PEACEPlan brings a unique understanding of the healthcare foundations we all expect and innovative ways to improve upon them. We have unleashed today’s brightest technology to solve some age old problems and bring you better access to the care you require and deserve.
Each member in the health plan will have their own personal Health Advocate, this Advocate will assist you in obtaining access to: Preventative Services, Primary Care, understanding what is and is not covered in your health plan benefits, obtaining specialist coverage, In/Out of Network Coverage, Prescriptions, Telemedicine, Behavioral Health, Vision services.
This is your FIRST POINT of contact with the healthcare system. This is VERY different than what you are used to with other health plans – we are here to help you navigate this very complex system. The goal is to provide simple, easy access, thus creating the necessary behavioral change and guide the participant with a high-touch service through the complex healthcare system to maximize their benefits.
Your Advocate is available 24/7, via Mobile APP, email or phone.
Advocacy Coaches support Members in understanding prevention, treatment options, provider choices and how to navigate the healthcare system.
In addition, the AHG Advocacy Coaches use Healthcare Bluebook online price/quality tools to help Members compare price and quality rankings between local providers for any healthcare procedures, tests or services they may need. Prices can vary by more than six hundred percent (600%) for the same in-network procedure or service of similar quality, depending upon which provider is selected. When Members understand how to choose high value providers, significant cost savings occur for both Members and their employers.
Healthcare Bluebook is also integrated into AHG’s precertification platform for approval of certain inpatient and outpatient services that are required by PEACEPlan health benefit plans. With almost all competitors, precertification requests come from network providers after such providers have been contacted by employees and dependents.
Technology is the backbone of the PEACEPlan.
Every member and dependent will receive a free Mobile APP for either iOS or Android phones. At the touch of a button, this Mobile APP will assist Members to directly communicate with your personal Healthcare Advocate, Plan services and information regarding individual plan, and provide access to other healthcare options.
PEACEPlan and its best-of-breed service firms are connected electronically so that the use, cost and payment of health benefits occurs quickly and seamlessly. These linkages allow PEACEPlan to track and assess how Members are using their benefits and what adjustments to the PEACEPlan model could improve performance for employers. This type of assessment doesn’t happen with the insured benefit plans offered by competitors to small employers.
The Healthcare Bluebook technology managed by American Health Group, AHG, drives cost effective utilization of the PEACEPlan provider network.
PEACEPlan will analyze the health data to assess how members are using their benefits and what adjustments to the IHS plans could reduce costs, improve population health and create greater efficiencies for members going forward.
Except for the High Deductible Plans, all Primary Care is covered at 100%, with no out of pocket copays, deductible or coinsurance. Your Advocates will help you choose a Primary care doctor if you do not already have one.
Members are encouraged to discuss with their Advocate any services needed or to be obtained through their Primary Care, such as an annual physical, preventative care or diagnostic.
Free Preventative Care
PEACEPlan covers all 66 preventative services for men, women and children that are required by the Affordable Care Act. There is no cost to Members for these services. Nearly all preventative services can be provided by primary care physicians in the PEACEPlan provider network.
This includes pediatric inoculations, flu shots, annual physicals, well visits, mammograms and colonoscopies.
Specialists & Specialty Care
PEACEPlan Advocates will assist you in finding an In-Network provider for any lab work, imaging, specialty providers needs and services.
PEACEPlan Advocates will also help you understand how to choose the highest quality provider at the lowest cost to you and your family. Pre-certification/authorization is required for most elective procedures in your Plan, your Advocate will be there to assist you in obtaining your authorization and insuring access to the care you need.
Your network is the First Health National Network, this means you have access to over 93% of the healthcare providers in the US.
This network provides discounts for services you may need and your Advocate can assist you in making sure that your provider is in the Network and that you are informed on the quality and cost of the service being provided before you obtain those services.
All Pharmacy Benefit Managers (PBM) are not created equal.
You have access to over 65,000 pharmacies across the U.S. Contact your Advocate if you have any questions on where and how to obtain your prescriptions at the lowest possible cost.
You will also have access to a pharmacy discount card option, which means you can shop for the best price for your pharmacy needs before you buy them
During pre-authorization by PBM, high cost drugs can be identified and alternatives may be identified. If there is only a brand name available, the stop loss carrier may elect to separate from the claims pool and manage independently
This is a FREE 24/7 service for any Non-Emergency healthcare needs, so you may not need to go to the Emergency Room or Clinic, there is NO Copay, deductible or coinsurance on your part for this service.
A Doctor will be able to prescribe medications over the phone and send them to your local pharmacy of choice.
Contact your Advocate for help in accessing the correct kind of care based on your needs.
Behavioral Health Benefits
This is a FREE 24/7 service for any mental or stress related concern or needs.
This benefit is COMPLETELY confidential and there are virtually no restrictions when accessing this benefit.
This is a Completely FREE benefit (no premium) for you and your family. You will have access to eye exams once a year for a $10 copay and additional benefits for eyeglasses and contacts. You can see your benefits book for more details or contact your Advocate for help in accessing and maximizing this benefit.
This benefit is highly recommended even if your eyesight is currently good. Eye exams can detect diabetes, MS, high cholesterol, thyroid, lupus and many cancers before they present any symptoms.
PEACEPlan has curated a health benefit package with some of the best partners in the business. With a shared vision for impacting and disrupting the current health benefit market, these partners stand ready to provide best-in-class service through an integrated benefit offering.
Third Party Administrator
Regional Care, Inc. (RCI) is one of the nation’s premier independent third-party administrators. We have continued to grow our business by offering unique products and delivering exemplary services to our clients and broker partners while managing healthcare costs effectively.
RxPreferred offers a full line of Pharmacy Benefit Management solutions for employers, hospitals, hospices, brokers and third-party administrators. RxPreferred focuses on guaranteed savings and cost-containment strategies while providing our clients with innovative, efficient, and effective pharmacy benefit management services.
Teladoc provides access to healthcare on your schedule with 24/7 access to U.S.-licensed doctors, connect by phone, web, or app from anywhere, and get medical treatment for non-emergency conditions.
Advocacy and Care Management
American Health Group, Inc. (“AHG”) provides a suite of health engagement services to employers, union trusts, health insurers and third party administrators in the western U.S. AHG offers an integrated engagement solution for PEACEPlan members that includes advocacy coaching, PCP selection, pre-certification of certain services directly with members, hospital stay review, second opinions, case management and use of Healthcare Bluebook to access less costly, quality providers.