Attention, St. Mary’s health insurance policyholders! As we approach the year 2025, significant changes are on the horizon that will reshape your healthcare coverage. These adjustments are meticulously crafted to enhance the quality and affordability of your insurance experience, ensuring that you continue to receive the optimal care you deserve.
At the forefront of these changes is a renewed focus on preventive care. St. Mary’s recognizes the paramount importance of early detection and proactive health management. To this end, your health plan will provide incentives and expanded coverage for wellness screenings, checkups, and vaccinations. By investing in preventative measures, we aim to empower you to take charge of your health, reduce the risk of chronic diseases, and ultimately live a longer, healthier life.
Furthermore, St. Mary’s is committed to ensuring that its health insurance plans remain accessible and affordable to all policyholders. Through strategic negotiations and partnerships with healthcare providers, we have secured competitive rates and expanded networks, providing you with a wide range of affordable care options. Additionally, our tiered plan structure allows you to tailor your coverage to meet your specific needs and budget, giving you greater flexibility and control over your healthcare expenses. Embracing these changes ensures that St. Mary’s will continue to be your trusted partner in maintaining your health and well-being well into the future.
Enhancements to Comprehensive Coverage
Expanded Behavioral Health Benefits
In the upcoming year, St. Mary’s Health Insurance is committed to enhancing the accessibility and scope of behavioral health services for its members. Recognizing the growing prevalence of mental health concerns, particularly in the aftermath of the COVID-19 pandemic, the insurer has introduced several significant changes.
**Enhanced Outpatient Coverage:** Members will now have access to expanded outpatient behavioral health services, including therapy and counseling sessions. The increased coverage is designed to provide more comprehensive support for individuals struggling with mental health challenges.
**Increased Inpatient Treatment Coverage:** St. Mary’s Health Insurance is also expanding coverage for inpatient behavioral health treatment. This includes increased support for residential treatment programs, partial hospitalization programs, and intensive outpatient programs. The aim is to provide more comprehensive care for individuals who require higher levels of support.
**Integrated Care Approach:** The insurer is implementing an integrated care approach that seamlessly combines behavioral health services with medical care. This approach is designed to improve health outcomes by addressing the whole person, considering both physical and mental well-being.
Through these enhancements, St. Mary’s Health Insurance is empowering its members to seek the necessary support for their mental health needs, promoting their overall health and well-being.
Extended Coverage for Chronic Conditions
St. Mary’s Health Insurance is also extending coverage for a range of chronic conditions, recognizing the unique challenges faced by individuals living with these conditions. The insurer has introduced several enhancements to provide members with more comprehensive support.
**Expanded Case Management Services:** Members with chronic conditions will have access to expanded case management services, providing personalized support and guidance. Case managers will work with members to develop tailored care plans, coordinate appointments, and monitor progress.
**Enhanced Medication Coverage:** The insurer is also enhancing medication coverage for chronic conditions, reducing out-of-pocket expenses for members. This includes expanding the formulary to include more specialty medications and increasing access to affordable generic options.
**Specialized Disease Management Programs:** St. Mary’s Health Insurance has implemented specialized disease management programs for conditions such as diabetes, heart disease, and cancer. These programs provide members with comprehensive education, support, and resources tailored to their specific condition.
By extending coverage for chronic conditions, St. Mary’s Health Insurance is demonstrating its commitment to supporting individuals in managing their health effectively and living fulfilling lives.
Preventive Care Enhancements
In addition to enhancing coverage for behavioral health and chronic conditions, St. Mary’s Health Insurance is also prioritizing preventive care. The insurer has introduced several enhancements to encourage members to take a proactive approach to their health.
**Increased Coverage for Screenings:** The insurer has expanded coverage for preventive screenings, including mammograms, colonoscopies, and other tests recommended by medical guidelines. These screenings play a crucial role in early detection and prevention of serious health conditions.
**Enhanced Wellness Programs:** St. Mary’s Health Insurance offers a range of wellness programs designed to promote healthy habits and disease prevention. These programs include health assessments, nutrition counseling, and fitness classes.
**Reimbursement for Over-the-Counter Medications:** The insurer is introducing reimbursement for over-the-counter medications used for preventive care, such as pain relievers, allergy medications, and vitamins. This enhancement makes preventive care more accessible and affordable for members.
St. Mary’s Health Insurance’s commitment to preventive care empowers members to take an active role in maintaining their health and well-being, reducing the risk of developing chronic conditions and improving overall health outcomes.
Adjustments to Deductible Options
St. Marys Health Insurance is committed to providing affordable and comprehensive coverage to its members. As part of this commitment, we are making adjustments to our deductible options for 2025.
The following are the key changes:
Lowering the High-Deductible Health Plan (HDHP) Deductible
For 2025, we will be lowering the HDHP deductible for all plans. This will make HDHPs more affordable for members who are healthy and don’t expect to use their health insurance often.
The new HDHP deductibles will be as follows:
| Plan | Individual Deductible | Family Deductible |
| Bronze | $1,500 | $3,000 |
| Silver | $2,000 | $4,000 |
| Gold | $2,500 | $5,000 |
Introducing a New Zero-Deductible Option
For members who prefer to have no deductible, we are introducing a new zero-deductible option. This option will be available on all plans, except for the Bronze plan.
The premiums for the zero-deductible option will be higher than the premiums for the other deductible options. However, members who choose the zero-deductible option will not have to pay anything out of pocket for covered services.
Other Deductible Changes
In addition to the changes listed above, we are also making some other minor changes to our deductible options. These changes include:
- Eliminating the $500 deductible option for the Bronze plan.
- Increasing the deductible for the Silver plan from $1,500 to $2,000.
- Increasing the deductible for the Gold plan from $2,000 to $2,500.
These changes will allow us to continue to offer affordable and comprehensive coverage to our members.
Premium Cost Modifications
2023 Plan Changes
There are several changes to the St. Mary’s Health Insurance plan for 2025. These changes are designed to make the plan more affordable and accessible for our members. The most significant change is a reduction in the monthly premium costs for all plan levels. The new premium costs are as follows:
| Plan Level | 2023 Monthly Premium |
|---|---|
| Bronze | $250 |
| Silver | $300 |
| Gold | $350 |
| Platinum | $400 |
Deductible Changes
In addition to the premium cost reductions, there have also been changes to the deductibles for all plan levels. The new deductibles are as follows:
| Plan Level | 2023 Deductible |
|---|---|
| Bronze | $1,000 |
| Silver | $750 |
| Gold | $500 |
| Platinum | $250 |
The deductible is the amount of money you have to pay out-of-pocket for covered medical expenses before your insurance starts to pay. A higher deductible means you will pay less for your monthly premium, but you will have to pay more for medical expenses before your insurance kicks in.
Coinsurance Changes
Coinsurance is the percentage of the cost of a covered medical expense that you are responsible for paying after you have met your deductible. The new coinsurance rates for all plan levels are as follows:
| Plan Level | 2023 Coinsurance |
|---|---|
| Bronze | 20% |
| Silver | 15% |
| Gold | 10% |
| Platinum | 5% |
For example, if you have a Bronze plan with a 20% coinsurance rate and you have a medical expense of $1,000, you would be responsible for paying $200 (20% of $1,000). The remaining $800 would be covered by your insurance.
Out-of-Pocket Maximum Changes
The out-of-pocket maximum is the most you will have to pay for covered medical expenses in a calendar year. The new out-of-pocket maximums for all plan levels are as follows:
| Plan Level | 2023 Out-of-Pocket Maximum |
|---|---|
| Bronze | $6,000 |
| Silver | $5,000 |
| Gold | $4,000 |
| Platinum | $3,000 |
Once you have reached your out-of-pocket maximum, your insurance will cover 100% of the cost of covered medical expenses for the rest of the calendar year.
Tiered Coverage Options
St. Mary’s Health Insurance is introducing tiered coverage options in 2025, providing members with more choices and flexibility in their health insurance plans. These tiers will vary in terms of cost, benefits, and network availability.
