Clearwater Internal Company Training PDF

Internal Company Training Part 1 of 3 Link to recording Thanks for joining! Please hold all questions until the end! Write them down as we go so you don’t forget. There will be a test! ● Releasing October 30 ● Open Note ● Meant to be a knowledge check Contents Part 1: ● ● ● ● ● ● ● Company Overview Healthshare 101 ClearShare-Only Memberships & Member Guidelines ClearShare Merge Memberships Care Coordination for ClearShare Virtual Services Questions Part 2: ● MEC Plans ● Major Medical Plans ● Care Coordination for Major Medical ● Health Savings Account 101 ● Supplemental Plans ● Questions Part 3: ● Plans Recap ● Business Rules ● Third Party Services ● GDrive Review ● Post Enrollment Review ● Questions Company Overview Who’s who in the ecosystem Clearwater Benefits Holdings, LLC This entity owns the agency and TPA. It houses shared services, such as ﬁnance, technology, and marketing. A company that provides virtual assistant services. Trident sponsors several insurance plans for Limited Partners. www.tridentbpo.com The agency or healthcare brokerage that does the selling. Sells Major Medical and supplemental insurance plans and healthshare memberships. The third-party administrator (TPA) that does the administrating (customer service, plan design, claims, billing, etc.) for health plans and employers. Previously known as Boomy Health. A nonproﬁt healthcare sharing organization. clearsharehealth.org Plans Major Medical Plans ● Copay 3500 ● Copay 4500 ● Copay 8000 ● HSA 5000 ● MVP Minimum Essential Coverage (MEC) Plans ● Advanced ● Basic ● HSA Supplementals ● Dental, vision ● Accident, critical illness, hospital indemnity ● Life ClearShare Memberships ● Advanced ClearShare 1000 ● Advanced ClearShare 2500 ● Advanced ClearShare 5000 ● Basic ClearShare 1000 ● Basic ClearShare 2500 ● Basic ClearShare 5000 ● ClearShare 1000 ● ClearShare 2500 ● ClearShare 5000 **ClearShare-only is often paired with a Trident MEC plan. Plans Major Medical Plans ● Copay 3500 ● Copay 4500 ● Copay 8000 ● HSA 5000 ● MVP Minimum Essential Coverage (MEC) Plans ● Advanced ● Basic ● HSA Merge Plans ClearShare -Only Supplementals ● Dental, vision ● Accident, critical illness, hospital indemnity ● Life ClearShare Memberships ● Advanced ClearShare 1000 ● Advanced ClearShare 2500 ● Advanced ClearShare 5000 ● Basic ClearShare 1000 ● Basic ClearShare 2500 ● Basic ClearShare 5000 ● ClearShare 1000 ● ClearShare 2500 ● ClearShare 5000 **ClearShare-only is often paired with a Trident MEC plan. Plans Major Medical Plans ● Copay 3500 ● Copay 4500 ● Copay 8000 ● HSA 5000 ● MVP Minimum Essential Coverage (MEC) Plans ● Advanced ● Basic ● HSA Merge Plans ClearShare -Only Supplementals ● Dental, vision ● Accident, critical illness, hospital indemnity ● Life ClearShare Memberships ● Advanced ClearShare 1000 ● Advanced ClearShare 2500 ● Advanced ClearShare 5000 ● Basic ClearShare 1000 ● Basic ClearShare 2500 ● Basic ClearShare 5000 ● ClearShare 1000 ● ClearShare 2500 ● ClearShare 5000 **ClearShare-only is often paired with a Trident MEC plan. Plan Major Medical Plans ● Copay 3500 ● Copay 4500 ● Copay 8000 ● HSA 5000 ● MVP Minimum Essential Coverage (MEC) Plans ● Advanced ● Basic ● HSA ClearShare Memberships ● Advanced ClearShare ● Basic ClearShare ● ClearShare-only ● $1000, $2500, $5000 annual max Dental and Vision Accident, Critical Illness, Hospital Indemnity, Life Clearwater (Agency) Role Clearwater Beneﬁts Administrators (TPA) Role Trident Role ClearShare Role Broker that sells the plans. Plan administration: customer service, billing, plan design, claims, etc. Note: HMA also assists Employer of these self-funded plans. To enroll, members ﬁrst become Limited Partners. NONE Broker that sells the plans. Plan administration: customer service, billing, plan design, claims, etc. Note: HMA also assists Employer of