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Purpose: Choose a new insurance company to partner with and provide health insurance coverage to the ASHA staff

and retirees.

Musts Indicator United Aetna Carefirst

Access available to CHC to handle enrollment & billing Admin Y/N Y Y Y


Covers domestic partners Cov Y/N Y Y Y
Network disruption report shows high degree of overlap Cov 90% or greater Y 97.5% Y 94% Y 98%
Customer service center inside US CS Y/N Y Y Y
Out of network reimbursement rate Cov percent Y 80% Y 80% N medicare
Greater than PHCS all hospitals,
High network penetration in the DC area Cov @ 7,000 Y 28,000 Y 28,000 Y
Implement our model speech and hearing benefits Cov Y/N Y Y N
Includes a 24/7 nurseline CS Y/N Y Y
No step therapy Cov Y/N Y Y N
Quote that is within our 2011 budget Admin Less than 3,060,410 Y Y Y
Relatively good NCQA rating CS NCQA Rating Y 81 Y 82
98.5% - Not 98% adding
exceeding more
2%. 1.5% physicians
Stable network Cov % turnover Y vol turnover. Y then loosing

Score Weighted Score Weighted


Wants Category Weight
Score Score

Account Manager accessibility - primary & secondary contacts Admin Perception 8 8 64 8 64


Reasonable, predictable, budgetable renewals Admin Mark's opinion 6 7 Y - Blended 42 5 Less 30
Medicare eligible rate for retirees Admin Y/N 5 10 Y 50 10 Y 50
Financial Guarantees for implementation Admin Y/N 3 10 Y - $10,000 30 0 N 0
Labeled ASHA as a strategic account Admin Y/N 2 10 Y 20 0 N 0
Network disruption report shows high degree of overlap Cov 90% or greater 10 7.5 97.5% 75 4 94% 40

Can do Can do
We can choose not to restrict number of visits for PT, OT & unlimited unlimited
Speech Cov Y/N 10 10 PT, OT, SLP 100 10 PT, OT, SLP 100
Appeals/1000 mbrs
Not too strict when determining medical necessity Cov + references 10 10 0.97 100 8 1.02 80
Labcorp
(67+
Physician's
High number of covered labs in the DC area Cov Number 9 6 offices) 54 9 Quest 161 81
No cap on DME Cov Amt 8 10 Y 80 10 Y 80
Offers a HSA option Cov Y/N 6 10 Y 60 10 Y 60
Does not outsource mental health mgmt Cov Y/N 5 10 Y 50 10 Y 50
Prescription drug coverage is not outsourced Cov Y/N 5 0 Medco 0 10 50
We can choose number of copays for 90 day supply Cov 5 5 2x 25 5 2x 25
Offers a HMO option Cov Y/N 5 10 Y 50 10 Y 50
Convenience
Automatic care centers offered
pre-authorization of scripts filled during 1st 90 days of Cov Y/N 5 10 Y 50 0 N 0
plan year during transition Cov Y/N 3 0 N 0 10 Y 30
High number of current out-of-network providers are in network Cov Percent 3 9 86% 27 7 74% 21

Y, Spectra -
$5 credit/mo
on Y - $200
Vision coverage offered Cov Y/N 2 8 med/enrollee 16 10 allowance 20
High rate of first call resolution CS Percent 9 4 94% 36 7 97.2% 63
Average claim turnaround time CS Days 9 10 1.79 days 90 10 1.9 days 90
Minimal hold time with CSC center CS Minutes 9 9 27 sec 81 10 18.1 sec 90
8am – 8pm
in caller’s
time-zone.
Willing to
extend until
11pm if we
CSC hrs outside normal business hours CS Y/N 8 9 request. 72 9 8am-9pm 72
Low call abandonment rate CS Percent 8 9 1.9% 72 10 1.0% 80
Carrier uses performance metrics for their service CS Y/N 7 9 Y 63 7 Y 49
1 level then 0
Up to 4. Can or operator to
How many levels of menu selections when calling CSC before hit 0 to get to get to live
having the option to speak to a live person CS Number 7 5 a rep. 35 7 person. 49
within 24 hrs
via Aetna
Navigator
Response time to emails CS Hours (48) 4 10 24 hrs 40 10 acct 40
7 yrs
10 yrs for
Average tenure of CSC CS # of years 3 4 4 yrs 12 7 mgrs 21
available
Web chat available -- what hours? CS Y/N 1 0 N 0 10 1/1/11 10
Provider ratings on quality of care Tech Y/N 7 10 Y 70 10 Y 70
Online utilization reports available to HR Tech Y/N 6 8 Y 48 10 Y 60
Online cost estimator Tech Y/N 5 10 Y 50 10 Y 50
iPhone app id network providers Tech Y/N 3 10 Y 30 10 Y 30
Member can request a card online and print a temp card Tech Y/N 3 10 Y 30 10 Y 30
iPhone app to carry id card Tech Y/N 2 0 N 0 10 Y 20
Willing to Can store
try. Have data but
worked w/ doesn’t get
Wellness initiatives that can be integrated with Lifework Strategies Well Y/N 3 8 Cyndi. 24 2 incorporated 6
Wellness incentive offered Well Y/N 2 9 Y 18 8 Y 16
Free flu shots Well Y/N 2 10 Y 20 0 N 0
Alerts on
Aetna
Screening reminders sent to members on their birthdays Well Y/N 1 10 mailed 10 4 navigator 4

Total 1694 1681

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