INDIVIDUALbcidaho.com

What’s in this issue: • Selecting the Right Care

• Turn Resolutions into Successful Goals

• Personal Health Support

• Understanding Your Deductible

M E M B E R N E W S L E T T E RBlue Bulletin W I N T E R

EDITION

WelcomeAs we begin wrapping up 2015, all of us at Blue Cross of Idaho would like to thank you for choosing us to fulfill the health insurance needs of you and your family. Our goal remains the same as it always has been: to give you access to the highest quality healthcare at the lowest possible cost.

Keeping healthcare costs in check is something we strive for every day as we deal with government regulations, unpredictable prescription drug costs, and an endlessly shifting healthcare landscape affecting both the public and the industry. Through it all, our focus remains on you – our members.

Not only does Blue Cross of Idaho give our members access to some of the best doctors and healthcare providers in the state, but as part of the Blue Cross Blue Shield Association, our members can access high-quality care wherever they are, whether that’s across the country or around the world.

We’re also always looking for new ways to help you take control of how much you spend on healthcare with things like our online cost transparency tool, CostAdvisor, and our mobile app for smartphones, which allows your coverage to keep up with you. In the coming year, watch for even more ways we can help you manage your healthcare costs while getting the access and convenience you deserve.

We look at some of those ways you can watch your budget in this issue of Blue Bulletin. On page 1, Blue Cross of Idaho Medical Director Ryan Heyborne shares how you can save by choosing the right place to get the care you need, whether that’s an emergency room, urgent care clinic or your doctor’s office.

We also offer information on how you can take better advantage of your preventive care benefits to help you stay healthy. For all of us who vow to get healthy each year, we have some tips on actually keeping those New Year’s resolutions on page 2. And to prove that staying healthy doesn’t have to mean giving up tasty food, check out the recipe on the back of the cover.

To help you stay on top of your insurance, we offer a primer on your annual deductible on page 4. You can also learn about new ways we’re making insurance easier, including a tour of our new homepage, some of the benefits of registering online and more.

Once again, thank you for choosing Blue Cross of Idaho. From all of us here to you and your family, have a happy and healthy 2016.

Zelda Geyer-Sylvia

President and CEO, Blue Cross of Idaho

W I N T E R 2 01 5 – 2 01 6 1

Selecting the Right Care By Dr. Ryan Heyborne

Winter offers an array of reasons to visit your doctor, from falls on the ice to unpleasant flus. But just where should you turn for help when you need it? Fortunately, as a Blue Cross of Idaho member, you have options.

I worked in an emergency department (ER) for years, and it’s the best place to get care for many serious illnesses, including strokes, heart-attacks, serious injuries and other conditions that need intensive care right away. The ER might also be the only place open, depending on the time or day. Emergency doctors are trained in treating a wide range of illnesses and can provide the care you need when you need it most.

For many less-serious illnesses and injuries, there are several options that not only offer fast care, but save you money on out-of-pocket costs. When you’re dealing with minor injuries – strains, sprains or even minor broken bones – or common ailments – sore throats, severe colds, flu – sometimes

a trip to an urgent care clinic or your own doctor’s office is the best choice.

Many doctor’s offices can schedule same-day or next-day appointments, and some even offer extended hours. Walk-in clinics – including urgent care clinics – are often open nights and weekends, and offer an array of services including X-rays and lab tests. Some clinics even specialize in treating certain urgent conditions, such as bone and joint injuries.

These options are also generally less expensive: The average copayment for going to an urgent care clinic or your doctor’s office is $20-$40, while the average copayment for an ER visit is $100-$250 on top of the cost of meeting your annual deductible and coinsurance costs. Additionally, urgent care clinics can often get you taken care of and on your way quickly and can be found just about anywhere.

Ambulatory surgery centers also offer a variety of non-emergency surgical services, often at a lower cost to patients than larger hospitals which provide a larger array of services. The same holds true for imaging services. The cost to you for an MRI, for example, can be lower at certain imaging centers than at a hospital.

Blue Cross of Idaho members can also use our online cost transparency tool, CostAdvisor, to get an estimate of how much a procedure is likely to cost at various providers in their area. You can learn more about CostAdvisor at members.bcidaho.com/knowbeforeyougo.