these self-funded NONE - but these plans are plans. To enroll, members ﬁrst often paired with a ClearShare become Limited Partners. membership. Broker that sells the plans. Membership administration: customer service, billing, needs, etc. Broker that sells the plans. Plan administration: customer service, billing, plan design, claims, etc. Note: HMA also assists Employer of these self-funded plans. To enroll, members ﬁrst become Limited Partners. NONE Broker that sells the plans. Clearwater handles billing, and a Employer of these self-funded third party (Breckpoint, Manhattan plans. To enroll, members ﬁrst Life) handles claims, plan design, become Limited Partners. etc. NONE NONE Oﬀering these healthshare membership is ClearShare’s purpose. ClearShare funds the organization. Additional Resources ● ● VIDEO: Two Paths - Major Medical and ClearShare BROCHURE: Clearwater Overview ● Websites: ○ ClearwaterHealth.com - Main/corporate website ○ ClearwaterBeneﬁtsAdmin.com - TPA site ○ ClearShareHealth.org - ClearShare site ○ TridentBPO.com - Trident site ○ Multiple white-labeled afﬁliate sites where members can enroll Healthshare 101 What’s a healthshare and how is it different from insurance? What is a healthshare? A healthshare (also called medical cost sharing or a healthcare sharing ministry), provides an organized structure for a community of like-minded members to contribute toward each other’s medical costs. They are not-for-proﬁt organizations in which members agree to abide by a commonly-shared code of conduct to help keep the overall care costs for the community down. Healthshares are not insurance. Healthshares are not bound by state or federal government laws and regulations around insurance. Additional Resources: ● ● Healthshare 101 Flyer How Healthshares work blog Healthshare vs insurance Apples: ● High in ﬁber, vitamins and minerals ● Can prevent many diseases ● Higher foliage Oranges: ● High in ﬁber, vitamins and minerals ● Can prevent many diseases ● Higher vitamin C Healthshare vs insurance Healthshare Healthshare: ● Used to pay medical expenses ● Not bound by laws & regulations ● Members submit needs Insurance Insurance: ● Used to pay medical expenses ● Bound by laws & regulations ● Providers submit claims Healthshare Terminology Healthshare Term Use this… Insurance Term Not this Need Claim “We share in needs” “We arrange cost sharing among members” “We pay claims” Monthly cost / Monthly contribution Premium Annual Max Deductible Visit fee / Member cost / Patient responsibility Copay Contents Part 1: ● ● ● ● ● ● ● Company Overview Healthshare 101 ClearShare-Only Memberships & Member Guidelines ClearShare Merge Memberships Care Coordination for ClearShare Virtual Services Questions Part 2: ● MEC Plans ● Major Medical Plans ● Care Coordination for Major Medical ● Health Savings Account 101 ● Supplemental Plans ● Questions Part 3: ● Plans Recap ● Business Rules ● Third Party Services ● GDrive Review ● Post Enrollment Review ● Questions ClearShare Memberships Clearwater is a broker and administrator for ClearShare memberships. ClearShare Membership Options We oﬀer four ClearShare Membership types to match your healthcare needs & preferences: ClearShare-only, Advanced, Basic, and HSA. Day-to-day Coverage? Major incidents? ❍ Advanced -More comprehensive plan -Set amounts for everyday care like doctor visits, prescriptions, & diagnostics including out-of-network ❍ ❍ Basic -Set amounts for doctor visits and prescriptions in network Pick your Annual Max HSA -HSA - Health Savings Account -Rarely visit the doctor -Pay for day-to-day needs with a tax deductible HSA Supplemental Insurance? How much do you want to pay in the event of a major health incident: ❍ Dental ❍ $1,000 ❍ $2,500 ❍ $5,000 ❍ Accident ❍ Vision ❍ Critical Illness ClearShare Membership Options We oﬀer four ClearShare Membership types to