2014 benefit changes bluecross and blueshield service benefit plan
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2014 Benefit Changes BlueCross and BlueShield Service Benefit Plan. Plan Overview Preventive Care Health Club Membership Special Features 2014 Benefits Changes 2014 Rates. Agenda. Service Benefit Plan Options. The Service Benefit Plan is a fee-for-service (FFS) plan

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2014 Benefit Changes BlueCross and BlueShield Service Benefit Plan

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2014 benefit changes bluecross and blueshield service benefit plan

2014 Benefit ChangesBlueCross and BlueShield Service Benefit Plan


Agenda

Plan Overview

  • Preventive Care

  • Health Club Membership

  • Special Features

    2014 Benefits Changes

    2014 Rates

Agenda


Service benefit plan options

Service Benefit Plan Options

  • The Service Benefit Plan is a fee-for-service (FFS) plan

  • We have a Preferred Provider Organization (PPO)

StandardOption

Standard Option & Basic Option

BasicOption

  • No deductibles

  • Copayment based

  • Preferred Providers only

  • Retail Rx

  • Deductible

  • Copayments and Coinsurance

  • Ability to Choose Provider (Preferred and Non-preferred)

  • Retail and Mail Rx

  • No Pre-Existing Conditions

  • No Referrals Required

  • No Lifetime Maximums

  • Unlimited I/P Hospital Days


Preventive care

Preventive Care

  • Free Preventive Care (Preferred Providers)

  • Free annual physicals for adults

  • Free well child care from birth up to the age of 22

  • Free cancer screenings

  • Free immunizations


Health club membership

Health Club Membership

Healthways Fitness Your Way

  • Online enrollment payment

  • $25 one time initiation fee

  • $25/month (3 monthsminimum)

  • Unlimited access to >8000 fitness centers

  • Web tools, trackers and online health tracking

  • Ongoing engagement through social networking and gaming


2014 benefits changes

2014 Benefits Changes


2014 benefit changes

2014 Benefit Changes

  • BRCA Testing

  • Vitamin D Supplements

  • Catastrophic Maximums

  • Prescription Drugs

  • Basic Option Copayments

  • Wellness Incentives

  • Other Changes


Preventive brca testing

Preventive BRCA Testing

  • Current Benefit:

    • Benefits are not available for BRCA testing when no condition is present

  • 2014 Benefit:

    • Benefits are available for BRCA testing, limited to one per lifetime, for:

      • Female members without personal diagnosis of breast or ovarian cancer who meet specific family history criteria; no member-cost share when provider is Preferred

      • Male or Female members with a cancer diagnosis when test is medically necessary to manage treatment of cancer; regular medical benefits apply

Standard Option and Basic Option


Vitamin d supplements

Vitamin D Supplements

  • Current Benefit:

    • Benefits are not available for Vitamin D supplements

  • 2014 Benefit:

    • Benefits are available with no member cost-share for Vitamin D supplements for adults, age 65 and over:

      • When prescribed by a physician;

      • When obtained from a Preferred retail pharmacy; and

      • Limited to 600-800 international units (I.U.s) daily

Standard Option and Basic Option


Catastrophic out of pocket maximums

Catastrophic Out-of-Pocket Maximums


Catastrophic maximum standard option

Catastrophic Maximum – Standard Option

  • Current Benefit:

    • The calendar year deductible does not count toward the catastrophic protection out-of-pocket maximum

  • 2014 Benefit:

    • Include the calendar year deductible in calculation of the catastrophic maximum


Standard option catastrophic out of pocket maximums

Standard Option: CatastrophicOut-of-Pocket Maximums

*Basic Option limited to Preferred providers


Catastrophic maximum basic option

Catastrophic Maximum – Basic Option

  • Current Benefit:

    • The member cost-share for Tier 3 (non-preferred brand-name) drugs does not apply toward the catastrophic maximum

  • 2014 Benefit:

    • Apply the member cost-share for Tier 3 (non-preferred brand-name) drugs toward the catastrophic maximum


Basic option catastrophic out of pocket maximums

Basic Option: CatastrophicOut-of-Pocket Maximums

*Basic Option limited to Preferred providers


Basic option surgical copayment

Basic Option Surgical Copayment

  • Current Benefit:

    • Member copayment = $150 per surgeon, regardless of place of service (Special exceptions exist for some minor procedures to be treated as office visit with copayment).