Tier 1: Basic Coverage
The basic coverage tier provides essential health benefits as required by the Affordable Care Act, including:
- Preventive care
- Emergency services
- Hospitalization
- Outpatient care
- Prescription drug coverage
This tier offers a lower premium cost but may have higher deductibles, copayments, and coinsurance.
Tier 2: Enhanced Coverage
The enhanced coverage tier includes all the benefits of Tier 1, plus additional coverage for:
- Expanded preventive care services
- Lower deductibles and copayments
- Coverage for certain out-of-network services
- Wellness programs
This tier comes with a higher premium cost than Tier 1 but provides more comprehensive coverage protection.
Tier 3: Premium Coverage
The premium coverage tier offers the broadest range of benefits, including:
- All the benefits of Tier 1 and Tier 2
- No deductibles for preventive care
- Lower out-of-pocket maximums
- Access to a wider network of providers
- Concierge-level customer service
This tier has the highest premium cost but provides the most comprehensive and flexible coverage options.
Network Options
Each tier of St. Mary’s Health Insurance offers different network options, including:
| Tier | Network |
|---|---|
| Tier 1 | Preferred Provider Organization (PPO) |
| Tier 2 | Health Maintenance Organization (HMO) or PPO |
| Tier 3 | PPO or Exclusive Provider Organization (EPO) |
Copays and Deductibles
The copayment and deductible amounts will vary depending on the tier of coverage selected.
| Tier | Copayment | Deductible |
|---|---|---|
| Tier 1 | $20-$50 per visit | $500-$2,000 |
| Tier 2 | $10-$20 per visit | $250-$1,000 |
| Tier 3 | $0-$10 per visit | $0-$500 |
Members will be responsible for paying these costs before their insurance coverage begins.
Coverage Limitations
It’s important to note that each tier of coverage may have certain limitations or exclusions. For example, some services may not be covered under Tier 1 but may be covered under Tier 2 or Tier 3. Members should carefully review their policy details to understand the specific coverage limitations.
Choosing the Right Tier
The best way to choose the right tier of coverage is to consider your individual needs, budget, and health status. If you have a high deductible health plan (HDHP), you may want to consider a lower premium tier to keep your monthly costs down. If you have chronic health conditions that require regular medical care, you may benefit from a higher tier that provides more comprehensive coverage.
**Prescription Drug Formulary Changes**
Effective January 1, 2025, St. Mary’s Health Insurance will be making some changes to its prescription drug formulary. These changes are designed to ensure that our members have access to the most affordable and effective medications available.
**What is a Formulary?**
A formulary is a list of prescription drugs that are covered by an insurance plan. Insurance companies develop formularies to ensure that they are providing their members with the most cost-effective and medically necessary medications.
**Why is the Formulary Changing?**
St. Mary’s Health Insurance regularly reviews its formulary to ensure that it is up-to-date with the latest medical evidence and cost-saving measures. These changes are made to improve the health of our members and reduce their out-of-pocket costs.
**What Drugs Are Being Added to the Formulary?**
Several new drugs will be added to the formulary in 2025, including:
- Ozempic
- Wegovy
- Rybelsus
- Mounjaro
**What Drugs Are Being Removed from the Formulary?**
A few drugs will be removed from the formulary in 2025, including:
- Januvia
- Byetta
- Victoza
**How Will These Changes Affect Me?**
If you are currently taking a drug that is being removed from the formulary, you will need to talk to your doctor about switching to a different medication. Your doctor will be able to help you find a medication that is both effective and affordable.
**What If I Have Questions?**
If you have any questions about the formulary changes, you can contact St. Mary’s Health Insurance at 1-800-555-1212. You can also visit our website at www.stmaryshealthinsurance.com for more information.
**11. Specific Changes to the Formulary**
The following table provides a detailed list of the drugs that are being added to and removed from the formulary in 2025:
| **Drug** | **Change** |
|---|---|
| Ozempic | Added |
| Wegovy | Added |
| Rybelsus | Added |
| Mounjaro | Added |
| Januvia | Removed |
| Byetta | Removed |
| Victoza | Removed |
These changes are effective January 1, 2025. If you have any questions about these changes, please contact St. Mary’s Health Insurance at 1-800-555-1212.
Premium Payment Plan Flexibilities
St. Mary’s Health Insurance is committed to providing its members with flexible and affordable premium payment options. In 2025, we will be introducing several new payment plan flexibilities to make it easier for our members to manage their health care costs.
Automatic Payment Discounts
Members who set up automatic payments for their premiums will receive a discount of 5%. This discount will be applied to all premium payments made through automatic withdrawal.
Payment Grace Period
Members will have a 30-day grace period after their premium due date to make their payment without incurring a late fee. This grace period will provide members with additional time to gather the necessary funds to make their premium payment.
Extended Payment Plans
Members who are experiencing financial hardship can apply for an extended payment plan. This plan will allow members to make smaller, more manageable monthly payments over a longer period of time.
Premium Holidays
St. Mary’s Health Insurance will offer premium holidays for members in good standing. Premium holidays will waive one month’s premium payment, providing members with financial relief during times of need.
Temporary Premium Assistance
Members who are facing a temporary financial hardship can apply for temporary premium assistance. This program will provide members with a one-time grant to help cover their premium costs.
Payment Assistance Programs
St. Mary’s Health Insurance offers a variety of payment assistance programs to help members with low incomes cover their premium costs. These programs include Medicaid, CHIP, and the SilverSneakers program.
Premium Payment Assistance Hotline
Members who have questions about their premium payments can call our dedicated Premium Payment Assistance Hotline at 1-800-555-1212. Our representatives will be happy to assist you with any questions you may have.
Online Premium Payment Portal
Members can make premium payments online through our secure portal. The portal is available 24/7 and allows members to make payments using a variety of payment methods.
Mobile Payment App
Members can also make premium payments using our mobile payment app. The app is available for both iOS and Android devices and allows members to make payments on the go.
Text-to-Pay Option
Members can make premium payments by texting the word “PAY” to 1-800-555-1212. Members will receive a text message with a link to our secure payment portal.
Important Information
| Effective Date | January 1, 2025 |
|---|---|
| Applicable Plans | All St. Mary’s Health Insurance plans |
| Customer Service | 1-800-555-1212 |
Employer Contribution Options
St. Mary’s Health Insurance Plan is excited to announce several changes and improvements for 2025, including a variety of employer contribution options designed to meet the diverse needs of our members.
Flexible Spending Account (FSA)
The FSA is a tax-advantaged savings account that allows members to set aside pre-tax dollars to pay for qualified healthcare expenses, such as deductibles, copayments, and prescription drugs.
Health Savings Account (HSA)
The HSA is another tax-advantaged savings account that allows members who are enrolled in high-deductible health plans (HDHPs) to save even more for healthcare expenses. Members can contribute pre-tax dollars, which grow tax-free until they are withdrawn for qualified medical expenses.
Health Reimbursement Arrangements (HRAs)
HRAs are employer-funded accounts that can be used to reimburse members for qualified healthcare expenses. HRAs are not subject to the same contribution limits as FSAs and HSAs, making them a more flexible option for employers.
Defined Contribution Plans
Defined contribution plans are a type of retirement plan that allows employers to make fixed contributions to employee accounts each year. Employees can choose how their contributions are invested, and they have the potential to grow tax-deferred until they are withdrawn.
Other Contribution Options
In addition to the above options, St. Mary’s also offers a variety of other contribution options, such as:
- Matching contributions
- Lump-sum contributions
- Quarterly or annual contributions
Contribution Amounts
| Contribution Type | Maximum Annual Contribution (2025) |
|---|---|
| FSA | $2,850 |
| HSA | $3,850 for individuals; $7,750 for families |
| HRA | No federal limit; set by employer |
| Defined Contribution Plan | 100% of eligible compensation, up to $66,000 in 2025 |
Contribution Deadlines
Employer contributions must be made by the deadline established by the plan. The deadline for the following contribution types is:
- FSA and HSA: December 31 of the plan year
- HRA: 2.5 months after the end of the plan year
- Defined Contribution Plan: April 15 of the following year
Choosing the Right Contribution Option
The best contribution option for your organization will depend on a number of factors, such as your budget, employee demographics, and business goals. St. Mary’s team of benefits experts can help you evaluate your options and choose the plan that is right for you.
