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HealthLink PPO Network

Configuration Health plans that contract with the HealthLink PPO network program allow enrollees to use any physician or facility, in- or out-of-network, and receive benefits for covered services. Benefits are higher and out-of-pocket costs lower for medical care received from contracted PPO physicians and hospitals.

Network Strength
HealthLink delivers broad regional access to contracted providers who have agreed to accept competitively discounted payments for health services. HealthLink service areas include: Arkansas, Illinois, Missouri and expansion markets of Ohio and Kentucky. HealthLink also provides a national network solution for clients with enrollees who reside or travel outside the service area.

Competitively Discounted Payments
Our disciplined approach to fixed payment methodologies, precise modeling/ forecasting of rate changes and actuarial calculations allows us to establish aggressive pricing targets by market and product.

Plan Performance Management
Our sophisticated rate modeling techniques analyze and evaluate how current market trends, enrollee demographics and client objectives affect plan design. We make this information available to you so that you may evaluate your health benefit program and have the ability to recognize the cost/benefit value of changing or adding programs and services when the time is right.

Our provider retention rate of 92% reflects the high levels of satisfaction that have become a HealthLink standard.

Flexible Plan Options
HealthLink has the flexibility to work with a wide range of plan administrators. Employers may choose the plan administrator along with the HealthLink network. The HealthLink PPO program can be integrated into company benefit plans to support any plan design. Clients may purchase the basic PPO program package, add components on a menu basis, or purchase a comprehensive PPO package of programs and specialty components at a special, discounted rate. Most pricing is PEPM. Please contact a sales representative for pricing information.

Basic PPO Program
Package Includes:

  • PPO network access
  • Claims Repricing
  • Client Management Reporting

Comprehensive PPO
Program Package Includes:

  • Basic PPO Program Package
  • Medical Management
  • Condition Management Programs
  • Maternity Management
  • 24-Hour Nurse Line

PPO Components
Available on a Menu Basis

  • Medical Management
  • Condition Management Programs
  • Maternity Management
  • 24-Hour Nurse Line
  • Worksite Wellness
  • Lifestyle Management
  • Workers’ Compensation (MO & IL)
  • Specialty Programs

Specialty Programs
HealthLink offers a broad portfolio of other specialty programs, including: Reinsurance; Life, Disability; Dental; Vision; and Workers’ Compensation.

Cost Management
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 help their patients achieve optimal health outcomes. The program includes three levels of services: HealthLink Signature; HealthLink Wellness Plus; and HealthLink Personal Care Resources.

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 to help clients determine eligibility in accordance with health benefit plan provisions and includes the following components:
  • Pre-Admission Certification of Planned Hospital Admission
  • Notification of Emergency Hospital Admission
  • Concurrent Hospital Stay Review
  • Discharge Planning
  • Pre-Certification of Selected Ambulatory/Outpatient Services
  • Pre-Certification of Selected Ancillary Services

HealthLink’s Case Management program is a collaborative process among HealthLink and other health professionals who manage the resources necessary to support individuals with catastrophic or chronic medical conditions. Case Management helps the treating health care professional(s) help the patient achieve optimal and timely medical outcomes.

HealthLink Signature Services also include the following:

  • Condition Management Programs – Individualized programs for members with Asthma, Chronic Obstructive Pulmonary Disorder, Coronary Artery Disease, Diabetes and Heart Failure.
  • Maternity Management – Maternity management program helps participants make informed decisions during pregnancy and after childbirth.
  • 24-Hour Nurse Line – 24/7 nurse hotline and audio library of more than 300+ health topics.

HealthLink Wellness Plus
The following programs are offered at no charge to the client or member:

  • SpecialOffers Online Discount Program – Helps promote health and well being. More than 20 third-party vendors provide discounts on services related to family and home, fitness and health, and vision/hearing/dental treatment.
  • TLC® (The Last Cigarette) – Smoking cessation program. Members request a TLC quit kit to assist in their efforts to be smoke-free.

The following programs are available on a fee-for-service basis. Please contact a sales account representative for pricing information:

  • Worksite Wellness Programs – Health educators and registered dietitians visit your workplace to share knowledge on a variety of health and lifestyle topics.
  • Lifestyle Management Programs – Engaging online programs and inspiring coaches use proactive outreach activities and support strategies to help employees in the areas of: tobacco cessation, weight management, stress management, physical activity and diet/nutrition.

HealthLink Personal Care Resources
The following value-added electronic member resources are available at no cost to clients and members:

Administrative Accountability
Accurate, efficient service and support are the foundation of all HealthLink network programs. We deliver results.

Administrative Services
HealthLink is committed to supporting your health plan’s benefit administration through maximum use of technology throughout our organization. We offer fast, efficient electronic claim repricing, eligibility management, a state-of-the-art customer service response system, a provider portal and a fully interactive website,

Account Management Services
HealthLink account managers serve as liaison between HealthLink and contracted clients. They are responsible for the timely resolution of day-to-day service issues. Account managers also make on-site service visits and compile/present management reports.

Management Reporting Timely reporting tracks membership, health care services, claims accuracy, payments and utilization.