  • 2014 Benefit:

    • Member copayment = $150 per surgeon for surgical procedures performed in an office setting

    • All other settings, a $200 copayment per surgeon will apply


Basic option inpatient admission copayment

Basic Option Inpatient Admission Copayment

  • Current Benefit:

    • Member copayment = $150 per day for inpatient admission (maximum of $750 per admission)

  • 2014 Benefit:

    • Member copayment = $175 per day for inpatient admission (maximum of $875 per admission)


Basic option diagnostic test copayments

Basic Option Diagnostic Test Copayments

  • Current Benefit:

    • No cost-share for neurological testing

    • $25 copayment for low-cost diagnostic tests

    • $75 copayment for professionally-billed high-cost diagnostic tests

    • $100 copayment for facility-billed high-cost diagnostic tests

  • 2014 Benefit:

    • $40 copayment for neurological tests and other low-cost diagnostic tests

    • $100 copayment for professionally-billed high-cost diagnostic tests

    • $150 copayment for facility-billed high-cost diagnostic tests


Wellness incentives

Wellness Incentives


Health assessment incentive

Health Assessment Incentive

  • Current Benefit:

    • Members receive up to $50 on a wellness incentive card for completing the Blue Health Assessment ($35) and up to 3 online coaching modules ($5 each) during the calendar year

  • 2014 Benefit:

    • Members receive up to $75 on a wellness incentive card for completing the Health Assessment ($40) and achieving up to 3 of 5 lifestyle goals ($15 for first goal; $10 each for two additional goals) during the calendar year. Lifestyle goals include exercise, nutrition, stress, weight management, and emotional health


Other changes

Other Changes


Insulin and diabetic supplies

Insulin and Diabetic Supplies

  • Current Benefit:

    • Members can obtain insulin and diabetic supplies from professional providers or through the pharmacy program(s)

  • 2014 Benefit:

    • Limit benefits for insulin and diabetic supplies to be dispensed exclusively through the pharmacy program(s)

    • Except for members with primary coverage under Medicare Part B, exclude coverage for insulin and diabetic supplies dispensed by professional providers


2014 benefit changes bluecross and blueshield service benefit plan

Wigs

  • Current Benefit:

    • Benefits are available for one wig per lifetime, up to a $350 maximum, for hair loss due to chemotherapy for the treatment of cancer

  • 2014 Benefit:

    • Benefits are available for one wig per lifetime, up to a $350 maximum, for hair loss due to the treatment of cancer


Home nursing care visits standard option only

Home Nursing Care Visits (Standard Option only)

  • Current Benefit:

    • 25 home nursing care visits, limited to 2 hours per visit, per calendar year

  • 2014 Benefit:

    • 50 home nursing care visits, limited to 2 hours per visit, per calendar year


Acupuncture limitations basic option only

Acupuncture Limitations (Basic Option only)

  • Current Benefit:

    • For Basic Option, current acupuncture benefit includes an unlimited number of visits, but limited to physicians only

  • 2014 Benefit:

    • Limits Basic Option acupuncture visits to 10 per calendar year (with all licensed providers now allowed to bill)


2014 rates standard option basic option

2014 RatesStandard OptionBasic Option


Enrollment codes

Enrollment Codes

Standard Option

  • 104 Self Only

  • 105 Self and Family

    Basic Option

  • 111 Self Only

  • 112 Self and Family


2014 rates standard option non postal rates

2014 Rates – Standard Option (Non-Postal Rates)

Bi WeeklyMonthly

  • Self 104 87.82 (+1.91)190.28(+4.14)

  • Family 105204.98 (+4.84)444.12(+10.49)

Source


2014 rates basic option non postal rates

2014 Rates – Basic Option (Non-Postal Rates)

  • Bi WeeklyMonthly

  • Self 11160.96 (+1.89)132.08(+4.10)

  • Family 112142.75 (+4.43)309.29(+9.60)


