1. 2014 Benefit Changes BlueCross and BlueShield Service Benefit Plan

2. Agenda Plan Overview Preventive Care Health Club Membership
Special Features
2014 Benefits Changes
2014 Rates
Agenda

3. Service Benefit Plan Options
The Service Benefit Plan is a fee-for-service (FFS) plan
We have a Preferred Provider Organization (PPO)
Standard Option
Basic Option
Deductible
Copayments and Coinsurance
Ability to Choose Provider (Preferred and Non-preferred)
Retail and Mail Rx
No deductibles
Copayment based
Preferred Providers only
Retail Rx
Standard Option & Basic Option
No Pre-Existing Conditions
No Referrals Required
No Lifetime Maximums
Unlimited I/P Hospital Days

4. Preventive Care Free Preventive Care (Preferred Providers)
Free annual physicals for adults
Free well child care from birth up to the age of 22
Free cancer screenings
Free immunizations
Cancer Screenings: Colorectal Cancer Screenings
Prostate Cancer Tests: PSA Prostate Specific Antigen
Cervical Cancer Tests
Screening mammograms
Ultrasound for Aortic Abdominal Aneurism
Osteoporosis Screening; Annual for women over 60
Immunizations Include: Hepatitis, Herpes Zoster (Shingles), Human Papillomavirus (HPV), Influenza (Flu), Measles, Mumps, Rubella, Meninggococcal, Pneumonia, (Tetanus, Diptheria and Pertussis Booster every 10 years) and Varicella

5. Health Club Membership
Healthways Fitness Your Way
Online enrollment payment
$25 one time initiation fee
$25/month (3 months minimum)
Unlimited access to >8000 fitness centers
Web tools, trackers and online health tracking
Ongoing engagement through social networking and gaming

6. 2014 Benefits Changes

7. 2014 Benefit Changes BRCA Testing Vitamin D Supplements
Catastrophic Maximums
Prescription Drugs
Basic Option Copayments
Wellness Incentives
Other Changes

8. Preventive BRCA Testing
Standard Option and Basic Option
Current Benefit:
Benefits are not available for BRCA testing when no condition is present
2014 Benefit:
Benefits are available for BRCA testing, limited to one per lifetime, for:
Female members without personal diagnosis of breast or ovarian cancer who meet specific family history criteria; no member-cost share when provider is Preferred
Male or Female members with a cancer diagnosis when test is medically necessary to manage treatment of cancer; regular medical benefits apply
A breast cancer (BRCA) gene test is a blood test to check for specific changes (mutations) in genes that help control normal cell growth.

9. Standard Option and Basic Option
Vitamin D Supplements
Standard Option and Basic Option
Current Benefit:
Benefits are not available for Vitamin D supplements
2014 Benefit:
Benefits are available with no member cost-share for Vitamin D supplements for adults, age 65 and over:
When prescribed by a physician;
When obtained from a Preferred retail pharmacy; and
Limited to international units (I.U.s) daily
Vitamin D is an essential vitamin that helps your body absorb calcium and phosphorus. Not enough vitamin D -- a vitamin D deficiency -- can cause pain, hormone problems, muscle weakness, and more.

10. Catastrophic Out-of-Pocket Maximums

11. Catastrophic Maximum – Standard Option
Current Benefit:
The calendar year deductible does not count toward the catastrophic protection out-of-pocket maximum
2014 Benefit:
Include the calendar year deductible in calculation of the catastrophic maximum
Does NOT apply to catastrophic limit:
35% coinsurance for I/P care at non member hospital
35% coinsurance for O/P care at non member facility
Dental expenses in excess of the fee schedule payment
$500 penalty for failure to obtain pre-cert
Services, benefits and drugs in excess of our maximum allowables
The difference between the plan allowance and the billed amounts

12. Standard Option: Catastrophic Out-of-Pocket Maximums
Current
Preferred
Non-Preferred
Self Only
$5,000
$7,000
Self and Family
2014
$6,000
$8,000
Offset factor slide 1c and in support of 3
*Basic Option limited to Preferred providers