For more information about your coverage, log on to members.bcidaho.com. You can also talk to your doctor so that he or she can help you decide where you can get the care you need at a cost you can afford.

We at Blue Cross of Idaho wish you a safe, healthy and happy holiday season.

AVERAGE MEMBER COPAYMENT FOR AN ER VISIT IS $100-$250.

Medication Update Winter 2015Brand Name Generic Name Drug Use

Pulmicort Respules Budesonide inhalation suspension Asthma

Xenazine Tetrabenazine Treatment of the involuntary movements associated with Huntington's disease

Invega ER Paliperidone SR Schizophrenia, schixoaffective disorder

Mirapex ER Pramipexole dihydrochloride Parkinson's disease

Copaxone Glatiramer acetate Multiple sclerosis

These brand-name drugs have recently been released in a generic form. Generics are a safe and effective way to lower the cost of your medications.

Ask your doctor or pharmacist if a generic medicine is right for you.

H O U S E CALLS

Dr. Ryan Heyborne is one of four medical directors at Blue Cross of Idaho. All four maintain close ties with the healthcare provider community. These doctors and the more than 100 clinicians, nurses and medical professionals who work with them ensure we remain at the forefront of changes and innovations to the healthcare delivery system that will help improve health and lower costs.

B L U E C R O S S O F I D A H O | M E M B E R N E W S L E T T E R2

Get Supported with WellConnectedMaking a resolution to get healthier in the new year is the easy part, but following through can be challenging. One of the keys to being successful is fi nding support.

As a Blue Cross of Idaho member, you have that kind of support thanks to the WellConnected wellness portal at members.bcidaho.com. Simply log in to your online account and select the WellConnected logo to open up a world of health tools, classes and advice.

Whether you’re looking for an online workshop to help you quit smoking, advice on how to make fi tness part of your routine, or even healthy recipes, WellConnected gives you access to a wealth of information.

Turn Resolutions into Successful GoalsNew Year’s resolutions are tricky and, sometimes, daunting things. We’re fi lled with commitment when we make them, but that dedication seems to evaporate a few weeks into January.

But resolutions don’t have to be a foregone failure. By thinking of resolutions as goals, you can lay the groundwork for improving your health and wellness.

HERE ARE SOME TIPS FOR ACHIEVING YOUR GOALS:

1. Make SMART goals:

• SPECIFIC: Be clear about what you want to achieve and how you’re going to do it.

• MEASUREABLE: Set markers for measuring your progress.

• ACTION ORIENTED: Outline what you need to do to reach your goal.

• REALISTIC AND RELEVANT: Make your goal something you can achieve and understand why it’s important to you.

• TIME BASED: Set a timeline for achieving your goal.

2. Come up with a plan for success, including how you will overcome challenges.

3. Use small rewards to motivate yourself at various stages.

4. Remember that changes don’t happen overnight, so be patient.

5. Find support to help you. Find a mentor or someone who wants to achieve the same goal and keep each other accountable.

6. Focus on what you are gaining in your life when things get tough.

7. Remember, it’s not all-or-nothing. If you hit a setback, don’t view it as a failure and give up. Simply come up with a plan to get back on track.

8. Take responsibilities for your choices and don’t blame others or the situation for leading you astray.

9. Mix up your routine to keep it fresh. If fi tness is your goal, try activities you haven’t done before. If you’re trying to eat healthier, fi nd new recipes.

10. Start small and build up to your ultimate goal. If you jump into something, you might get overwhelmed and quit. Set small goals along the way to mark your achievements.

Turning your wellness resolution into a personal success is never easy, but keeping focused, positive and supported can help you live a happier and healthier life now and into the future.

W I N T E R 2 01 5 – 2 01 6 3

Open Enrollment SeasonDON’T FORGET – if you have one of the new Affordable Care Act (ACA) plans, you have through the end of January to sign up for a new plan if you’re considering a change. If you’re happy with your existing plan, you will be automatically reenrolled at the end of December – no need for you to do anything.

If you bought your plan from Your Health Idaho and have questions about your options, visit them at yourhealthidaho.org. If you purchased your plan directly from Blue Cross of Idaho, visit bcidaho.com or give us a call at 855-230-6862.

Personal Health SupportDealing with the healthcare system can be daunting, especially when it comes to chronic or complex health conditions. Keeping track of appointments, medications and understanding treatment plans can be overwhelming.

