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2014 BCBS Insurance Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent.

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Presentation on theme: "2014 BCBS Insurance Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent."— Presentation transcript:

1 2014 BCBS Insurance Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Copyright © All rights reserved. 1

2 Affordable Care Act – Benefit Changes January Out of Pocket Limits for Essential Health Care Benefits –Out of Pocket must include Deductible, Office Visit Copayments, Emergency Room Copayments for In Network services. –Out of Pocket Limits cannot exceed $6,350 Individual or $12,700 Family coverage Coverage for Clinical Trials –Requires a if a “qualified individual” is in an “approved clinical trial” then the plan may not: Deny the individual participation in the clinical trial Deny the coverage of routine patient costs for items and services furnished in connection with the trial Discriminate against the individual on the basis of the individual’s participation in such trial Preexisting Conditions Removed

3 Preventative Women’s Services No patient cost share for in-network services for the below services: –Well-woman visits –Screening for gestational diabetes –Testing for HPV in women at least 30 years old –Counseling for sexually transmitted infections –Screening and counseling for HIV –FDA-approved contraception methods and counseling (refer to specific covered list) –Breastfeeding support, supplies and counseling –Interpersonal and domestic violence screening and counseling 3

4 Contraceptives Depending on the particular plan, coverage without cost-sharing may expand to include contraceptive services when using an in network provider: –Prescription Drugs – One or more products within the categories approved by the FDA –Over-the-counter – Contraceptives available over-the-counter approved by the FDA for women (foam, sponge, female condoms) when prescribed by a physician –The morning after pill –Designated medical devices such as a IUD, diaphragm, cervical cap, contraceptive implants –Female sterilization including tubal ligation 4

5 Ambulance Services BlueOptions Coverage –Covered at 100% of allowable charge –Preferred Providers are EagleMed/Apollo Ground Ambulance (Cities that have special arrangements i.e. LifeNet Consequences of using an out of network provider 5

6 BlueOptions 6 BenefitsBluePreferred Network BlueChoice Network Out of Network CopaymentsPrimary Care Physician $30.00 Specialist $50.00 DeductibleIndividual $ Family $2, *If there is a family of three or more and the combined deductible (with no one member's deductible being more than $750.00) reaches $2, then the family deductible is met. Deductible credit of $ for Employee and Spouse when the online Health Assessment is completed between July 2013-December Coinsurance80% of allowable charges after deductible is met 70% of allowable charges after deductible is met 50% % of allowable charges after deductible is met Out of Pocket Individual - $4,250 *Family $12,700 *If there is a family of three or more and the combined out of pocket (with no one member's out of pocket being more than $4,250) reaches $12,700 then the family out of pocket is met.

7 BlueOptions Deductible Example Calendar year deductible Individual - $4,250 Family - $12,700 Example: Carol covers her spouse and three dependents. Chip will not have to meet his deductible for the calendar year because the family deductible was satisfied in the below example. Covered Family MemberAmount satisfied towards family deductible Carol$ Dave$ Cindy$ Dustin$ Chip$0

8 BlueOptions Out of Pocket Example Calendar year deductible Individual - $750 Family - $2,250 Example: Carol covers her spouse and three dependents. Chip will not have to meet his deductible for the calendar year because the family out of pocket was satisfied in the below example. Covered Family MemberAmount satisfied towards family deductible Carol$ Dave$ Cindy$ Dustin$ Chip$0

9 Health Assessment Deductible Credit $250 Deductible Credit for Employee and/or Spouse for Completion of Health Assessment. Applies to BlueOptions Activity Dates – July-December 2014 –Important reminder for Incentives when completed July-December Display will not be updated until January 2014 Activity date will reflect January 2014 Must be completed prior to expenses that apply to the deductible. There will be no retro adjudication of claims allowed. Must be completed before a claim is processed in Who to contact to determine appropriate credit applied? 9

10 Special Beginnings Deductible Credit 10 $ Deductible Credit under the BlueOptions plan. Must be enrolled by the 1 st Trimester to qualify. Recommend enrollment if after the 1 st trimester for educational opportunities

11 BlueOptions Prescription Drug Plan Monthly supply limit –200 units for a one month supply, except Diabetic test strips which are 300 units for a one month supply –All generics are $4.00 for a one month supply or $10.00 for a three month supply Value Based Benefit Design –Coronary Artery Disease Program Reduction on Hypertension and Hyperlipidemia Drugs copayments –Diabetes Management Program Reduction applies to prescription drugs, glucose testing strips, lancets and syringes 11

12 How to Find a Provider OR Contact your physicians and ask 12

13 Benefits and ClaimsMember Care Profile Integrated Provider Finder and Member Liability Estimator Provider Finder ® Be Smart. Be Well. ® eCards for Health SM Health Care School Blue Access for Members SM ID Card Management Blue365 ® Discount Program Blue Access for MEMBERS SM Join us on Facebook Follow us on Twitter Mobile Preferences Claim History and Health Snapshot Well onTarget SM Wellness Portal Life Points Special Beginnings®´Health Assessment 13

14 Blue Access Mobile SM Blue Access for Members SM Public Site Find a Doctor / Hospital Health Care 101 Shop for Insurance Log in or register for Blue Access for Members Contact Us Text Messaging Static – One-Way Alerts Rx Reminders, Diabetes, CAD, Diet Tips, Claim Status, Exercise & Fitness Tips Dynamic – Two-Way ID Card Management, Coverage Management Digital ID Card Benefits / eligibility Claims Status User Profile Health and Wellness Articles – Diabetes, Maternity Care, Nutrition, Blue365 ®, Obesity, Fitness, My Care Profile, Metabolic Syndrome 14 4,300 mobile page views per day More than AND FOUR text messages every minute

15 Enables new moms to stay healthy with a suite of educational resources tailored to each week of pregnancy. A calendar of what to expect during each week of pregnancy Articles to help moms stay healthy and informed throughout their pregnancy Information on vaccines and tests during pregnancy Educational videos from a cross-disciplinary panel of experts on pregnancy Special Beginnings ® Web Don’t miss the Duty Calls and Tot Tracker Mobile apps. 15

16 Check out the MY HEALTH tab for access to hundreds of articles, health information links to videos and more helpful resources Find out more about the 24/7 Nurseline, and our Lifestyle Management program, Blue365 ® member discount programs or to review your Care Profile The MY HEALTH Tab 16

17 New Member Wellness Portal | o Health Assessment o Member dashboard o Self-directed courses o Trackers and tools o Health & wellness content o Food and exercise diary o Social networking o Text messaging o Member rewards program o Fitness program o Life Points via Corporate Facility Fitness Center Portal Highlights 17

18 Exclusive health and wellness deals from national and local retailers Save money on gym memberships, vision exams and services, hearing aids and diet-related services Share deals with friends and family and receive cash rewards on future offers Blue365 ® Member Discount Program Member discounts simply for being a BCBS member Log on to Blue Access for Members SM for updates and to register for weekly s Under the My Coverage tab 18


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