13. Catastrophic Maximum – Basic Option
Current Benefit:
The member cost-share for Tier 3 (non-preferred brand-name) drugs does not apply toward the catastrophic maximum
2014 Benefit:
Apply the member cost-share for Tier 3 (non-preferred brand-name) drugs toward the catastrophic maximum
Does NOT apply to catastrophic limit:
Services, benefits and drugs in excess of our maximum allowable amounts
The difference between the plan allowance and the billed amounts
Except for special situations, Coinsurance member pays for care at Par/Non Par professional providers and Member/Non Member facilities

14. Basic Option: Catastrophic Out-of-Pocket Maximums
Current
Preferred
Non-Preferred
Self Only
$5,000
N/A
Self and Family
2014
$5,500
$7,000
Offset factor slide 1c and in support of 3
*Basic Option limited to Preferred providers

15. Basic Option Surgical Copayment
Current Benefit:
Member copayment = $150 per surgeon, regardless of place of service (Special exceptions exist for some minor procedures to be treated as office visit with copayment).
2014 Benefit:
Member copayment = $150 per surgeon for surgical procedures performed in an office setting
All other settings, a $200 copayment per surgeon will apply
For members who are looking to save money on premiums of course our goal is to move them rather than lose them. For those members the $200 copay is still a better deal (in most cases)than the ded and coins they would have with S/O.

16. Basic Option Inpatient Admission Copayment
Current Benefit:
Member copayment = $150 per day for inpatient admission (maximum of $750 per admission)
2014 Benefit:
Member copayment = $175 per day for inpatient admission (maximum of $875 per admission)
Factor slide 2

17. Basic Option Diagnostic Test Copayments
Current Benefit:
No cost-share for neurological testing
$25 copayment for low-cost diagnostic tests
$75 copayment for professionally-billed high-cost diagnostic tests
$100 copayment for facility-billed high-cost diagnostic tests
2014 Benefit:
$40 copayment for neurological tests and other low-cost diagnostic tests
$100 copayment for professionally-billed high-cost diagnostic tests
$150 copayment for facility-billed high-cost diagnostic tests
Remind members that there is still no deductible.
LOW COST - EEGs, Ultrasounds, X-Rays, neurological testing
HIGH COST - Bone Density Tests, Sleep Studies, CT Scans, MRIs, PET Scans, Diagnostic Angiography, Genetic Testing & Nuclear Medicine

18. Wellness Incentives

19. Health Assessment Incentive
Current Benefit:
Members receive up to $50 on a wellness incentive card for completing the Blue Health Assessment ($35) and up to 3 online coaching modules ($5 each) during the calendar year
2014 Benefit:
Members receive up to $75 on a wellness incentive card for completing the Health Assessment ($40) and achieving up to 3 of 5 lifestyle goals ($15 for first goal; $10 each for two additional goals) during the calendar year. Lifestyle goals include exercise, nutrition, stress, weight management, and emotional health
The purpose of these assessments is not so that we, the insurer, can find out about health conditions within the group. After all, we get the claims so we pretty much know. We want the members to know the status of their own health and the questions on the assessment should encourage members to go to a doctor so they will know what they need to know about their health.

20. Other Changes

21. Insulin and Diabetic Supplies
Current Benefit:
Members can obtain insulin and diabetic supplies from professional providers or through the pharmacy program(s)
2014 Benefit:
Limit benefits for insulin and diabetic supplies to be dispensed exclusively through the pharmacy program(s)
Except for members with primary coverage under Medicare Part B, exclude coverage for insulin and diabetic supplies dispensed by professional providers
Managing overall costs – Members should be reminded that controlling costs affects premiums.

