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BHCG Frequently Asked Questions (FAQs)
For Brokers
- What is the Humana Health Benefit Plan offering designed exclusively for BHCGSW?
- What are the BHCG health plan benefits?
- How is this different from other health plans?
- What providers are included in Humana Preferred (BHCG), a high performance network?
- How are providers reviewed for participation in Humana Preferred (BHCG)?
- Are all Humana providers included in the Humana Preferred (BHCG) plan offering?
- What if my physician is in a group that is not a Humana Preferred (BHCG) participating group?
- How often will Humana make changes to Humana Preferred (BHCG)? When might providers have an opportunity to join?
- How can physicians be considered for the Humana Preferred (BHCG)?
What is the Humana Health Benefit Plan offering designed exclusively for BHCGSW?
The new plan offering is called Humana Preferred (BHCG). These benefit plans are tied to a high performance network designed to assist consumers in using efficient health care providers. It is similar to other PPO or EPO plans you may be familiar with, but will offer additional benefits that traditional PPO or EPO plans do not offer today.
What are the BHCG health plan benefits?
In addition to exclusive access to Wisconsin’s first health plan designed to provide consumers with efficient health care providers based on the actual cost of services, BHCG health plan members have:
- A member portal, through MyHumana.com, which will include online tools with efficiency and effectiveness indicators to help health care purchasers make informed decisions about the providers they choose for health care services.
- Access to many of the best-known hospitals and health systems in the area.
- Choice of providers -- Like other PPO health plans, Humana Preferred (BHCG) provides varying levels of benefit coverage for both in-network and out-of-network providers.
- Access to ActiveHealth Management’s industry leading technology which identifies and communicates important care information to physicians and their patients to ensure optimal patient care is being delivered on a timely basis.
How is this different from other health plans?
This is a new approach to health care in the region that asks all involved parties to be accountable for doing their part to control health care costs. To succeed, there must be accountability and partnership with providers, consumers, employers, and the insurance administrator, Humana.
The business community was the driving force in supporting these new, health plan offerings which are designed to control health care cost trend for employers and their employees by promoting consumer engagement, open access to provider price and performance information, and improved efficiency and effectiveness in the delivery of health care services.
What providers are included in Humana Preferred (BHCG), a high performance network?
How are providers reviewed for participation in Humana Preferred (BHCG)?
Physicians identified as efficient in 20 specialties were evaluated by statistical methods, which identified and measured episodes of care costs, including physician, hospital, ancillary, pharmacy, and laboratory costs. There were additional criteria applied to large physician groups.
Not all Humana Preferred (BHCG) physicians were evaluated in the selected specialties or met the evaluation criteria. Some are included because they practice in a physician group practice which as a whole has met the criteria. Other physicians who have not been evaluated or meet the evaluation criteria are included in order to meet geographic access standards or practice in a unique sub-specialty needed in the network.
If a currently contracted Humana provider did not have enough data available to evaluate, the provider was included in the high performance network plan offering; however Humana will continue to track the provider’s data every six months and once a sufficient number of episodes are realized, the provider’s individual performance will be analyzed for continued participation in the high performance network. Physicians who are just starting their participation with Humana (never have been contracted with Humana as a provider) will be included in other Humana networks and products, except for the high performance network for a minimum of one year, allowing time for the provider to gain sufficient practice data to be analyzed based on Humana’s episode of care methodology.
Are all Humana providers included in Humana Preferred (BHCG)?
Not all Humana contracted physicians are included in Humana Preferred (BHCG). However, all types of providers are included in the Humana Preferred (BHCG) plan offering to ensure comprehensive care delivery by network providers.
What if my physician is in a group that is not a Humana Preferred (BHCG) participating group?
Individual physicians who are part of physician groups participating in Humana Preferred (BHCG) are always included if the group is included. Likewise, individual physicians who are with a group that is a nonparticipating group, are not participating if the group is not participating.
How often will Humana make changes to Humana Preferred (BHCG)? When might providers have an opportunity to join?
Humana will make changes on an annual basis if necessary. Provider participation is based on Humana's selection process.
How can physicians be considered for Humana Preferred (BHCG)?
If a physician is not currently a participating provider with Humana, they can call Humana’s Provider Relations Department (800) 626-2741 for more information. Note: Physicians who are currently Humana contracted physicians not currently included in the Humana Preferred (BHCG) plan offering will be evaluated annually for possible participation.
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