayment options available
• Services including prior-authorization, case management and concurrent review processes are administered by HAP's medical management team or though an external medical management firm
• External or internal TPA administration
• Emergency and urgent care coverage worldwide
• Affinity discounts: access to complementary services through HAP Advantage

HAP Senior Plus HMO

• Federally funded program that reimburses private plans for each enrollee using historic average costs by county (AAPC)
• Typically offers Medicare eligible beneficiaries more benefits than Medicare
• Employers select from a range of benefits above Original Medicare to create a custom package
• Optional Medicare Prescription Drug Benefit (Medicare Part D) available
• Employers select the HAP Senior Plus HMO HFHS Network Plan or the Expanded Nine County Network Plan

Medicare Complementary

• This plan supplements Medicare benefits while Medicare remains primary coverage
• Typically offers more benefits than Medicare and costs more
• Premiums are increasing due to rapid escalation in Rx costs