experience. wellness. everywhere. · 2010-04-06 · g smoking cessation expenses, such as...

OUTHE UNIVERSITY OF OKLAHOMA EMPLOYEE BENEFITS

2009

Experience. Wellness. Everywhere.

TABLE OF CONTENTS

Benefit Enrollment & Making Changes During the Year . . . . . . .2

Medical Plan Options . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3

BlueLincs® HMO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

BlueChoice® PPO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

BlueEdgeSM HCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7

Plan Comparison Chart . . . . . . . . . . . . . . . . . . . . . . . . 8-13

What’s Not Covered . . . . . . . . . . . . . . . . . . . . . . . . . . .14

ID Cards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Wellness Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-17

Resource Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Contacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

For more than 68 years, Blue Cross and Blue Shield of Oklahoma (BCBSOK) has delivered high value

products and unrivaled customer service to more Oklahomans than any other health insurance plan. And

our nationwide network of physicians and hospitals, coupled with local resources and friendly service,

keeps you connected to your health care coverage no matter where you are.

Through the University of Oklahoma, we are pleased to offer benefits that give you and your family the

best care possible and services that allow you to put your health care decisions and health education

closer to your fingertips. Please take a few minutes to look through this summary guide and review the

three plan options that are available to you – BlueLincs HMO, BlueChoice PPO, and BlueEdge Health Care

Account (HCA). You may also visit www.bcbsok.com/OU for more information. It is our desire during the

enrollment period that you gain a clear understanding of each option and to help you decide what is best

for your health care needs.

Being a member of BCBSOK doesn’t just provide you with traditional insurance coverage; you also have

a complete suite of health and wellness resources and tools at your fingertips, to encourage healthier

living and smarter health decisions. Blue Cross and Blue Shield of Oklahoma is a health care industry

leader in creating and promoting wellness programs that you and your family can conveniently integrate

into your daily life. Merging technology and medical management with online resources, education,

one-on-one coaching, rewards and multiple touch points, BCBSOK’s Blue Care Connection® program aims

to ultimately improve you and your family’s health and wellness.

Welcome to Blue Cross and Blue Shield of Oklahoma, and to your benefit enrollment period. This is your opportunity to select health benefits for you and your family for the coming year. We are delighted that the University of Oklahoma has chosen us as your health benefits company.

WELCOME

The following are key

benefit changes to your

2009 health care, including

several enhancements to

your coverage:

g Routine Physicals are now covered every

calendar year, rather than once every

24 months.

g Smoking Cessation expenses, such as

over-the-counter medications, acupuncture,

hypnosis, and stop smoking aids will be

reimbursed up to $500 annually ($1,500

lifetime maximum per person).

g Hospice Care is no longer a limited benefit.

g HMO Urgent Care – The BlueLincs HMO

copayment for urgent care visits has been

lowered to $50.

g Chiropractic, physical, occupational, and

speech therapies are subject to a 60 visit

combined calendar year maximum.

g Speech Therapy for Autism – Although services

related to autism are not covered under your

plan, benefits will now be available for 20

speech therapy visits per calendar year.

g Pharmacy Changes – Changes have been

made to the Formulary and Tiers.

Please refer to www.bcbsok.com/OU for a list

of the most frequently used prescription drugs to

see if any tier changes will impact you.

g The interactive programs will help you manage personal wellness and

encourage healthier behaviors by awarding Blue Points,sm which recognize

healthy activities.

g The Personal Health Manager provides tools, information and

encouragement to improve and maintain a healthier lifestyle.

g By showing your BCBSOK ID card at participating locations, you can

save money through discounts and memberships on certain health care

products and services, including participating Jenny Craig and Curves

locations, as well as GlobalFit, which operates through a number of

different fitness facilities throughout Oklahoma.

g The self-service Web site, Blue Access for Members®, allows you access

to the Personal Health Manager, information and resources on medical

conditions, and a history of your claims. Additionally, the BCBSOK Web

site for OU located at www.bcbsok.com/OU, has a wealth of general

information available, including provider directories.

g The 24/7 Nurseline provides telephone access to registered nurses

at any time, day or night, to help with your health-related questions

and issues.

These benefits, plus many more wellness-related programs, are offered along

side your health care coverage for a total health and wellness package.

Our goal at Blue Cross and Blue Shield of Oklahoma is to provide you with first class service, and to do the job right the first time, every time. We appreciate the opportunity to serve you.

Sincerely,

Jeffrey R. Tikkanen Vice President, Marketing and Sales Blue Cross and Blue Shield of Oklahoma

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02

Benef i t En ro l lmen t & Making Changes Dur ing the Year

During the open and new member enrollment period, you can add or delete dependents from your health care coverage without a “qualifying event”. The enrollment period is the time to make sure all of your eligible dependents are enrolled and that Human Resources has all the correct information about your dependents on file.

The health care plan options you select during the enrollment period will remain in effect during the calendar year.

In order to change benefit elections outside of the enrollment period, the employee must have:

1) Experienced an Applicable Qualifying Event, as defined by the Internal Revenue Service (IRS). Changes based on financial reasons alone are not allowed under the current IRS regulations. AND 2) The request for a change of benefits must be made within 31 days of the Applicable Qualifying Event.

Within the context of changing benefits, “Applicable” refers to a change that is directly related to the individual experiencing the qualifying event.

A qualifying event includes:

g A birth or adoption

g Marriage, divorce or legal separation

g Death

g Child loses eligibility because of age or marriage

g Employee’s spouse gains or loses coverage through employment

g Significant change in the financial terms of health benefits provided through a spouse’s employer or another carrier

Except for coverage of a newborn or adopted child, all other changes in coverage begin the first day of the month following the qualifying event. Coverage for the newborn is effective on the child’s date of birth. Coverage for an adopted child is effective on the date of placement. In both instances, the employee must initiate and complete the appropriate paperwork.

Changes in provider networks (for example, your doctor leaving the network) are not considered acceptable reasons for you to be able to change your product election outside of the enrollment period.

Please visit the “Benefits” section of the OU Human Resources Web site for more information at www.hr.ou.edu.

E l ig ib i l i t y

Please visit the “Benefits” section of the OU Human Resources Web site for information at www.hr.ou.edu

Medica l P lan Opt ions

The following pages (2 – 14) provide an overview of the health benefits of each of the program options. These are only summaries – not the actual plan descriptions. If you have questions that aren’t answered in the summary information in this booklet, please contact customer service at 1-888-881-4648 or review the detailed Summary Plan Descriptions (available late first quarter 2009). Dental care benefits are offered separately, and are not highlighted in this benefit guide.

