2. Deductible Credit From Prior Carrier
HOW IT WORKS
Deductible Credit From Prior Carrier
Date
Action
Comments
June 15
Highmark requests a report from your current healthcare carrier of deductible amounts you have already met to date – you do not need to do anything to initiate this process
A second report will be requested later to capture deductible amounts not yet available to include on this report
June 30
Highmark applies “credits”
Deductible amounts from your current carrier will be applied to your Highmark deductible as a “credit”
July 1
Highmark benefits begin
You only need to satisfy any remaining balance of your deductible
Until all credits are applied, you could experience out-of-pocket expenses for Highmark claims
August 15
Highmark requests the 2nd report from your current carrier
This report captures amounts not included on the first report (for services prior to 7/1/17)
After all credits are applied, Highmark will reprocess claims to reimburse you for any out-of-pocket expenses that should have counted toward your deductible

3. Preventive Care Your benefits are covered 100% in-network:
Preventive Care Visits (adult & pediatric)
Pediatric Immunizations
Routine Gynecological Exams (including Pap test)
Mammograms
Preventive Screenings
Preventive care is a really important part of your coverage…at every stage of life, from immunizations and vaccines for babies and kids, to women’s care, to health screenings like a colonoscopy and blood work that can quite literally save your life, you and your family members are covered at 100% for your preventive care services.

4. Virtual Medicine (Telemedicine)
Great for non-emergency conditions – such as sinus infections, upper respiratory infections, bronchitis, pink eye, sore throat, cough, etc.
You have access to these Highmark approved vendors for telemedicine services – you can choose to use one or all of these vendors for your virtual consultation.
KEY VENDOR DIFFERENCES:
Doctor On Demand
Video consult ONLY
Available in 46 states and DC. NOT yet available in Alabama, Alaska, Arkansas & Louisiana
Amwell
Video and phone consults
Available in 46 states and DC. NOT yet available in Alabama, Alaska, Arkansas & Texas

5. Virtual Medicine (Telemedicine)
What is it?
A “virtual” doctor’s visit from the convenience of your computer, smartphone, or tablet
Why use virtual medicine
Convenience – the doctor is available 24/7
Easy – it’s so easy to connect to doctor
Care– doctors are able to treat and diagnose
More than 90% of urgent care visits
When should you consider virtual medicine?
When you are on vacation
When you don’t want to go the
urgent care center
Follow-up visits with a PCP or specialist when available
Your benefits include Telemedicine coverage (effective 1/1/2016).
Effective 12/31/2015, our contract with Teladoc will end. Teladoc will not be available for fully insured.
Providers are US-based, board certified and licensed to practice medicine in the state in which the member is located. The technology used is private, secure and HIPAA-compliant in order to provide a safe and confidential consult with a doctor online. Once the member is connected and register, the doctor can review their history, answer questions and at their discretion diagnose, treat and even prescribe medication. If the member receives a prescription, it will be sent straight to the member’s pharmacy.

6. Find out more now – so you’re ready when you need care
Go to the website and register or
download the free app:
doctorondemand.com
amwell.com
You need to register with each vendor before being able to use their services.
Register/Create Profile
Medical history
Medications
Allergies
Select Your Location
Doctors will be licensed in the state in which the patient is located

7. Make the right health care decisions
It’s easy with these online health tools at :
Find a Doctor: The information you need to find the right doctor in your network.
Care Cost Estimator: Eliminate sticker shock over the costs of medical care.
Claims Tab: View your claims and stay on top of your health care spending.

8. Eliminate sticker shock
Know ahead of time what you’ll owe for services with our Care Cost Estimator.
Cost estimates are based on your specific coverage
Compare cost estimates side-by-side
Estimates include all charges for a specific procedure, including hospital and doctor fees, anesthesia, medical supplies, etc.
Access to over 1,600 procedures to search for cost estimates.

9. A key part to your health coverage.

10. What’s a prescription drug formulary?
A list of covered prescription drugs and medications
Express Scripts is our PBM. CBC uses CVS Caremark. Different PBM = Different Formularies.
Highmark’s formulary includes thousands of medications in every major therapeutic category.
You can look up formulary medications online at your Highmark member website, highmarkblueshield.com.

11. Two ways to get your prescription drugs
Retail (31-day supply)
Generic Copay
Formulary Brand Copay
Non-Formulary Brand Copay
Mail order (90-day supply)
2x Generic Copay
2x Formulary Brand Copay
2x Non-Formulary Brand Copay
*QHDHP: rx copays apply after deductible is met

14. ID Cards Will Be Arriving By The End Of June.
Members will receive an ID card in the mail, with a sticker reminding them to call to activate the card.
For Internal Use Only. Confidential and Proprietary

15. Reach Member Service at highmarkblueshield.com
Online … or on the phone!
Reach Member Service at highmarkblueshield.com
or by calling

16. Health Wire Mobile Messaging

17. Health Wire Mobile Messaging

18. For Internal Use Only. Confidential and Proprietary
Thank You!
For Internal Use Only. Confidential and Proprietary