Transcript Using your health plan

Open Enrollment 2017
Ready to choose your Anthem Blue Cross and Blue Shield benefits?
We can point you in the right direction.
51502MUMENABS Rev. 3/16
Agenda
• What’s new for 2017?
• Enrolling in your health plan
• Using your health plan
• Making things easier with tips and resources
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What’s new for 2017?
• Medical and prescription drug
plans are moving to Anthem Blue
Cross and Blue Shield effective
January 1
• Dental plan is staying with
Anthem
• You will have 2 ID cards ▪ One Medical and Pharmacy
▪ One Dental
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How the PPO plan
works
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Copay
You pay a set
amount for
doctors’ visits
and services
from a doctor in
the PPO plan.
=
Annual
deductible
Your percentage
of the costs
The amount you
pay each year
before the plan
starts to pay
for care.
Out-of-pocket
maximum
You pay a percentage
of the costs for most
other services, such
as outpatient surgery,
hospital care or tests.
Once you pay the
annual maximum for
your percentage of
the costs, the plan
pays 100% of other
covered expenses
for that year.
Medical copays and
deductibles are part
of your out-of-pocket
maximum
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The PPO plan
Key features
• Freedom to get care from
any doctor.
• You don’t need a referral to see
a specialist.
Things to consider
• If you seek care from a doctor
who is not in the PPO plan, you’ll
pay a higher percentage of the
costs, as well as any amount over
the maximum allowed amount.
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Your plan
Medical plan
KeyCare 25/650
Doctors in your plan
KeyCare Network – in Virginia
BlueCard PPO National network
Benefits from doctors who aren’t in the
plan
Out of network benefits apply;
balance billing may occur
Primary care doctor
Not required, but recommended
Specialist referrals
Not required
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Your plan
KeyCare 25/650
Medical plan
Doctors in your plan
Doctors not in your plan
$650
$780
Employee + 1
$1,300
$1,480
Employee + Family
$1,300
$1,480
$25 per visit
40% after ded
$37.50 per visit
40% after ded
20% after ded
40% after ded
Employee
$2,600
$5,200
Employee + 1
$5,200
$10,400
Employee + Family
$5,200
$10,400
Employee
Deductible
Office visits
Doctor
Specialist
Your percentage of the costs
Out-of-pocket
limit
Retail
Smart 90
Prescription
drugs
Home Delivery
Out-of-pocket limit
40% coinsurance
Tier 1: $50 max; Tiers 2, 3, and 4: $100 max
40% coinsurance
Tier 1: $125 max; Tiers 2, 3, and 4: $300 max
40% coinsurance
Tier 1: $125 max; Tiers 2, 3, and 4: $300 max
$4,500 Individual/$9,000 Family
(separate from the Medical out of
pocket maximum)
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Where to go for care
Medical plan
KeyCare 25/650
Doctors in your plan
Preventive care
Primary Care Doctor visit
Specialist visit
LiveHealth Online sick visit*
Urgent care center visit
Emergency room visit
No cost share
$25 copay
$37.50 copay
$15 copay
$37.50 copay
$65 copay
Getting care at the right place can save you money.
* The LHO copay is for non-Behavioral health visits, LHO BH visits are at the standard BH $25
copay/visit.
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Prescription drug plan
Save money
Anthem’s pharmacy
program includes over
64,000 retail pharmacies
across the country, plus
an easy home delivery
option.
Specialty Medications must be
filled through ESI’s Specialty
drug pharmacy, Accredo.
• Ask your doctor if there’s a generic
equivalent for the brand-name
medications you’ve been taking.
• After 2 fills of your maintenance
medication at your local pharmacy, you
will need to get your 90-day supply via
Anthem mail order or a Smart 90
retail pharmacy
• Smart 90 includes CVS, Target,
Kroger, Safeway, Walmart, as well
as Strategic Health Alliance (some
independents)
• It does not include Rite Aid or
Walgreens
Save time
• Refill your prescriptions online
or over the phone.
• Take advantage of home delivery.
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Dental Prime
Dental Complete
• Annual checkups are covered
— at 100%, no deductible.
• Easy access to any
dentist or specialist.
• Discounts with dentists
in the plan.