But you don’t have to face it alone. At Blue Cross of Idaho, we offer our members dealing with chronic or complex health issues personal support, helping make sure they get the quality, cost-effective healthcare they need.

Our Personal Health Support program team includes trained nurses, licensed mental health professionals and board-certifi ed medical directors to help our members deal with any barriers they run into – whether it’s accessing healthcare or dealing with an unexpected setback – as well as identifying alternatives and making sure they’re getting the most out of their healthcare benefi ts.

Additionally, our team helps deal with chronic conditions, including asthma, diabetes, chronic obstructive pulmonary disease (COPD) and Coronary Artery Disease (CAD)We identify participants through claims information and they are automatically enrolled in the program and receive materials to help them manage their condition. Participation is voluntary and members can drop out at any time.

For more information, or to opt out, call the Personal Health Support team at 208-387-6924 or 800-627-6655, or email personalhealthsupport@bcidaho.com. You can also sign in to your online member account at members.bcidaho.com and select Medical Management under the Health & Wellness menu.

Schedule your Annual Wellness Visit TodayDID YOU KNOW that depending on your coverage, your annual wellness visit might be completely free to you? This kind of preventive screening is an important tool you and your doctor can use to help address any potential issues and reach the best health possible.

During your visit, your doctor will look at many health indicators, including the following:

• BLOOD PRESSURE: Ideally, your blood pressure should be less than 140/90.

• BODY MASS ASSESSMENT: This helps maintain a healthy weight.

• CHOLESTEROL: Levels should be less than 200.

• DIABETES: Know your risk levels to deal with potential issues.

• CERVICAL CANCER: Get a Pap test at least once every three years.

• BREAST CANCER: Get a mammogram once every one to two years after age 40.

• VACCINATIONS: Get the recommended vaccinations against preventable diseases, as well as your annual fl u shot.

• COLORECTAL CANCER: Get a colonoscopy every 10 years after age 50.

B L U E C R O S S O F I D A H O | M E M B E R N E W S L E T T E R4

Avoiding Back SurgeryBeginning in early 2016, the Blue Cross of Idaho Spine Centers of Excellence program will have a new name and better benefi ts.

The Healthy Backs program will still help members explore non-surgical options to deal with back pain, but the program will now include 10 physical therapy sessions outside of each plan’s physical therapy allotment. Additionally, a Blue Cross of Idaho wellness coach will support participating members throughout the program.

Members must be referred to the program by a participating physiatrist before enrolling, and the program is only available within the state of Idaho. To fi nd out if you have access to the Healthy Backs program, call the Blue Cross of Idaho Customer Service Department at the number on the back of your member ID card.

For more information about Healthy Backs, visit members.bcidaho.com/healthy-backs.

Understanding how much you owe after a medical procedure can be confusing. Some services (like preventive exams) are completely covered by your health insurance as long as you go to an in-network doctor. But others are only partially covered, leaving a portion for you to pay out-of-pocket.

While each plan is different, an important factor to keep in mind is your DEDUCTIBLE, which is the amount you have to pay before Blue Cross of Idaho begins to pay a portion of the cost of some services.

While there is no deductible for preventive care, you will have to pay out-of-pocket for most other services until you reach your deductible. Your plan will then either begin paying a set percentage of the cost, or increase that percentage, depending on the services and your plan.

Deductibles vary, but they reset at the beginning of the year or on your plan renewal date, so it’s important to check your benefi ts details to know when your deductible resets.

Remember, even if you haven’t yet reached your deductible, you still get the advantage of lower costs

if you visit an in-network provider. You can save money thanks to the lower rates we negotiate with providers who are part of our network. We set these rates in advance and pass the savings on to our members.

You can check your deductible status anytime by logging on to your online account at members.bcidaho.com, by downloading the Blue Cross of Idaho mobile app for smartphones, or by calling our Customer Service Department at the number on the back of your member ID card.

DEDUCTIBLE: THE AMOUNT YOU PAY FOR COVERED SERVICES BEFORE YOUR HEALTH PLAN BEGINS TO PAY. USUALLY, THE HIGHER THE PLAN’S DEDUCTIBLE, THE LOWER THE PLAN’S MONTHLY PREMIUM. DEDUCTIBLES VARY BY PLAN.