The medical plan you select during the enrollment period will apply for the calendar year. You will not be able to make changes to your medical plan during the year UNLESS YOU HAVE A QUALIFYING EVENT. In no event will you be able to switch from one plan to another during the year, unless you are on the HMO plan and move outside the service area. A brief description of the various aspects of each program follows on the next pages.

Medica l P lan Compar i sons

What type of plans do I have to choose from? There are three notably different benefit plans to choose from:

1) BlueLincs HMO 2) BlueChoice PPO 3) BlueEdge HCA

The BlueLincs HMO is a health maintenance organization type of plan, otherwise known as a “managed care” plan. It requires selection and use of a primary care physician (PCP), and referrals are usually needed for specialty care. The BlueChoice PPO plan is a preferred provider organization type of plan, which gives you the flexibility to choose between a PPO provider or non-PPO provider. Benefits are almost always higher if you use a PPO provider. The BlueEdge HCA is considered a consumer-driven health plan (CDHP), which pairs a high deductible PPO plan with a health fund that can be used to pay for certain out-of-pocket medical expenses.

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What should I consider when choosing between the PPO, HMO and HCA plan options? There are four key areas (in no particular order) to consider when comparing benefit plans:

1) Benefit design 2) Rates 3) Provider access 4) Flexibility

There are important differences between the plans that should be considered. Here are some factors to keep in mind:

1) Benefit design – There are notable differences between the plans, which impacts the coverage and the out-of-pocket costs you’ll have when you utilize your benefits. The BlueLincs HMO has very low out-of-pocket costs with just applicable copays. And, there is no calendar year deductible to satisfy.

The BlueChoice PPO has a calendar year deductible to satisfy before coverage begins. But, like the HMO plan, many services are covered with just a copay, so depending on the type of services you need, you may not even need to meet your deductible during the year.

The BlueEdge HCA has a notably higher deductible to satisfy each year, and most services, except for some of your preventive care benefits, are subject to that deductible before your coverage begins. To help offset the higher deductible with this plan, money is put into a health care account each year on your behalf, which can be applied to your deductible or other eligible out-of-pocket medical expenses.

2) Rates – The BlueLincs HMO plan has the lowest rates of the three medical plans. Keep in mind, however, that as an HMO it has less flexibility than the other two plans, and it has a smaller network of providers to choose from. The BlueEdge HCA is the middle cost plan. It provides a high level of flexibility, but it has higher out-of-pocket costs than the other two plans. The BlueChoice PPO has higher rates than the other two plans, but it provides both a high level of flexibility and an overall high level of coverage.

3) Provider access – The BlueChoice network, which is used for both the BlueChoice PPO and BlueEdge HCA plan, is BCBSOK’s largest network in the state. There are fewer providers in the BlueLincs HMO network than there are in the BlueChoice network. Be sure to verify that your current physicians are in the network for the plan you are considering. If you are joining the HMO and want to choose a new primary care physician (PCP), make sure that physician is accepting new patients.

With BlueLincs HMO, out-of-state coverage is generally limited to emergency treatment. If you have a dependent living out-of-state (for example, a college student), or if you are moving out-of-state during the year, you may be eligible to enroll in the Away From Home Care Program, which connects BlueLincs HMO members to a participating out-of-state HMO.

The Away From Home Care Program does not cover the entire United States. If you are considering the HMO, and you have an out-of-state dependent, please contact BCBSOK to discuss your options.

PPO members (BlueChoice PPO and BlueEdge HCA) have nationwide access to contracting providers through the BlueCard® Program when you or your covered family members live, work, or travel anywhere in the country.

Additionally, when you travel outside the United States, PPO members have access to contracting providers in more than 200 countries through BlueCard Worldwide®.

4) Flexibility – Both the BlueChoice PPO and BlueEdge HCA give you the most flexibility since you have coverage for both in-network (PPO) and out-of-network providers. Keep in mind that you will always receive your highest level of benefits available when choosing an in-network provider. The BlueLincs HMO plan is a managed care plan that requires the use of BlueLincs contracted providers. You also are required to select a PCP to provide or coordinate most of your care, and because it is an HMO, referrals from your PCP are required for most specialty care. The other two plans do not have those requirements; you “manage” your own care.

Nourish to flourish.People sometimes turn to popular diets to achieve quick weight loss. For lasting changes and healthy eating, balance what you eat to meet your need for nutrition and enjoyment. Enjoy a variety of foods while keeping key food groups in mind and use moderation when choosing less nutritious foods.

04Enjoy a state of balance.

BlueL incs HMO

If you are enrolling in BlueLincs HMO, you must specify a Primary Care Physician (PCP) during your enrollment. During your online enrollment process, you will be asked to provide your PCP’s ID number.

g You must select your own PCP from the HMO provider network, and you must see him or her to coordinate care in order to receive benefits.

g You may choose a different PCP for each family member, or you may select the same one for the entire family.

g If you receive non-emergency care outside the HMO network or from a provider without a referral from your PCP (except as noted in the following bullet), you receive no benefits.

g To visit a specialist, a referral is required from your PCP for most care. Referrals are not required when you receive an annual exam from a network OB/GYN or from a network ophthalmologist or optometrist for routine exams.

Besides the BlueLincs HMO plan, an additional HMO plan is available for Tulsa employees. Please visit the “Benefits” section of the OU Human Resources Web site for more information at www.hr.ou.edu.

BlueLincs HMO Frequently Asked Questions

Where do I get my PCP’s ID number? A provider directory is available through www.bcbsok.com/OU. There you can search for a PCP you currently use or locate a new PCP that is available through the BlueLincs HMO network. You must enter the entire ID number, including all zeros. The ID must be five numeric digits (no letters), including any zeros. (Example: 00123)

I had an HMO last year, and want to keep my current PCP. What do I do during the enrollment period? You should verify through the provider directory on www.bcbsok.com/OU that your current PCP is covered under the BlueLincs HMO network. If your PCP is covered, you will need to “re-enroll” your PCP during the enrollment period.

I want to change my current PCP. Can I do that during the enrollment period? Yes, and you are able to do that up to four times a year as well. Consult the provider directory on www.bcbsok.com/OU to choose a PCP in the HMO network. During the enrollment period, include the PCP’s ID number on the application. During the year, simply call customer service to make this change.

My dependents live out-of-state. Can I choose BlueLincs HMO? With BlueLincs HMO, out-of-state coverage is generally limited to emergency treatment only. If you have a dependent living out-of-state (for example, a college student), or if you are moving out-of-state during the year, you or your dependent may be eligible to enroll in the Away From Home Care Program, which connects BlueLincs HMO members to a participating out-of-state HMO. The program is designed for members who:

g have a child attending school out-of-state

g have family members living in different service areas

g have a long-term work assignment in another state

g are retired with dual residence

The Away From Home Care Program does not cover every area in the entire United States. If you are considering the HMO, and you have an out-of-state dependent, please contact BlueLincs HMO toll free at 1-800-580-6202 to discuss your options.

