ASO Signature Producer Communication #780 Issued October 31, 2016

Transcription

1 ASO Signature Producer Communication #780 Issued October 31, 2016 Message Introducing ASO Signature, a ready-made self-funding solution that offers customers the right coverage, at the right cost. With ASO Signature, employers have the flexibility to choose from our most popular plan designs, which are backed by resources to help them make cost-effective health plan management decisions. ASO Signature is available to new groups with a 1/01/2017 effective date. Details ASO Signature is a key component of our ASO financial improvement work. By including our standard plan designs, limiting customization, providing online-only access to plan documents and resources, and encouraging electronic enrollment, ASO Signature will help us save on operational costs, which we can pass on to customers through reduced administrative fees. The ASO Signature sm overview (C-557) outlines the package details, and we have developed the ASO Signature Inclusions and Buy-Ups guide(c-565) which lists the included benefits and services for quick reference. While ASO Signature s benefit designs are not customizable, the guide lists the available buyup options. With ASO Signature, the group would choose a health plan from our suite of standard products listed in the 2017 ASO Signature Product Snapshot (C-618). Each option includes prescription drug coverage, Telehealth (except CareConnect plans), The Theon platform s Care Engager module, clinical management programs, and much more. Of note, ASO Signature: - Exclusions and limitations are listed in a specially designed ASO Signature proposal. - Is available to new groups (100+ employees) beginning with a January 1, 2017 effective date.. - Groups and members can access plan documents and benefit information on a custom landing page on capbluecross.com. - Includes a one-month fee holiday, which is administered internally as an implementation credit.. Producer training sessions on this package were held earlier this year. Attachments Attachment A ASO Signature Overview (C-557) Attachment B ASO Signature Inclusions and Buy Ups Guide (C-565) Attachment C 2017 ASO Signature Product Snapshot (C-618) Questions Contact your Preferred Agency with any questions. Thank you. Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company, Capital Advantage Assurance Company and Keystone Health Plan Central. Independent licensees of the Blue Cross and Blue Shield Association. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies.

2 ASO SIGNATURE SELF-FUNDING MADE SIMPLE Capital BlueCross is an Independent Licensee of the BlueCross BlueShield Association

3 THE RIGHT COVERAGE. AT THE RIGHT COST. Welcome to ASO Signature, a cost-effective self-funding solution powered by a ready-made benefits and services package from the name trusted for nearly 80 years. With ASO Signature, you have the freedom to choose from a wide portfolio of our most popular plan designs, and enjoy the security of a card most accepted by doctors and hospitals. BUILT RIGHT IN ASO Signature plans include: Telehealth 1 Visit a doctor 24/7 by live, high-quality video from a smartphone, tablet, or computer. Ways to Save Alerts 2 Receive s or text messages with ways to save on common and recurring expenses. Blue365 3 Enjoy exclusive discounts on gym memberships, fitness apparel, nutrition plans, and much more. Rx COVERAGE Employers enjoy significant costs savings when they pair their health plan with prescription coverage. So ASO Signature combines medical and drug benefits to provide: A full picture of member claims and experience, which helps improve health management A single dedicated account management team One customer service number and ID card for employees CLARITY FOR YOUR HEALTH PLAN DATA With Theon Care Engager, 4 an innovative advanced data and analytics platform, you can easily uncover actionable information to help you reduce waste, control costs, and manage employee health conditions. Theon Care Engager features: Daily admission and discharge updates Monthly utilization and quality metrics Action reports that include high-dollar claims and other important information

4 BEYOND THE BENEFITS Capital BlueCross is so much more than a health insurance company. With ASO Signature, we empower our customers with programs and tools that give them the stability to live life to the fullest, with confidence. Care Management From chronic disease management to maternity care support, from digital health coaching to services for members with complex medical needs, our award-winning clinical programs help members be their healthy best. Nurse Line ( ; TTY: 711) Get peace of mind in the middle of the night or avoid an unnecessary and costly trip to the ER. Licensed registered nurses are available 24/7, by phone or online, to chat about any health-related concern. Search & Save Center Find doctors and hospitals, compare costs, and start saving using this onestop online resource. Prescription Cost Estimator Look up covered medications and estimate their prices before a trip to the pharmacy. Personal Profile Employees can create a unique plan to help them achieve their health and wellness goals with this online health risk assessment. EVEN MORE VALUE On top of the benefits and services that come standard with ASO Signature, you can add a number of other features to round out your self-funding solution. HRA and HSA Administration Consider these tax-advantaged cost-sharing vehicles to help you and your employees budget for health care costs. Health and Wellness Clinics Help your employees Take Charge (diabetes management/nutrition), EMPOWER (weight management) them to make the lifestyle changes they ve longed for, or set them on a course to Freedom from Smoking. 5 EASY DOES IT You re in business to serve your customers and achieve your financial goals. That s why we do everything we can to make managing your health plan as easy as possible. Submit enrollment files right from your desktop Visit the Employer Portal on capbluecross.com to download communications that educate your employees on how to make informed health care decisions Encourage employees to access their Certificates of Coverage and other plan documents through their secure member page

