1. Blue Shield of CA Plan F Extra

2. Overview of Plan F Extra
It is a competitively priced plan F sold by Blue Shield of CA
It is generally $20 - $30 cheaper than the standard plan F
It contains some hearing and vision value added benefits (no dental)
Blue Shield offers dental plans at an additional cost – we will not be offering these at this time
Since CUL does not coordinate benefits you can carry both policies and use them together

3. Vision Benefits Plan F Extra CUL (1000/1500 max)
Eye Exam (no waiting period)
In network: $20 copay then covered at 100%
Out of network: $60 allowance
Frames (no waiting period)
In network: $100 allowance
Out of network: $40 allowance
Lenses (no waiting period)
In network: $25 copay then covered at 100%
Out of network: $43 - $200 allowance
Contacts (no waiting period)
In network: Covered at 100%
Out of network: up to $250 allowance
Eye Exam (no waiting period)
Covered at 60% year 1, 70% year 2, 80% year 3
Frames (6 month waiting period)
Lenses (6 month waiting period)
Contacts (6 month waiting period)

4. Vision Costs Example
Example eye exam costs $200 (How does CUL work Plan F Extra Vision?)
A CUL patient pays:
$80 year 1
$60 year 2
$40 year 3
A Plan F Extra patient pays:
In network: $25 copay
Out of network: patient gets $60 allowance so they pay $140
CUL with Plan F Extra (out of network)
Year 1: patient pays $80 + gets a $60 allowance so they pay $20
Year 2: patient pays $60 + gets $60 allowance so they pay $0
Year 3: patient pays $40 + gets $60 allowance so they earn $20
Network benefits favor F Extra benefits over CUL. However, CUL could work in conjunction with the out of network benefits.
Since you can carry both policies, clients stand to MAKE money in some cases. Example: client goes for vision exam that totals $200 to an in network provider. They pay $25 and then the exam is covered. They can then submit the claim for the entire $200 amount to CUL and received $120 back. After the copay they paid, this would mean they MAKE $95 off that exam.

5. Hearing Benefits
Plan F Extra– Administered through EPIC Hearing Healthcare (EPIC)
CUL (1000/1500 max)
Hearing Exam (no waiting period)
Covered at 100%
Hearing aids (no waiting period)
In network: not covered, but does have pre- negotiated prices which cannot be exceeded:
$500 per aid for Vista 610 model
$799 per aid for Vista 810 model
Hearing exam (no waiting period)
Covered at 60% year 1, 70% year 2, 80% year 3
Hearing aids (12 month waiting period)
Covered at 0% year 1, 70% year 2, 80% year 3

6. Hearing Costs Examples
General exam could cost $250 without insurance
Covered at 100% with F Extra
File a claim with CUL and get reimbursed: $150 (in year 1)
Client makes $150 on this exam
Hearing aids can cost $1500 (on the low end)
F Extra has negotiated $500 per aid = $1000
If, after your CUL 12 month waiting period, you file a claim for $1000 you would be reimbursed $700 (70%)
$1000 negotiated price - $700 reimbursement = $300 (final total)

7. Dental plans cost Blue Shield dental Plans CUL
$1000 max benefit AKA “Dental PPO 1000”: $40.70/month
$1500 max benefit AKA “Dental PPO 1500”: $49.80/month
$1000 max benefit (65 – 74): $34.17
$1500 max benefit (65 – 74): $45.17
The Blue Shield dental plans cost more than the full CUL plans.
Can use doc in and out of network; out of network docs pay less
As a company, we will not be offering the dental plans. We have no way of capturing this rider in MA for quoting/tracking/reporting.
If a client wants the BS dental plan over the CUL plan, they will need to sign up for this with BS directly after approval.

8. Dental Benefits (Called Dental PPO)
Blue Shield CA Dental plans (additional cost – NOT included)
CUL (1000/1500 max)
Preventative (exam/x-rays)
No waiting period
$1000 max – covered at 100%
$1500 max – covered at 100%
Basic services (fillings/simple extractions)
$1000 max – covered at 50%
$1500 max – covered at 80%
Major services (root canals/oral surgery)
12 month waiting period
$1500 max – covered at 50%
Preventative (exam/x-rays)
No waiting period
Covered at 60% year 1, 70% year 2, 80% year 3
Basic services (fillings/simple extractions)
Major services (root canals/oral surgery)
12 month waiting period
Covered at 0% year 1, 70% year 2, 80% year 3

9. Plan F Extra vs. CUL Talking Points
For preventative dental, Blue Shield Dental PPO plans do have better coverage.
For basic dental services, Blue Shield Dental PPO 1500 has better coverage but CUL 1500 but CUL 1000 has better coverage than Blue Shield Dental PPO 1000
For major dental services, CUL has the better benefits.
When it comes to vision/hearing – CUL works really well with F Extra and ensures maximum benefits received
Part of the benefit of going with CUL will be an easy application process and our ability to help them service the policy whenever they need it. With a dental rider add on, they will have to go to company direct.
Benefit to CUL is no-network freedom

10. Network Info
Vision: Access to thousands of providers in Blue Shield Network
Includes LensCrafters, Wal-Mart, JC Penny, Sears Optical, Contacts and more
Provider Search: tool to see if their doc is in network
Hearing: Access to thousands of providers through EPIC Hearing Healthcare Network
Locations for this provider can be found HERE
Dental: Access to thousands of providers statewide within the Blue Shield PPO Network
Check to see if your doctor is in network by using this LINK

11. FAQs Can you slide into this plan using CA birthday rule?
NO: if someone is on a plan F currently and wants an F Extra with Blue Shield, they must be underwritten into it.
F Extra is considered “additional coverage” in comparison to standardized plans
Can they GI into this plan?
YES; treat it like a plan F
How does F Extra fit into the conversation of a plan F “phase out” by 2020?
Same rules apply to F Extra as standard F: If you turn 65 on or before 12/31/2019, you will be eligible to buy and keep one of these plans indefinitely
If they are first eligible for Medicare part B on 1/1/2020 or later, they will not be eligible to pick up this plan.
Can they get both a Blue Shield dental plan and CUL?
Yes, but it would be expensive and might not be worth the premiums (approx. an additional $70-$80/month combined). Assess which one is the right fit and guide your client to go Blue Shield direct if necessary.
What are rate increases predicted to be like?
About 4% each year.
Are the vision/hearing benefits guaranteed for the life of the policy or are they subject to change?
The vision/hearing benefits are embedded in this policy and will never change.
Any other benefits I should know about?
Yes – Blue Shield offers Silver Sneakers with all of their policies!

12. GI Into Plan F Extra
From now until 4/15, if your client has a Med Supp currently, they can apply for a Plan F Extra and there will be NO medical underwriting
Must have a med supp
Does not apply to F standard
Current Med Supp can be from any carrier