  • Pharmacy programs

    Pharmacy Programs

    Blue Cross and Blue Shield Service Benefit Plan

    2013 HBO Open Season Seminar


    Agenda1

    • Pharmacy Programs Overview

    • 2014 Tier Structure

    • 2014 Benefits

    • Member Resources

    Agenda


    Pharmacy program overview for 2014

    Pharmacy Program Overview for 2014

    • Continuation of…

      • CVS/Caremark Administration

      • Generic Incentive Program

      • Medicare Part B member savings

    • Added Tier 5 in Specialty Program

    • Enhanced Diabetic Benefit

    • Affordable Care Act Impact

      • Basic Option non-Preferred Brand cost share now applies to Catastrophic Benefit

      • Vitamin D supplements with a prescription for members over 65


    2014 tier structure

    2014 Tier Structure

    • Tier 1 – Generics (least out-of-pocket)

    • Tier 2 – Preferred Brands (moderate out-of-pocket)

    • Tier 3 – non-Preferred Brands (most out-of-pocket)

    • Tier 4 – Specialty Preferred

    • *Tier 5 – Specialty non-Preferred

      • *New for 2014

      • Letter mailing to impacted members


    2014 standard option benefits

    2014 Standard Option Benefits


    2014 basic option benefits

    2014 Basic Option Benefits


    Enhanced diabetic benefit

    Enhanced Diabetic Benefit

    • Insulin and supplies available through pharmacy benefit

      • Medical Benefit available to Medicare Part B members

      • Free Diabetic Meter Program 

      • $0 cost share for selected meters ACCU-CHEK or OneTouch

        • Preferred strips – Tier 2

      • Alcohol Swabs covered with a prescription

      • Toll free number 855.582.2024

        • Delivered 7-10 business days after the request  

      • Letters will be sent to diabetic members


    Generic incentive program

    Generic Incentive Program

    • Program will continue in 2014

      • Started in 2010

      • Increase generic alternative awareness

      • Generics contain same active ingredient as brands

      • Save member out-of-pocket costs

      • Change from brand to generic in specific categories

      • Copay and Coinsurance waiver

      • List of drugs on brochure page _ _ _


    Member resources

    Member Resources

    • Retail Pharmacy Program

      • (800) 624-5060

      • Available 24/7

    • Mail Pharmacy Program

      • (800) 262-7890

      • Available 24/7

    • Specialty Pharmacy Program

      • (888) 346-3731

      • M-F 7am- 9pm

      • S/S 8am-6:30pm


    Questions

    Questions

    Contact Information


    Fep blue dental e asy to do business with

    FEP BlueDentalEasy to do Business With!

    HBO Seminar -- 2013


    Agenda2

    Agenda


    2014 benefit changes bluecross and blueshield service benefit plan

    • 2014 Premiums (monthly rate)


    It s more than you expect

    It’s More Than You Expect

    • All FEP BlueDental members receive 2 paid-in-fullexams and cleanings when they see an in-network provider

    • With FEP BlueDental, members have in-network preventive and diagnostic treatments available at no cost

    • There are no calendar year deductibles applied to services performed by an in-network provider

    • Orthodontic benefits available (covering 50% of allowed amount) for both children and adults following a 12 month waiting period


    2014 benefit changes bluecross and blueshield service benefit plan

    A Benefit for All Your Dental Needs

    • FEP BlueDental has four types of covered services:

      • Class A (Basic) – Preventive and Diagnostic

      • Class B (Intermediate) – Fillings, minor endodontic, minor periodontal


    2014 benefit changes bluecross and blueshield service benefit plan

    A Benefit for All Your Dental Needs

    • FEP BlueDental has four types of covered services:

      • Class C (Major) – major restorative, endodontic, periodontal and prosthodontic services

      • Class D -- Orthodontic Services - 50% for High & Standard for both in and out of the network

    44


    2014 benefit changes bluecross and blueshield service benefit plan

    A Benefit for All Your Dental Needs

    • High Option annual benefit maximum for non-orthodontic services is $10,000 for in-network services and $3,000 for out-of-network services

    • Standard Option annual benefit maximum for non-orthodontic services is $1,500 for in-network services and $750 for out-of-network services

    • Lifetime maximum for High Option orthodontic services is $3,500 for both in-network and out-of-network services

    • Lifetime maximum for Standard Option orthodontic services rendered by an in-network provider is $2,000 and services rendered by an out-of-network provider are subject to a $1,000 limitation.


