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Published byColin Lane Modified over 7 years ago
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
How to Find a PPO Provider 2 Call Customer Service on the back of your ID card 866-295-1212 From your computer OR mobile phone, log on to bcbstx.com and click on “Doctors and Hospitals” For Worldwide Assistance, call 1-800-810 BLUE ( 2583)
Plan Overview Benefits (In-Network) A&M Care In-Network* You Pay 65+ Plan You Pay Medical Deductible (per plan year) $700 person $2,100 family $500 person – Out-of-Pocket Maximum (per plan year) $5,000 person + $700 deductible $10,000 family + $2,100 deductible $1,400 person + $500 deductible – Office Visit (per visit) Primary Care and Mental Health Providers Specialists $30 copay** $45 copay** 20% coinsurance after deductible Preventive Services (covered at 100%) 0% 3 *Out-of-network benefits are also available. When using out-of-network providers, you pay 50 percent after the out-of-network deductible. **Retirees age 65 and older enrolled in the 65+ Plan are not eligible for copays. Your 65+ Plan benefits are secondary to Medicare. Please refer to your Benefits Booklet for more detailed information. What’s NewBeginning 9/1/2015 Out-of-Pocket Maximum Prescription drug deductible and copays apply to the out-of- pocket maximum along with medical copays and coinsurance
Preventive Coverage What’s covered? Recommended routine gender- and age-specific preventive care, such as annual physical, OB/GYN exams, mammograms and other cancer screenings, well-child care and immunizations – both facility and professional services Preventive coverage provided in-network at 100% with no copay, no deductible Get an annual physical to be sure you get the lowest premium! Remember: Lab tests related to an illness or condition are not considered preventive and may pay differently 4 Inform your doctor’s office that you are scheduling your “annual wellness checkup”
Retiree Information 5 Retirees under age 65 Are considered Network and can use the Network providers Remember: Enroll in BOTH Medicare parts A & B. When you receive your Medicare Card, notify BCBSTX and your Human Resource Office of your Medicare number which includes an alpha character. If you use a Provider that accepts Medicare or is a BCBSTX provider, you cannot be balance billed. Retirees age 65 and older Choose from: A&M Care Plan 65 Plus – you must be: –Age 65 and enrolled in Medicare Parts A&B or disabled under 65 and enrolled in Medicare Parts A&B –Working for the A&M System, if at all, less than 50% time or for less than 4.5 months during the plan year –If covering dependents, spouse must be age 65 or older (or disabled) and enrolled in Medicare Parts A&B
Retiree Coordination of Benefits Example A&M CARE PLAN (deductible not met) A&M CARE PLAN (deductible is met) Charge $500 Medicare Paid 80% $400 Patient Share 20% $100 A&M Care Plan Deductible $700MET Applied to Deductible $500Zero BCBSTX Would Have Paid Zero$400 A&M Care Plan Payment Zero$100 Patient’s Responsibility $100Zero Plans calculate the normal plan benefits, then pay that amount, or the difference after Medicare has paid, whichever is less. Your coinsurance will continue until you meet the out-of-pocket maximum, then plan pays at 100%. A&M Care 65 Plus = $1,400 + $500 Individual A&M Care Plan = $5,000 + $700 Per Person / $10,000 + $2,100 Family 6
Preventive Care Immunizations — Covered at 100% Option 1: Go To Personal PhysicianOption 2: Go to Walgreens or HEB Present your ID cardPay the full cost File the claim with Medicare File claim along with the Medicare explanation of benefits with BCBSTX 7 Option 1: Go To Personal PhysicianOption 2: Go to Walgreens or HEB Present your ID card Present your ID card (Pharmacy files claim under BCBSTX Medical Provider Number) If you are an active employee and you want to get a shingles vaccine: If you are 65 or older, or Medicare-eligible and you want to get a shingles vaccine:
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Other Programs & Services
The BVA Benefits Value Advisor EDUCATION GUIDANCE SUPPORT 9 ONE CALL SOLUTION Help you understand your benefits Cost comparison on X-rays, MRIs, CT Scans, maternity services, surgeries Appointment scheduling Find in-network providers Help you access online educational tools
Well onTarget ® Health Assessment Biometrics Preventive care Member Portal and online tools 24/7 Nurseline Behavioral Health Lifestyle management Utilization management Special Beginnings ®’ maternity program Care Coordination and Early Intervention Blue Care Advisors nurse coaching Condition management Case management - complex and catastrophic HEALTHY AT-RISK CHRONIC CONDITION COMPLEX CONDITION BLUE CARE CONNECTION ® An active approach to integrated health management. 866-412-8795 10
Save time with self-service support tools and health and wellness resources on a convenient and secure online site. 11 BLUE ACCESS FOR MEMBERS SM
A FULL SUITE OF SELF-DIRECTED AND INTERACTIVE WELLNESS TOOLS Health Assessment Self-paced courses Food and exercise diary Life Points Health and wellness content Fitness Program Complementary and alternative medicine MEMBER PORTAL 12
14 BCBSTX App Mobile App Overview Centered Healthy Family 5 AlwaysOn Well onTarget® 14 BCBSTX APP Text BCBSTXAPP to 33633 Centered Text CENTERED to 33633 Healthy Family Text FAMILY to 33633 Well onTarget (AlwaysOn) --Download from App Store
Medical benefit coverage questions Help with finding network providers Help from a Benefits Value Advisor ID card requests Help with navigating online tools Health education and transfer to other health programs Claim questions or status Call your BCBSTX customer service team 866-295-1212 8 am to 8 pm / CST Monday -Friday Service that Takes You Out of the Middle 15
ID Cards Will Not Be Reissued for 9/1/15 16 Need Assistance? See the back of your ID card for important phone numbers
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Questions?
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