05BlueChoice PPO

g You have access to an extensive network of providers and hospitals throughout the country, including therapists, chiropractors, behavioral health professionals and other specialists.

g You are not required to select a Primary Care Physician, and no referrals are required.

g You can select any covered provider for care within the PPO network or outside the network.

g When you receive care from in-network PPO providers, you receive the highest level of benefits.

g When you receive care from out-of-network providers, you not only receive a lower level of benefits, but you may also be subject to out-of-pocket costs for amounts the provider charges that are above the maximum allowable charge.

National and International Coverage

As a PPO member, you have nationwide access to contracting providers through the BlueCard® Program when you or your covered family members live, work or travel anywhere in the country. You can easily locate PPO network doctors and hospitals at www.bcbs.com or by calling BlueCard Access at 1-800-810-BLUE (2583). When you use BlueCard providers, you receive the highest level of benefits. You usually do not have to pay up front or file claim forms, and you take advantage of the savings the local plan has negotiated with area providers.

When you travel outside the United States, you have access to contracting providers in more than 200 countries through BlueCard Worldwide®. If you receive care from a non-BlueCard Worldwide provider, you will have to pay the doctor or hospital for care at the time of service and then submit a claim for reimbursement.

BlueChoice PPO Frequently Asked Questions

How do I find a doctor in the PPO network? Go to www.bcbsok.com/OU and use the provider directory, or call customer service.

I travel out-of-state fairly often. What happens if I need emergency care while I’m traveling? When you or covered family members need emergency care, go immediately to the nearest emergency facility. You don’t need to try to find a network physician or hospital for emergency care.

Do I need a referral from my doctor to see a specialist? No. With the PPO plan you can see any doctor at any time without a referral. If you see a specialist who is part of the PPO network, your benefits will be paid at the highest level. You can also see a specialist who is not part of the network, but your benefits will be paid at a lower level.

The BlueChoice PPO network is one of the largest in the state, with more than 5,400 physicians and specialists and over 125 hospitals contracting with Blue Cross and Blue Shield of Oklahoma. The National PPO network includes more than 800,000 doctors and 5,000 hospitals contracting with Blue Cross and Blue Shield Plans nationwide.

You can easily locate PPO network doctors and hospitals at www.bcbs.com or by calling BlueCard Access at 1-800-810-BLUE (2583).

06Live a life of commitment.

BlueEdge HCA

What is it?

With the BlueEdge HCA plan, a specific amount of money is deposited each benefit year in a health care account (HCA). In 2009 for example, $500 is deposited for an individual employee, or $1,000 is deposited for an employee with enrolled dependents. In both cases, that amount is pro-rated if you are enrolling in the middle of the year. This includes new employees starting after the beginning of the calendar year (see the pro-ration schedule at right). When you need any covered medical care, the first out-of-pocket costs you have are paid from available funds in this account. The money paid from your health care account is applied toward meeting your annual plan deductible or other copay or coinsurance amounts you may be responsible for. Any unused health care account funds roll over year to year, as long as you remain in the BlueEdge HCA.

Benefits

The HCA that Blue Cross and Blue Shield of Oklahoma offers is called BlueEdge. However, the network of providers that are covered under the BlueEdge HCA is the same network as the BlueChoice PPO plan.

g As a PPO member, you have access to an extensive network of providers and hospitals throughout the country. You can select any provider for care within the PPO network or outside the network. When you receive care from a PPO provider, you receive the highest level of benefits. When you receive care from a non-PPO provider, you receive a lower level of benefits.

g You do not have to select a primary care physician, and you never need a referral to see a specialist.

g Under BlueEdge HCA, some of your well child and adult preventive care services are covered in full, including routine OB/GYN exams and mammograms, and well child immunization. Many other well child and adult preventive care services are covered at 100 percent up to the first $250 each year. (Additional preventive services are covered under your regular benefits.)

How does it work?

1) At the beginning of each year, funds are deposited into your HCA account. In 2009, $500 is deposited for an individual employee, or $1,000 for an employee with enrolled dependents. Available funds in the HCA are used to pay for your initial health care deductible expenses each year.

g The $1,000 credit for employees with dependents can be used in any combination by the covered members of one family for covered expenses, including the entire $1,000 being used by one family member.

2) Once your available HCA funds are depleted, you are responsible for any remaining deductible and coinsurance.

3) Once the deductible is met, benefits for covered services begin. As with any PPO, you need to use an in-network provider to receive the highest level of benefits.

g When providers submit their claims to BCBSOK, out-of-pocket expenses for covered services are automatically paid from available funds in your HCA. There is no special paperwork to be submitted for reimbursement, and you will receive an Explanation of Benefits (EOB) showing what benefits are payable under your plan, noting the amount paid from your HCA. You can also keep track of your HCA and deductible balance online.

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4) Once your out-of-pocket maximum is reached, eligible health care services will be covered at 100 percent of the allowable amount for the remainder of the calendar year.

g If you don’t spend all of your HCA funds in one year, the balance rolls over to the next year and is added to the annual amount contributed to your account. There is no maximum on the amount you can accumulate in your HCA. The higher your HCA balance is, the less you’ll have to pay out-of-pocket when you do need to utilize your health benefits.

g Any funds accumulated in excess of your deductible will be used to pay for any coinsurance you incur. If you switch to a different product option at a future enrollment, you will forfeit any balance in your HCA. The HCA will not be paid out in cash under any circumstance.

Addi t iona l in fo rmat ion abou t the B lueEdge HCA

Pro-ration HCA funds are pro-rated for employees starting work after the beginning of the calendar year, following this pro-ration schedule:

Jan. 1 – March 31 100% contribution $500 individual /$1,000 family

April 1 – June 30 75% contribution $375 individual /$750 family

July 1 – Sept. 30 50% contribution $250 individual /$500 family

Oct. 1 – Dec. 31 25% contribution $125 individual /$250 family

Wellness Services Many wellness services are paid at 100% and are not subject to your annual deductible. Additionally, the preventive care services that are covered at 100% are not paid with any of the funds in your HCA.

Eligible expenses that can be paid from available HCA funds

Deductible, coinsurance and copayment amounts you are responsible for under your benefit plan for covered services.