match your healthcare needs & preferences: ClearShare-only, Advanced, Basic, and HSA. Day-to-day Coverage? Major incidents? ❍ Advanced -More comprehensive plan -Set amounts for everyday care like doctor visits, prescriptions, & diagnostics including out-of-network ❍ ❍ Basic -Set amounts for doctor visits and prescriptions in network Pick your Annual Max HSA -HSA - Health Savings Account -Rarely visit the doctor -Pay for day-to-day needs with a tax deductible HSA Supplemental Insurance? How much do you want to pay in the event of a major health incident: ❍ Dental ❍ $1,000 ❍ $2,500 ❍ $5,000 ❍ Accident ❍ Vision ❍ Critical Illness Plans Major Medical Plans ● Copay 3500 ● Copay 4500 ● Copay 8000 ● HSA 5000 ● MVP Minimum Essential Coverage (MEC) Plans ● Advanced ● Basic ● HSA Merge Plans ClearShare -Only Supplementals ● Dental, vision ● Accident, critical illness, hospital indemnity ● Life ClearShare Memberships ● Advanced ClearShare 1000 ● Advanced ClearShare 2500 ● Advanced ClearShare 5000 ● Basic ClearShare 1000 ● Basic ClearShare 2500 ● Basic ClearShare 5000 ● ClearShare 1000 ● ClearShare 2500 ● ClearShare 5000 **ClearShare-only is often paired with a Trident MEC plan. ClearShare-Only Membership Where are the member guidelines? ● ClearShareHealth.org/member-guidelines/ Additional resources: ● ● ● ● ● ClearShare 1000 plan page ClearShare 2500 plan page ClearShare 5000 plan page VIDEO: ClearShare General How to Submit a ClearShare Medical Need Request Statement of Beliefs and Membership Eligibility Membership eligibility in ClearShare is primarily based on two factors: 1. 2. Adherence to the ClearSare Statement of Beliefs Participation in the community by submitting monthly contributions Enrollment Requirements Age caps: ● Primary members must be at least 18 years old. ● All members must be under 65 years old. ● Dependents can be on a parent’s plan until age 26. Membership Tiers: ● Member Only: An individual member of ClearShare ● Member + Spouse: A member and their spouse ● Member + Children: A member and their dependent child or children ● Member + Family: A member, spouse, and any dependent children Tobacco Surcharge ● Monthly tobacco surcharge is $50 per household. How Needs Are Shared Need: Expenses related to the same medical condition, whether expenses for a single incident or separate incidents, will be shared as one need. The related expenses will accumulate toward the total need amount. Annual Maximum: The annual maximum is the amount that a member will pay before the ClearShare community shares in medical expenses. The Annual Maximum is also known as your personal responsibility. ClearShare has three primary levels of personal responsibility: $1000, $2500, and $5000. Service copays or service costs that apply to a member’s deductible are not included in the annual maximum. How Needs Are Shared Family Annual Maximum: If you have family members on the plan, they have to meet their own Annual Max until the overall Family Annual Max has been met. Once the household has paid up to its Family Annual Max, the ClearShare community will share in eligible medical expenses at 100%. Family Annual Max - Example ● ● ● ● Family of four ClearShare 1000 Annual Max: $1,000 Family Annual Max: $3,000 Primary: Pays $1,000 Household: Paid $1,000 Jan 2023 Feb 2023 Mar 2023 Apr 2023 May 2023 June 2023 July 2023 Aug 2023 Sept 2023 Oct 2023 Nov 2023 Dec 2023 Family Annual Max - Example ● ● ● ● Primary: Pays $1,000 Child 1: Pays $1,000 Household: Paid $1,000 Household: Paid $2,000 Jan 2023 Feb 2023 Mar 2023 Apr 2023 Family of four ClearShare 1000 Annual Max: $1,000 Family Annual Max: $3,000 May 2023 June 2023 July 2023 Aug 2023 Sept 2023 Oct 2023 Nov 2023 Dec 2023 Family Annual Max - Example ● ● ● ● Family of four ClearShare 1000 Annual Max: $1,000 Family Annual Max: $3,000 Primary: Pays $1,000 Child 1: Pays $1,000 Primary