Additional Information
For more information about St. Mary’s Health Insurance Plan’s employer contribution options, please visit our website or contact our customer service department at 1-800-555-1212.
Network Provider Directory Overhaul
Provider Network Changes
St. Mary’s Health Insurance is undergoing significant updates to its network of providers to enhance access to high-quality healthcare services. Effective January 1, 2025, the following changes will take effect.
Additions to the Network
To expand coverage and provide a wider range of healthcare options, St. Mary’s is adding:
- Renowned medical specialists in various fields
- Conveniently located primary care physicians
- Specialized clinics and hospitals that meet specific healthcare needs
Removals from the Network
To maintain network quality and ensure efficiency, St. Mary’s has determined to remove certain providers from its network. These providers may not align with the latest healthcare standards or may no longer offer the services needed by our members.
Effective Date and Transition Period
The network changes will take effect on January 1, 2025. Members who are currently undergoing treatment with a provider who is being removed from the network will have a transition period to complete their course of treatment.
Network Provider Directory Updates
To ensure members have up-to-date information about available providers, St. Mary’s is enhancing its online and physical network provider directories.
Online Directory
The St. Mary’s website will feature a user-friendly online directory that allows members to:
- Search for providers by specialty, location, or name
- View provider profiles, including their experience and qualifications
- Book appointments and make inquiries
Physical Directory
Members will also receive an updated physical network provider directory that includes comprehensive information about available providers. The directory will be distributed to members in the mail prior to the effective date of the changes.
Provider Communication
St. Mary’s is actively communicating with providers who are being added or removed from the network. Members who are affected by the changes will receive advance notification and assistance in finding new providers.
Member Responsibilities
Members are encouraged to review the updated network provider directory and contact their healthcare providers to confirm their coverage status. While St. Mary’s is committed to providing a broad network of high-quality providers, it is recommended that members explore their healthcare options and communicate any concerns they may have.
Frequently Asked Questions (FAQs)
Q: What types of providers will be added to the network?
A: St. Mary’s is adding renowned medical specialists, conveniently located primary care physicians, and specialized clinics and hospitals that meet specific healthcare needs.
Q: How do I find out if my current provider is being removed?
A: Members will receive advance notification by mail or email. You can also check the updated network provider directory on the St. Mary’s website.
Q: What is the transition period for members who are currently undergoing treatment with a provider who is being removed?
A: Members will have a transition period to complete their course of treatment. Please contact St. Mary’s for more information.
Q: Where can I find the most up-to-date information about the network changes?
A: Visit the St. Mary’s website or call the customer service number listed on your insurance card.
Plan Navigator Tool Updates
St. Mary’s Health Insurance has made significant updates to its Plan Navigator Tool for 2025. These updates aim to enhance the user experience, streamline the plan selection process, and provide more personalized guidance.
1. Enhanced User Interface
The Plan Navigator Tool now features an updated user interface that is more intuitive and user-friendly. The redesign includes improved navigation, simplified menus, and a modern layout.
2. Personalized Recommendations
The tool has been enhanced with personalized recommendations that tailor plan options based on individual needs and preferences. Users answer a series of questions about their health, lifestyle, and budget to receive customized plan suggestions.
3. Comprehensive Plan Information
The Plan Navigator Tool provides detailed information on all available plans, including coverage details, benefits, premiums, and provider networks. This enables users to make informed decisions based on a comprehensive understanding of plan offerings.
4. Side-by-Side Plan Comparison
Users can now compare multiple plans side-by-side to assess their coverage and costs. This feature helps identify the most suitable plan based on individual requirements.
5. Healthcare Professional Search
The Plan Navigator Tool includes a built-in healthcare professional search that allows users to find providers within their plan’s network. This streamlines the process of finding qualified care providers.
6. Enrollment Assistance
Users can connect with a licensed insurance agent directly through the Plan Navigator Tool for guidance and assistance with enrollment. This personalized support ensures a smooth and hassle-free enrollment experience.
7. Online Enrollment
The Plan Navigator Tool enables users to complete the enrollment process entirely online. This convenient feature eliminates the need for physical paperwork or in-person enrollment.
8. Mobile Optimization
The Plan Navigator Tool is now fully optimized for mobile devices, allowing users to access and use the tool from anywhere, at any time.
9. Member Portal Integration
Once enrolled, users can access their member portal through the Plan Navigator Tool. This portal provides real-time information on coverage, claims, and benefits.
10. HDHP and HSA Eligibility Check
The Plan Navigator Tool includes a feature that allows users to check their eligibility for High-Deductible Health Plans (HDHPs) and Health Savings Accounts (HSAs). This helps determine if these options are a suitable fit.
11. Educational Resources
The Plan Navigator Tool provides educational resources to help users understand health insurance concepts and terminology. These resources include articles, videos, and glossaries.
12. Printable Plan Summaries
Users can generate printable plan summaries from the Plan Navigator Tool to keep for reference or share with others.
13. Premium Estimator
The Plan Navigator Tool includes a premium estimator that provides an approximate estimate of monthly premiums based on selected coverage options.
14. Frequently Asked Questions (FAQs)
The Plan Navigator Tool features a comprehensive FAQ section that addresses common questions about plan selection, enrollment, and coverage.
15. 24/7 Support
Users can access customer support 24/7 through the Plan Navigator Tool for any questions or assistance they may need.
16. Secure and Private
The Plan Navigator Tool employs robust security measures to protect user data and privacy. All information entered into the tool is encrypted and stored securely.
17. Step-by-Step Guide to Plan Selection Using the Plan Navigator Tool
Step 1: Visit the St. Mary’s Health Insurance website and navigate to the Plan Navigator Tool.
Step 2: Answer the personalized questions to provide the tool with information about your health, lifestyle, and budget.
Step 3: Review the personalized plan recommendations and explore the plan details.
| Plan Name | Premium | Deductible | Copays |
|---|---|---|---|
| Plan A | $500 | $2,500 | $20 |
| Plan B | $700 | $1,500 | $30 |
| Plan C | $900 | $1,000 | $40 |
Step 4: Compare plans side-by-side to assess coverage and costs.
Step 5: Find providers within your plan’s network using the healthcare professional search.
Step 6: Enroll in the selected plan online or connect with an agent for assistance.
Medicare Advantage Plan Integration
Expanding Plan Options
Members will have access to a wider range of Medicare Advantage plans, including:
- HMOs (Health Maintenance Organizations)
- PPOs (Preferred Provider Organizations)
- SNPs (Special Needs Plans)
- DSNPs (Dual Special Needs Plans)
Each plan offers unique benefits and cost-sharing arrangements, allowing members to choose the option that best meets their specific needs.
Enhanced Enrollment Support
To ensure a seamless enrollment experience, St. Mary’s Health Insurance will provide personalized assistance to members. This includes:
- Dedicated enrollment advisors
- Educational materials and workshops
- Online self-service tools
Members can access support through phone, email, or in-person appointments, ensuring they have the information they need to make informed decisions.
Improved Care Coordination
St. Mary’s Health Insurance will collaborate closely with primary care physicians and other healthcare providers to enhance care coordination for members enrolled in Medicare Advantage plans. This will include:
- Regular communication between providers and the insurer
- Coordination of appointments and referrals
- Access to case management services
By streamlining communication and collaboration, members will receive more comprehensive and timely care.
Expanded Provider Network
Members enrolled in St. Mary’s Health Insurance Medicare Advantage plans will have access to an expanded network of providers. This includes:
- Local and national hospitals
- Specialists in all major medical fields
- Urgent care clinics
The expanded network ensures that members have convenient and accessible healthcare options.
New Benefits and Services
In addition to the expanded plan options, care coordination, and provider network, St. Mary’s Health Insurance Medicare Advantage plans will offer a range of new benefits and services, including:
- Telehealth visits
- Wellness programs
- Prescription drug coverage
These benefits aim to improve the overall health and well-being of members.
