blue cross blue shield association is an association of independent blue cross and blue shield...
TRANSCRIPT
Blue Cross Blue Shield Association is an Association of independent Blue Cross and Blue Shield companies.
2014 Benefit Changes
BlueCross and BlueShield Service Benefit Plan
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Agenda
Plan Overview
• Preventive Care
• Health Club Membership
• Special Features
2014 Benefits Changes
2014 Rates
3 Service Benefit Plan Options
Standard Option
• Deductible• Copayments and Coinsurance
• Ability to Choose Provider (Preferred and Non-preferred)
• Retail and Mail Rx
Basic Option
• No deductibles• Copayment based• Preferred Providers only
• Retail Rx
• The Service Benefit Plan is a fee-for-service (FFS) plan• We have a Preferred Provider Organization (PPO)
Standard Option & Basic Option
• No Pre-Existing Conditions• No Referrals Required• No Lifetime Maximums• Unlimited I/P Hospital Days
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• 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
Preventive Care
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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–
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2014 Benefits Changes
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• BRCA Testing
• Vitamin D Supplements
• Catastrophic Maximums
• Prescription Drugs
• Basic Option Copayments
• Wellness Incentives
• Other Changes
2014 Benefit Changes
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Preventive BRCA Testing
• 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
Standard Option and Basic Option
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Vitamin D Supplements
• 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 600-800 international units (I.U.s) daily
Standard Option and Basic Option
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Catastrophic Out-of-Pocket Maximums
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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
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Standard Option: CatastrophicOut-of-Pocket Maximums
*Basic Option limited to Preferred providers
CurrentPreferred Non-Preferred
Self Only $5,000 $7,000 Self and Family $5,000 $7,000
2014Preferred Non-Preferred
Self Only $5,000 $7,000 Self and Family $6,000 $8,000
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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
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Basic Option: CatastrophicOut-of-Pocket Maximums
*Basic Option limited to Preferred providers
CurrentPreferred Non-Preferred
Self Only $5,000 N/A Self and Family $5,000 N/A
2014Preferred Non-Preferred
Self Only $5,500 N/A Self and Family $7,000 N/A
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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
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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)
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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
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Wellness Incentives
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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
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Other Changes
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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
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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
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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
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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)
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2014 Rates
Standard Option
Basic Option
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Standard Option
– 104 Self Only
– 105 Self and Family
Basic Option
– 111 Self Only
– 112 Self and Family
Enrollment Codes
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Source
2014 Rates – Standard Option (Non-Postal Rates)
Bi Weekly Monthly
• Self 104 87.82 (+1.91) 190.28 (+4.14)
• Family 105 204.98 (+4.84) 444.12 (+10.49)
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2014 Rates – Basic Option (Non-Postal Rates)
Bi Weekly Monthly
Self 111 60.96 (+1.89) 132.08 (+4.10)
Family 112 142.75 (+4.43) 309.29 (+9.60)
Blue Cross Blue Shield Association is an Association of independent Blue Cross and Blue Shield companies.
Pharmacy Programs
Blue Cross and Blue Shield Service Benefit Plan
2013 HBO Open Season Seminar
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Agenda
• Pharmacy Programs Overview
• 2014 Tier Structure
• 2014 Benefits
• Member Resources
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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
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• 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
2014 Tier Structure
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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
30% of the plan allowance
1st fill ONLY at retail
30% of the plan allowance
1st fill ONLY at retail
Non-Preferred Retail Pharmacy
45% 45% 45% 45% 45%
Mail Order Pharmacy
(Up to 90 day supply)
Up to $15Medicare B Members:
Up to $10Up 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 30-day supply Up to $55
Up to 90-day supply(after 3 fills)Up to $155
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2014 Basic 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
(Up to 30-day supply)
Up to $10 Up to $45 for30 day supply
50% ($55 minimum)
Up to $60 for up to a 30-day supply only1st 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 supplyUp to $50
Up to 90-day supply(after 3 fills)Up to $140
Up to 30-day supplyUp to $70
Up to 90-day supply(after 3 fills)Up to $195
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• 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 855.582.2024
• Delivered 7-10 business days after the request
– Letters will be sent to diabetic members
Enhanced Diabetic Benefit
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• 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 _ _ _
Generic Incentive Program
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• Retail Pharmacy Program– (800) 624-5060
– Available 24/7
• Mail Pharmacy Program– (800) 262-7890
– Available 24/7
• Specialty Pharmacy Program– (888) 346-3731
– M-F 7am- 9pm
– S/S 8am-6:30pm
Member Resources
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Contact Information
Questions
Blue Cross Blue Shield Association is an Association of independent Blue Cross and Blue Shield companies.