Pays $0! Household: Paid $1,000 Household: Paid $2,000 Household: Paid $2,000 Jan 2023 Feb 2023 Mar 2023 Apr 2023 May 2023 June 2023 July 2023 Aug 2023 Sept 2023 Oct 2023 Nov 2023 Dec 2023 Family Annual Max - Example ● ● ● ● Primary: Pays $1,000 Child 1: Pays $1,000 Household: Paid $1,000 Household: Paid $2,000 Jan 2023 Feb 2023 Mar 2023 Family of four ClearShare 1000 Annual Max: $1,000 Family Annual Max: $3,000 Primary Pays $0! Child 2: Pays $700 Household: Household: Paid $2,000 Paid $2,700 Apr 2023 May 2023 June 2023 July 2023 Aug 2023 Sept 2023 Oct 2023 Nov 2023 Dec 2023 Family Annual Max - Example ● ● ● ● Family of four ClearShare 1000 Annual Max: $1,000 Family Annual Max: $3,000 Family Annual Max met! Primary: Pays $1,000 Child 1: Pays $1,000 Household: Paid $1,000 Household: Paid $2,000 Jan 2023 Feb 2023 Mar 2023 Primary Pays $0! Child 2: Pays $700 Spouse: Pays $300 Household: Household: Paid $2,000 Paid $2,700 Apr 2023 May 2023 June 2023 July 2023 Household: Paid $3,000 Aug 2023 Sept 2023 Oct 2023 Nov 2023 Dec 2023 Family Annual Max - Example ● ● ● ● Family of four ClearShare 1000 Annual Max: $1,000 Family Annual Max: $3,000 Family Annual Max met! Primary: Pays $1,000 Child 1: Pays $1,000 Household: Paid $1,000 Household: Paid $2,000 Jan 2023 Feb 2023 Mar 2023 Primary Pays $0! Child 2: Pays $700 Household: Household: Paid $2,000 Paid $2,700 Apr 2023 May 2023 June 2023 July 2023 Aug 2023 Spouse: Pays $300 Child 2: Pays $0 Household: Paid $3,000 Household: Paid $3,000 Sept 2023 Oct 2023 Nov 2023 Dec 2023 How Needs are Shared ● Members submit their need request online: ClearShareHealth.org/need-request ● Need request should include the Superbill (the itemized bill with CPT codes on it), and medical records ● Membership must be in good standing (paid) ● Membership must be active during dates of service and when determination is made. ● Six months to submit need from date of service. ● Read more: How to Submit a ClearShare Medical Need Request Pre-membership medical conditions 12 Month Treatment Free: Needs that arise from conditions that existed prior to membership are only shareable if the condition was regarded as cured and did not require treatment for 12 months prior to the effective date of membership. Any illness or injury for which a person has been: ● Examined ● Taken medication ● Had a diagnostic test performed or ordered by a physician ● Or received medical treatment Exceptions for High Blood Pressure, High Cholesterol, Diabetes High blood pressure, high cholesterol, and diabetes (types 1 and 2) will not be considered pre-membership medical conditions as long as the member has not been hospitalized for the condition in the 12 months prior to effective date and is able to control it through medication and/or diet. Exceptions for Cancer, Heart Disease, Stroke, COPD: Cancer, Heart Disease, Stroke, and COPD are only shareable if the condition was regarded as cured and did not require treatment for 5 years prior to the effective date of membership. Pre-membership medical conditions Pre-Membership Medical Condition Phase-In Period Shareable amounts for pre-membership medical conditions: ● Year One: $0 (waiting period) ● Year Two: $25,000 maximum beneﬁt per pre-membership medical condition ● Year Three: $50,000 maximum beneﬁt per pre-membership medical condition ● Year Four: $125,000 maximum beneﬁt per pre-membership medical condition After year four of membership, expenses related to pre-membership medical conditions will remain shareable at a maximum of $125,000 in a 12-month rolling period and resetting each membership year based on effective date. Speciﬁc Sharing Qualiﬁcations / Medical Expenses Ineligible for Sharing Member needs not associated with a pre-membership medical condition are generally shareable. ● Speciﬁc Sharing Qualiﬁcations: 38 conditions with special rules or limitations ● Medical Expenses Ineligible for Sharing: 16 conditions that are not shareable. Use CTRL + F to quickly search the member guidelines. ClearShareHealth.org/member-guidelines Maternity As a general rule, maternity needs are shareable and are treated like any other medical need. ● ● Annual max applies Baby’s needs are separate Pregnancy Prior to Membership Conception that occurs prior to membership or within the ﬁrst 60 days of membership is eligible for sharing, but with a $50,000 limit. In this event, medical expenses for all newborns are also eligible for sharing, but with another $50,000 limit. Additional Resources: ● ClearShare Maternity Guidelines ClearShare-Only Network ClearShare-only has NO restrictions on providers members can access. They can go anywhere for care! Member Guidelines ClearShareHealth.org/ member-guidelines ClearShare Memberships Merge Plans - Advanced & Basic Plans Major Medical Plans ● Copay 3500 ● Copay 4500 ● Copay 8000 ● HSA 5000 ● MVP Minimum Essential Coverage (MEC) Plans ● Advanced ● Basic ● HSA Merge Plans ClearShare -Only Supplementals ● Dental, vision ● Accident, critical illness, hospital indemnity ● Life ClearShare Memberships ● Advanced ClearShare 1000 ● Advanced ClearShare 2500 ● Advanced ClearShare 5000 ● Basic ClearShare 1000 ● Basic ClearShare 2500 ● Basic ClearShare 5000 ● ClearShare 1000 ● ClearShare 2500 ● ClearShare 5000 **ClearShare-only is often paired with a Trident MEC plan. ClearShare Membership Options We oﬀer four ClearShare Membership types to match your healthcare needs & preferences: ClearShare-only, Advanced, Basic, and HSA. Day-to-day Coverage? Major incidents? ❍ Advanced -More comprehensive plan -Set amounts for everyday care like doctor visits, prescriptions, & diagnostics including out-of-network ❍ ❍ Basic -Set amounts for doctor visits and prescriptions in network Pick your Annual Max HSA -HSA - Health Savings Account -Rarely visit the doctor -Pay for day-to-day needs with a tax deductible HSA Supplemental Insurance? How much do you want to pay in the event of a major health incident: ❍ Dental ❍ $1,000 ❍ $2,500 ❍ $5,000 ❍ Accident ❍ Vision ❍ Critical Illness Advanced ClearShare Advanced ClearShare Healthshare Term Use this… Insurance Term Not this Need Claim “We share in needs” “We arrange cost sharing among members” “We pay claims” Monthly cost / Monthly contribution Premium Annual Max Deductible Visit fee / Member cost / Patient responsibility Copay Advanced ClearShare ● Annual Max does not apply ● Pre-membership conditions do not apply Advanced ClearShare These Services are on a Network To ﬁnd a list of providers, go to the PHCS Network website: 1. 2. 3. 4. Click on "Change Network" Click on "PHCS" Click on "Speciﬁc Services" Search for a provider If you need to ﬁnd a provider outside of the PHCS Speciﬁc Services network, go to the PNOAe network website. Select the "PNOAe (Exclusive) Network" option. For expensive and emergency services, members have no network restrictions and can receive care anywhere. This includes major procedures, accidents, surgeries, ER, and hospital visits. Advanced ClearShare Network Applies Services part of the “Advanced” portion of the plan = Part of PHCS or PNOA No Network Services part of ClearShare-only Advanced ClearShare: Additional Resources Watch: Advanced ClearShare ● ● ClearShare Advanced Membership Add-On Guidelines Sample plan page: Advanced + ClearShare 1000 ClearShare Membership Options We oﬀer four ClearShare Membership types to match your healthcare needs & preferences: ClearShare-only, Advanced, Basic, and HSA. Day-to-day Coverage? Major incidents? ❍ Advanced -More comprehensive plan -Set amounts for everyday care like doctor visits, prescriptions, & diagnostics including out-of-network ❍ ❍ Basic -Set amounts for doctor visits and prescriptions in network Pick your Annual Max HSA -HSA - Health