18. Comprehensive Dental and Vision Coverage
Starting in 2025, St. Mary’s Health Insurance Medicare Advantage plans will include comprehensive dental and vision coverage. This is a significant enhancement to the current coverage options and provides members with essential preventive and restorative care.
The dental coverage includes:
- профилактические осмотры
- Cleanings
- X-rays
- Fillings
- Extractions
The vision coverage includes:
- Офтальмологические осмотры
- Очки или контактные линзы
- Хирургические вмешательства, связанные со зрением
The expanded dental and vision coverage will help members maintain their oral and eye health, reducing the risk of future health complications.
| Benefit | Coverage |
|---|---|
| Dental | Prophylactic exams, cleanings, X-rays, fillings, extractions |
| Видение | Eye exams, glasses/contacts, vision-related surgeries |
Note: Coverage may vary depending on the specific Medicare Advantage plan selected.
Medicaid Expansion Collaboration
As part of our commitment to providing access to affordable health coverage for all, St. Mary’s Health Insurance is excited to announce our continued collaboration with Medicaid expansion programs. This partnership aims to extend our reach to underserved communities and individuals, ensuring they have access to the essential healthcare services they need.
Enhanced Access to Medicaid Coverage
Through our collaboration with Medicaid expansion programs, we’ve significantly expanded access to health insurance coverage. In the past year alone, over 10,000 individuals have enrolled in our Medicaid plans, gaining access to a wide range of healthcare services.
Specific Benefits for Medicaid Enrollees
Our Medicaid plans provide comprehensive coverage to our enrollees, including:
- Preventive and primary care services
- Hospitalization and emergency care
- Mental health and substance abuse treatment
- Prescription drug coverage
- Dental and vision care
Customized Plans tailored to Individual Needs
We understand that each individual has unique healthcare needs. Our Medicaid plans are tailored to meet the specific requirements of our enrollees. This includes offering culturally competent care and support, as well as access to language interpretation services.
Provider Network for Quality Care
Our Medicaid plans provide access to a robust network of healthcare providers. Our providers are committed to delivering high-quality, compassionate care to our enrollees. We regularly monitor our providers’ performance to ensure they meet our standards of excellence.
Coordination of Care
We collaborate with other healthcare providers and social service organizations to coordinate care for our Medicaid enrollees. This ensures that our members receive a seamless and comprehensive approach to their healthcare.
Outreach and Education
We активно participate in outreach and education programs in the communities we serve. Our goal is to increase awareness of Medicaid coverage and help individuals understand their eligibility options. We provide information about our plans and assist with the enrollment process.
Community Partnerships for Enhanced Services
To complement our Medicaid coverage, we partner with local organizations and community health centers. These partnerships enable us to offer additional services and support to our enrollees, such as:
- Health screenings and wellness programs
- Transportation assistance
- Case management and social support services
Medicaid Expansion Data
The following table provides an overview of Medicaid expansion data from the past year:
| Metric | Value |
|---|---|
| Number of Medicaid enrollees | 10,045 |
| Increase in preventive care visits | 15% |
| Decrease in hospitalizations | 7% |
| Improved access to mental healthcare | 20% |
Our Commitment to Healthcare Equity
At St. Mary’s Health Insurance, we believe that everyone deserves access to affordable, quality healthcare. Our Medicaid expansion collaboration is a testament to our commitment to healthcare equity and ensuring that our most vulnerable populations have the coverage they need.
Changes for St. Mary’s Health Insurance 2025
Chronic Condition Management Programs
St. Mary’s Health Insurance is committed to providing its members with the best possible care. That’s why we’re proud to offer a variety of chronic condition management programs designed to help you manage your condition and live a healthier life.
1. Diabetes Management Program
Our Diabetes Management Program is designed to help you manage your diabetes and improve your overall health. The program includes:
- Individualized education and support from a registered dietitian and certified diabetes care and education specialist
- Monthly support group meetings
- Access to online resources and tools
2. Heart Failure Management Program
Our Heart Failure Management Program is designed to help you manage your heart failure and improve your quality of life. The program includes:
- Individualized education and support from a registered nurse and cardiologist
- Monthly support group meetings
- Access to online resources and tools
3. COPD Management Program
Our COPD Management Program is designed to help you manage your COPD and improve your breathing. The program includes:
- Individualized education and support from a registered nurse and respiratory therapist
- Monthly support group meetings
- Access to online resources and tools
4. Asthma Management Program
Our Asthma Management Program is designed to help you manage your asthma and improve your breathing. The program includes:
- Individualized education and support from a registered nurse and asthma specialist
- Monthly support group meetings
- Access to online resources and tools
5. Weight Management Program
Our Weight Management Program is designed to help you lose weight and improve your overall health. The program includes:
- Individualized education and support from a registered dietitian and exercise physiologist
- Weekly support group meetings
- Access to online resources and tools
6. Smoking Cessation Program
Our Smoking Cessation Program is designed to help you quit smoking and improve your overall health. The program includes:
- Individualized education and support from a tobacco treatment specialist
- Weekly support group meetings
- Access to online resources and tools
- Nicotine replacement therapy
7. Cancer Care Program
Our Cancer Care Program is designed to provide you with the support and resources you need to cope with cancer. The program includes:
- Individualized education and support from a registered nurse and social worker
- Monthly support group meetings
- Access to online resources and tools
8. Mental Health Program
Our Mental Health Program is designed to provide you with the support and resources you need to cope with mental illness. The program includes:
- Individualized education and support from a licensed mental health professional
- Weekly support group meetings
- Access to online resources and tools
9. Substance Abuse Program
Our Substance Abuse Program is designed to provide you with the support and resources you need to cope with substance abuse. The program includes:
- Individualized education and support from a licensed substance abuse counselor
- Weekly support group meetings
- Access to online resources and tools
10. Home Health Program
Our Home Health Program is designed to provide you with the care you need in the comfort of your own home. The program includes:
- Skilled nursing care
- Physical therapy
- Occupational therapy
- Speech therapy
- Medical social work
11. Hospice Program
Our Hospice Program is designed to provide you with the care and support you need at the end of life. The program includes:
- Palliative care
- Pain management
- Emotional support
- Spiritual care
12. Long-Term Care Program
Our Long-Term Care Program is designed to provide you with the care you need if you have a chronic condition that requires long-term care. The program includes:
- Nursing home care
- Assisted living care
- Home health care
- Hospice care
13. Dental Program
Our Dental Program is designed to provide you with the dental care you need to maintain a healthy smile. The program includes:
- Preventive care
- Restorative care
- Cosmetic care
14. Vision Program
Our Vision Program is designed to provide you with the vision care you need to maintain good eyesight. The program includes:
- Eye exams
- Glasses
- Contact lenses
15. Hearing Program
Our Hearing Program is designed to provide you with the hearing care you need to maintain good hearing. The program includes:
- Hearing tests
- Hearing aids
- Cochlear implants
16. Prescription Drug Program
Our Prescription Drug Program is designed to provide you with affordable access to the prescription drugs you need. The program includes:
- Discounts on prescription drugs
- Mail-order prescription service
- Specialty pharmacy services
17. Medical Equipment Program
Our Medical Equipment Program is designed to provide you with the medical equipment you need to manage your chronic condition. The program includes:
- Durable medical equipment
- Home medical equipment
- Mobility aids
18. Transportation Program
Our Transportation Program is designed to provide you with transportation to and from your medical appointments. The program includes:
- Transportation vouchers
- Ride-sharing services
- Public transportation passes
19. Caregiver Support Program
Our Caregiver Support Program is designed to provide you with the support and resources you need to care for a loved one with a chronic condition. The program includes:
- Individualized education and support
- Support group meetings
- Access to online resources and tools
20. Financial Assistance Program
Our Financial Assistance Program is designed to provide you with financial assistance if you have a chronic condition that requires expensive medical care. The program includes:
- Grants
- Loans
- Payment plans
21. Health Promotion Program
Our Health Promotion Program is designed to help you improve your overall health and well-being. The program includes:
- Health screenings
- Wellness classes
- Nutrition counseling
22. Disease Management Program
Our Disease Management Program is designed to help you manage your chronic condition and improve your quality of life. The program includes:
- Individualized education and support
- Disease-specific support groups
- Access to online resources and tools
23. Telehealth Program
Our Telehealth Program is designed to provide you with access to medical care from the comfort of your own home. The program
Remote Patient Monitoring Services
St. Mary’s Health Insurance is committed to providing comprehensive coverage for its members, including innovative and convenient healthcare solutions. Remote patient monitoring (RPM) is one such service that has been introduced to enhance the accessibility and quality of care for our members.
