HealthLink provides network access to approximately 200 payors who administer benefits on behalf of contracted HealthLink clients. These clients include:

• Contracted Insurance Carriers
• Self-Funded, Self-Administered Clients
• Third Party Administrators

HealthLink PPO is a non-gatekeeper plan, and certain employer groups may require pre-certification (please refer to the enrollee’s ID card). HealthLink prices PPO claims per the contract and sends the claim along with the pricing to the specified claims administrator for claim adjudication benefit determination and payment for covered services. To verify eligibility, benefit or claims payment information, please contact the health plan benefit administrator identified on the enrollee’s ID card.

HealthLink Open Access is a non-gatekeeper plan, and certain employer groups may require pre-certification (please refer to the enrollee’s ID card). Enrollees may self-refer to physicians, hospitals and other health care professionals.

Open Access I (OAI) is a single-tier program: This program has one level of benefit. Enrollees may only self-refer to HealthLink HMO physicians, hospitals or other health care professionals. There are no PPO or out-of-network benefits.

Open Access II (OAII) is a two-tier program: This program has two levels of benefits. The highest level of benefit is available to enrollees who self-refer to HealthLink HMO participating physicians, hospitals and other health care professionals. A second, lower level of benefit is available to enrollees who self-refer to out-of-network physicians, hospitals and other health care professionals.

Open Access III (OAIII) is a three-tier program: This program has three levels of benefits. The highest level of benefit is available to enrollees who self-refer to HealthLink HMO participating physicians, hospitals and other health care professionals. A second, lower level of benefit is available to enrollees who self-refer to HealthLink PPO participating physicians, hospitals and other health care professionals. The third level of benefit is available to enrollees who self-refer to out-of-network physicians, hospitals and other health care professionals.

AWC is a certified Workers&rsquo Compensation PPO network program, licensed or registered in the states in which it conducts business. More than two million employees are enrolled in Workers’ Compensation plans that access the AWC networks. The AWC service area includes portions of Missouri, Illinois, Arkansas, Iowa and Indiana. AWC objective is to assist employers in managing the financial risk associated with work-related illness and injury by providing access to participating health care professionals, physicians and facilities.

HealthLink’s Health Care Management Program is an extensive suite of health promotion and wellness information, case management and care coordination services to help physicians assist their patients achieve optimal health outcomes. The program includes three levels of services: HealthLink Signature; HealthLink Wellness Plus; and HealthLink Member Extras.

HealthLink Signature Services

• Medical Management
  HealthLink Medical Management is comprised of two components: Utilization Management and Case Management.
  • The URAC-accredited Utilization Management program provides clinical review of the medical necessity for medical care.
  • HealthLink’s Case Management program is a collaborative process among HealthLink and other health care professionals who manage the resources necessary to support individuals with catastrophic and chronic medical conditions.
• Condition Management Programs
  HealthLink’s Condition Management programs take an individual-centered approach to supporting people with greater health needs. Fully licensed health professionals coach individuals to better understand their conditions and develop self-management skills.
• Maternity Management
  Maternity Management encourages participants to be proactive in health-related decisions during and after pregnancy.
• 24-Hour Nurse Line
  24-Hour Nurse Line offers access to nurse counselors and audio-taped messages via a health information phone line.

HealthLink Member Extras
The following value-added electronic member resources are available at no cost.

• Healthy Living Website
  Members can access health and wellness tips and tools online 24/7.
• eHouseCall
  A monthly wellness newsletter sent to members.
• Preventive Health Guidelines
  As recommended by the U.S. Preventative Services Task Force and other health-related agencies.
• Healthy Habits for Kids How-to Guides
  Four-booklet series of children-friendly education tips and tools.
• Enrollee Rights and Responsibilities
  General guidelines for health care consumers.

HealthLink once offered an HMO and POS (Point of Service) product portfolio. These programs have ultimately migrated to Open Access product portfolio and will no longer be actively marketed. The identification card presented by members will include the specific plan descriptions. For more information, please contact your Network Consultant.