Savings Account -Rarely visit the doctor -Pay for day-to-day needs with a tax deductible HSA Supplemental Insurance? How much do you want to pay in the event of a major health incident: ❍ Dental ❍ $1,000 ❍ $2,500 ❍ $5,000 ❍ Accident ❍ Vision ❍ Critical Illness Basic ClearShare Basic ClearShare Healthshare Term Use this… Insurance Term Not this Need Claim “We share in needs” “We arrange cost sharing among members” “We pay claims” Monthly cost / Monthly contribution Premium Annual Max Deductible Visit fee / Member cost / Patient responsibility Copay Basic ClearShare ● Annual Max does not apply ● Pre-membership conditions do not apply Basic ClearShare These Services are on a Network To ﬁnd a list of providers, go to the PHCS Network website: 1. 2. 3. 4. Click on "Change Network" Click on "PHCS" Click on "Speciﬁc Services" Search for a provider If you need to ﬁnd a provider outside of the PHCS Speciﬁc Services network, go to the PNOAe network website. Select the "PNOAe (Exclusive) Network" option. For expensive and emergency services, members have no network restrictions and can receive care anywhere. This includes major procedures, accidents, surgeries, ER, and hospital visits. Basic ClearShare Network Applies Services part of the “Basic” portion of the plan = Part of PHCS or PNOA No Provider Restrictions No Provider Restrictions No Provider Restrictions No Provider Restrictions No Provider Restrictions No Network Services part of ClearShare-only Basic ClearShare: Additional Resources Watch: Basic ClearShare ● ● ClearShare Basic Membership Add-On Guidelines Sample plan page: Basic + ClearShare 1000 Advanced vs Basic Advanced ClearShare Basic ClearShare ClearShare Membership Options We oﬀer four ClearShare Membership types to match your healthcare needs & preferences: ClearShare-only, Advanced, Basic, and HSA. Day-to-day Coverage? Major incidents? ❍ Advanced -More comprehensive plan -Set amounts for everyday care like doctor visits, prescriptions, & diagnostics including out-of-network ❍ ❍ Basic -Set amounts for doctor visits and prescriptions in network Pick your Annual Max HSA -HSA - Health Savings Account -Rarely visit the doctor -Pay for day-to-day needs with a tax deductible HSA Supplemental Insurance? How much do you want to pay in the event of a major health incident: ❍ Dental ❍ $1,000 ❍ $2,500 ❍ $5,000 ❍ Accident ❍ Vision ❍ Critical Illness ClearShare Membership Options We oﬀer four ClearShare Membership types to match your healthcare needs & preferences: ClearShare-only, Advanced, Basic, and HSA. Day-to-day Coverage? ❍ Advanced -More comprehensive plan -Set amounts for everyday care like doctor visits, prescriptions, & diagnostics including out-of-network ❍ ❍ Basic -Set amounts for doctor visits and prescriptions in network The HSA portion of the plan is a Trident Minimum Essential Coverage (MEC) plan! Major incidents? Pick your Annual Max HSA -HSA - Health Savings Account -Rarely visit the doctor -Pay for day-to-day needs with a tax deductible HSA Supplemental Insurance? How much do you want to pay in the event of a major health incident: ❍ Dental ❍ $1,000 ❍ $2,500 ❍ $5,000 ❍ Accident ❍ Vision ❍ Critical Illness Contents Part 1: ● ● ● ● ● ● ● Company Overview Healthshare 101 ClearShare-Only Memberships & Member Guidelines ClearShare Merge Memberships Care Coordination for ClearShare Virtual Services Questions Part 2: ● MEC Plans ● Major Medical Plans ● Care Coordination for Major Medical ● Health Savings Account 101 ● Supplemental Plans ● Questions Part 3: ● Plans Recap ● Business Rules ● Third Party Services ● GDrive Review ● Post Enrollment Review ● Questions Care Coordination For ClearShare Care Coordination for ClearShare Care Coordination is here to help you lower your healthcare costs. We connect you with lower cost , high quality providers for your labs, imaging and major procedures. Care