What is Remote Patient Monitoring?
RPM is a healthcare technology that enables patients to track and monitor their health conditions remotely. Using wireless devices, patients can collect and transmit health data such as blood pressure, blood sugar levels, weight, and more to healthcare providers.
Benefits of Remote Patient Monitoring
RPM offers numerous benefits for both patients and healthcare providers, including:
*
*
*
*
*
How Remote Patient Monitoring Works
St. Mary’s Health Insurance partners with trusted vendors to provide RPM services. Members who are eligible for RPM will be provided with a wireless device, such as a blood pressure monitor or glucometer, as well as instructions on how to use the device.
Patients can collect health data using the device at home or on the go. The data is then automatically transmitted to a secure portal, where healthcare providers can access it and monitor the patient’s progress.
Covered Services
Under the 2025 plan, St. Mary’s Health Insurance will cover a range of RPM services, including:
- Blood pressure monitoring
- Blood sugar monitoring
- Weight monitoring
- Respiratory monitoring (e.g., pulse oximetry)
- Cardiac monitoring (e.g., electrocardiography)
- Medication adherence monitoring
Eligibility
Eligibility for RPM services will be determined on a case-by-case basis by a healthcare provider. Generally, patients who meet one or more of the following criteria may be eligible:
- Chronic health conditions, such as diabetes, hypertension, or heart disease
- Need for close monitoring of health conditions
- Difficulty accessing in-person healthcare appointments
Cost
The cost of RPM services will vary depending on the type of device and service provided. However, St. Mary’s Health Insurance will cover a portion of the cost for eligible members.
Privacy and Security
St. Mary’s Health Insurance takes the privacy and security of our members’ health data seriously. All RPM devices and portals are HIPAA-compliant, ensuring that patient data is protected and confidential.
How to Get Started
Members who are interested in utilizing RPM services should contact their healthcare provider. The provider will determine eligibility and provide instructions on how to get started.
Coverage Details
For more detailed information on coverage and eligibility requirements, please refer to the following table:
| Service | Covered Device | Eligibility | Cost |
|---|---|---|---|
| Blood Pressure Monitoring | Wireless Blood Pressure Monitor | Hypertension | 20% copay |
| Blood Sugar Monitoring | Wireless Glucometer | Diabetes | 10% copay |
| Weight Monitoring | Wireless Smart Scale | Obesity | 25% copay |
| Respiratory Monitoring | Wireless Pulse Oximeter | COPD, Asthma | 15% copay |
| Cardiac Monitoring | Wireless ECG Monitor | Heart Disease | 30% copay |
| Medication Adherence Monitoring | Pillbox with Smart Lid | Adherence Issues | $25 monthly fee |
Health Risk Assessment Integration
In 2025, St. Mary’s Health Insurance will be integrating a Health Risk Assessment (HRA) into its health insurance plans. This HRA will be used to identify individuals who are at risk for developing certain health conditions, and to provide them with personalized recommendations to improve their health.
Benefits of the HRA Integration
The HRA integration will provide several benefits to St. Mary’s health insurance members, including:
- Earlier identification of health risks
- Personalized recommendations to improve health
- Access to resources to help members achieve their health goals
- Potential for lower health care costs in the future
How the HRA Will Work
The HRA will be a confidential online questionnaire that members can complete at their convenience. The questionnaire will ask about a variety of health-related topics, including:
- Medical history
- Lifestyle habits
- Family history
- Current health status
Once the questionnaire is completed, members will receive a personalized health report that will include:
- Their risk level for developing certain health conditions
- Personalized recommendations to improve their health
- Access to resources to help members achieve their health goals
Impact on Health Insurance Premiums
The HRA integration will not impact health insurance premiums for St. Mary’s members. However, members who complete the HRA and take steps to improve their health may be eligible for discounts on their premiums in the future.
Timeline for HRA Integration
The HRA integration will be implemented in phases beginning in 2025. All St. Mary’s health insurance members will be required to complete the HRA by the end of 2025.
Frequently Asked Questions (FAQs)
| Question | Answer |
|---|---|
| Is the HRA mandatory? | Yes, all St. Mary’s health insurance members will be required to complete the HRA by the end of 2025. |
| Will the HRA impact my health insurance premiums? | No, the HRA integration will not impact health insurance premiums for St. Mary’s members. However, members who complete the HRA and take steps to improve their health may be eligible for discounts on their premiums in the future. |
| What if I don’t want to complete the HRA? | Members who do not complete the HRA will not be eligible for any HRA-related benefits, such as personalized health recommendations or discounts on health insurance premiums. |
Personalized Health Plan Recommendations
To further enhance your healthcare experience, St. Mary’s Health Insurance introduces personalized health plan recommendations tailored to your unique needs and preferences. By analyzing your health data, lifestyle factors, and personal goals, our innovative platform provides customized plan options that align seamlessly with your healthcare journey.
Powered by Advanced Artificial Intelligence (AI):
Our AI engine leverages advanced algorithms and machine learning techniques to analyze billions of data points, identifying patterns and insights that inform our personalized recommendations. This ensures highly accurate and relevant plan suggestions for each individual.
Comprehensive Health Data Integration:
We seamlessly integrate data from your electronic health records, wearable devices, and other sources to create a holistic view of your health status. This comprehensive data analysis empowers us to make well-informed recommendations tailored to your specific health conditions, risk factors, and lifestyle.
Personalized Plan Options:
Based on your health profile, our platform generates a range of plan options that meet your unique needs. These plans may include:
- Customized coverage for specific health conditions
- Personalized wellness programs and incentives
- Tailored premium pricing based on your health status
- Access to exclusive health services and resources
Real-Time Plan Adjustments:
As your health evolves, so too will your personalized health plan. Our platform continuously monitors your health data and lifestyle changes, adjusting your plan recommendations to ensure they remain aligned with your evolving needs.
Easy-to-Use Interface:
Our user-friendly platform makes it effortless to navigate and explore your personalized health plan recommendations. You can easily compare plans, access plan details, and make changes at your convenience.
Expert Guidance and Support:
Throughout your journey, our dedicated team of healthcare professionals is available to provide expert guidance and support. They can assist you in understanding your plan options, making informed decisions, and optimizing your healthcare experience.
Benefits of Personalized Health Plan Recommendations:
- Improved health outcomes
- Reduced healthcare costs
- Increased patient satisfaction
- Enhanced patient engagement
- Empowered decision-making
Our Commitment to Your Health:
At St. Mary’s Health Insurance, we are committed to providing you with the highest quality healthcare. Our personalized health plan recommendations are a testament to our unwavering dedication to empowering you on your journey to optimal health.
**Frequently Asked Questions**
- How do I access my personalized health plan recommendations?
You can access your personalized health plan recommendations through our secure online portal or mobile app.
- Can I change my personalized health plan recommendations?
Yes, you can make changes to your personalized health plan recommendations at any time. Our platform will automatically update your recommendations based on your feedback.
- How often will my personalized health plan recommendations be updated?
Your personalized health plan recommendations will be updated in real-time as your health data and lifestyle factors change.
- Is my personal health information secure?
We take the security of your personal health information very seriously. Our platform adheres to the highest industry standards for data protection and privacy.
Online Claims Submission Simplifications
For easier and faster claims submission, we’ve streamlined the process online. Here are the key simplifications:
Simplified Claims Form
Our online claims form has been redesigned for clarity and ease of use. You can now complete and submit your claims with just a few clicks.
Automated Data Entry
We’ve introduced automated data entry features to minimize errors and speed up processing. The system will automatically extract relevant information from your medical history and insurance policy.
File Upload Improvements
File uploads are now more efficient. You can drag and drop multiple files, including images and documents, directly into the claims submission portal.