22. Wigs
Current Benefit:
Benefits are available for one wig per lifetime, up to a $350 maximum, for hair loss due to chemotherapy for the treatment of cancer
2014 Benefit:
Benefits are available for one wig per lifetime, up to a $350 maximum, for hair loss due to the treatment of cancer
Factor slide 4c

23. Home Nursing Care Visits (Standard Option only)
Current Benefit:
25 home nursing care visits, limited to 2 hours per visit, per calendar year
2014 Benefit:
50 home nursing care visits, limited to 2 hours per visit, per calendar year
Factor slide 4c – The benefit DOUBLED!

24. Acupuncture Limitations (Basic Option only)
Current Benefit:
For Basic Option, current acupuncture benefit includes an unlimited number of visits, but limited to physicians only
2014 Benefit:
Limits Basic Option acupuncture visits to 10 per calendar year (with all licensed providers now allowed to bill)
In NC, the requirement that the provider be an MD meant that the benefit was great on paper only. Members couldn’t use it because there just aren’t that many MD’s that perform the service. Finding one would require quite a bit of research.
So although this went from unlimted to 10, it’s still a better benefit in most markets because before, they couldn’t use it at all and 10 is better than 0.

25. 2014 Rates Standard Option Basic Option

26. Enrollment Codes Standard Option 104 Self Only 105 Self and Family
Basic Option
111 Self Only
112 Self and Family

27. 2014 Rates – Standard Option (Non-Postal Rates)
Bi Weekly Monthly
Self (+1.91) (+4.14)
Family (+4.84) (+10.49)
Source

28. 2014 Rates – Basic Option (Non-Postal Rates)
Bi Weekly Monthly
Self (+1.89) (+4.10)
Family (+4.43) (+9.60)

29. Blue Cross and Blue Shield Service Benefit Plan
Pharmacy Programs
Blue Cross and Blue Shield Service Benefit Plan
2013 HBO Open Season Seminar

30. Agenda Pharmacy Programs Overview 2014 Tier Structure 2014 Benefits
Member Resources
Agenda

31. Pharmacy Program Overview for 2014
Continuation of…
CVS/Caremark Administration
Generic Incentive Program
Medicare Part B member savings
Added Tier 5 in Specialty Program
Enhanced Diabetic Benefit
Affordable Care Act Impact
Basic Option non-Preferred Brand cost share now applies to Catastrophic Benefit
Vitamin D supplements with a prescription for members over 65

32. 2014 Tier Structure Tier 1 – Generics (least out-of-pocket)
Tier 2 – Preferred Brands (moderate out-of-pocket)
Tier 3 – non-Preferred Brands (most out-of-pocket)
Tier 4 – Specialty Preferred
*Tier 5 – Specialty non-Preferred
*New for 2014
Letter mailing to impacted members

33. 2014 Standard Option Benefits
Tier 1
Tier 2
Tier 3
Tier 4
Tier 5
Generic Medication
Preferred Brand Name Medication
Non-Preferred Brand Name Medication
Preferred Specialty Medication
Non-Preferred Specialty Medication
Preferred Retail Pharmacy
20% of the
plan allowance
Medicare B Members:
15% of the plan allowance
30% of the plan allowance
45% of the plan allowance
1st fill ONLY at retail
Non-Preferred Retail Pharmacy
45%
Mail Order Pharmacy
(Up to 90 day supply)
Up to $15
Up to $10
Up to $80
Up to $105
Specialty Pharmacy
(Limit of up to 30 -day supply for first 3 fills)
Up to 30-day supply
Up to $35
Up to 90-day supply (after 3 fills)
Up to $95
Up to $55
Up to 90-day supply
(after 3 fills)
Up to $155

34. 2014 Basic Option Benefits Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
Tier 1
Tier 2
Tier 3
Tier 4
Tier 5
Generic Medication
Preferred Brand Name Medication
Non-Preferred Brand Name Medication
Preferred Specialty Medication
Non-Preferred Specialty Medication
Preferred Retail Pharmacy
(Up to 30-day supply)
Up to $10
Up to $45 for
30 day supply
50%
($55 minimum)
Up to $60 for up to a 30-day supply only
1st fill ONLY at retail
Up to $80 for up to a 30-day supply only
 1st fill ONLY at retail
Specialty Pharmacy
(Limit of up to 30 -day supply for first 3 fills)
Up to 30-day supply
Up to $50
Up to 90-day supply
(after 3 fills)
Up to $140
Up to $70
Up to $195

