«Member_Name» «Member_Address_Line_1» «Member_Address_Line_2» «Member_City», «Member_State» «Member_Zip»

Transcription

1 *** October 2018 «Member_Name» «Member_Address_Line_1» «Member_Address_Line_2» «Member_City», «Member_State» «Member_Zip» Dear «Member_First», Subscriber ID#: «Subscriber_ID» Good News! We will automatically renew your coverage for 2019! We understand that when it comes to health insurance you have a choice and thank you for being part of the Blue Cross of Idaho family. We believe a health plan shouldn't get in your way. Nothing should get between you and what matters most. That means we leave health decisions to you and your doctor, so you can leave the rest to us. When health gets complicated, we re here to help. And that includes not leaving you. The better you understand your health plan, the better you know what to expect from it. We think that s just the way healthcare should work. Did you know that you can visit our member website at members.bcidaho.com to find out more about what you get with your Blue Cross insurance plan? In this packet, you ll find important information, including: Your new monthly premium for 2019 Changes to your plan that are effective on January 1 What you should do to ensure any financial assistance continues next year Please read this information carefully. You can also see information about these changes by logging into your account at members.bcidaho.com. YOUR NEW PREMIUM DEPENDS ON YOUR ELIGIBILITY FOR FINANCIAL ASSISTANCE For 2019, your monthly premium is «M_2019_Total_Premium». Your financial assistance amount may be different for 2019, depending on changes to your household income and family size. In 2018, you enrolled through Your Health Idaho with a total monthly premium of «M_2018_Total_Premium» and financial assistance of «M_2018_APTC». The amount you paid each month was «M_2018_BALANCE». If you are

2 eligible for an APTC in 2019, you will receive information from the Idaho Department of Health and Welfare. If you do not receive this information by November 1 or if what you receive is incorrect, please contact them directly at You must call the Idaho Department of Health and Welfare to provide updated income and household size information so that the assistance you receive is correct. Once you receive your tax credit eligibility letter from the Department of Health and Welfare, you should preview the plan that you will be automatically re-enrolled in for any changes. You can do this by accessing your account on Your Health Idaho at yourhealthidaho.org on or after November 1, YOU HAVE A CHOICE You can choose a new health insurance plan for 2019 during the Open Enrollment period from November 1, 2018 until December 15, If you do not select a different plan by December 15, you will be automatically re-enrolled in your current plan. Your Health Idaho Enrollment Enroll in a new health plan through Your Health Idaho and continue to receive help paying for your health insurance costs if you qualify. o If you qualify for help paying out-of-pocket costs like deductibles or copays, you must choose a Silver level plan to get this help. o Your Health Idaho will also check if you or your family members qualify for Medicaid or the Children s Health Insurance Program (CHIP). o You may also enroll in coverage through Your Health Idaho using a certified insurance agent or broker. o Remember that if you receive a tax credit to help pay for your health insurance, you must report changes in your income and household size during the year to Your Health Idaho. If you do not report changes, you could owe money when you file your income tax return because your tax credit was based on outdated information. Enrollment outside Your Health Idaho Enroll in a new health plan directly with an insurance company during open enrollment or get help from a local insurance agent or broker. If you qualify for financial assistance for paying your premiums and out-of-pocket costs, you must enroll through Your Health Idaho to receive those benefits. We know that cost is important to you, and we know that local health care costs and national pharmacy costs continue to rise. We work hard on your behalf to keep them as low as possible for you. If you have questions about your plan, please call Blue Cross of Idaho customer service at , from 7 am to 7 pm Monday through Friday and from 8 am to 12 pm on Saturday.

3 If you need help exploring your plan options for 2019 coverage, «Contact_Variable_1» Sincerely, Blue Cross of Idaho Renewal Team «Agent_Tag» «Broker_Name» «Broker_Address» «Broker_City», «Broker_State» «Broker_Zip» «Broker_Phone» Enclosures Policy Update, with personalized plan comparison