Annual Enrollment Required Enrollment in an HCA does not automatically continue from year to year. If you enroll in the BlueEdge HCA, it will be necessary for you to re-enroll in it every year during the enrollment period.

Most people compare covered benefits, network providers, the cost of coverage and other out-of-pocket expenses when choosing a health plan. Since BlueEdge is a relatively new health plan, BCBSOK has developed the Health Care Cost Advisor – an innovative online tool available through www.bcbsok.com/OU that features a series of questions to help you decide if BlueEdge HCA meets your needs, and a budgeting tool to assist in the plan selection process.

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Coverage (Benefit period is one calendar year) BlueLincs HMO BlueChoice PPO BlueEdge HCATraditional Indemnity

(over 65 Retirees Only)

HMO Network Only In-Network Out-of-Network In-Network Out-of-Network No Network

Calendar Year Deductible Individual/Family $0 $500/$1,000 $750/$1,500 $1,500/$3,000 $2,500/$5,000 Your deductible is reduced by your HCA fund amount None

Out-of-Pocket Maximum Individual/Family $2,000/$4,000

Does not include copays for prescription drugs

$3,000/$6,000 Does not include copay

amounts


amounts

$3,000/$6,000 Includes deductible and

copay amounts


copay amounts

$3,000/ $6,000

Health Care Account Fund Not applicable Not applicable $500 Individual $1,000 Family (see BlueEdge HCA section)

Not Applicable

Lifetime Health Care maximum (per person) Unlimited Unlimited Unlimited Unlimited

PHYSICIAN SERVICES The amounts shown below are what you are responsible for paying for each type of service or treatment.

Office visit & services (excluding surgery) /consultation /second opinion $25 copay per visit ($35 copay for specialist)

$25 copay per visit ($35 copay for specialist) 30% after deductible 15% after deductible 35% after deductible 20%

Physical, Occupational, Speech, and Chiropractic Therapies (60 visit maximum combined for all therapies) $35 copay $35 copay 30% after deductible 15% after deductible 35% after deductible 20%

Allergy Injections $25 copay $25 copay ($35 copay for specialist) 30% after deductible 15% after deductible 35% after deductible 20%

Allergy Testing $35 copay $35 copay 30% after deductible 15% after deductible 35% after deductible 20%

Allergy Serum Covered in full $25 copay 30% after deductible 15% after deductible 35% after deductible 20%

Inpatient Physician Services Covered in full 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Outpatient Physician Services $35 copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Lab & X-ray (Physician Office) Covered in full after office visit copay Covered in full after office visit copay 30% after deductible 15% after deductible 35% after deductible 20%

Lab & X-ray (Outpatient Facility) $35 copay (covered in full if done in conjunction with an office visit)

Covered in full if done in conjunction with an office visit 30% after deductible 15% after deductible 35% after deductible 20%

MRI, CT, PET, EEG, and other similar imaging tests $35 copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

PREVENTIVE CARE SERVICES The amounts shown below are what you are responsible for paying for each type of service or treatment.

Routine Physical (once every calendar year) $25 copay (age 19 and older) $25 copay (age 19 and older) 30% after deductible

Covered in full for the first $250, then subject to deductible and coinsurance.

The first $250 (covered in full) is not counted against the HCA Fund.

100%

Adult Immunizations $25 copay $25 copay ($35 copay for specialist) 30% after deductible 100%

Well Child Exams $25 copay $25 copay 30% after deductible 100%

Routine Eye Exam* (does not include hardware) $25 copay $35 copay 30% after deductible 100%

Routine Hearing Exam* (does not include hardware/hearing aids) $25 copay $25 copay 30% after deductible 100%

Routine Ob/Gyn Exam $25 copay $25 copay ($35 copay for specialist) 30% after deductible 100%

Routine Mammograms Covered in full Covered in full Covered in full Covered in full Covered in full 100%

Routine Prostate Specific Antigen (PSA) and Digital Rectal Exams (DRE) $25 copay $25 copay 30%, no deductible 15%, no deductible 35%, no deductible 100%

Well Child Immunizations Covered in full Covered in full Covered in full Covered in full Covered in full 100%

P lan Compar i son Char t

*Routine vision and hearing exams limited to once every 24 months.

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Calendar Year Deductible Individual/Family $0 $500/$1,000 $750/$1,500 $1,500/$3,000 $2,500/$5,000 Your deductible is reduced by your HCA fund amount None

Out-of-Pocket Maximum Individual/Family $2,000/$4,000

Does not include copays for prescription drugs


amounts


amounts


copay amounts


copay amounts

$3,000/ $6,000

Health Care Account Fund Not applicable Not applicable $500 Individual $1,000 Family (see BlueEdge HCA section)

Not Applicable

Lifetime Health Care maximum (per person) Unlimited Unlimited Unlimited Unlimited

PHYSICIAN SERVICES The amounts shown below are what you are responsible for paying for each type of service or treatment.

Office visit & services (excluding surgery) /consultation /second opinion $25 copay per visit ($35 copay for specialist)

$25 copay per visit ($35 copay for specialist) 30% after deductible 15% after deductible 35% after deductible 20%

Physical, Occupational, Speech, and Chiropractic Therapies (60 visit maximum combined for all therapies) $35 copay $35 copay 30% after deductible 15% after deductible 35% after deductible 20%

Allergy Injections $25 copay $25 copay ($35 copay for specialist) 30% after deductible 15% after deductible 35% after deductible 20%

Allergy Testing $35 copay $35 copay 30% after deductible 15% after deductible 35% after deductible 20%

Allergy Serum Covered in full $25 copay 30% after deductible 15% after deductible 35% after deductible 20%

Inpatient Physician Services Covered in full 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Outpatient Physician Services $35 copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Lab & X-ray (Physician Office) Covered in full after office visit copay Covered in full after office visit copay 30% after deductible 15% after deductible 35% after deductible 20%

Lab & X-ray (Outpatient Facility) $35 copay (covered in full if done in conjunction with an office visit)

Covered in full if done in conjunction with an office visit 30% after deductible 15% after deductible 35% after deductible 20%

MRI, CT, PET, EEG, and other similar imaging tests $35 copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

PREVENTIVE CARE SERVICES The amounts shown below are what you are responsible for paying for each type of service or treatment.

Routine Physical (once every calendar year) $25 copay (age 19 and older) $25 copay (age 19 and older) 30% after deductible

Covered in full for the first $250, then subject to deductible and coinsurance.

The first $250 (covered in full) is not counted against the HCA Fund.