35. Enhanced Diabetic Benefit
Insulin and supplies available through pharmacy benefit
Medical Benefit available to Medicare Part B members
Free Diabetic Meter Program 
$0 cost share for selected meters ACCU-CHEK or OneTouch
Preferred strips – Tier 2
Alcohol Swabs covered with a prescription
Toll free number
Delivered 7-10 business days after the request  
Letters will be sent to diabetic members

36. Generic Incentive Program
Program will continue in 2014
Started in 2010
Increase generic alternative awareness
Generics contain same active ingredient as brands
Save member out-of-pocket costs
Change from brand to generic in specific categories
Copay and Coinsurance waiver
List of drugs on brochure page _ _ _

37. Member Resources Retail Pharmacy Program Mail Pharmacy Program
(800)
Available 24/7
Mail Pharmacy Program
(800)
Specialty Pharmacy Program
(888)
M-F 7am- 9pm
S/S 8am-6:30pm

38. Questions
Contact Information

39. FEP BlueDental Easy to do Business With!
HBO Seminar

40. Agenda Why Dental? 2014 Premiums Benefit Summary FEP Dental Network
FEP BlueDental Value
Contact Information
Questions
Agenda

41. 2014 Premiums (monthly rate)
Rating Area
High Option
Self Only
High Option Self Plus One
High Option Self and Family
Standard Option Self Only
Standard Option Self Plus One
Standard Option Self and Family
Monthly 1
$35.40
$70.85
$106.25
$20.35
$40.76
$61.10 2
$40.30
$80.62
$120.92
$23.16
$46.35
$69.51 3
$44.66
$89.35
$134.01
$25.65
$51.35
$77.00 4
$47.17
$94.40
$141.57
$27.06
$54.17
$81.23 5
$52.17
$104.39
$156.56
$29.92
$59.91
$89.83
International

42. It’s More Than You Expect
All FEP BlueDental members receive 2 paid-in-full exams and cleanings when they see an in-network provider
With FEP BlueDental, members have in-network preventive and diagnostic treatments available at no cost
There are no calendar year deductibles applied to services performed by an in-network provider
Orthodontic benefits available (covering 50% of allowed amount) for both children and adults following a 12 month waiting period

43. A Benefit for All Your Dental Needs
FEP BlueDental has four types of covered services:
Class A (Basic) – Preventive and Diagnostic
Class B (Intermediate) – Fillings, minor endodontic, minor periodontal
IN-NETWORK
we pay:
OUT-OF-NETWORK
HIGH OPTION
100%
90%
STANDARD OPTION
60%
IN-NETWORK
we pay:
OUT-OF-NETWORK
HIGH OPTION
70%
60%
STANDARD OPTION
55%
40%

44. A Benefit for All Your Dental Needs
FEP BlueDental has four types of covered services:
Class C (Major) – major restorative, endodontic, periodontal and prosthodontic services
Class D -- Orthodontic Services - 50% for High & Standard for both in and out of the network
IN-NETWORK
we pay:
OUT-OF-NETWORK
HIGH OPTION
50%
40%
STANDARD OPTION
35%
20% 44

45. A Benefit for All Your Dental Needs
High Option annual benefit maximum for non-orthodontic services is $10,000 for in-network services and $3,000 for out-of-network services
Standard Option annual benefit maximum for non-orthodontic services is $1,500 for in-network services and $750 for out-of-network services
Lifetime maximum for High Option orthodontic services is $3,500 for both in- network and out-of-network services
Lifetime maximum for Standard Option orthodontic services rendered by an in-network provider is $2,000 and services rendered by an out-of-network provider are subject to a $1,000 limitation.