5 Call your account executive or producer to learn more, or visit capbluecross.com/asosignature capbluecross.com capitalbluestore.com Clinical services and digital health coaching are not intended to be substitutes for services or advice received from your health care providers who are the only ones that can diagnose or treat your individual medical conditions. Capital BlueCross and its affiliated companies believe these services to be useful for general information or support but do not assume any liability associated with their use. 1 The telehealth benefit is not available on CareConnect SM PPO plans, Individual HMO plans, and SeniorBlue HMO plans. Refer to your certificate of coverage for benefit details. Copays and deductibles may apply. Doctors will be added to the network as they are approved by Capital BlueCross to deliver telehealth services. On behalf of Capital BlueCross. 2 Ways to Save Alerts is a trademark of Change Healthcare Corporation. On behalf of Capital BlueCross, Change Healthcare Corporation provides health information content and member health platform tools. Change Healthcare Corporation is an independent company. 3 The Blue365 program is brought to you by the BlueCross BlueShield Association. The BlueCross BlueShield Association is an association of independent, locally operated BlueCross and/or BlueShield Companies. Blue365 offers access to savings on health and wellness products and services and other interesting items that members may purchase from independent vendors, which are different from covered benefits under your policies with Capital BlueCross and its family of companies. 4 Theon Care Engager is a registered trademark of Geneia LLC. On behalf of Capital BlueCross, Geneia LLC provides health data informatics, analytical support, and services. Geneia LLC is an independent company. 5 Freedom From Smoking is a registered trademark of the American Lung Association. On behalf of Capital BlueCross, the American Lung Association assists in the administration of the nicotine cessation program. The American Lung Association is an independent organization. Benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company, Capital Advantage Assurance Company and Keystone Health Plan Central. Independent licensees of the BlueCross BlueShield Association. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies. C-557 (03/31/16)

6 ASO SIGNATURE BENEFITS AND SERVICES THE RIGHT COVERAGE. AT THE RIGHT COST. With ASO Signature, you have the freedom to choose from a wide portfolio of our most popular plan designs, all of which include the following benefits and services. BENEFITS AND CLAIMS PROCESSING SERVICES Standard medical and Rx benefit plans Claims processing Electronic enrollment and invoicing Annual data and analytics reporting review National and International BlueCard network access Coordination of benefits Subrogation Behavioral health COMMUNICATIONS AND PLAN MATERIALS Electronic Plan Documents Certificate of Coverage Summary of Benefits and Coverage Group/member web portals Includes resources to help members make cost-effective health care decisions Group landing page CONSUMER TOOLS AND SERVICES Blue365 Ways to Save Alerts Telehealth CLINICAL AND WELLNESS SERVICES Utilization management and concurrent review (includes discharge planning) Chronic disease management Asthma, diabetes, coronary artery disease, and congestive heart failure Case management For complex medical needs Nurse Line Precious Baby Prints well baby program Health risk assessment Online health coaching GROUP AND MEMBER SERVICES Theon Care Engager access Customer service Basic open enrollment support Two meetings, training, and video

7 ASO SIGNATURE BUY-UP OPTIONS EVEN MORE VALUE. On top of the benefits and services that come standard with ASO Signature, you can add a number of other features to help round out your self-funding solution. HSA or HRA administration Stop-loss coverage and reporting Freedom from Smoking program EMPOWER weight management clinic* Take Charge diabetes management and nutrition clinic* *Minimum participation requirements capbluecross.com capitalbluestore.com BlueCard and BlueCard Worldwide are trademarks of the BlueCross BlueShield Association. Theon Care Engager is a service of Geneia LLC. On behalf of Capital BlueCross, Geneia LLC provides health data informatics, analytical support, and services. Geneia LLC is an independent company. The Blue365 program is brought to you by the BlueCross BlueShield Association. The BlueCross BlueShield Association is an association of independent, locally operated BlueCross and/or BlueShield Companies. Blue365 offers access to savings on health and wellness products and services and other interesting items that members may purchase from independent vendors, which are different from covered benefits under your policies with Capital BlueCross and its family of companies. Ways to Save Alerts is a trademark of Change Healthcare Corporation. On behalf of Capital BlueCross, Change Healthcare Corporation provides health information content and member health platform tools. Change Healthcare Corporation is an independent company. Clinical services, digital health coaching, and Nurse Line are not intended to be substitutes for services or advice received from your health care providers who are the only ones that can diagnose or treat your individual medical conditions. Capital BlueCross and its affiliated companies believe these services to be useful for general information or support but do not assume any liability associated with their use. Freedom From Smoking is a registered trademark of the American Lung Association. On behalf of Capital BlueCross, the American Lung Association assists in the administration of the nicotine cessation program. The American Lung Association is an independent organization. Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company, Capital Advantage Assurance Company and Keystone Health Plan Central. Independent licensees of the BlueCross BlueShield Association. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies. C-565 (07/18/16)

