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

  2. 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???

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. Questions?