Transcript Open Enrollment - Texas A&M University System

Welcome
Annual Enrollment
Health Care Coverage
For You
and
Your Family
A&M Care Plan
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee
of the Blue Cross and Blue Shield Association
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
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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
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More Hospitals and Doctors
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
Available
24 Hours a Day, Seven Days a Week
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Your BlueChoice PPO Benefits
In- and Out-of-Network
Member Share
Benefits
A&M Care In-Network /
Out-of-Network Plan
65 + Plan
$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
–
$30/$45 per visit /
50% after deductible
20% after deductible
100% covered / Not covered
100% paid after deductible
30% after deductible /
50% after deductible
20% after deductible
Deductible – Individual
Office Visit (primary care / specialist)
Most Lab and X-ray paid at 100%
Preventive Services
In-Patient Hospital
Emergency Room
30% after deductible /
30% after deductible
(50% after deductible for
non-emergency)
20% after deductible
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
Retirees over age 65 are not eligible for copays, your benefits are
secondary to Medicare
30% after deductible/
50% after deductible
20% after deductible
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Preventive Coverage
Stay Healthy by Getting Regular Check-ups
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
$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
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Retiree Information
Retirees under age 65
Are Considered Network and can use the Network providers
Retirees over age 65
Remember:
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
• 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.
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Retiree Coordination of Benefits
A&M Care Plan and 65 Plus
A&M Care Plan deductible not met
A&M Care Plan deductible is met
Charge
$500.00
$500.00
Medicare paid 80%
$400.00
$400.00
Patient Share 20%
$100.00
$100.00
A&M Care Plan Deductible
$700.00
MET
Applied to Deductible
$500.00
Zero
BCBSTX would have paid
Zero
$350.00
A&M Care Plan Payment
Zero
$100.00
Patient’s Responsibility
$100.00
Zero
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
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Other Programs
and Services
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee
of the Blue Cross and Blue Shield Association
Condition and Decision Support
If you have a chronic
condition, we offer support
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 are identified as being at risk or having one of the
managed chronic conditions, one of our Blue Care Advisors
will contact you.
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Tobacco Cessation and
Weight Management Programs
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
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Making wellness simpler, more affordable and more accessible for members
Weight Management –
Discounts at Jenny Craig®´
on membership and food
Complementary
Alternative Medicine –
Discounts on acupuncture, health
clubs, chiropractic, naturopaths,
spas, massage therapy, vitamins
and supplements, and more
Vision Care and
Eyewear– Discounts
on
eyewear, contact lenses and laser
vision correction surgery
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
Dental Products – Discounts
hearing aids for members, parents
and grandparents
on Procter & Gamble oral care
bundles.
Under the My Coverage tab
Register online at
blue365deals.com/BCBSTX/
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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
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Blue Access for MEMBERS
SM
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*
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Blue Access Homepage
Access Provider
Finder to locate
doctors & hospitals
My Coverage
includes benefit
highlights, spending
accounts, as well as
deductibles and outof-pocket and copay
summaries for
Medical,
My Claim Activity
displays recent
claims, or go to the
Claims Center for
all your claim details
My Health tab links
you to health and
wellness content,
articles, videos, and
My Care Profile
Quick Links for
easy access to
Health Assessment,
Fitness Program,
Member Discounts,
or to get an ID card
Form Finder easier
to view and find
specific forms for
members
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Our new wellness is for EVERYONE
Introducing
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
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Health Assessment
Powerful Health and Wellness Tool
User-friendly health assessment tool
• Personal Health Assessment designed
www.bcbstx.com
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
Complete all topics under
the HA and receive a $50.00
deductible credit for
members and dependents
ages 18 and over
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Blue Access Mobile Overview
SM
Current Mobile Offerings
► Mobile
Web (public)
► Blue Access for MembersSM (secure)
► Text Messaging (static and dynamic)
► Provider Finder® App (iPhone and Android)
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Benefits Value Advisor
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
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The NEW Integrated Provider Finder®
Online provider search engine and care decision support tool
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-tonavigate web design with multiple access
points
o Available to members and non-members*
bcbstx.com
2020
What if I Have Questions
Personalized Service 8 am – 8 pm
• Our Philosophy – “Take the Member
Out of the Middle”
• Call your dedicated customer service
team for:
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Benefit information
Network provider information
Membership and eligibility
Inquiries (telephone and e-mail)
ID card requests
Claims inquiries
Help with online tools
866-295-1212
Toll-free
Customer Service
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