• Go to
www.anthem.com/mydentalvis
ion/ and use the Provider
Finder to search for Dental
Prime and Dental Complete
participating providers
• Dependents now covered until
end of month turn 26
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Dental Plan
Anthem Dental
Deductible
Preventive Care
(Oral exams, teeth, cleanings)
Annual Benefit Maximum
Basic Care –
(Fillings - Amalgam)
Major Care – 12 month waiting period
(Crowns)
Orthodontics – 12 month waiting period
(Braces)
$50/$150
100% of the allowable charge
$1,500 per member
80% of the allowable charge
after deductible
50% allowable charge
after deductible
50% of the allowable charge
(deductible does not apply)
$1,000 per member/lifetime
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Open enrollment
October 31 – November 18
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Tools to help
you choose
Enrollment Guide
Read this guide to help understand your plan
Open enrollment web page
Easily access benefit details, medication lists and more - anytime, at work or at
home.
Find a Doctor
Search for local doctors, hospitals and health care professionals.
Interactive videos
Learn more about your health plan options and how to effectively use them.
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Using your
health plan
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The benefits of registering
at anthem.com
When you register online, you have
great personalized tools to help you:
Search for doctors.
Check your claims.
Estimate your costs.
Review your
medical benefits.
View your ID card.
Refill a prescription.
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Looking for a doctor?
Finding one online
is fast and easy.
Look up a doctor,
pharmacy or urgent
care center.
View doctor profiles
and read patient reviews.
Get directions to
health care facilities.
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Comparison shop
for your care
With our Estimate Your Cost online tool, find out what a
test, procedure or other type of care will cost before
visiting a doctor.
• See average costs for common procedures and
services in almost 400 treatment categories, plus
quality information for procedures done at a
hospital.
• Compare doctors and facilities based on cost and
quality of care ratings for procedures.
• By being informed, you can make the choice that’s
right for you – and save money.
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LiveHealth Online
See a doctor or therapist at home
•
Have a private video visit with a doctor or therapist on
your smartphone, tablet or computer with a webcam.
•
Choose from board-certified doctors and
licensed therapists.
•
You can be at home or even on vacation.
•
Sign up at livehealthonline.com or download the app.
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24/7 NurseLine
• Get health information
instantly.
• Talk with registered
nurses.
• Call 24 hours a day,
toll-free.
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Future Moms
• Get screenings and
support during
pregnancy.
• Consult with nurse
coaches.
• Call 24 hours a day, tollfree.
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ConditionCare
• Get help and support following
your care plan.
• Consult with nurse coaches.
• Better manage your health.
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Discounts
• Save money with stuff that’s
good for you at our site,
anthem.com.
• Access healthy discounts
on weight-loss programs,
gym memberships, vitamins,
glasses and much more.
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To Help With your
Transition to Anthem
Open Mail Order Prescriptions
Will be transferred over from your current
carrier to Anthems Home Delivery Pharmacy
Download the Anthem Anywhere App
Search for information about
doctors in your area, have access to your ID
card on your smartphone, look up cost
estimates of medical services and/or
prescriptions
Register on Anthem.com
As soon as you receive your ID card to access
all of the tools available to help you get the
most out of your plan.
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To Help With your
Transition to Anthem
Transition of Care
•
Only applies if you will be using a Nonparticipating provider AND have one of the
following situations:
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You have just begun intensive medical
treatment (e.g., newly diagnosed cancer,
recent heart attack, chemotherapy, radiation
therapy, or recent surgery).
You are in your third trimester of pregnancy
as of your new Anthem medical coverage
effective date
Major surgery previously scheduled after 60
days of the date that your new Anthem
medical coverage begins (e.g., heart
transplant surgery)
Transition of care is not available for chronic
medical conditions such as diabetes,
allergies or asthma.
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here
We’re
if you have questions
Answers and information at your fingertips,
by phone or online 24/7.
During Open Enrollment:
Call -(866) 263-0361
Monday – Friday: 8am to 6pm
or visit anthem.com
As of 1/1/17, please contact Anthem Member
Services for assistance at 800-451-1527.
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These policies have exclusions and limitations to benefits and terms under which the policy may be renewed or discontinued. For costs and complete details of the coverage, contact
your Benefits Administrator or Anthem Blue Cross and Blue Shield.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In
Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Anthem Blue Cross and Blue Shield is the trade name of Blue Cross and Blue
Shield of Georgia, Inc. Independent licensee of the Blue Cross and Blue Shield Association. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of
Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO
Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only
provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by
HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire,
Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross
and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue
Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or
administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield
Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and
Blue Shield Association.
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