Transcript Open Enrollment
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
PPO Features A&M Care Plan
• Administered by Blue Cross and Blue Shield of Texas (BCBSTX) • No primary care physician (PCP) required; no referrals required to see a specialist • Select any provider for care within the PPO network or outside the network • When you receive care inside the network – Highest level of benefits – No claims to file – No balance billing for amounts over the BCBSTX allowed amount • When you receive care outside the network – May have to file own claims – Receive lower level of benefits and can be balanced billed • Worldwide coverage for emergency and non-emergency care 2
What’s New?
Effective 9/1/2014 for A&M Care Plan
CHANGE FROM CHANGE TO Coinsurance Plan pays 70% You pay 30% Plan pays 80% You pay 20% Copays DO NOT apply to the out-of-pocket maximum DO apply to the out-of-pocket maximum
No benefits changes
for the 65+ Plan
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More Hospitals and Doctors
For a current listing of all providers see our website at:
bcbstx.com
Offers names, addresses, map and directions.
For World Wide Assistance
Call 1-800-810-BLUE (2583) Or Collect 1-804-673-1177
In-network coverage is available when traveling or living worldwide 24 Hours a Day, Seven Days a Week
Available 4
Your BlueChoice PPO Benefits
Deductible – Individual Deductible – Family Out-of-Pocket Maximum – Individual Out-of-Pocket Maximum – Family Office Visit (primary care / specialist) Most Lab and X-ray paid at 100% Preventive Services Inpatient Hospital Emergency Room
BENEFITS
Chiropractic – 30 visits per plan year Maternity Care – Doctor Diagnostic Procedures/MRIs and PET scans All other covered services
MEMBER SHARE A&M Care In-Network / Out-of-Network Plan
$700 / $1,400 $2,100 / $4,200 $5,000 / $10,000 $10,000 / $20,000 $30/$45 per visit / 50% after deductible 100% covered / Not covered 20% after deductible / 50% after deductible 20% after deductible / 20% after deductible (50% after deductible for non-emergency) $45 per visit / 50% after deductible $30 initial visit only / 50% after deductible 20% after deductible / 50% after deductible 20% after deductible/ 50% after deductible
65+ Plan
$500 – $1,400 – 20% after deductible 100% paid after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible Retirees over age 65 are not eligible for copays, your benefits are secondary to Medicare
5
Preventive Coverage
Stay Healthy by Getting Regular Check-ups
Get an annual physical and reduce your monthly premium!
What’s covered?
Recommended routine gender- and age-specific preventive care, such as annual physical, OB/GYN exams, mammograms and other cancer screenings, well-child care and immunizations – both facility and professional services
Preventive coverage provided in-network at 100% with no copay, no deductible Remember:
Lab tests related to an illness or condition are not considered preventive and may pay differently
6
Retiree Information Retirees under age 65
Are considered Network
and can use the
Network providers
Retirees over age 65
• •
Choose from:
A&M Care Plan 65 Plus – you must be: –
Age 65 and enrolled in Medicare Parts A&B or disabled under 65 and enrolled in Medicare Parts A&B
–
Working for the A&M System, if at all, less than 50% time or for less than 4.5 months during the plan year
–
If covering a spouse, spouse must be age 65 or older (or disabled) and enrolled in Medicare Parts A&B
• • •
Remember:
Enroll in BOTH Medicare parts A & B.
When you receive your Medicare Card, notify BCBSTX and your Human Resource Office of your Medicare number which includes an alpha character.
If you use a Provider that accepts Medicare or is a BCBSTX provider, you cannot be balance billed.
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Retiree Coordination of Benefits
Example
Charge Medicare paid 80% Patient Share 20% A&M Care Plan Deductible Applied to Deductible BCBSTX Would Have Paid A&M Care Plan Payment Patient’s Responsibility A&M CARE PLAN (deductible not met)
$500 $400 $100 $700 $500 Zero Zero $100
A&M CARE PLAN (deductible is met)
$500 $400 $100 MET Zero $350 $100 Zero
Plans calculate the normal plan benefits, then pay that amount, or the difference after Medicare has paid, whichever is less.
Your coinsurance will continue until you meet the out-of-pocket maximum, then plan pays at 100%.
A&M Care 65 Plus = $1,400 A&M Care Plan = $5,000 individual/$10,000 Family 8
Benefits Value Advisor
•
Same procedure, lower cost
1
Now you can speak to a BCBSTX
Benefits Value Advisor
who helps you find
quality providers
for health care
services
such as: – Imaging services (X-rays/MRIs/CT scans) – Maternity services – Joint replacement surgery – Back surgery • Benefits Value Advisors can also
help you plan
for your health care by: – Helping you understand your benefits – Finding in-network providers – Scheduling visits – Requesting preauthorization – Helping you access online educational tools 1. Benefits Value Advisors offer cost estimates for various providers, facilities and procedures. Lower pricing and cost savings are dependent on the provider or facility of your choosing.
10
Benefits Value Advisor
Cost comparison for an MRI at two different providers:
PROVIDER A – KNEE MRI PROVIDER B – KNEE MRI
$374* $2,573*
Costs can vary by $2,000 for the same procedure depending on where you go!*
One call can result in big savings!
Just call the number on the back of your member ID card to reach a Benefits Value Advisor.
*Example cost data from Tarrant county.