FEP BlueDental
Easy to do Business With!HBO Seminar -- 2013
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Agenda
Why Dental?2014 Premiums Benefit SummaryFEP Dental NetworkFEP BlueDental ValueContact InformationQuestions
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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 Monthly Monthly Monthly Monthly 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 $52.17 $104.39 $156.56 $29.92 $59.91 $89.83
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• 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
It’s More Than You Expect
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IN-NETWORKwe pay:
OUT-OF-NETWORKwe pay:
HIGH OPTION 100% 90%
STANDARD OPTION
100% 60%
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-NETWORKwe pay:
OUT-OF-NETWORKwe pay:
HIGH OPTION 70% 60%
STANDARD OPTION 55% 40%
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A Benefit for All Your Dental Needs
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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-NETWORKwe pay:
OUT-OF-NETWORKwe pay:
HIGH OPTION 50% 40%
STANDARD OPTION 35% 20%
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• 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.
A Benefit for All Your Dental Needs
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• 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 (www.fepblue.org) or call us at 855.504.BLUE (2583)
Provider Network
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• 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:
International Benefits
• Claims are available on our website at www.fepblue.org. You may use this website to get other benefit related information or call us at: 855-504-BLUE(2583), TTY number 1-888-853-7570
FEP BlueDental ClaimsPO Box 75Minneapolis, MN 55440-0075
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1.855.504.BLUE (2583)
TTY 1-888-853-7570
Call Center Hours (EST):
• Monday through Friday: 8:00 a.m. – 8:00 p.m.
Or visit www.fepblue.org any time!
To enroll: Visit www.benefeds.com or call 1.877.888.FEDS
Contact us today to get the FEP BlueDental coverage you deserve
Blue Cross Blue Shield Association is an Association of independent Blue Cross and Blue Shield companies.
Health Benefits Officer Seminar
Fall 2013
FEP BlueVision:Take a new look at eyecare
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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
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2014 Premiums
Biweekly & Monthly Premiums
High Standard
Biweekly Monthly Biweekly Monthly
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!
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A Benefit For Your Vision Plan Feature/In-Network Benefits
High Option Standard Option
Lenses Basic Lens Covered in Full Annually 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)
1/ Additional discounts not applicable at Costco, Sam’s Club or Walmart locations* For a complete description, please refer to your benefit brochure.
Evaluation, fitting and follow-up fees fully covered for non-specialty lenses and covered up to $60 for specialty contact lenses.
$130 allowance plus 15% off overageAnnually
$150 allowance plus 15% off overageAnnually
Allowance
OR
FEP BlueVision Exclusive Collection
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Optional Lenses and Treatments
High Option Standard Option Average Retail
Ultraviolet Coating $0 $0 $28
Plastic Photosensitive Lenses (Transitions)
$0 $65 $123
Scratch Resistant Coating
$0 $0 $25-$45
Standard Progressives
$0 $50 $173
Premium Progressives $90 $90 $248
Standard Anti-Reflective Coating
$35 $35 $60
More Benefits!
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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 (www.fepblue.org) or call us at 888-550-2583
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Contact us today to get the FEP Bluevision coverage you deserve
1.888.550.BLUE (2583)TTY 1.800.523.2847
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 www.fepblue.org any time!
To enroll: Visit www.benefeds.com or call 1.877.888.FEDS