HealthLink Programs and Services

HealthLink offers a broad selection of programs and services to support our core PPO and Open Access network programs. Our Specialty and Health Care Cost Management components can round out your health and wellness benefits package by giving you the flexibility to design a plan that meets the specifics of your member population. HealthLink offers the following specialty products at discounted prices through product bundling. To learn more, contact your HealthLink Account Manager or Sales Executive.

Provider Network Solutions

HealthLink PPO
HealthLink OAIII


Specialty Offerings

Vision
Dental
Life and AD&D
Disability
Workers’ Compensation
Voluntary Specialty
Reinsurance
Health Care Cost Management

Medical Management
Comprehensive Behavioral Health
Condition Management
Employee Assistance Program
Lifestyle Management
Worksite Wellness
Preventive Reminders
24-Hour Nurse Line
Maternity Management
Employer Wellness Tool Kit



Provider Network Solutions

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HealthLink Preferred Provider Organization (PPO)

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. Learn More.



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HealthLink Open Access III (OAIII)

The Open Access program can be designed with up to three tiers of benefit coverage. A typical Open Access III benefit plan provides benefits as follows: 90% HMO in-network; 80% PPO in-network and 60% out-of-network. Open Access I and Open Access II options are also available. Please consult a HealthLink sales representative for more information. Learn More.



Specialty Offerings
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Vision

The vision network offers access to a convenient, national network of more than 50,000 providers and provider locations. The network includes an ideal mix of independent practitioners as well as popular retailers like LensCrafters, Pearle Vision, Sears Optical, Target Optical and JCPenney Optical. The program includes a generous frame or contact lens allowance and easy-to-understand flate rate pricing for popular lens upgrades like progressive lenses and antireflective lens coating.

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Dental

Our dental plans provide coverage for diagnostic, preventive, basic and major services – some with orthodontic options. They offer a choice of deductibles, annual maximums and provider networks, and include access to emergency dental care for members traveling outside the U.S. Most of the plans offer 100% coverage when members use a network dentist for most diagnostic and preventive care. In addition, the vast majority of our plans also include an extra cleaning or periodontal maintenance procedure for diabetic and pregnant members.

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Life and AD&D

The life insurance product includes services like financial consultation, will preparation, identity theft recovery, face-to-face counseling, and travel assistance if there is a medical emergency while traveling from home.

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Disability

The disability suite of products includes short- and long-term disability as well as Family Medical Leave Act administration services. The products include services that can help with everything from legal and financial advice to face-to-face counseling. We also offer seamless transitions from short- to long-term disability claims for employees with extended disabilities.

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Workers’ Compensation Network Program

Competitive, network contracted rates program to help employers control medical and related costs associated with work-related illness and injury. Flexibility to build customized Medical Provider Networks (MPNs) to deliver outcomes based and performance management results over time.

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Voluntary Specialty

Funded 100% by employees, the plan enables them to purchase additional benefits at lower group rates. Voluntary applies to Vision, Dental, Life and AD&D and Disability options.

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Reinsurance

Stop-loss protection for self-funded health plans includes specific and aggregate risk limits tailored to meet the financial needs of each employer group.



Health Care Cost Management

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Medical Management

HealthLink’s medical management program includes URAC-accredited utilization management, case management, transplant case management. Utilization, transplant and case management are sold as a package and cannot be unbundled. Medical management is provided by a team of utilization management and case management nurses using a single medical management platform for operations. This system ensures thorough integration and data sharing. The program utilizes Milliman guidelines as a basis for inpatient medical necessity and level of care determination, and Corporate Medical Policy and Clinical Guidelines as a basis for outpatient medical necessity determination regarding various services and procedures.

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Utilization Management

URAC-accredited utilization review ensures HealthLink members receive medically necessary services in an appropriate setting. Medical necessity review recommendations are not medical treatment decisions, nor are they benefit determinations. Medical treatment is provided by the attending physician(s) and benefits are determined by the benefit administrator according to health plan provisions.

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Case Management

HealthLink’s case management program empowers members to take control of their health care needs by coordinating health care services and optimizing benefits through a realistic, cost-effective and timely care management plan.

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Transplant Management

Transplant Case Management is fully integrated into the overall medical management platform. The program’s dedicated team has special expertise in transplant evaluation and is effective in channeling transplant patients to appropriate providers.

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Comprehensive Behavioral Health

Comprehensive Behavioral Health is a cost effective solution that provides clinical management and review services for inpatient facility services and adds clinical utilization management services for partial hospitalization, intensive outpatient, residential treatment and day treatment services. Also included is an outpatient review after the 12th session to balance barrier-free access with accountability per mental health parity requirements.

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Condition Management

HealthLink’s Condition Management program identifies, engages and supports members living with a chronic health condition. Dedicated nurse coaches and a support team of experts work together to help participants better understand their conditions and develop self-management skills. Conditions include asthma, diabetes, heart failure, chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD). Learn more.

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Employee Assistance Program

The EAP helps members resolve work-related personal problems that potentially impact their performance, health, and well-being. The program includes assessment, short-term counseling and referral services for members and their families. Learn more.

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Lifestyle Management

While condition management programs emphasize cost containment and focus primarily on the 20% of employees with health problems, wellness programs emphasize cost avoidance and focus primarily on the 80% of employees who are basically healthy. HealthLink’s Lifestyle Management is an online wellness initiative that promotes healthy lifestyle choices. The program also offers one-on-one telephonic coaching for additional costs per member. Learn more.

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Worksite Wellness

Worksite Wellness programs enable employers to make an investment in employee health that can pay off in lower health care costs, increased productivity and employee retention. Health educators and registered dietitians visit your workplace to share knowledge or administer screenings on a variety of health and lifestyle topics. HealthLink Worksite Wellness components are offered ŕ la Carte and as bundled packages. Learn more.

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Preventive Reminders

Preventive Reminders is a high-impact, targeted outreach program that can help save lives and unnecessary costs. The program identifies members according to age and gender-specific criteria and delivers telephonic/email reminders to schedule routine preventive care. Learn more.

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24-Hour Nurse Line

The 24-Hour Nurse Line program provides round-the-clock telephone access to qualified registered nurses who advise members on health and wellness-related issues. The program also includes a telephonic audio library with more than 400 health topics and a web site that provides information about symptoms and treatment of common health concerns. Learn more.

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Maternity Management

HealthLink’ OB/GYN nurse care managers help participants be proactive in health-related decisions during and after pregnancy. The program includes early risk assessment, obstetrical nursing support and post-delivery follow-up. Learn more.

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Employer Wellness Tool Kit

HealthLink’s online communications tool kit for employers includes posters, articles, flyers and other member communications on a variety of health and wellness topics. Employers can print on-demand to build a culture of wellness in the workplace. Learn more.