Town of Duxbury Benefit Changes to Active Plans Network Blue NE /Blue Care Elect Preferred 7-1-14 - PowerPoint PPT Presentation

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Town of Duxbury Benefit Changes to Active Plans Network Blue NE /Blue Care Elect Preferred 7-1-14. Agenda. Highlight the changes effective 7-1-14 Network Blue NE and Blue Care Elect – In Network ONLY Discuss deductible scenarios Review hospital tiering RX co-payment change Questions???.

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Town of Duxbury Benefit Changes to Active Plans Network Blue NE /Blue Care Elect Preferred 7-1-14

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Town of duxbury benefit changes to active plans network blue ne blue care elect preferred 7 1 14

Town of Duxbury Benefit Changes to Active Plans

Network Blue NE /Blue Care Elect Preferred

7-1-14


Agenda

Agenda

  • Highlight the changes effective 7-1-14

  • Network Blue NE and Blue Care Elect – In Network ONLY

  • Discuss deductible scenarios

  • Review hospital tiering

  • RX co-payment change

  • Questions???


Deductible 7 1 14

Deductible 7-1-14

$250 Individual/$500 Two Party and $750 Family deductible

Impacts services on or after 7-1-14. Deductible is plan year

You do not pay deductible up front. Each claim that has a deductible applied will process by BCBSMA and you and provider will get notice

Claims Summary – retain as all information regarding deductible and Out of Pocket expenses


More on deductible

More on Deductible…

  • Deductible does NOT apply to Office Visits or Prescription Drugs

  • Deductible does apply to :

    • Emergency Room Services

    • High Tech Radiology Services

    • Inpatient Admissions

    • Surgical Day admissions

    • X –Rays and Labs


Deductible and co payments

Deductible and Co-payments

  • These are your costs after deductible :

    Emergency Room$100

    Inpatient Admission$300 or $700

    Surgical Day$150

    High Tech Radiology$100


Hospital co payments are structured by cost quality

Hospital Co-payments are structured by Cost/Quality

  • High cost/high quality hospitals $700 co-payment

    • South Shore, MA General, Brigham and Women’s, Children’s

      Lower cost/high quality $300 co-payment

    • Jordan, Beth Israel, Tufts New England Medical Center


Co payment only

Co-payment only

:

  • All office visits except Preventive

    • $20 for PCP /PCP Type $35 for Specialists

  • All prescription drugs-except generic birth control.

    • $10/25/50 for 30 days retail and $20/50/110 for 90 days mail ( no deductible) List of $9 RX for 90 days generic


Added protection

Added protection

  • Maximum Out of Pocket ( MOOP) Plan Year

  • Network Blue NE and Blue Care Elect ( in network)

  • $5000 Individual/$10000 Fam. All member cost share EXCEPT RX counts toward MOOP.

  • 7-1-15 the RX co-payments will be included


Extra s

Extra’s

  • $300 Fitness Benefit

  • $150 Weight Loss Reimbursement

  • $90/45 Child Education Classes

  • $9 Generic Mail Order List

  • Discounts on eye glasses, alternative therapies :massage, acupuncture etc


Questions

Questions?


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