Blue Cross Plus 101 Tips for Employees. Brought to you by the UCSF Health Care Facilitator Program HR Benefits/Financial Planning 2007. Topics. Plan structure/design In-Network Benefits Out-of-Network Benefits Specific Coverage Issues Prescription Drug Benefits Behavioral Health Benefits
Brought to you by the UCSF Health Care Facilitator Program
HR Benefits/Financial Planning
*Subscriber must live in the California service area to be eligible for this plan.
*Select In-Network level - Open Panel HMO
All care is coordinated through a Primary Care Provider (PCP)
Exceptions - Direct Access Programs, OB/GYN
You pay a $20 co-pay for most services, $250 for hospital in-patient and $75 ER co-pay
No claim forms, no deductibles
*Based on benefits, 2007
*Select Out-of-Network level -
Self-refer for care
After a $500 individual deductible, $1500 family (3 or more) the plan pays 70% of Usual Customary and Reasonable (UCR) charges for most services or 70% of the contracted rate if there is one
Self-referral to PPO providers means no balance billing
World Wide CoverageHow does the plan work?You Choose to........
Blue Cross, Preferred Provider Organization (PPO)
and Non-PPO Providers
*Assumes you’ve met the annual deductible
You should always verify in the EOC or with Blue Cross customer service if you have any questions, or to confirm your benefits.
Brown & Toland
John Muir/Mt. Diablo
Santa Clara IPA
This information subject to change, contact your medical group to determine participation in Direct Access.
Sonoma County IPABay Area Medical Groups’ participation in Blue Cross Plus Direct Access Program:
“Emergency is a sudden, serious, and unexpected acute illness, injury, or condition (including without limitation sudden and unexpected severe pain) which the member reasonable perceives, could permanently endanger health if medical treatment is not received immediately. Final determination as to whether services were rendered in connection with an emergency will rest solely with us or your medical group.”
– Call UBH directly, (888) 440-8225. UBH will either refer you to a provider or you can designate an in-network provider
– www.liveandworkwell.com enter access code 11280
– You pay $0 co-pay for first 5 visits, then $10 for 6+ visits
– No claim forms, no deductibles
– $500 annual out-of-pocket maximum
– No co-pay
– Notify UBH within 48 hours for emergency admissions
*One to three sessions
Tips for Blue Cross Plus Members
Members must select a PCP that is within 30 miles of the home or work address
For License/Certification information
California Health Care Quality Ratings
Office of the Patient Advocate
Annual Quality of Care Report Card
The End Service?Please complete your evaluation form. Your feedback will help us improve our program.Please make sure you signed in on the sign-in sheet.
Thank You for Participating