100%

Adult Immunizations $25 copay $25 copay ($35 copay for specialist) 30% after deductible 100%

Well Child Exams $25 copay $25 copay 30% after deductible 100%

Routine Eye Exam* (does not include hardware) $25 copay $35 copay 30% after deductible 100%

Routine Hearing Exam* (does not include hardware/hearing aids) $25 copay $25 copay 30% after deductible 100%

Routine Ob/Gyn Exam $25 copay $25 copay ($35 copay for specialist) 30% after deductible 100%

Routine Mammograms Covered in full Covered in full Covered in full Covered in full Covered in full 100%

Routine Prostate Specific Antigen (PSA) and Digital Rectal Exams (DRE) $25 copay $25 copay 30%, no deductible 15%, no deductible 35%, no deductible 100%

Well Child Immunizations Covered in full Covered in full Covered in full Covered in full Covered in full 100%

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HOSPITAL SERVICES The amounts shown below are what you are responsible for paying for each type of service or treatment.

Inpatient Hospital $250 copay per admission 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Outpatient Surgery $100 copay per surgery 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Emergency Room $100 copay per visit – waived if admitted 20% after $100 copay and deductible – copay waived if admitted 15% after deductible 20%

Urgent Care $50 copay 20% after $50 copay and deductible 30% after deductible 15% after deductible 35% after deductible 20%

ExTENDED CARE INPATIENT/HOME

Skilled Nursing Facility $250 copay per admission 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Skilled Nursing Facility Maximum No limit 90 visits per calendar year, combined in- and out-of-network 90 visits per calendar year, combined in- and out-of-network90 visits

per calen-dar year

Home Health Covered in full 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Home Health Maximum No limit 120 days per calendar year, combined in- and out-of-network 120 days per calendar year, combined in- and out-of-network120 visits per calen-dar year

Private Duty Nursing Covered in full 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Private Duty Nursing Maximum No limit 70 visits per calendar year, combined in- and out-of-network 70 visits per calendar year, combined in- and out-of-network70 visits

per calen-dar year

Hospice - Inpatient (no benefit limit) $250 copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Hospice - Outpatient (no benefit limit) Covered in full 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

MATERNITY & FAMILY PLANNING The amounts shown below are what you are responsible for paying for each type of service or treatment.

Prenatal & Postnatal visits $35 copay for initial visit then no charge

$25 copay/$35 copay for specialist for initial visit;

all other services 20% after deductible

30% after deductible 15% after deductible 35% after deductible 20%

Inpatient Hospital $250 per admission 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Infertility Testing & Treatment Infertility coverage provided for diagnosis and treatment of underlying cause only. Covered with applicable copay $25 copay

($35 for specialist) 30% after deductible 15% after deductible 35% after deductible 20%

Voluntary Sterilization Covered with applicable copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Reversal of sterilization is not covered.

Pregnancy Termination (therapeutic & non-therapeutic) Covered with applicable copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Contraceptive Devices Covered with applicable copay Covered with applicable copay 30% after deductible 15% after deductible 35% after deductible 20%

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HOSPITAL SERVICES The amounts shown below are what you are responsible for paying for each type of service or treatment.

Inpatient Hospital $250 copay per admission 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Outpatient Surgery $100 copay per surgery 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Emergency Room $100 copay per visit – waived if admitted 20% after $100 copay and deductible – copay waived if admitted 15% after deductible 20%

Urgent Care $50 copay 20% after $50 copay and deductible 30% after deductible 15% after deductible 35% after deductible 20%

ExTENDED CARE INPATIENT/HOME

Skilled Nursing Facility $250 copay per admission 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Skilled Nursing Facility Maximum No limit 90 visits per calendar year, combined in- and out-of-network 90 visits per calendar year, combined in- and out-of-network90 visits

per calen-dar year

Home Health Covered in full 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Home Health Maximum No limit 120 days per calendar year, combined in- and out-of-network 120 days per calendar year, combined in- and out-of-network120 visits per calen-dar year

Private Duty Nursing Covered in full 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Private Duty Nursing Maximum No limit 70 visits per calendar year, combined in- and out-of-network 70 visits per calendar year, combined in- and out-of-network70 visits

per calen-dar year

Hospice - Inpatient (no benefit limit) $250 copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Hospice - Outpatient (no benefit limit) Covered in full 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

MATERNITY & FAMILY PLANNING The amounts shown below are what you are responsible for paying for each type of service or treatment.

Prenatal & Postnatal visits $35 copay for initial visit then no charge

$25 copay/$35 copay for specialist for initial visit;

all other services 20% after deductible

30% after deductible 15% after deductible 35% after deductible 20%

Inpatient Hospital $250 per admission 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Infertility Testing & Treatment Infertility coverage provided for diagnosis and treatment of underlying cause only. Covered with applicable copay $25 copay

($35 for specialist) 30% after deductible 15% after deductible 35% after deductible 20%

Voluntary Sterilization Covered with applicable copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Reversal of sterilization is not covered.

Pregnancy Termination (therapeutic & non-therapeutic) Covered with applicable copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Contraceptive Devices Covered with applicable copay Covered with applicable copay 30% after deductible 15% after deductible 35% after deductible 20%

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MENTAL HEALTH The amounts shown below are what you are responsible for paying for each type of service or treatment.

Inpatient Hospital/Facility $250 copay per admission 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Inpatient Facility Day Maximum per Calendar Year 30 days Unlimited Unlimited Unlimited

Outpatient Charges $35 copay $35 copay 30% after deductible 15% after deductible 35% after deductible 20%

Outpatient: Maximum per Calendar Year 20 days Unlimited Unlimited Unlimited

SUBSTANCE ABUSE The amounts shown below are what you are responsible for paying for each type of service or treatment.


Inpatient Facility Day Maximum per Calendar Year 30 days 30 days 30 days 30 days


Outpatient: Maximum per Calendar Year 20 visits 26 visits 26 visits 30 days

PRESCRIPTIONS The amounts shown below are what you are responsible for paying for each type of service or treatment.

Retail Pharmacy Care Generic (Tier I)/Preferred Brand (Tier II)/Non-Preferred Band (Tier III) (30 day supply with one copay or 31-90 day supply with two copays) $10/$30/$60 $15/$25/$40 30% after

$15/$25/$40$15/$25/$40 after deductible

$30/$50/$80 after deductible

$8/$35/50% ($100 minimum; $200 maximum)

Mail Order RX Generic (Tier I)/Preferred Brand (Tier II)/Non-Preferred Band (Tier III) (90 day supply) $20/$60/$120 $30/$50/$80 Not covered $30/$50/$80

after deductible Not covered$16/$70/50% ($100 minimum; $200 maxi-mum) out-of-network

not covered

Prescription Smoking Cessation Products Covered Covered Covered Covered

Oral Contraceptives Covered Covered Covered Covered

Sexual Dysfunction Drugs (limited to eight doses per 30 days - no mail order) Not covered Covered Covered Not covered

Diabetic Supplies – Diabetic Supplies can be covered under medical benefits (applicable deduct-ible and coinsurance would apply) or under pharmacy benefit (applicable copays will apply). Covered Covered Covered Covered*

Step Therapy – For listing of drugs that apply to Step Therapy, please see Formulary at www.bcbsok.com/OU. Applies Applies Applies Applies

Pre-Authorization – For listing of drugs that require Pre-Authorization, please see Formulary at www.bcbsok.com/OU). Applies Applies Applies Applies

OTHER SERVICES AND SUPPLIES The amounts shown below are what you are responsible for paying for each type of service or treatment.

Smoking Cessation Benefit (non-RX) – 100% member reimbursement for over-the-counter medications, acupuncture, hypnosis, stop smoking aids, etc., to a maximum of $500 per calendar year, $1,500 lifetime maximum (per person)

Applies Applies Applies Applies Applies Applies

Bariatric Surgery Covered Not covered Not covered Not covered Not covered Not covered

Durable Medical Equipment Covered in full 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Ambulance (Ground/Air) Covered in full Covered in full 15% after deductible 20%

Routine Audiological Exam $25 copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Routine Audiological Exam for children up to age 18 including routine diagnostic audiological exam/evaluation and hearing aids, limited to 2 every 24 months. For children up to age 2, coverage includes 4 additional molds per years. * Covered (syringes, needles, alcohol swabs). Diabetic management supplies (insulin, insulin pump, etc.) must be covered by Medicare Part B

Speech Therapy for Autism – Although services related to Autism are not covered under your health plan, benefits will now be available for 20 speech therapy visits per calendar year.

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MENTAL HEALTH The amounts shown below are what you are responsible for paying for each type of service or treatment.


Inpatient Facility Day Maximum per Calendar Year 30 days Unlimited Unlimited Unlimited


Outpatient: Maximum per Calendar Year 20 days Unlimited Unlimited Unlimited

SUBSTANCE ABUSE The amounts shown below are what you are responsible for paying for each type of service or treatment.


Inpatient Facility Day Maximum per Calendar Year 30 days 30 days 30 days 30 days


Outpatient: Maximum per Calendar Year 20 visits 26 visits 26 visits 30 days

PRESCRIPTIONS The amounts shown below are what you are responsible for paying for each type of service or treatment.

Retail Pharmacy Care Generic (Tier I)/Preferred Brand (Tier II)/Non-Preferred Band (Tier III) (30 day supply with one copay or 31-90 day supply with two copays) $10/$30/$60 $15/$25/$40 30% after

$15/$25/$40$15/$25/$40 after deductible

$30/$50/$80 after deductible

$8/$35/50% ($100 minimum; $200 maximum)

Mail Order RX Generic (Tier I)/Preferred Brand (Tier II)/Non-Preferred Band (Tier III) (90 day supply) $20/$60/$120 $30/$50/$80 Not covered $30/$50/$80

after deductible Not covered$16/$70/50% ($100 minimum; $200 maxi-mum) out-of-network

not covered

Prescription Smoking Cessation Products Covered Covered Covered Covered

Oral Contraceptives Covered Covered Covered Covered

Sexual Dysfunction Drugs (limited to eight doses per 30 days - no mail order) Not covered Covered Covered Not covered

Diabetic Supplies – Diabetic Supplies can be covered under medical benefits (applicable deduct-ible and coinsurance would apply) or under pharmacy benefit (applicable copays will apply). Covered Covered Covered Covered*

Step Therapy – For listing of drugs that apply to Step Therapy, please see Formulary at www.bcbsok.com/OU. Applies Applies Applies Applies

Pre-Authorization – For listing of drugs that require Pre-Authorization, please see Formulary at www.bcbsok.com/OU). Applies Applies Applies Applies

OTHER SERVICES AND SUPPLIES The amounts shown below are what you are responsible for paying for each type of service or treatment.

Smoking Cessation Benefit (non-RX) – 100% member reimbursement for over-the-counter medications, acupuncture, hypnosis, stop smoking aids, etc., to a maximum of $500 per calendar year, $1,500 lifetime maximum (per person)

Applies Applies Applies Applies Applies Applies

Bariatric Surgery Covered Not covered Not covered Not covered Not covered Not covered

Durable Medical Equipment Covered in full 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Ambulance (Ground/Air) Covered in full Covered in full 15% after deductible 20%

Routine Audiological Exam $25 copay 20% after deductible 30% after deductible 15% after deductible 35% after deductible 20%

Routine Audiological Exam for children up to age 18 including routine diagnostic audiological exam/evaluation and hearing aids, limited to 2 every 24 months. For children up to age 2, coverage includes 4 additional molds per years. * Covered (syringes, needles, alcohol swabs). Diabetic management supplies (insulin, insulin pump, etc.) must be covered by Medicare Part B

Speech Therapy for Autism – Although services related to Autism are not covered under your health plan, benefits will now be available for 20 speech therapy visits per calendar year.

What ’ s Not Covered

Your plan options do not cover all health care expenses, and include exclusions and limitations. You should refer to plan-specific documents to determine which health care services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on state mandates, the plan design or rider(s) purchased. Visit the “Benefits” section of the OU HR Web site for plan-specific information at www.hr.ou.edu

g Services that BCBSOK determines are experimental/investigational in nature

g Any condition to the extent payment would have been made under Medicare if the member had applied for Medicare and claimed Medicare benefits

g Diagnosis, treatment or medications for infertility and fertilization procedures, including artificial insemination; ovulation induction procedures; in vitro fertilization; embryo transfer. (Coverage for infertility is limited to diagnosis and treatment of underlying cause.)

g Conditions related to autistic disease of childhood, hyperkinetic syndromes, learning disabilities, behavioral problems, mental retardation, or for inpatient confinement for environmental change. However, the plan will cover medically necessary services such as physician’s services related to the diagnosis and treatment of ADD and ADHD, and prescription drug therapy for treatment of ADD/ADHD for children.

g Cosmetic surgery or complications resulting there from, including surgery to improve or restore your appearance

g Reverse sterilization

g Treatment of sexual problems not caused by organic disease

g Foot care only to improve comfort or appearance, such as care for flat feet, subluxation, corns, bunions (except capsular and bone surgery), calluses, toenails, etc.

g Acupuncture, whether for medical or anesthesia purposes (acupuncture for smoking cessation is covered under the annual smoking cessation benefit. See page 1 of this booklet.)