46. Provider Network
Providers in all 50 states and includes more than 85,000 unique dentists and 199,000 access points
If you have Service Benefit Plan (SBP) your in-network provider will file directly with the local BCBS Plan for primary coverage and then the claim will be sent to FEP BlueDental
Dental network may be different from medical network
Specialties included in the network are: Endodontics, General Dentistry, Oral Maxilofacial Surgery, Orthodontics, Pediatric Dentistry, and Periodontics
Provider nominations are welcome
To find a provider visit our web site ( or call us at BLUE (2583)

47. International Benefits
The International Dental Program includes English-speaking dentists in approximately 100 countries worldwide
You will only receive in-network benefits levels if you use a dentist in our International Dental Program
You are responsible for paying the dentist (we will reimburse you in US $’s) and for submitting claims to the following address:
FEP BlueDental Claims
PO Box 75
Minneapolis, MN
Claims are available on our website at You may use this website to get other benefit related information or call us at: BLUE(2583), TTY number

48. Contact us today to get the FEP BlueDental coverage you deserve
TTY
Call Center Hours (EST):
Monday through Friday: 8:00 a.m. – 8:00 p.m.
Or visit any time!
To enroll: Visit or call FEDS

49. FEP BlueVision: Take a new look at eyecare
Health Benefits Officer Seminar
Fall 2013

50. FEP BlueVision - It’s More Than You Expect
You receive an annual eye exam with no copay when you see a participating provider
Eyeglass wearers have many lens options available at no cost or at discounted copays
You can receive a generous frame allowance toward ANY frame you choose or you may select a frame from our Exclusive Collection that is covered-in-full with no copay

51. 2014 Premiums Biweekly & Monthly Premiums High Standard Biweekly
Self Only
$4.67
$10.12
$3.69
$8.00
Self + One
$9.36
$20.28
$7.39
$16.01
Self + Family
$14.04
$30.42
$11.08
$24.01
We continue to enhance benefits making it affordable to care for your vision. Without increasing premiums!

52. A Benefit For Your Vision
Plan Feature/
In-Network Benefits
High Option
Standard Option
Lenses
Basic Lens Covered in Full Annually
Frame
$150 allowance plus 20% off overage/1 Annually
Covered in Full Annually
$130 allowance plus 20% off overage/1 Every Other Year
Covered in Full Every Other Year
Contact Lens
Contact Lens (in lieu of eyeglasses)
Allowance OR
FEP BlueVision Exclusive Collection
$150 allowance plus 15% off overage Annually
$130 allowance plus 15% off overage Annually
Evaluation, fitting and follow-up fees fully covered for non-specialty lenses and covered up to $60 for specialty contact lenses.
1/ Additional discounts not applicable at Costco, Sam’s Club or Walmart locations
* For a complete description, please refer to your benefit brochure.

53. Optional Lenses and Treatments
More Benefits!
Optional Lenses and Treatments
High Option
Standard Option
Average Retail
Ultraviolet Coating $0
$28
Plastic Photosensitive Lenses (Transitions)
$65
$123
Scratch Resistant Coating
$25-$45
Standard Progressives
$50
$173
Premium Progressives
$90
$248
Standard Anti-Reflective Coating
$35
$60

54. We provide a convenient network for you
The FEP BlueVision network is specific to routine vision care and is different from the member’s medical plan network.
More than 41,000 points of access
Includes: ophthalmologists, optometrists, and many top national retail providers
12% ophthalmologists
88% optometrists
74% independents
26% retail
Costco, with 439 locations nationwide, joining network in 2014
Exceeds OPM’s access standards
Provider nominations are welcome
Visit our Web site ( or call us at

55. Contact us today to get the FEP Bluevision coverage you deserve
TTY
Call Center Hours (EST):
Monday through Friday: 8:00 a.m. – 11:00 p.m.
Saturday: 9:00 a.m. – 4:00 p.m.
Sunday: 12:00 p.m. – 4:00 p.m.
Or visit any time!
To enroll: Visit or call FEDS