What You Need to Know About

Transcription

1 What You Need to Know About Member Identification Cards 2016 Edition Published by Provider Relations and Education Your Partners in Outstanding Quality, Satisfaction and Service Revision: December 2015

2 This guide will give you an overview of the various BlueCross BlueShield of South Carolina and BlueChoice HealthPlan member identification (ID) cards, the symbols on these cards and how to use the information on the cards. When members arrive at your office or facility, ask to see their current member ID cards at each visit. This will help you identify the product the member has and get health plan contact information. It will also help you with claims processing. Remember, ID cards are for identification purposes only. They do not guarantee eligibility or payment of your claim. You should always verify patient eligibility by using My Insurance Manager SM on our websites, or 2

3 State Health Plan State Health Plan (SHP) Network Group product lines access the broad commercial BlueCross SHP Network. The SHP and State Savings Plan alpha prefix is ZCS. The MUSC Health Plan alpha prefix is ZCK. Newer cards reflect the Public Employee Benefit Authority (PEBA) logo. 3

4 BlueCross BlueShield of South Carolina Preferred Blue Network Federal Employee Program (FEP) Group product lines access the broad commercial BlueCross Network (Preferred Blue). Cards reflect the FEP product name. ID numbers begin with the letter R. There are two plans, Basic and Standard. The plan name on the front of the card, upper right corner, identifies the Basic plan. Basic plan members do not have out-of-network benefits. The Standard plan operates as a traditional preferred provider organization (PPO). 4

5 BlueCross BlueShield of South Carolina Preferred Blue Network BlueCross Large Group PPO Group product lines access the broad commercial BlueCross Network (Preferred Blue). There are multiple alpha prefixes for these plans. Alpha prefixes and plan benefits vary. 5

6 BlueCross BlueShield of South Carolina Preferred Blue Network BlueCross Small Group PPO Group product lines access the broad commercial BlueCross Network (Preferred Blue). The alpha prefix is ZCY. Note: ZCY prefix may also represent an individual PPO policy. Plan benefits vary. 6

7 NEW BlueCross BlueShield of South Carolina Group Products BlueCross Exclusive SM Upstate I Network BlueCross Select Upstate I (Small Group PPO) Group product lines access the new commercial Blue Exclusive 1 Upstate Network. The alpha prefix is JJD. The ID card also indicates the network is an Exclusive Provider Organization (EPO). There are no out-of-network benefits, except for true emergency services provided in an emergency room setting. 7

8 BlueChoice HealthPlan Medicaid BlueChoice HealthPlan Medicaid Network Individual product lines access the broad BlueChoice HealthPlan Medicaid Network. Members are required to also carry their state-issued Healthy Connections ID cards (also pictured here). The alpha prefix is ZCD. These ID cards also feature the Healthy Connections logo. 8

9 BlueChoice HealthPlan of South Carolina BlueChoice Network Commercial Network Open Access (PPO) Group product lines access the broad commercial BlueChoice Network. Members do not need referrals to see specialists within the network. The alpha prefix is ZCL. These ID cards also indicate the plans with the Carolina Advantage and Advantage Plus logos. 9

10 BlueChoice HealthPlan of South Carolina BlueChoice Network Commercial Network High Deductible Open Access (PPO) Group product lines access the broad commercial BlueChoice Network. Members do not need referrals to see specialists within the network. The alpha prefix is ZCL. These ID cards also indicate the plans with the Carolina Advantage High Deductible Health Plan (HDHP) and Advantage Plus HDHP logos. Members have a cost-sharing account to help in meeting deductibles and other approved health care expenses: o Health savings account (HSA) o Health reimbursement account (HRA) 10

11 BlueChoice HealthPlan BlueChoice Network MyChoice (Primary Choice Plans HMO) Individual product lines access the BlueChoice HMO Network. Members must select a primary care physician. Members need referrals to see specialists within the network. The alpha prefix is ZCC. Members do not have out-of-network benefits. These ID cards indicate the plans with the Primary Choice MyChoice and HMO Network logos. 11

12 BlueChoice HealthPlan BlueChoice Network Commercial MyChoice Individual (PPO) Individual product lines access the broad commercial BlueChoice Network. Members do not need referrals to see specialists within the network. The alpha prefix is ZCL. These ID cards also indicate the plans with the MyChoice individual coverage, MyChoice individual coverage HDHP or MyChoice Open Access logos. 12

13 NEW BlueChoice HealthPlan Group Products BlueChoice Select Upstate Network BusinessADVANTAGE Select Upstate I (Small Group PPO) Group product lines access the new commercial BusinessADVANTAGE Select Upstate 1 Network. The alpha prefix is ZCI. These ID card indicates that the network is an Exclusive Provider Organization (EPO). There are no out-of-network benefits, except for true emergency services provided in an emergency room setting. 13

14 Individual (Non-Commercial) Product Exchange Network ID Cards Only individual product lines access the Blue Essentials SM Network (BlueCross) and the Blue Option SM Network (BlueChoice). Alpha prefixes are: BlueCross (ZCU, ZCF and ZCQ) and BlueChoice (ZCX and ZCJ). These ID cards also indicate the networks with Blue Essentials Network and Exclusive Provider Organization on the cards for BlueCross and the Blue Option logo and (EPO on the cards for BlueChoice. Benefits are only available in network! See the back of the ID card. The suitcase on the front of the card, lower right, indicates the network that members access when out of state. Note: All group products continue to access the broad commercial networks. This includes those purchased through the federal or private exchange. 14

15 BlueCross BlueShield of South Carolina Individual (Non- Commercial) Products Blue Essentials Network Blue Essentials Individual (EPO) ID Cards Only individual product lines access the Blue Essentials Network. Alpha prefixes are ZCU, ZCF and ZCQ. These ID cards also indicate the networks with Blue Essentials Network and Exclusive Provider Organization. Benefits are only available in network! See the back of the ID card. 15

16 BlueCross BlueShield of South Carolina Group Products BlueCross PPO Network Small Group PPO Group product lines access the broad commercial BlueCross Network (Preferred Blue). The alpha prefixes are ZCV and ZCR. These ID cards also indicate the network with Preferred Blue Network. 16

17 BlueChoice HealthPlan Individual (Non-Commercial) Products Blue Option SM Network Blue Option Individual (EPO) Only individual product lines access the Blue Option Network. Alpha prefixes are ZCX and ZCJ. These ID cards also indicate the networks by having the Blue Option Network logo. Benefits are only available in network! See the back of the ID card. 17

18 BlueChoice HealthPlan Individual (Non-Commercial) Products Blue Option Network Blue Option HDHP Individual (EPO) Only individual product lines access the Blue Option Network. Alpha prefixes are ZCX and ZCJ. These ID cards also indicate the networks by having the Blue Option Network logo. These ID cards also indicate the plans with the Blue Option HDHP logos. Benefits are only available in network! See the back of the ID card. 18

19 BlueChoice HealthPlan Group Products BlueChoice Network BusinessADVANTAGE (Small Group PPO) Group product lines access the broad commercial BlueChoice Network. The alpha prefixes are ZCL and ZCG. These ID cards also indicate the network with the Advantage Network logo. 19

20 BlueChoice HealthPlan Group Products BlueChoice Network BusinessADVANTAGE HDHP (Small Group PPO) Group product lines access the broad commercial BlueChoice Network. The alpha prefixes are ZCL and ZCG. These ID cards also indicate the network with the Advantage Network logo. These ID cards also indicate the plans with the BusinessADVANTAGE HDHP logos. 20

21 Notes 21