Progress Tracking
Track the status of your claims in real-time. You’ll receive notifications and updates on the progress of your claim, keeping you informed every step of the way.
Enhanced Security Measures
We’ve implemented robust security measures to protect your sensitive information. Your claims data is encrypted and stored securely, ensuring the privacy and confidentiality of your information.
Personalized Claim Portal
Your online claims portal is now personalized to your needs. You can easily access your recent claims, track progress, and manage your insurance information.
Batch Claim Submission
Need to submit multiple claims at once? Our batch claims submission feature allows you to upload and process up to 28 claims at a time, saving you time and effort.
Batch Claim Submission Simplified
For high-volume claim submissions, our enhanced batch claim submission process offers significant benefits:
Supported File Formats
Our system supports various file formats for batch claims submissions, including:
| File Type | Supported Format |
|---|---|
| Electronic Data Interchange (EDI) | 837 Claim |
| Non-EDI | CSV (Comma-Separated Values) |
File Requirements
To ensure successful batch claim submission, please adhere to the following file requirements:
| Requirement | Details |
|---|---|
| File Size | Maximum 10 MB per file |
| File Name | Alphanumeric characters only, no spaces |
| File Header | Must include column headings |
| Data Formatting | Follow the specified data formats and field lengths |
Validation and Error Handling
Our system will review your batch claim files for errors and provide detailed validation reports. Common errors include missing data, invalid formats, and duplicate claims. Address these errors promptly to avoid delays in processing.
Claim Reconciliation
Once your batch claims are processed, you can reconcile them against your original submissions to ensure completeness and accuracy. Our system will provide you with reconciliation reports to facilitate this process.
Accessibility and Language Support Expansion
St. Mary’s Health Insurance is committed to providing accessible and comprehensive healthcare coverage to all members. As part of our ongoing efforts to improve accessibility, we are expanding our language support services and implementing new technologies to enhance the member experience.
Enhanced Language Support
St. Mary’s Health Insurance recognizes the importance of providing clear and understandable information to all members, regardless of their native language. To ensure effective communication, we are expanding our language support capabilities in the following ways:
- Additional Language Options: Adding support for additional languages, including Spanish, Chinese, Vietnamese, and Russian, to cater to the diverse member base.
- Trained Interpreters: Providing access to trained medical interpreters who can assist members with limited English proficiency during appointments and interactions with customer service.
- Translated Materials: Translating essential member materials, including plan documents, benefits summaries, and member handbooks, into multiple languages to facilitate understanding.
Technology Advancements for Accessibility
St. Mary’s Health Insurance is leveraging technology to enhance accessibility and provide a seamless experience for all members:
Assistive Technology
Supporting the use of assistive technologies, such as screen readers and keyboard navigation, to ensure that members with disabilities can access our online platforms and resources.
Closed Captioning
Providing closed captions for online videos and educational materials to make them accessible to deaf or hard of hearing members.
Audio Description
Incorporating audio descriptions into videos to enhance accessibility for visually impaired members.
Accessible Website Design
Designing our website and online tools in accordance with Web Content Accessibility Guidelines (WCAG) to meet the needs of members with diverse abilities.
Member-Centric Improvements
St. Mary’s Health Insurance is implementing member-centric initiatives to address accessibility concerns:
- Accessibility Feedback Forms: Providing online and physical feedback forms for members to report accessibility issues or suggest improvements.
- Accessibility Training: Conducting regular training for staff on accessibility best practices and the importance of inclusive communication.
Upcoming Milestones
St. Mary’s Health Insurance is committed to a timeline for implementing these enhancements:
| Milestone | Estimated Completion Date |
|---|---|
| Expansion of Language Support Options | January 2025 |
| Assistive Technology Support | February 2025 |
| Closed Captioning and Audio Description | March 2025 |
| Accessible Website Design | April 2025 |
St. Mary’s Health Insurance believes that all members deserve access to high-quality healthcare coverage. By expanding our accessibility and language support offerings, we are empowering members to make informed decisions about their health and well-being.
Employer HR Integration
St. Mary’s Health Insurance plans are undergoing significant changes in 2025, and employers are encouraged to integrate these changes into their HR systems as soon as possible. Integration will ensure that employees have access to the most up-to-date information and can make informed decisions about their health insurance coverage.
Open Enrollment Process
The open enrollment process for St. Mary’s Health Insurance plans in 2025 will begin on [Date] and end on [Date]. During this period, employees will be able to make changes to their coverage, including adding or dropping dependents, changing plans, or increasing or decreasing coverage amounts.
Plan Changes
The following plan changes will take effect on January 1, 2025:
- The premium for the Silver plan will increase by 5%.
- The premium for the Gold plan will increase by 3%.
- The premium for the Platinum plan will increase by 2%.
- The deductible for the Silver plan will increase from $1,000 to $1,200.
- The deductible for the Gold plan will increase from $500 to $600.
- The deductible for the Platinum plan will remain unchanged at $250.
Employee Communication
Employers should communicate the following information to their employees as soon as possible:
- The dates of the open enrollment period.
- The changes to the premiums and deductibles for the different plans.
- The process for making changes to coverage during open enrollment.
- The resources available to employees to help them understand their options and make informed decisions.
Employer Support
Employers can support their employees during the open enrollment process by providing them with the following resources:
- Educational materials about the different health insurance plans.
- Assistance with completing the enrollment forms.
- Access to a benefits counselor who can answer questions and provide guidance.
Table of Changes
| Plan | Premium Change | Deductible Change |
|---|---|---|
| Silver | 5% increase | $1,000 to $1,200 |
| Gold | 3% increase | $500 to $600 |
| Platinum | 2% increase | No change |
Additional Information
For more information about the changes to St. Mary’s Health Insurance plans in 2025, please visit the St. Mary’s Health Insurance website or contact your HR department.
Dental and Vision Coverage Enhancements
Dental Coverage Enhancements
In 2025, St. Mary’s Health Insurance is enhancing its dental coverage to provide members with even more comprehensive care. These enhancements include:
Coverage for Advanced Procedures
Previously excluded advanced procedures, such as crowns, bridges, and root canals, will now be covered under the plan. This means members can receive essential dental treatments without having to pay out-of-pocket costs.
Increased Frequency of Cleanings and Exams
The number of covered dental cleanings and exams has been increased to twice per year, ensuring members can maintain optimal oral health.
Expansion of Preventative Services
St. Mary’s Health Insurance is expanding its coverage for preventative dental services to include fluoride treatments and sealants. These services help prevent tooth decay and cavities.
Vision Coverage Enhancements
In addition to dental coverage enhancements, St. Mary’s Health Insurance is also improving its vision coverage in 2025. These enhancements include:
Expanded Network of Eye Care Providers
The plan’s network of eye care providers has been expanded to include more specialists and sub-specialists, ensuring members have access to a wide range of eye care professionals.
Coverage for Advanced Lenses
Coverage for advanced lenses, such as progressive and multifocal lenses, has been added to the plan. These lenses provide members with clearer vision and improved quality of life.
Increased Coverage for Eye Exams
The frequency of covered eye exams has been increased to once per year, allowing members to regularly monitor their eye health.
Additional Benefits
In addition to the enhancements listed above, St. Mary’s Health Insurance is also introducing a number of other benefits to its members in 2025. These benefits include:
Table of Additional Benefits
| Benefit |
|---|
| Telehealth services for dental and vision care |
| Wellness discounts on gym memberships and healthy food purchases |
| Personalized health management programs |
Travel Assistance Benefits
St. Mary’s Health Insurance offers various travel assistance benefits to ensure your peace of mind while traveling both domestically and internationally. These benefits include:
40. Emergency Medical and Dental Expenses
In case of a medical or dental emergency during your trip, St. Mary’s Health Insurance provides coverage for up to $25,000 per person. This coverage includes the cost of medical attention, hospitalization, and dental work. The plan also covers the cost of medically necessary transportation, such as an ambulance or air evacuation, if required.
| Expense | Maximum Coverage |
|---|---|
| Medical | $25,000 per person |
| Dental | $25,000 per person |
| Medical Transportation | Medical necessity required |
Other Essential Travel Assistance Benefits
In addition to emergency medical and dental expenses, St. Mary’s Health Insurance provides coverage for the following travel-related incidents:
- Trip Delay and Cancellation: Up to $1,000 per person for expenses incurred due to a covered trip delay or cancellation.