4 CONTRACT UPDATES To Your Blue Cross of Idaho Individual Contract Please Read Carefully Dear Blue Cross of Idaho Enrollee: This Contract Update is a summary of the changes to your Contract, effective on your Contract s renewal date. We encourage you to review this carefully. For reference, the words and terms capitalized in this document are defined in your member contract Plan Name Bronze HSA 6000 Bronze HSA 6000 Network «M_2018_Network» «M_2019_Network» In-Network Out-of-Network In-Network Out-of-Network Annual Annual Out-of- Pocket Maximum Amount $6,000 individual $12,000 family $6,550 individual $13,100 family $50,000 individual $100,000 family $75,000 individual $150,000 family $6,000 individual $12,000 family $6,550 individual $13,100 family $50,000 individual $100,000 family $75,000 individual $150,000 family Coinsurance 20% 80% 20% 80% Doctor Office Visits 20% Coinsurance after 80% Coinsurance after 20% Coinsurance after 80% Coinsurance after Inpatient Hospital Stays 20% Coinsurance after 80% Coinsurance after 20% Coinsurance after 80% Coinsurance after Tier 1 Preferred Generic No charge after In- Tier 1 Preferred Generic - No charge after In- Network Individual/Family is met Network Individual/Family is met Prescription Drugs Tier 2 Non-Preferred Generic - $10 Copay after In-Network Individual/Family is met Tier 3 Preferred Brand Name - $30 Copay after In-Network Individual/Family is met Tier 4 Non-Preferred - $50 Copay after In- Network Individual/Family is met Tier 5 Preferred Specialty - 30% Coinsurance after In-Network Individual/Family is met Tier 6 Non-Preferred Specialty- 50% Coinsurance after In-Network Individual/Family is met Tier 7 Preventive No charge Tier 2 Non-Preferred Generic - $10 Copay after In-Network Individual/Family is met Tier 3 Preferred Brand Name - $30 Copay after In-Network Individual/Family is met Tier 4 Non-Preferred - $50 Copay after In- Network Individual/Family is met Tier 5 Preferred Specialty and Generic Specialty - 30% Coinsurance after In-Network Individual/Family is met Tier 6 Non-Preferred Specialty- 50% Coinsurance after In-Network Individual/Family is met ACA Preventive No charge HSA Preventive No charge Outline of Coverage If you receive this document and/or any other notices electronically, you have the right to receive paper copies of the electronic documents upon request at no additional charge.

5 You can review our online directory located on the BCI Web site, under Find a Doctor, for names and locations of PCP s. Diabetes Prevention Program (DPP) A new program for Diabetes Prevention has been added to your Contract. This program is available at no cost to Members who qualify. Find out if you qualify by taking a one (1) minute survey at Solera4me.com/bcidahoindividual or call the BCI Diabetes Prevention Program hotline at Major Medical Benefits Added a benefit for Outpatient Applied Behavioral Analysis (ABA) as part of an approved treatment plan. Removed all visit limits for Autism Spectrum Disorder services identified as part of the approved treatment plan. Clarified the Outline of Coverage is attached to the Contract and contains general payment information and a descriptive list of Covered Services. Updated the Transplant Language to include hematopoietic, CAR T-Cell, and other autotransplants as Medically Necessary. Eligibility Section Updated the Eligible Dependent language to state the child of a Surrogate Mother is not considered an Eligible Dependent under the Contract. Prescription Drug Updated the prior authorization response timeline for prescription drugs to two (2) business days following receipt of the medical information necessary to make the determination. Clarified the Fifth Tier, Covered Preferred Specialty Drugs, includes Covered Generic Specialty Drugs. Definitions Section Added definitions for Applied Behavioral Analysis (ABA), Autism Spectrum Disorder, and Treatments for Autism Spectrum Disorder. Updated the definition of Home Health Skilled Nursing Care Services, and removed the definition of Home Health Nursing. Updated the term Technology Evaluation Center (TEC) to Center for Clinical Effectiveness (CCE). Updated the Service Area definition to include the location of the Provider Directory on BCI s Web site, under Find a Doctor, to locate Contracting Providers in the Members geographical area. Added a definition for Surrogate Mother. Exclusions and Limitations Moved the exclusions and limitations listed separately throughout the Contract to the Exclusions and Limitations Section, to keep all exclusions listed in one location. General Provisions Section Updated the Inquiry and Appeals Procedures section to clarify a Member must complete an Appointment of Authorized Representative form to authorize another individual to act on the Members behalf. Please note: This Contract Update is only a brief highlight of the changes made by Blue Cross of Idaho.

6 Nondiscrimination Statement: Discrimination is Against the Law Blue Cross of Idaho complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Blue Cross of Idaho does not exclude people or treat them differently because of race, color, nationalorigin, age, disability or sex. Blue Cross of Idaho: Grievances and Appeals Provides free aids and services to people with disabilities to 3000 East Pine Avenue, Meridian, Idaho communicate effectively with us, suchas: Telephone: (800) ext.3838, Fax: (208) o Qualified sign language interpreters TTY: o Written information in other formats (large print, audio, grievances&appeals@bcidaho.com accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages If you need these services, contact Blue Cross of Idaho s Customer Service Department. Call (TTY: ) or call the customer service phone number on the back of your card. If you believe that Blue Cross of Idaho has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with Blue Cross of Idaho s Grievances and Appeals Department at: Manager, You can file a grievance in person or by mail, fax, or . If you need help filing a grievance, our Grievances and Appeals team is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services,200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, , (TTY). Complaint forms are available at index.html. Reference: