Presentation is loading. Please wait.

Presentation is loading. Please wait.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Annual.

Similar presentations


Presentation on theme: "A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Annual."— Presentation transcript:

1 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Annual Enrollment Health Care Coverage For You and Your Family A&M Care Plan Welcome

2 What’s New for 9/1/2013 Plan Year No changes to the A&M Care Plan or 65 Plus Plan Integrated Provider Finder 365 Discount Program Well on Target Portal 2

3 PPO Features A&M Care Plan Administered by Blue Cross and Blue Shield of Texas (BCBSTX) No primary care physician (PCP) required; no referrals required to see a specialist Select any provider for care within the PPO network or outside the network When you receive care inside the network –Highest level of benefits –No claims to file –No balance billing for amounts over the BCBSTX allowed amount When you receive care outside the network –May have to file own claims –Receive lower level of benefits and can be balanced billed Worldwide coverage for emergency and non-emergency care 3

4 More Hospitals and Doctors 4 Available For a current listing of all providers see our website at: www.bcbstx.com Offers names, addresses, map and directions. For World Wide Assistance Call 1-800-810-BLUE (2583) Or Collect 1-804-673-1177 In-network coverage is available when traveling or living worldwide 24 Hours a Day, Seven Days a Week

5 Your BlueChoice PPO Benefits In- and Out-of-Network Benefits Member Share A&M Care In-Network / Out-of-Network Plan 65 + Plan Deductible – Individual $700 / $1,400$500 Deductible – Family $2,100 / $4,200– Out-of-Pocket Maximum – Individual $5,000 / $10,000$1,400 Out-of-Pocket Maximum – Family $10,000 / $20,000– Office Visit (primary care / specialist) Most Lab and X-ray paid at 100% $30/$45 per visit / 50% after deductible 20% after deductible Preventive Services 100% covered / Not covered100% paid after deductible In-Patient Hospital 30% after deductible / 50% after deductible 20% after deductible Emergency Room 30% after deductible / 30% after deductible (50% after deductible for non-emergency) 20% after deductible Chiropractic – 30 visits per plan year $45 per visit / 50% after deductible 20% after deductible Maternity Care – Doctor $30 initial visit only / 50% after deductible 20% after deductible Diagnostic Procedures/MRIs and PET scans 30% after deductible / 50% after deductible 20% after deductible All other covered services 30% after deductible/ 50% after deductible 20% after deductible Retirees over age 65 are not eligible for copays, your benefits are secondary to Medicare 5

6 Preventive Coverage What’s covered? –Recommended routine gender- and age-specific preventive care, such as annual physical, OB/GYN exams, mammograms and other cancer screenings, well-child care and immunizations – both facility and professional services Preventive coverage provided in-network at 100% with no copay, no deductible 6 Stay Healthy by Getting Regular Check-ups $50.00 deductible credit for all members and dependents who complete an annual physical Remember: Lab tests related to an illness or condition are not considered preventive and may pay differently

7 Retiree Information 7 Retirees under age 65 Are Considered Network and can use the Network providers Remember: Enroll in BOTH Medicare parts A & B. When you receive your Medicare Card, notify BCBSTX and your Human Resource Office of your Medicare number which includes an alpha character. If you use a Provider that accepts Medicare or is a BCBSTX provider, you cannot be balance billed. Retirees over age 65 Choose from: A&M Care Plan 65 Plus – you must be: –Age 65 and enrolled in Medicare Parts A&B or disabled under 65 and enrolled in Medicare Parts A&B with a spouse, if covered age 65 and older (or disabled) and enrolled in Medicare Parts A&B –Working for the A&M System, if at all, less than 50% time for less than 4.5 months during the plan year

8 Retiree Coordination of Benefits A&M Care Plan and 65 Plus A&M Care Plan deductible not metA&M Care Plan deductible is met Charge$500.00 Medicare paid 80%$400.00 Patient Share 20%$100.00 A&M Care Plan Deductible$700.00MET Applied to Deductible$500.00Zero BCBSTX would have paidZero$350.00 A&M Care Plan PaymentZero$100.00 Patient’s Responsibility$100.00Zero Plans calculate the normal plan benefits, then pay that amount, or the difference after Medicare has paid, whichever is less. Your coinsurance will continue until you meet the out-of-pocket maximum, then plan pays at 100%. A&M Care 65 Plus = $1,400 A&M Care Plan = $5,000 individual/$10,000 Family 8

9 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Other Programs and Services

10 10 Blue Care Advisors – clinical professionals – can help you manage chronic health conditions like: Asthma, coronary disease, diabetes, COPD or Low Back Pain Understand and follow your physician’s orders Review medications, side effects, compliance, refills and current services Establish goals with caregivers, scheduling follow-ups as appropriate If you have a chronic condition, we offer support If you are identified as being at risk or having one of the managed chronic conditions, one of our Blue Care Advisors will contact you. Condition and Decision Support

11 Tobacco Cessation and Weight Management Programs 11 Self-Paced Approach Online program and resources available Secure e-mail outreach to keep members on track Lifestyle Management Support Counseling and coaching with licensed Wellness Coaches 24/7 Nurseline Referrals when appropriate Blue365 ® Discounts Jenny Craig Life Time Fitness Davis Vision Proctor& Gamble Dental Products

12 Making wellness simpler, more affordable and more accessible for members 12 Weight Management – Discounts at Jenny Craig ®´ on membership and food Vision Care and Eyewear – Discounts on eyewear, contact lenses and laser vision correction surgery Complementary Alternative Medicine – Discounts on acupuncture, health clubs, chiropractic, naturopaths, spas, massage therapy, vitamins and supplements, and more Life Time ®´ Fitness – Enrollment fee will be waived for new members who join one of the Life Time Fitness clubs nationwide Hearing Aids – Discounts on hearing aids for members, parents and grandparents Dental Products – Discounts on Procter & Gamble oral care bundles. Under the My Coverage tab Register online at blue365deals.com/BCBSTX /

13 24/7 Nurseline Around-the-Clock Advice and Information by Phone 1-800-581-0368 24/7 access to registered nurses for health conditions such as: High fevers Earaches Cuts and bruises 1,200 audio health library topics Referral of members with care needs to the appropriate program Follow-up calls for emergency care needs Available in English and Spanish 13

14 Save time with self-service support tools and health and wellness resources on a convenient and secure online site Check claims and claims history View, save or print Explanation of Benefits (EOBs) Sign up for electronic EOBs, and turn off paper View benefits and covered dependents Check coverage details Manage mobile and texting preferences Request new ID cards or print temporary ID cards Access health and wellness information and guides Get details on wellness, discounts, 24/7 Nurseline … and more Log and perform protected transactions 24 hours a day, 7 days a week * 14 Blue Access for MEMBERS SM

15 My Claim Activity displays recent claims, or go to the Claims Center for all your claim details Form Finder easier to view and find specific forms for members Quick Links for easy access to Health Assessment, Fitness Program, Member Discounts, or to get an ID card My Coverage includes benefit highlights, spending accounts, as well as deductibles and out- of-pocket and copay summaries for Medical, My Health tab links you to health and wellness content, articles, videos, and My Care Profile Access Provider Finder to locate doctors & hospitals 15 Blue Access Homepage

16 More robust, completely integrated A new way to experience wellness Health Assessment Self Directed Courses Trackers and Tools Health and Wellness Content Food and Exercise Diary Life Points Reward Fitness Program Dedicated Coach Page Introducing 16 Our new wellness is for EVERYONE

17 Health Assessment Powerful Health and Wellness Tool 17 Complete all topics under the HA and receive a $50.00 deductible credit for members and dependents ages 18 and over User-friendly health assessment tool Personal Health Assessment designed to be completed in 10 to 15 minutes Choose your assessment topic, such as health and wellbeing or fitness and physical activity All topics must be completed to receive credit Know Your Risks Manage Your Health Examines the member’s overall health and wellbeing and provides a personalized report showing areas where you can improve www.bcbstx.com

18 18 Blue Access Mobile SM Overview Current Mobile Offerings ► Mobile Web (public) ► Blue Access for Members SM (secure) ► Text Messaging (static and dynamic) ► Provider Finder ® App (iPhone and Android)

19 BCBSTX wants to help you maximize your benefits and plan for your health care Now you can speak to a BCBSTX Benefits Value Advisor who helps you find quality providers for health care services such as: –CAT, CT scans or MRIs – Hip or joint replacement –Colonoscopy or endoscopy procedures –Back, knee, shoulder, spinal or bariatric surgery Benefits Value Advisors can also help you plan for your health care: –Helping you understand your benefits –Providing a cost estimate for health services –Scheduling a doctor or procedure appointments To reach a Benefits Value Advisor, call your customer service number on the back of your ID card 1-866-295-1212 19 Benefits Value Advisor

20 The NEW Integrated Provider Finder ® o Combines real member cost, quality, patient experience, and advanced demographics information in one easy-to-use site. o BlueCard ® PPO cost & quality data integrates with real-time benefits information to deliver an accurate picture of member share o Retail experience with responsive, easy-to- navigate web design with multiple access points o Available to members and non-members* Online provider search engine and care decision support tool bcbstx.com 20

21 What if I Have Questions 21 Toll-free Customer Service 866-295-1212 Personalized Service 8 am – 8 pm Our Philosophy – “Take the Member Out of the Middle” Call your dedicated customer service team for: ‒ Benefit information ‒ Network provider information ‒ Membership and eligibility ‒ Inquiries (telephone and e-mail) ‒ ID card requests ‒ Claims inquiries ‒ Help with online tools


Download ppt "A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Annual."

Similar presentations


Ads by Google