- Lost or Stolen Luggage: Up to $500 per person for the cost of replacing lost or stolen luggage and its contents.
- Emergency Communication and Assistance: 24/7 access to a travel assistance hotline for emergency communication and assistance with travel arrangements.
- Trip Interruption: Up to $1,000 per person for expenses incurred if you must interrupt your trip due to a covered event.
- Return of Minor Children: Coverage for the cost of returning minor children to their home country in case of an emergency.
Coverage Exclusions and Limitations
It’s important to note that there are certain exclusions and limitations to the travel assistance benefits provided by St. Mary’s Health Insurance. These include:
- Pre-existing medical conditions
- Suicide or self-inflicted injuries
- Activities deemed inherently dangerous, such as skydiving or rock climbing
- War or acts of terrorism
How to Access Travel Assistance Benefits
To access your travel assistance benefits, you should contact the travel assistance hotline provided by St. Mary’s Health Insurance. The hotline is available 24/7 and can assist you with any travel-related emergencies or questions.
Additional Tips for Safe and Insured Travel
In addition to having travel assistance insurance, there are several steps you can take to ensure a safe and enjoyable trip:
- Inform your doctor about your travel plans to discuss any necessary vaccinations or precautions.
- Make copies of your important documents, such as your passport, visa, and health insurance card, and store them separately from the originals.
- Pack a first-aid kit and any essential medications.
- Be aware of your surroundings and avoid potentially dangerous situations.
By following these tips and utilizing the travel assistance benefits provided by St. Mary’s Health Insurance, you can help ensure that your next trip is both enjoyable and safe.
Innovation and Technology Upgrades
Personalized Health Solutions
St. Mary’s is investing heavily in personalized health solutions to tailor care plans and treatments to each individual’s unique needs. These include advanced data analytics, wearable devices, and remote patient monitoring systems.
Virtual Health Services Expansion
Telemedicine has become an essential component of modern healthcare, and St. Mary’s is expanding its virtual health services. This allows patients to access care from the comfort of their homes, reducing travel time, costs, and potential exposure to illnesses.
Remote Patient Monitoring
Advanced technology allows St. Mary’s to monitor patients remotely, enabling timely interventions and preventing adverse events. This includes blood glucose monitoring for diabetics, heart rate and blood pressure monitoring for cardiac patients, and respiratory monitoring for those with breathing conditions.
Improved Connectivity and Interoperability
St. Mary’s is upgrading its IT infrastructure to enhance connectivity and interoperability among its healthcare systems. This ensures seamless data sharing between providers, reduces inefficiencies, and improves patient safety.
Data Analytics for Evidence-Based Decision Making
St. Mary’s is leveraging data analytics to analyze patient data and identify patterns and trends. This enables providers to make evidence-based decisions, optimize treatments, and improve overall health outcomes.
Innovative Medical Equipment and Technologies
St. Mary’s is continuously investing in cutting-edge medical equipment and technologies. These include advanced imaging systems, robotic-assisted surgery, and innovative diagnostic tools that enhance accuracy, reduce recovery time, and minimize patient discomfort.
41. Artificial Intelligence (AI) Integration
St. Mary’s is embracing AI to enhance its healthcare delivery in various ways:
- Automated Risk Assessment: AI algorithms can analyze patient data and identify those at high risk for certain diseases, enabling proactive interventions.
- Personalized Treatment Planning: AI can help create tailored treatment plans based on individual patient characteristics, improving outcomes and reducing side effects.
- Reduced Diagnostic Errors: AI-powered diagnostic tools can assist radiologists and pathologists in interpreting complex images and identifying potential abnormalities more accurately.
- Precision Medicine: AI can analyze genetic information and other factors to identify the optimal treatments for each patient, maximizing efficacy and minimizing adverse events.
- Virtual Health Chatbots: AI-powered chatbots can provide 24/7 support to patients, answering questions, scheduling appointments, and connecting them with appropriate healthcare professionals.
- Automated Claims Processing: AI-driven systems can streamline claims processing, reducing administrative costs and improving efficiency.
- Preventive Care Reminders: AI can analyze patient data and send personalized reminders for preventive screenings, vaccinations, and other health-promoting actions.
- Improved Population Health Management: AI can help analyze data from multiple sources to identify population-level health trends and develop targeted interventions.
- Early Detection of Disease: AI-powered algorithms can analyze data from wearable devices and other sensors to detect early signs of disease, enabling timely interventions.
- Virtual Nurse Triaging: AI-powered virtual nurses can assess patient symptoms and provide guidance, recommending self-care measures or connecting them with the appropriate provider.
Regulatory Compliance Updates
St. Mary’s Health Insurance is committed to maintaining regulatory compliance and providing quality health care services to our members. As part of our ongoing efforts, we are implementing the following changes to our health insurance plans in 2025.
Affordable Care Act (ACA) Updates
The ACA is a comprehensive health care reform law that was enacted in 2010. The law includes a number of provisions that are designed to make health insurance more affordable and accessible to all Americans. In 2025, we will be making the following changes to our health insurance plans to comply with the ACA:
- Expanding coverage for essential health benefits
- Eliminating annual and lifetime limits on coverage
- Offering premium subsidies to low- and middle-income families
Medicare Advantage (MA) Updates
MA is a type of health insurance plan that is offered by private insurance companies to Medicare beneficiaries. MA plans provide comprehensive health care coverage, including hospital, medical, and prescription drug coverage. In 2025, we will be making the following changes to our MA plans:
- Expanding coverage for dental and vision services
- Offering new coverage options for chronic conditions
- Lowering premiums for some plans
Medicaid Expansion
Medicaid is a health insurance program for low-income individuals and families. In 2014, the ACA expanded Medicaid eligibility to include adults with incomes up to 138% of the federal poverty level (FPL). In 2025, we will be expanding our Medicaid coverage to include the following populations:
- Childless adults
- Individuals with disabilities
- Pregnant women
Mental Health and Substance Use Disorder Coverage
Mental health and substance use disorders are serious public health issues that affect millions of Americans. In 2025, we will be expanding our coverage for mental health and substance use disorder services to include the following:
- Outpatient therapy
- Inpatient treatment
- Medication management
42. Prescription Drug Coverage
Prescription drug coverage is an important part of health insurance. In 2025, we will be making the following changes to our prescription drug coverage:
- Expanding coverage for generic drugs
- Lowering co-pays for some brand-name drugs
- Offering a new formulary that includes more affordable drugs
Table of Changes
| Change | Effective Date |
|---|---|
| Expansion of coverage for essential health benefits | January 1, 2025 |
| Elimination of annual and lifetime limits on coverage | January 1, 2025 |
| Offering premium subsidies to low- and middle-income families | January 1, 2025 |
| Expansion of coverage for dental and vision services | January 1, 2025 |
| Offering new coverage options for chronic conditions | January 1, 2025 |
| Lowering premiums for some plans | January 1, 2025 |
| Expanding Medicaid coverage to include childless adults, individuals with disabilities, and pregnant women | January 1, 2025 |
| Expanding coverage for mental health and substance use disorder services | January 1, 2025 |
| Expanding coverage for generic drugs | January 1, 2025 |
| Lowering co-pays for some brand-name drugs | January 1, 2025 |
| Offering a new formulary that includes more affordable drugs | January 1, 2025 |
Data Security Enhancements
To safeguard the privacy and security of our members’ protected health information, we are implementing a comprehensive suite of data security enhancements for St. Mary’s Health Insurance in 2025.
Multi-Factor Authentication (MFA)
MFA is a security measure that requires users to provide multiple forms of identification when accessing our online portals and applications. This adds an extra layer of protection, making it more difficult for unauthorized individuals to gain access to sensitive information.
Encryption at Rest and in Transit
We implement robust encryption measures to protect data both at rest (stored on our servers) and in transit (being transmitted over networks). Advanced encryption algorithms ensure that data remains unreadable to unauthorized parties.
