Wyandotte High School Health Insurance Plans

HMO (Health Maintenance Organization) Select a Primary Care Physician (PCP) No Referral for Network Specialist In-Network Only PPO (Preferred Provider Organization) Freedom of Choice – You select your Primary Care Physician In and Out of Network /National and International Coverage Consumer Driven Health Plan - QHDHP (Qualified High Deductible Health Plan) In and Out-of Network /National and International Coverage Employee Owned Health Savings or Personal Care Account HSA or PCA to Pay for Medical, Drug, Vision, & Dental Expenses

Medical Plans Con’t HMO (Health Maintenance Organization) - a plan prepaid by an individual or by a company for its employees, that provides treatment, preventive care, and hospitalization to each participating member PPO (Preferred Provider Organization) -a comprehensive health plan offered to employees that allows them to choose their own physicians and hospitals within certain limits. CDHP (Consumer Driven Health Plan) must be tied to a tax-exempt health savings account (HSA) or health reimbursement account (HRA), in which you or your employer deposit money to use for medical expenses. The HSA is used by the employee to pay medical expenses on a pre-tax basis

Health Care Definitions Deductible - The amount for which the insured is liable for before an insurance company will make payment. First responsibility in a calendar year Coinsurance - A cost-sharing agreement between the insured and the insurer under a health policy which pays a percentage of the covered costs after the deductible has been paid. at the time the service is rendered. Out of pocket maximum - The most you will have to pay in a year for deductibles and coinsurance for covered benefits. Copay - The amount an insured person is expected to pay for a medical expense at the time of the visit. A flat fee charge regardless of services rendered (Example: $20) Pre-existing Condition- a health condition (other than a pregnancy) or medical problem that was diagnosed or treated before enrollment in a new health plan or insurance policy; also written pre-existing condition. On the PPO plan - Pre-existing Exclusion Period does not apply to children under age 19. Basic Coverage Limit- Lowest amount of coverage for which an insurance policy can be written, as prescribed in the insurance legislation or as set by the insurance company.

Before We Get Started…. Health Care Reform What’s covered now? And what’s covered in the future? – Dependents are covered to the end of the calendar year they turn 26 regardless of student status – 100% Coverage on Preventive Care – Network and Non-network Emergency Services paid the same – Unlimited Lifetime Maximum – On the PPO plan - Pre-existing Exclusion Period does not apply to children under age 19 – No Calendar Year Maximum on DME (Durable Medical Equipment) – Unlimited Lifetime Maximum on Organ Transplants – BlueKC.com will provide current information and Frequently Asked Questions

Primary Care Physician (PCP) (GP, FP, IM, Ped) $25 copay Specialist (no referral) (Allergist, ENT, OB/Gyn) $50 copay Inpatient Hospital Services/Outpatient Surgery $100 per day up to $1,000 individual / $2,000 family MRI, MRA, CT and PET Scans – Physician’s Office, Imaging Center, Outpatient Setting $150 copay Urgent Care (includes CVS Minute Clinics; Walgreen’s Take-Care Centers) $50 copay (Office Visit and Lab only) Emergency Room Services$150 copay (Copay waived if admitted to a network hospital) HMO

Traditional HMO Plan Centerpoint Medical Center Children’s Mercy Hospitals KU Medical Center Lee’s Summit Hospital Menorah Medical Center North Kansas City Olathe Medical Center Overland Park Regional Providence Medical Center Research Medical Center Shawnee Mission Medical Cente St. Luke’s Hospitals ARE NOT in the Blue-Care network Blue-Care Blue

PPO In-NetworkOut-of-Network Deductible: The portion the covered person must pay each calendar year before insurance will provide benefits. Individual Deductible Family Deductible $500 $1,000 $2,000 Coinsurance: Portion of covered charges paid by BCBSKC after you satisfy your deductible. CoinsuranceMember pays: 10% BCBSKC pays: 90% Member pays: 20% BCBSKC pays: 80% Out-of-Pocket Maximum In-NetworkOut-of-Network Individual Maximum Family Maximum $2,500 $5,000 $10,000 Out-of Pocket Maximum: Total of deductible and coinsurance that members pay each calendar year toward covered services before insurance pays 100%.

Preferred-Care Blue (PPO) 53 Metro Area Hospitals Including: Centerpoint Medical Center Children’s Mercy KU Hospital Lee’s Summit Hospital Menorah Medical Center North Kansas City Hospital Olathe Medical Center Overland Park Regional Research Hospitals Saint Luke’s Hospitals Shawnee Mission Medical Center Liberty, St. Joseph, St. Mary’s and Truman Hospitals are not in the Preferred-Care Blue Network

Urgent Care Receive care for non-life threatening conditions. You are responsible for the copay when using Urgent Care Facilities Use Walgreen Take-Care Centers or CVS Minute Clinics If you are outside of the service area, contact your Primary Care Provider prior to treatment. – (HMO Plan Only) Emergency Care Go to the nearest Emergency Room or call “911”. Receive treatment and pay the copay. Contact your PCP – within 48 hours (or as soon as reasonably possible) after you receive medical attention. Urgent Care and Emergency Care

Travel with Your PPO Health Plans As a Member, you can take your healthcare benefits with you across the country and around the world. The PPO Program gives you access to over 6,000 hospitals and 800,000 physicians around the country, giving you the peace of mind that you can take charge of your health, wherever you are. Visit our website at click Find BlueKC Doctors, Hospitals and Pharmacies, click BlueCard Provider Directory, click Continue. Login using the ID number on the front of your BCBSKC ID Card. or call (800) 810-BLUE (2583) to receive a complete list of network hospitals and physicians.

Prescription Drugs [Not Creditable To Medicare Part D] Costco’s, CVS, Hen House, Hy-Vee, K-Mart, Price Chopper, Sam’s Club, Sun Fresh, Target, Walgreen’s, Wal-Mart Retail (34 day supply) : $10 copay for Tier 1 $30 copay for Tier 2 $50 copay for Tier 3 Tier 1 – Generics Tier 2 – Name Brand Tier 3 – New on Market

Routine Preventive Care Covered at 100% Physician Examinations CBC Metabolic Screening Urinalysis Glucose Screening Thyroid Stimulating Hormone Screening Lipid Cholesterol Panel HIV Screening HPV Screening Chest X-ray EKG Covered at 100% PSA Tests Pelvic Exams and Pap Smears Mammograms Childhood Immunizations Lead Testing Colorectal Cancer Exams Newborn Hearing Screening

What Can I Do? Annual Preventive Exams Always Use Network Providers Use Urgent Care Centers/Take-Care Facilities Ask your doctor for prescription drug samples Take Medication as Prescribed by Physician or according to Manufacturers Guidelines Consider Your Overall Health..diet, exercise, personal habits… Ask your Doctor or Pharmacist if there is a generic substitute for a name brand prescription Not sure? Ask Questions! Traveling? Do your homework. Find a network provider in that area.

Thank you! Questions & Answers