Coordination Example A member needed knee-replacement surgery. There were two options for care nearby: MD Anderson Hospital ● ● Specialty is NOT ortho Charges $80,000 Orthopedic Surgery Center ● ● Specializes in ortho Charges $40,000 We recommended the Orthopedic Surgery Center because: ● ● ● Their surgeons are more specialized and experienced. Their price is much lower! We cut the cost in half, allowing us to keep monthly costs low. In return, we covered this member's out-of-pocket fees. They got a knee-replacement surgery for FREE, just for choosing an experienced and fair provider. Care Coordination for ClearShare What services qualify? Care Coordination for ClearShare What services qualify? Care Coordination can help you ﬁnd local providers if the primary and secondary network doesn’t provide the coverage you need in your area. Care Coordination for ClearShare What services qualify? Can I choose the doctor I want to see? Care Coordination can help you ﬁnd local providers if the primary and secondary network doesn’t provide the coverage you need in your area. No, Care Coordination works to ﬁnd and recommend you a fair-priced, high quality provider. If you want to choose your own provider, you an use your plan’s applicable in-network or out-of-network services. Additional Resources ● About Care Coordination ● Introduction to Care Coordination ● Care Coordination FAQ Note: Care Coordination works a little bit differently on ClearShare than on Major Medical! Contents Part 1: ● ● ● ● ● ● ● Company Overview Healthshare 101 ClearShare-Only Memberships & Member Guidelines ClearShare Merge Memberships Care Coordination for ClearShare Virtual Services Questions Part 2: ● MEC Plans ● Major Medical Plans ● Care Coordination for Major Medical ● Health Savings Account 101 ● Supplemental Plans ● Questions Part 3: ● Plans Recap ● Business Rules ● Third Party Services ● GDrive Review ● Post Enrollment Review ● Questions Virtual Services Lyric Telemedicine & Talkspace Lyric Telemedicine Access 24/7 virtual access to doctors for $0. Includes urgent care for $0 and behavioral health counseling for $0. ● ● Access Lyric Telemedicine within your Health Wallet App Or call Lyric toll free: 800-363-3725 Adding my family members ● Primary members, spouses, and dependents aged 18-26 can access their own unique Lyric accounts through their own Health Wallet accounts. ● Add child dependents within Lyric account settings. Additional Resources ● Lyric Brochures ● The Advantages of Telemedicine Talkspace Beneﬁts ● Unlimited Messaging Therapy for members and dependents age 13+ ● Therapy: One 30-minute Live Video Session per month for individuals age 13+, $65 for additional sessions ● Psychiatry: up to 13 Live Video Sessions annually for individuals age 18+ Talkspace Access To access Talkspace, visit Talkspace.com/Clearwater and and sign up using the following information: ● Organization name: Clearwater ● Keyword for psychiatry: Clearwater Psych Therapy Additional Resources ● Talkspace FAQ ● Talkspace Comms Portal ● Video: Talkspace Member Overview Psychiatry Contents Part 1: ● ● ● ● ● ● ● Company Overview Healthshare 101 ClearShare-Only Memberships & Member Guidelines ClearShare Merge Memberships Care Coordination for ClearShare Virtual Services Questions Part 2: ● MEC Plans ● Major Medical Plans ● Care Coordination for Major Medical ● Health Savings Account 101 ● Supplemental Plans ● Questions Part 3: ● Plans Recap ● Business Rules ● Third Party Services ● GDrive Review ● Post Enrollment Review ● Questions Questions? Use the Raise Hand function on Zoom. If we run out of time or you are watching the recording, ask here: https://docs.google.com/forms/d/e/1FAIpQLSdzBRk_ jgiTEMACX2vjAgIWFA xreHtunKAWEanqF2ZQo3NL4g/viewform?usp=sf_link

Clearwater Internal Company Training PDF

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