    Provider network

    Provider Network

    • Providers in all 50 states and includes more than 85,000 unique dentists and 199,000 access points

    • If you have Service Benefit Plan (SBP) your in-network provider will file directly with the local BCBS Plan for primary coverage and then the claim will be sent to FEP BlueDental

    • Dental network may be different from medical network

    • Specialties included in the network are: Endodontics, General Dentistry, Oral Maxilofacial Surgery, Orthodontics, Pediatric Dentistry, and Periodontics

    • Provider nominations are welcome

    • To find a provider visit our web site (www.fepblue.org) or call us at 855.504.BLUE (2583)


    International benefits

    International Benefits

    • The International Dental Program includes English-speaking dentists in approximately 100 countries worldwide

    • You will only receive in-network benefits levels if you use a dentist in our International Dental Program

    • You are responsible for paying the dentist (we will reimburse you in US $’s) and for submitting claims to the following address:

    FEP BlueDental Claims

    PO Box 75

    Minneapolis, MN 55440-0075

    • Claims are available on our website at www.fepblue.org. You may use this website to get other benefit related information or call us at: 855-504-BLUE(2583), TTY number 1-888-853-7570


    Contact us today to get the fep blue dental coverage you deserve

    Contact us today to get the FEP BlueDental coverage you deserve

    1.855.504.BLUE (2583)

    TTY 1-888-853-7570

    Call Center Hours (EST):

    • Monday through Friday: 8:00 a.m. – 8:00 p.m.

      Or visit www.fepblue.organy time!

      To enroll: Visit www.benefeds.com or call 1.877.888.FEDS


    Fep blue vision take a new look at eyecare

    FEP BlueVision:Take a new look at eyecare

    Health Benefits Officer Seminar

    Fall 2013


    Fep bluevision it s more t han y ou expect

    FEP BlueVision - It’s More Than You Expect

    • You receive an annual eye exam with no copay when you see a participating provider

    • Eyeglass wearers have many lens options available at no cost or at discounted copays

    • You can receive a generous frame allowance toward ANY frame you choose or you may select a frame from our Exclusive Collection that is covered-in-full with no copay


    2014 premiums

    2014 Premiums

    We continue to enhance benefits making it affordable to care for your vision. Without increasing premiums!


    A benefit for your vision

    A Benefit For Your Vision

    Allowance

    OR

    FEP BlueVision Exclusive Collection

    $150 allowance plus 15% off overageAnnually

    $130 allowance plus 15% off overageAnnually

    Evaluation, fitting and follow-up fees fully covered for non-specialty lenses and covered up to $60 for specialty contact lenses.

    1/ Additional discounts not applicable at Costco, Sam’s Club or Walmart locations

    * For a complete description, please refer to your benefit brochure.


    More benefits

    More Benefits!


    We provide a convenient network for you

    We provide a convenient network for you

    The FEP BlueVision network is specific to routine vision care and is different from the member’s medical plan network.

    • More than 41,000points of access

    • Includes: ophthalmologists, optometrists, and manytop national retail providers

      • 12% ophthalmologists

      • 88% optometrists

      • 74% independents

      • 26% retail

    • Costco, with 439 locations nationwide, joining network in 2014

    • Exceeds OPM’s accessstandards

    • Provider nominationsare welcome

    • Visit our Web site (www.fepblue.org) or call us at 888-550-2583


    Contact us today to get the fep bluevision coverage you deserve

    Contact us today to get the FEP Bluevision coverage you deserve

    1.888.550.BLUE (2583)

    TTY 1.800.523.2847

    Call Center Hours (EST):

    • Monday through Friday: 8:00 a.m. – 11:00 p.m.

    • Saturday: 9:00 a.m. – 4:00 p.m.

    • Sunday: 12:00 p.m. – 4:00 p.m.

      Or visitwww.fepblue.organy time!

      To enroll: Visitwww.benefeds.comor call 1.877.888.FEDS


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