ID Cards

You will receive an ID card in the mail soon after the enrollment period is complete. If you are enrolled with dependents, you will receive two ID cards. Additional cards can be ordered through customer service or online via the Blue Access for Members Web site. You should present your ID card when visiting a physician’s office or hospital, and verify that they have the correct insurance information on file for you. Your new card will resemble the card below, and will be customized with your name and plan information. Dependents’ names will not be printed on the ID card.

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You can print a temporary ID card and order a replacement card on Blue Access for Members (BAM) if you ever lose or misplace

your card.

In the future, the magnetic stripe on the back of the ID card will allow BCBSOK and your providers to take advantage of emerging

“card-reading” technologies. For providers who have card readers, office staff will be able to “swipe” your ID card when registering

your new insurance information, and in real time, he/she can verify your eligibility and benefits (such as copayment amounts).

Currently, the magnetic stripe on your ID card only includes your general information (such as name, birth date, ID number and

group ID number) and can be read only by health care providers with certain card readers, software, and connectivity.

Group NumberEffective DateBenefit Network

The University of Oklahoma

Office Visit Copay:

Specialist Copay:

Rx Copay:

PlanName

Subscriber:John Q. SampleIdentification Number:ABC12345678

Customer Web Address: www.bcbsok.com/OUCustomer Service: 1-877-XXX-XXXXPharmacy: 1-877-XXX-XXXX24/7 Nurseline: 1-877-XXX-XXXXProvider Locator: 1-877-XXX-XXXXDelta Dental: 1-877-XXX-XXXXPayflex Customer Svc: 1-877-XXX-XXXX

Some services must be preauthorizedbefore you receive them. Your benefitbooklet has more information.Network coverage is available through participating network providers.Non-network services will be covered at a lower level.All mental health and chemical dependency treatment must be preauthorized.

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

www.bcbsok.com

L13

Group NumberEffective DateBenefit Network

The University of Oklahoma

Office Visit Copay:

Specialist Copay:

Rx Copay:

PlanName

Subscriber:John Q. SampleIdentification Number:ABC12345678

Customer Web Address: www.bcbsok.com/OUCustomer Service: 1-877-XXX-XXXXPharmacy: 1-877-XXX-XXXX24/7 Nurseline: 1-877-XXX-XXXXProvider Locator: 1-877-XXX-XXXXDelta Dental: 1-877-XXX-XXXXPayflex Customer Svc: 1-877-XXX-XXXX

Some services must be preauthorizedbefore you receive them. Your benefitbooklet has more information.Network coverage is available through participating network providers.Non-network services will be covered at a lower level.All mental health and chemical dependency treatment must be preauthorized.

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

www.bcbsok.com

L13

15

† Please review the Blue Points Program Rules listed on the Personal Health Manager for complete information on the program. Program rules are subject to change without prior notice.

Exper ience. Wel lness . Everywhere.

New for OU! Biometric screenings will be available to all OU employees in 2009. Please watch your email and employee bulletin boards for more information on dates and locations. In addition to the confidential Health Risk Assessment on the Personal Health Manager, a biometric screening provides a detailed assessment of your basic health indicators, including blood pressure, body mass index (calculated from height and weight), cholesterol (HDL and LDL) and blood glucose. This screening will give you an awareness of potential health conditions.

Personal Health Manager Online Resources

Through the Blue Care Connection program, you’ll find tools and services that inform, support and motivate you on your journey to wellness.

Our online health resources are available through Blue Access for Members at www.bcbsok.com/OU. Set goals toward a healthier lifestyle, understand and manage a health condition, and keep track of your health care. Interactive tools and extensive information cover all aspects of health and wellness, including nutrition, fitness, work-life balance, medical conditions and more.

Use the Personal Health Manager to:

g Learn about your health status and possible health risks by completing the confidential Health Risk Assessment. After you complete and submit your Health Risk Assessment, you will immediately receive information on your overall health status and specific health categories such as sleep and nutrition, as well as helpful tips. When health risks are revealed, you also receive recommendations for making healthy changes. You may also receive online messages or outreach phone calls from Blue Care Advisors to help you take action to reduce your health risks and improve your health. Before starting the Health Risk Assessment, it’s helpful—but not essential—to know your most recent:

g Height and weight

g Blood pressure

g Total cholesterol level

g HDL cholesterol level

g Blood glucose level

g Get health and wellness questions answered by Blue Care Advisor nurses and other health care professionals via secure e-mail.

g Ask registered nurses (Blue Care Advisors) your health-related questions with the Ask A Nurse feature.

g Request fitness and weight loss advice from a team of personal trainers with Ask A Trainer.

g Ask registered dietitians for nutrition advice with Ask A Dietitian.

g Receive help on managing stress, workplace conflicts and other similar issues with Ask A Life Coach.

g Adopt healthier behaviors and stay motivated using the interactive Get Fit, Eat Right and Live Well tools in the For Your Health section. Find information on fitness, nutrition and lifestyle issues that can be customized to meet your needs. Plus, you can keep track of your activities and results online to keep you motivated.

g Learn more about health conditions and medical procedures to help you manage your care or prepare for diagnostic testing or treatments by searching the health encyclopedia.

g Set up a personal health record to keep track of and manage your family’s health information – within one secure location. Using tracking tools, you can also track your progress by entering values such as cholesterol, blood pressure and blood glucose levels, and view a graph showing how you are doing over a time period.

Reward Yourself with Blue PointsSM †

At Blue Cross and Blue Shield of Oklahoma, we understand how hard it can be to change habits and maintain healthy lifestyle changes. That’s why Blue Care Connection builds in a reward program to keep you motivated and offers additional programs that can help you start on a healthy path, and support you along the way. Every time you use the Personal Health Manager to track a fitness workout, report a meal, use the Ask A features, and participate in For Your Health interactive programs, you automatically earn Blue Points. Redeem your Blue Points for reward items such as health-related products, popular merchandise and gift certificates at the Blue Points Redemption Center, accessed through the Personal Health Manager.

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Weight Management Support for a slimmer, healthier you

The program offers guidance and support through behavioral and motivational coaching, personalized goal setting with an action plan, online tools and discounts to wellness-related products and services. To get started, go to the Personal Health Manager available through Blue Access for Members at www.bcbsok.com/OU and click the Weight Loss button. Or, call customer service.

Tobacco Cessation Support for smokers who want to quit

The program provides personal coaching, online tools and discounts to wellness-related products and services. To participate, go to the Personal Health Manager and select the Stop Smoking button/link – or call customer service. Also, see page 1 of this booklet for more information on an annual smoking cessation benefit.