Member communications and information from Benefits Value Advisors are not meant to replace the advice of health care professionals. Members are encouraged to seek the advice of their doctors to discuss their health care needs. Decisions regarding course and place of treatment remain with the member and his or her health care providers. Cost estimates are just an estimate. In addition to your usual deductibles, copayments and/or coinsurance, the actual cost of the services may vary based on a number of factors including the date of service, the actual procedure performed and what services were billed by the provider and your particular benefit plan. Coverage is subject to the limitations and exclusions of your plan. 11
Condition Management
If you have a chronic condition, we offer support
Blue Care
®
Advisors – clinical professionals
– can help you manage chronic health conditions such as:
Asthma, coronary disease, diabetes, COPD or low back pain
• • Understand and follow your physician’s orders Review medications, side effects, compliance, refills and current services • Establish goals with caregivers, scheduling follow-ups as appropriate
If you are identified as being at risk or having one of the managed chronic conditions, one of our Blue Care Advisors will contact you.
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Lifestyle Management Support Tobacco Cessation and Weight Management Programs
• Personal telephone coaching • Secure email outreach • Self-paced online courses • Tobacco cessation resources • Weight management resources
Other Resources
• Counseling and coaching with licensed Wellness Coaches • 24/7 Nurseline • Well onTarget
®
• Blue 365
®
• Referrals when appropriate • Jenny Craig ® • Life Time Fitness ® • Proctor & Gamble Dental Products • Vision Plans • And more… 13
24/7 Nurseline
Around-the-Clock Advice and Information by Phone
1-800-581-0368
• • • • •
24/7 access to registered nurses for health conditions such as:
‒ High fevers ‒ Earaches ‒ Cuts and bruises
1,200 audio health library topics Referral of members with care needs to the appropriate program Follow-up calls for emergency care needs Available in English and Spanish
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A New Way to Experience Wellness
Access Well onTarget by logging in to Blue Access for Members and get support to make healthy choices o Health Assessment (HA) o Self-Paced Courses o Trackers o Food and Exercise Diary o Health and Wellness Content o Fitness Program o Complementary and Alternative Medicine 15
Making wellness simpler, more affordable and more accessible for members Vision Care and Eyewear
– Discounts on eyewear, contact lenses and laser vision correction surgery
Dental Products
– Discounts on Procter & Gamble oral care bundles
Hearing Aids
– Discounts on hearing aids for members, parents and grandparents
Life Time
®´
Fitness
– Enrollment fee will be waived for new members who join one of the Life Time Fitness clubs nationwide
Weight Management
Discounts at
Jenny Craig
®´ – on membership and food
And more
Under the
My Coverage
tab Register online at
blue365deals.com/BCBSTX
/ 16
Blue Access for MEMBERS
SM
Save time with self-service support tools and health and wellness resources on a convenient and secure online site
• Check claims and claims history • View, save or print Explanation of Benefits (EOBs) • Sign up for electronic EOBs, and turn off paper • View benefits and covered dependents • Check coverage details • Manage mobile and texting preferences • Request new ID cards or print temporary ID cards • Access health and wellness information and guides • Get details on wellness, discounts
… and more
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Blue Access Homepage
My Coverage
shows who’s covered on your plan, YTD spending for each family member, cost estimator, deductible discounts and ID card request . From My Coverage page, click on
Incentives
, then
Visit Site
to view completed activities so you can make sure that your Wellness Exam Incentive has been recorded.
My Claim Activity
displays recent claims, or go to the
Claims Center
for all your claim details Access
Provider Finder ®
to locate doctors, specialists, facilities, directions and Blue Distinction Centers ®
My Health tab
links you to health and wellness content, articles, videos, and My Care Profile
Quick Links
for easy access to Health Assessment, Fitness Program, Member Discounts, or to get an ID card
Form Finder
easier to view and find specific forms for members 18
Health Assessment Powerful Health and Wellness Tool
User-friendly health assessment tool
•
Personal Health Assessment designed to be completed in 10 to 15 minutes
•
Choose your assessment topic, such as health and wellbeing or fitness and physical activity
•
All topics must be completed to receive credit
bcbstx.com
Complete all topics under the HA and receive a
$50
deductible credit for members and dependents ages 18 and over
Know Your Risks
Manage Your Health
Examines the member’s overall health and wellbeing and provides a
personalized report
showing areas where you can improve 19
Blue Access Mobile
SM
Overview Current Mobile Offerings
• Mobile Web (public) • • • Blue Access for Members SM (secure) Text Messaging (static and dynamic) Provider Finder ® App (iPhone and Android)
Provider Finder ® puts you in charge
bcbstx.com
Use Provider Finder to:
o Find a network primary care physician, specialist or hospital o Search results by doctor, specialty, ZIP code, language and gender – even get directions from Google Maps™ o Estimate the cost of a provider’s procedures, treatments and tests o Determine if a Blue Distinction Center for Specialty Care ® is an option for treatment o View patient feedback or add your review for a provider o View quality, certifications and recognitions for doctors 21
What if I Have Questions
• •
Personalized Service 8 am – 8 pm
Our Philosophy – “Take the Member Out of the Middle” Call your dedicated customer service team for:
‒ ‒ ‒ ‒ ‒ ‒ ‒
Benefit information Network provider information Membership and eligibility Inquiries (telephone and email) ID card requests Claims inquiries Help with online tools
866-295-1212
Toll-free
Customer Service 22
Your ID Card
Need Assistance?
Call the
Customer Service
number on the back of the ID card to: • Ask about benefits and claims • Talk to a
Benefits Value Advisor (BVA)
to locate facilities for MRIs, CTs, maternity services, hip/knee/spine surgeries, and more 23