New Year, New Deductible

WHY GO DIGITAL? Cutting

back on our printing and mailing keeps

administrative costs down, and we’re able to

pass the savings on to our members.

Prior Authorization ChangesWe’re changing the way we notify you of pre-authorization approvals. Beginning January 1, 2016, members will no longer get a letter notifying them when a request is approved. Instead, you can check the status of your requests by logging in to your online account at members.bcidaho.com.

You’ll still receive a letter if a request is denied. You can also request a copy of any request approval by contacting the Blue Cross of Idaho Customer Service Department at the number on the back of your member ID card.

W I N T E R 2 01 5 – 2 01 6 5

Free Identity Monitoring for MembersBeginning January 1, 2016, Blue Cross of Idaho will begin offering most members free identity theft monitoring as part of our continuing effort to safeguard your information.

All individual plan members and most group members (check with your group administrator to verify) will be able to sign up for free identity monitory by AllClear ID, one of the industry leaders in identity theft protection.

Details are still being fi nalized, but you can get the latest available information at members.bcidaho.com/identity-protection.page.

New Look OnlineIn the coming months you may notice that our website at bcidaho.com has a new look. We’re fi nalizing a new homepage we hope will offer our members a better and easier online experience.

So watch for our new look, as well as even more ways we’re working to make health insurance even easier in the future.

Retail Store Offers New Approach to Health InsuranceWe’re always looking for new ways to make health insurance both easier and more accessible, and our latest offering comes in the form of our fi rst ever retail store in Twin Falls.

A health insurance retail store may seem like a strange combination, but the idea behind the store is to create a place where the public can easily take care of all their health insurance needs – from shopping to getting questions answered to purchasing a policy. Customers can walk into the new store to speak directly with professionals who can help with all their needs. Additionally, members can get one-on-one personal service.

“We know that health insurance is important. It’s emotional and it’s complicated,” said Dave Jeppesen, senior vice president of Sales and Marketing at Blue Cross of Idaho. “Consumers can walk into the Blue Cross of Idaho store and have their enrollment questions answered in person, by knowledgeable, friendly staff.”

The new store features bright, open space, an enrollment lounge, self-service enrollment kiosks and even a children’s play corner.

The Twin Falls store is just a fi rst step in what we hope will be a new and engaging way to help our members navigate the ever-changing world of health insurance.

WHY GO DIGITAL? Cutting

back on our printing and mailing keeps

administrative costs down, and we’re able to

pass the savings on to our members.

Contact Us

Website: members.bcidaho.comEmail: customerservice@bcidaho.com

Access the information on your mobile phone.

Call our Customer Service line at the numberlisted on the back of your member ID card.

Moved recently? Don’t forget to change your contact information with Blue Cross of Idaho so you can still get important information regarding your health insurance coverage. Simply log in to your account at members.bcidaho.com or call customer service at the number on the back of your member ID card.

Have a Question?

3000 E. Pine Ave.Meridian, ID 83642

Published by Blue Cross of Idaho. © 2015 by Blue Cross of Idaho, an independent licensee of the Blue Cross and Blue Shield Association. All rights reserved. No material may be reproduced in whole or in part from this publication without the express written permission of the

publisher. The information in this publication is intended to complement – not take the place of – the recommendations of your healthcare provider. Consult your physician before making major changes in your lifestyle or healthcare regimen. Blue Cross of Idaho makes no

endorsements or warranties regarding any of the products and services included in this publication or its articles.

Healthy Recipe

Slowcooker Spaghetti Squash and Meatballs

• 1 medium spaghetti squash

• 1 lb. of 85-percent lean Italian chicken sausage

• 1 24-oz. jar of spaghetti sauce

Cut the spaghetti squash in half around the middle and use a spoon to remove the seeds and membrane. Place squash cut-side down in the center of the crockpot and pour spaghetti sauce around the sides. Roll the lean Italian chicken sausage into 8-10 meatballs and place in the sauce around the edges of the squash. Cook on low for 5-6 hours, or on high for 3-4 hours. Use tongs to carefully remove the squash from the crockpot and use a fork to remove the squash fl esh from the shell. Discard the shell. Serve the squash with the meatballs and sauce from the crockpot.