1. 2013 Medical Plans
Babson College

2. Agenda
Open Enrollment is from 10/24 thru 11/ Effective January 1st, 2013
Choose from 3 medical plans
HMO Blue New England Value Plus
HMO Blue New England Enhanced Value
PPO Blue Care Elect Saver with HSA (Health Savings Account)
Introduction of Value Based Benefits (New)
No Pre-Existing Conditions or Waiting Periods 2 2 2

3. Preventive Visits for Medical Plans
Preventive Visits, Related Tests & Immunizations
Covered In Full In Network– No Copayment!
Well-Child Care Visits
Routine Adult Physical Exams
Routine GYN Exams
Routine Vision Exams
Routine Hearing Exams
Family Planning Services Office Visits

4. Benefit Enhancements Women’s Preventive Health Services
No-Cost to BCBSMA enrolled members in network
Annual well-women visits
Screening for gestational diabetes
Human papillomavirus (HPV) DNA testing
Counseling for sexually transmitted infections
Counseling and screening for human immunodeficiency virus (HIV)
Contraceptive methods and counseling
Breastfeeding support and breast pumps
Domestic violence screening

5. Prescription Benefit Enhancement for HMO and PPO Medical Plans
Certain Covered Smoking Cessation Drugs
Certain Covered Drugs For: Asthma, Diabetes, Coronary Artery Disease Or Risk For Cardiovascular Disease (Concurrently Taking High Blood Pressure Medications And High Cholesterol Medications), And Depression Associated With Any Of These Conditions
Mail Service $15/$30/$150 (90-Day Supply)
Please note that for Value Based Medications the Deductible Does Not Apply on the PPO Plan

6. HMO Blue New England Plans – Enhanced Value & Value Plus
Use network providers – all 6 NE States
Choose PCP Any Time
Referrals to network specialists
No referrals for: OB/GYN, chiropractic or outpatient behavioral health visits, routine vision exam, emergency or out-of-area urgent care
Same covered services under both plans
Difference in cost sharing 6

7. Comparison of HMO Plans- Enhanced Value & Value Plus
HMO Blue New England Value Plus
HMO Blue New England Enhanced Value
Preventive Visits
You Pay Nothing
Other Office Visits (including office surgery)
You Pay $20
You Pay $25
High Tech Imaging Tests
You Pay $75
Emergency Room Visits
You Pay $150*
Inpatient Admissions
You Pay $250*
You Pay $500*
Hospital Day Surgery
Rx Retail: 30-Day Supply
You Pay $10/$25/$45
You Pay $15/$30/$50
Rx Mail Service: 90-Day Supply
You Pay $20/$50/$90
You Pay $30/$60/$100
*Out-of-Pocket Maximum
$1,000/$2,000 Calendar-Year Maximum
$2,000/$4,000 Calendar-Year Maximum

8. PPO Blue Care Elect Saver With HSA
Blue Cross Blue Shield PPO National Plan (Blue Care Elect Saver)
Health Savings Account (HSA)
- Babson College puts money in your account Tax Free
- You can contribute Pre-Tax dollars to your HSA just like you do an FSA
- No “use it or lose it” – you may roll over unused funds
- Funds grow tax free plus you have Investment
Opportunities
- Use it now for Eligible Medical Expenses or build
wealth for later years – It’s Your Money!

9. PPO Blue Care Elect Saver Plan
National Preferred Provider Organization (PPO)
Choose any doctor or hospital
No primary care physician or referrals needed
Two levels of benefits - where you choose to go determines benefit level: In network or out of network
Use national BCBS PPO provider or any emergency room for in-network benefits
Use any licensed provider for out-of-network benefits

10. PPO Blue Care Elect Saver Plan
For preventive visits & related routine tests, you pay nothing in network or 20% out of network
For all other services, before plan provides any benefits,
you pay plan-year deductible
- $1,500/individual membership
- $3,000/family membership
Entire family deductible must be met before
benefits are provided for any family member

11. PPO Blue Care Elect Saver Plan
After deductible is met:
You pay $150 for emergency room visits
You pay $10/$25/$45 for retail prescriptions*
($20/$50/$90 at out-of-network retail pharmacies)
You pay $20/$50/$90 for mail service prescriptions
You pay nothing for all other in-network services
You pay 20% for out-of-network services
*reminder that the deductible does not apply to Value Based medications

12. PPO Blue Care Elect Saver Plan
Plan-year out-of-pocket maximum
$5,000/individual membership
$10,000/family membership
Includes deductible, out-of-network coinsurance and all
co-payments
Entire family out-of-pocket maximum must
be met before any family member receives
full benefits

13. Health Savings Account (HSA)
Administered by Wells Fargo
Available only with PPO Blue Care Elect Saver Plan
For 2013, Babson College will contribute (Tax Free to You) the following amount toward your deductible :
- Individual contract: $500
- 2-person and Family contracts: $1,000
Paid as a lump sum in January
This contribution is available for 2013, and is under review for following years