Access Control and Auditing
We have implemented strict access controls to limit who can access protected health information. User permissions are carefully managed, and all access activities are audited regularly to detect any suspicious behavior.
Network Security
Our network infrastructure is protected by firewalls, intrusion detection systems, and other advanced security measures to prevent unauthorized access and protect against cyber threats.
Vulnerability Management
We continuously monitor our systems for vulnerabilities and promptly apply security patches to address any potential security risks. Regular security scans and penetration testing help identify vulnerabilities before they can be exploited.
Employee Security Awareness
We provide comprehensive security awareness training to our employees to educate them about the importance of data protection. Training covers topics such as phishing, social engineering, and best practices for handling sensitive information.
Data Breach Response Plan
In the unlikely event of a data breach, we have a comprehensive response plan in place to mitigate its impact. The plan includes notification of affected individuals, investigation of the incident, and implementation of corrective actions.
Compliance with Regulations
We are fully compliant with all applicable data security regulations, including the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health Act (HITECH), and the Payment Card Industry Data Security Standard (PCI DSS).
44. Cloud Security
Recognizing that data may be stored and processed in the cloud, we have implemented stringent security measures to protect member information in cloud environments. These measures include:
- Encryption: Data is encrypted at all times, both at rest and in transit.
- Access Control: Only authorized personnel have access to data in the cloud. Access is controlled through role-based permissions and multi-factor authentication.
- Data Segregation: Member data is logically separated from other data in the cloud, ensuring privacy and preventing unauthorized access.
- Security Monitoring: Cloud services are continuously monitored for suspicious activity and potential security threats.
- Disaster Recovery: We have robust disaster recovery plans in place to ensure data availability and integrity in the event of an outage or disaster.
Privacy Policy Updates
St. Mary’s Health Insurance is committed to protecting the privacy of our members and their health information. We have recently updated our Privacy Policy to reflect changes in healthcare laws and regulations, as well as to provide our members with more information about how we use and protect their personal information. The updated Privacy Policy will be effective January 1, 2025.
What’s Changing?
The following are some of the key changes to our Privacy Policy:
- We have added a new section on “Marketing and Advertising.” This section explains how we use and disclose personal information for marketing and advertising purposes.
- We have updated our section on “Third-Party Disclosures.” This section now includes more information about the types of third parties to whom we may disclose personal information and the purposes for which we may disclose such information.
- We have added a new section on “Data Security.” This section explains the steps we take to protect personal information from unauthorized access, use, or disclosure.
Accessing Your Privacy Policy
You can access our updated Privacy Policy online at www.stmaryshealthinsurance.com/privacy-policy. You can also request a copy of our Privacy Policy by calling our Member Services department at 1-800-555-1212.
Contact Us
If you have any questions about our Privacy Policy, please contact us by phone at 1-800-555-1212 or by email at [email protected].
Table of Key Changes to Privacy Policy
| Provision | Original Policy | Revised Policy |
|---|---|---|
| Marketing and Advertising | No mention of marketing or advertising | New section added explaining how personal information is used for marketing and advertising purposes |
| Third-Party Disclosures | Limited information about third-party disclosures | Updated section now includes more information about the types of third parties to whom personal information may be disclosed and the purposes for which such information may be disclosed |
| Data Security | No specific mention of data security | New section added explaining the steps taken to protect personal information from unauthorized access, use, or disclosure |
Health Care Cost Transparency Measures
Subtopic 47: Disclosure of Negotiated Rates for Covered Out-of-Network Providers
Effective January 1, 2025, health insurers will be required to disclose the negotiated rates they pay to out-of-network providers for covered services.
This transparency measure is intended to provide patients with more information about the cost of their health care, allowing them to make more informed decisions about their treatment and care.
Insurers will be required to disclose the negotiated rates for all covered out-of-network providers, including physicians, hospitals, and other health care professionals.
The rates will be disclosed in a machine-readable format that is easily accessible to patients and researchers.
This transparency measure is a significant step towards empowering patients with the information they need to make informed decisions about their health care.
The table below provides a summary of the key provisions of the new transparency requirements:
| Requirement | Effective Date |
|---|---|
| Disclosure of negotiated rates for covered out-of-network providers | January 1, 2025 |
| Rates must be disclosed in a machine-readable format | January 1, 2025 |
| Rates must be easily accessible to patients and researchers | January 1, 2025 |
Provider Reimbursement Updates
Reimbursement Rates for 2025
For 2025, St. Mary’s Health Insurance will be implementing the following changes to reimbursement rates for participating providers:
- Inpatient Services: Reimbursement rates for inpatient services will increase by an average of 2.5%.
- Outpatient Services: Reimbursement rates for outpatient services will increase by an average of 2%.
- Professional Services: Reimbursement rates for professional services will increase by an average of 2.2%.
Quality Incentive Programs
St. Mary’s Health Insurance is committed to supporting providers who deliver high-quality care. In 2025, we will be introducing the following quality incentive programs:
- Value-Based Payment Program: This program will reward providers for delivering care that meets or exceeds quality and efficiency standards.
- Patient Experience Program: This program will reward providers for providing a positive patient experience.
Administrative Simplification and Streamlining
We are committed to simplifying and streamlining administrative processes to reduce the burden on providers. In 2025, we will be implementing the following changes:
- Electronic Prior Authorization: Providers will be able to submit prior authorization requests electronically, which will reduce processing times and paperwork.
- Automated Claim Adjudication: We will be implementing an automated claim adjudication system that will process claims faster and more accurately.
- Provider Portal Enhancements: We will be enhancing our provider portal to make it easier for providers to access information and submit requests.
Other Updates
In addition to the changes outlined above, we will be implementing the following additional updates in 2025:
- Coverage Expansions: We will be expanding coverage for certain services, such as mental health services and chronic disease management.
- Provider Directory Updates: We will be updating our provider directory to ensure that it reflects the most current information.
- Billing and Coding Updates: We will be implementing updates to our billing and coding policies to reflect industry best practices.
Reimbursement Rates for CPT Code 49
The reimbursement rate for CPT code 49, which is used for inpatient consultations, will increase by 2.7% in 2025. This increase is in line with the overall increase in reimbursement rates for inpatient services. The following table shows the new reimbursement rates for CPT code 49 for 2025:
| Service | Reimbursement Rate |
|---|---|
| Inpatient Consultation | $120.00 |
Provider Education and Support
We are committed to supporting providers as they transition to these new changes. We will be offering the following education and support resources:
- Webinars: We will be hosting a series of webinars to provide providers with an overview of the changes and how they will affect them.
- Educational Materials: We will be distributing educational materials to providers, such as fact sheets and FAQs.
- Dedicated Support Team: We will have a dedicated support team available to answer providers’ questions and assist them with the transition.
We are confident that these changes will improve the quality of care for our members and make it easier for providers to do business with St. Mary’s Health Insurance.
Changes for St. Mary’s Health Insurance 2025
St. Mary’s Health Insurance is committed to providing our members with high-quality, affordable health care coverage. As part of our ongoing efforts to improve our plans and meet the needs of our members, we are making some changes to our coverage for 2025.
These changes are designed to make our plans more comprehensive, affordable, and easier to use. We understand that changes to your health insurance plan can be disruptive, and we are committed to making this transition as smooth as possible for our members.
We encourage you to review the changes and contact us if you have any questions. We are here to help you understand your coverage and make sure that you have the plan that best meets your needs.
People Also Ask About Changes for St. Mary’s Health Insurance 2025
When will these changes take effect?
The changes will take effect on January 1, 2025.
What are the most significant changes?
The most significant changes include:
- Lower deductibles
- Lower copays
- New coverage for preventive care
- Expanded coverage for mental health and substance abuse treatment
How will these changes affect my premiums?
The changes will result in a modest increase in premiums for most members. However, we have worked hard to keep the increases as low as possible while still providing our members with the coverage they need.
What can I do to prepare for these changes?
We encourage you to review the changes and contact us if you have any questions. We are here to help you understand your coverage and make sure that you have the plan that best meets your needs.