8 2017 ASO Signature Benefits Snapshot HRA Option Deductible (2x Family) Coinsurance Out-of- Pocket Maximum PCP Specialist Emergency Room Urgent Care Lab Ind Hos Hi-Tech Imaging IP Rx $0 Rx $250 (Brand Only Deductible) Rx CC Plan In-Network In-Network In-Network In-Network In-Network In-Network In-Network Ind/Hosp In-Network In-Network Preferred Generic; Non-Preferred Generic; Preferred Brand; Non-Preferred Brand PPO 0/0/35 $0 0% $6,350 $35 $65 $300 $125 $0 $75 $250 $0 $4/$15/$45/$70 $4/$20/$40/$65 N/A PPO 500/0/25 $500 0% $6,350 $25 $50 $150 $75 $0 D D D $4/$15/$45/$70 $4/$20/$40/$65 N/A PPO 500/20/25 $500 20% $4,000 $25 $50 $150 $75 $0 D/20% D/20% D/20% $4/$15/$45/$70 $4/$20/$40/$65 N/A PPO 1000/0/25 $1,000 0% $6,350 $25 $50 $150 $75 $0 D D D $4/$15/$45/$70 $4/$20/$40/$65 N/A CareConnect SM 1000/0/10 $1,000 0% $6,350 $10 $30 $200 $100 $0 D D D N/A $6/$20/$45/$70; VB Drugs $3/$10/$22/$35 PPO 2000/0/30 Y $2,000 0% $6,350 $30 $50 $150 $75 $0 D D D $4/$15/$45/$70 $4/$20/$40/$65 N/A PPO HSA 2000/0/0 $2,000 0% $6,350 D D D D D D D Deductible combined with Medical $7/$25/$55/$80 after deductible N/A PPO 2000/20/35 $2,000 20% $6,350 $35 $70 $200 $100 $0 D/20% D/20% D/20% $4/$15/$45/$70 $4/$20/$40/$65 N/A PPO HSA 2750/0/0 $2,750 0% $6,350 D D D D D D D Deductible Combined with Medical $7/$25/$55/$80 after deductible N/A PPO 3000/0/30 Y $3,000 0% $6,350 $30 $50 $150 $75 $0 D D D $4/$15/$45/$70 $4/$20/$40/$65 N/A CareConnect 3000/0/30 $3,000 0% $6,350 $30 $60 $200 $100 $0 D D D N/A $6/$20/$45/$70; VB Drugs $3/$10/$22/$35 PPO 3000/20/35 $3,000 20% $6,350 $35 $70 $200 $100 $0 D/20% D/20% D/20% $4/$15/$45/$70 $4/$20/$40/$65 N/A PPO HSA 3500/0/0 $3,500 0% $6,350 D D D D D D D Deductible combined with Medical $7/$25/$55/$80 after deductible N/A PPO 4000/0/30 Y $4,000 0% $6,350 $30 $50 $150 $75 $0 D D D $4/$15/$45/$70 $4/$20/$40/$65 N/A PPO 5000/0/30 Y $5,000 0% $6,350 $30 $50 $150 $75 $0 D D D $4/$15/$45/$70 $4/$20/$40/$65 N/A PPO HSA 5500/0/0 $5,500 0% $6,350 D D D D D D D Deductible combined with Medical $7/$25/$55/$80 after deductible N/A PPO 6000/0/30 Y $6,000 0% $6,350 $30 $50 $150 $75 $0 D D D $4/$15/$45/$70 $4/$20/$40/$65 N/A PPO HSA 6550/0/0 $6,550 0% $6,550 D D D D D D D Deductible combined with Medical no copays after deductible N/A 1 Speciality drug coverage = 20% up to $250 per fill/20% up to $350 per fill/20% up to $450 per fill 2 Tiered Lab benefits. Independent labs Hospital based labs 3 D = Deductible D/$ = Deductible applies first then a copay 4 Plan naming convention = Plan type, Deductible/Coinsurance/Office Visit Copay 5 CareConnect copays listed are for PCP directed care Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company, Capital Advantage Assurance Company and Keystone Health Plan Central. Independent licensees of the BlueCross BlueShield Association. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies. C-618 (08/22/16)