14. Health Savings Account (HSA) Eligibility
Employee Must be Enrolled in HDHP
Employee Is Not Eligible For Medical FSA
Employee Cannot be Covered Under a Spouse’s Medical Plan or Medical FSA
Employee Cannot be Enrolled in Medicare
Employee Cannot be Claimed as a Dependent on Someone
Else’s Tax Return

15. Payment For Services
For Rx before deductible is met, & for Rx & ER copayments after deductible
Show provider your BCBS ID card
Pay discounted charge for Rx or copayment
Provider sends claim to BCBS for balance of payment
For all other deductible & coinsurance services
Pay nothing
Provider sends claim to BCBS
BCBSMA sends claim summary to you & provider
Provider sends you a bill
You pay provider

16. Sample Claim Summary 16

17. Added Value $150 fitness benefit $150 weight loss benefit
Childbirth class benefit
Living Healthy Babies
Blue Care Line: BLUE (2583)
Living Healthy Vision discounts
Living Healthy Naturally discounts
Safe Beginnings discounts
We offer additional benefits to encourage you to maintain or improve your overall health. Detailed information about all of these benefits is included in your enrollment materials and on our web site. You are eligible for a $150 reward each calendar year per family toward a membership to any health or fitness club. An additional $150 reward is available each calendar year per family toward the cost of any hospital-based weight-loss program or a Weight Watchers retail or at-work program. We offer the Living Healthy Babies program (which includes a reimbursement toward the cost of childbirth classes) to provide information and support to new parents. Medical advice from a registered nurse is available 24 hours a day by calling our Blue Care Line toll-free number. There is no charge for this service and our members who call the Blue Care Line have eliminated many unnecessary emergency room visits. Carrying the Blue Cross Blue Shield ID card gives you access to some great discounts for vision correction and alternative medicine, including acupuncture, massage therapy, nutritional counseling, yoga, Pilates, Tai Chi and personal trainers. To take advantage of these discounts, call us or go to our web site and find a provider in your area who has agreed to give the discount and, when you go, show them your Blue Cross Blue Shield ID card. Discounts are also available for home safety items.

18. Member Central Account
Go to to register for Member Central &
manage your plan
Change PCP (HMO members)
Request an ID card
Review your benefits
Review your claims
Review your pharmacy program
Find a doctor
Link to Wells Fargo to review your PPO Health Savings Account
You can go to our web site, bluecrossma.com, and register for member self service. This will give you access to your membership information. You can confirm who’s covered under your plan and change your primary care physician. If you lose your ID card you can request a new one. You will be able to access the HMO Blue Options Deductible Plan Subscriber Certificate for the complete details of your plan. You will also be able to access all of your claims. And by enrolling in My Blue Health, you will have access to our many web-based wellness programs.

19. Healthy You is here to help you lead a healthy lifestyle!
Healthy You is the wellness program brought to you by the Boston Consortium for Higher Education & Babson College
Healthy You is here to help you lead a healthy lifestyle!
Health Assessment
Biometric Screenings
Concierge Care Center
The Healthy You Fall Inintiative is underway. Complete your Personal health Assessment (PHA) by 11/16/12 and receive a $100 gift card through the BCBS web portal.
Health Assessment & Biometric Screenings were conducted this past spring.
Concierge Care Center launched on 1/1/11 – new 800# & Healthy You logo put onto ID cards
More activities will be coming out this fall

20. Dedicated Boston Consortium for Higher Education Healthy You Concierge Care Center
A dedicated, integrated member service, clinical guidance model offering BCBSMA members a single point of reference for navigating the health care system. Simply call the number 888# on your ID card!
Member Services
Highly trained Member Service Representatives to support your service needs and inquiries.
Nurse Care Center
A dedicated team of nurses and researchers to accept your inbound calls and to make outbound calls to support your health care needs– all to make a positive impact on your health.
Inbound Calls
Educating you about a diagnoses, medications, treatment, planned surgeries, and community resources
Giving referrals to and/or information on appropriate BCBSMA programs or benefits
Choosing a provider and conducting a provider search
Directing you to campus-wide wellness initiatives (i.e. onsite biometrics, health assessment) or other appropriate campus resources (i.e. EAP)
Outbound Calls
Recent discharge or pre-authorization for upcoming procedure
Follow up to recent ER visit or call to the Blue Care Line
Health Assessment results
Members call the 800 member service # on their ID card and will follow the prompts to be directed to the Member Service center or the Nurse Care Center. Both areas can seamlessly transfer members back and forth based on needs.
Reasons for follow up on Health Assessment may include – smoker status, high biometric readings, no PCP, pregnancy, etc.
Hours of Nurse Care Center – M – R 8a – 8p / F – 8a – 4p / Closed S & S

21. Questions?
For provider information or questions about membership, benefits, referrals or claims call your dedicated member service team
Toll-free telephone number on your ID card
Representatives available Monday – Friday, 8 a.m. – 6 p.m.
Visit
If you need provider information or wish to speak with a Blue Cross Blue Shield Member Service representative about your membership, referrals, benefits or claims, please call Member Service between 8 a.m. and 6 p.m. You can visit our web site anytime. We look forward to meeting all of your health care needs. And thank you, again, for taking the time to review your new medical plan.