The BlueExtrasSM Discount Program†

With BlueExtras, you can take advantage of discounts on health-related products and services that help support a healthy lifestyle. These discounts apply to health care products and services not usually covered by your health care benefits plan. Plus, there are no claims to file, no referrals or pre-authorizations and no additional fees to participate. To find out more about BlueExtras, visit www.bcbsok.com/OU.

BlueExtras provides discounts to:

g Jenny Craig weight management program

g Curves fitness and weight loss facilities

g Complementary Alternative Medicine items, such as vitamins, health and wellness magazines, gym memberships, massages, spas, acupuncture, yoga, tai chi and more

g Vision care and hearing aid products

g Safety products, such as bicycle helmets, childproofing and home safety items

g GHS auto insurance

24/7 Nurseline

Health concerns don’t always follow a 9-to-5 schedule. Fortunately, you can call the toll-free 24/7 Nurseline 24 hours a day, seven days a week to get the information you need…when you need it.

The 24/7 Nurseline is staffed by registered nurses who can answer your general health questions and direct you to your doctor or encourage you to seek emergency services if necessary. In a matter of minutes, a nurse can help identify options and provide information to help you choose the appropriate care for your concerns. Plus, when you call, you also have the option to access an audio library of more than 1,000 health topics – from allergies to women’s health – with more than 600 topics available in Spanish.

Call the 24/7 Nurseline toll free at (800) 581-0407.

Special Beginnings – A Healthy Start for Mothers and Babies

If you are expecting, this prenatal program can help guide you through your pregnancy and postpartum care. The program provides support and education, pregnancy risk assessment and ongoing attention/monitoring.

Enrolled members receive frequent, personal contact from obstetrical nurses who can help them better understand and manage their pregnancies. Educational materials promote healthy behaviors, preventive care, and identify warning signs of complications. Topics also include nutrition, fetal development and newborn care. Additionally, members can call a 24-hour toll-free BabyLine staffed by maternity nurses.

For information on enrolling, call the toll-free Special Beginnings phone number at (877) 904-2229.

Blue Care Advisors

If you have certain chronic health conditions or are at risk for medical complications, a Blue Care Advisor may contact you. Working with you through regularly scheduled telephone calls, these registered nurses and other health care professionals offer health counseling, coaching and support.

The Blue Care Advisor can help you learn to manage your condition more successfully, identify behaviors that may be barriers to better health, set goals for improving your health and help you adopt healthier habits.

BlueExtras is a discount program available to BCBSOK members. This is NOT insurance. Some of the services offered through BlueExtras may be covered under your health plan. Please refer to your benefit booklet or call the customer service number on the back of your ID card for specific benefit information under your health plan. Use of BlueExtras does not affect your premium, nor do costs of BlueExtras’ services or products count toward your plan deductible, calendar year or lifetime maximums. Discounts are only available through participating vendors.

BCBSOK does not guarantee or make any claims or recommendations regarding the services or products offered under BlueExtras. You may want to consult with your physician prior to use of these services and products. Services and products are subject to availability by location. BCBSOK reserves the right to discontinue or change this discount program at any time without notice.

17

Case Managers

In the event that you or a covered family member experiences multiple or complex medical problems, our case management nurses – registered nurses with specialized training and clinical experience – can work with you.

At a time that’s usually stressful, case managers can be your advocate by:

g Helping to explain your medical problems and treatment plans

g Facilitating communication among many health care providers

g Coordinating treatment plans

g Explaining your health care benefits and how to get the most out of them

g Helping you access the right resources and services

g Assisting with transitions from one health care setting to another

Other Resources to Help You

Blue Cross and Blue Shield of Oklahoma also provides other health and wellness information.

Preventive Health Care Guidelines are published each year and made available via www.bcbsok.com/OU. This is a good source of information on preventive care guidelines, which are based on recommendations set by national health agencies and medical associations. You can learn about recommended screenings, and immunizations and doctor visits for all ages, from prenatal care and infancy through the senior years.

Be Smart. Be Well.TM is our Web site dedicated to raising awareness of largely preventable health and safety issues. You’ll find in-depth information on a variety of issues, including traumatic brain injuries, drug interactions and mental health at www.besmartbewell.com.

Glucose Meters help members with diabetes manage their condition and can be ordered at no charge. For information on the meters that are available, call customer service.

Start your journey to wellness today!

It’s easy to use the Personal Health Manager! Just log in to our secure Blue Access® for Members Web site at www.bcbsok.com/OU. Access the Personal Health Manager from the My Health tab on Blue Access for Members or just click on the Personal Health Manager icon.

Commit to Wellness.Wellness is the state of being healthy in body and mind, especially as the result of deliberate effort. It is the actively sought goal of good physical and mental health, maintained by proper diet, exercise and habits.

RESOURCE PURPOSE HOW TO ACCESS

Blue Access for Members

Site provides:• TemporaryIDcard• Viewclaimstatus• Findadoctororhospital• ViewHCAaccountbalances• ViewWellnessRewardspoints• AccesstoBlueExtras

Go to www.bcbsok.com/OU• EnterBlueAccessforMembersuserID

and password • IfyoudonothaveauserIDandpassword,

go to “Sign Up Today”.

Blue Points Earn points, redeemable for rewards, for health-related activities

Go to BAM at www.bcbsok.com/OU• ClickonPersonalHealthManager• ClickonanyoftheFor Your Health links

(Get Fit, Eat Right, Live Well)• ClickontheBluePointstabtoseehowmany

points you’ve earned

Locate a Health Care Provider

Find a doctor, specialist, or hospital in your area

Go to www.bcbsok.com/OU •Clickon“Doctors&Hospitals”

OU Benefits Web Site

Find benefit related information www.hr.ou.edu

BCBSOK Web Site for OU

•AccessthePersonalHealthManager •View/printbenefitbrochures •Locateadoctororhospital

www.bcbsok.com/OU

ONLINE BENEFIT RESOURCES

CONTACTS This enrollment guide highlights OU’s Benefits Program. A complete description of each benefit can be found in the legal documents governing the plans. Every effort has been made to provide an accurate summary of the plans in this guide. However, if there is a conflict between this material and the legal documents, the legal documents will govern. If you have any questions after reviewing your enrollment materials, please contact customer service at the number below.

SUBJECT CONTACT

Customer Service 1-888-881-4648

Pharmacy 1-800-423-1973

BlueCard 1-800-810-BLUE (2583)

24/7 Nurseline 1-800-581-0407

Special Beginnings 1-877-904-2229

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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 70450.0908

experience. wellness. everywhere. · 2010-04-06 · g smoking cessation expenses, such as...

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