2018 OPEN ENROLLMENT AIR PRODUCTS AND CHEMICALS, INC. Capital BlueCross is an Independent Licensee of the BlueCross BlueShield Association

Transcription

1 2018 OPEN ENROLLMENT AIR PRODUCTS AND CHEMICALS, INC. Capital BlueCross is an Independent Licensee of the BlueCross BlueShield Association

2 Welcome Your Coverage Using MyPlan Advisor More Than Health Insurance Questions AGENDA 2

3 Your Coverage 3

4 IMPORTANT DEFINITIONS Term Deductible Coinsurance Copayment Out-of-Pocket Maximum Participating Provider Definition The amount you pay for covered health care services before your plan starts to pay. The percentage of covered health care costs you pay after the deductible has been met. The amount you pay to the provider at the time of your visit. The maximum amount of deductible, copayments, and coinsurance that you or your family pay during a benefit period. A doctor, hospital, or other health care facility or professional who has a contract with Capital BlueCross or another BlueCross BlueShield plan to provide health care under your coverage. 4

5 THE BLUES BY THE NUMBERS H 1 in3 Americans covered by BCBS million National Account members 1 84 of Fortune 100 companies served 2 93% of physicians are in-network 3 96% of hospitals are in-network 3 97% of claims paid in-network 4 1 BCBSA Quarterly Enrollment Report, BCBSA Analysis 2 Fortune Magazine, BCBSA Analysis 3 CHP Network Compare Findings 4 Hewitt Discount Benchmarking Analysis 5

6 YOUR PPO 500 MEMBER ID CARD The key to accessing your benefits Preauthorization Certain services and all nonemergency inpatient hospitalization admissions require preauthorization Copayments Amount you pay for each service Suitcase BlueCard and BlueCross BlueShield Global Core The Blue Cross Blue Shield Global Core program was formerly known as BlueCard Worldwide. BlueCard, BlueCard Worldwide, and Blue Cross Blue Shield Global are trademarks of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield companies. 6

7 YOUR PPO HSA MEMBER ID CARD The key to accessing your benefits Preauthorization Certain services and all nonemergency inpatient hospitalization admissions require preauthorization Copayments Amount you pay for each service Suitcase BlueCard and BlueCross BlueShield Global Core The Blue Cross Blue Shield Global Core program was formerly known as BlueCard Worldwide. BlueCard, BlueCard Worldwide, and Blue Cross Blue Shield Global are trademarks of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield companies. 7

8 YOUR PLAN DESIGN OPTIONS PPO 500 PPO 1500 PPO

9 PPO 500 SUMMARY OF COST-SHARING Member Responsibility Participating Providers Nonparticipating Providers Deductible (per benefit period) Office visit Specialist visit Inpatient Outpatient surgery Urgent care Emergency room $500 per member $1,500 two-party $1,500 per family $15 copay/visit $35 copay/visit n/a n/a $50 copay/visit $100 copay/visit waived if admitted $1,000 per member $3,000 two-party $3,000 per family 40% coinsurance per visit 20% coinsurance after deductible Coinsurance 20% 40% Telehealth Out-of-pocket maximum $10 copay $1,750 per member $4,000 two-party $4,000 per family 40% coinsurance after deductible $3,500 per member $8,000 two-party $8,000 per family The above list is not a complete summary of benefits. Please refer to your Certificate of Coverage for a detailed description of all benefits, limitations, definitions of terms, and exclusions that apply to your plan. 9

10 PPO 1500 SUMMARY OF COST-SHARING Member Responsibility Participating Providers Nonparticipating Providers Deductible * (per benefit period) Coinsurance Office visit Specialist Urgent care Inpatient Outpatient surgery Telehealth $1,500 single coverage $3,000 family coverage 20% coinsurance after deductible $3,000 single coverage $6,000 family coverage 40% coinsurance after deductible Emergency room copay 20% coinsurance after deductible Out-of-pocket maximum $5,000 single coverage $10,000 family coverage $10,000 single coverage $20,000 family coverage * Deductible is combined to include medical and prescription drug benefits. Individuals within a family cannot contribute more than $6,650 in out-of-pocket expenses. The above list is not a complete summary of benefits. Please refer to your Certificate of Coverage for a detailed description of all benefits, limitations, definitions of terms, and exclusions that apply to your plan. 10

11 PPO 2500 SUMMARY OF COST-SHARING Member Responsibility Participating Providers Nonparticipating Providers Deductible * (per benefit period) Coinsurance Office visit Specialist Urgent care Inpatient Outpatient surgery Telehealth Emergency room copay $2,500 single coverage $5,000 family coverage 30% coinsurance after deductible $5,000 single coverage $10,000 family coverage 50% coinsurance 30% coinsurance after deductible Coinsurance 30% 50% Out-of-pocket maximum $6,650 single coverage $13,300 family coverage $13,300 single coverage $26,600 family coverage * Deductible is combined to include medical and prescription drug benefits. The above list is not a complete summary of benefits. Please refer to your Certificate of Coverage for a detailed description of all benefits, limitations, definitions of terms, and exclusions that apply to your plan. 11

12 HOW THE PLAN WORKS SCENARIO ONE OFFICE VISIT PPO 1500 Office visit = $150; plan allowance = $100 PPO 500 PPO 1500 and 2500 $15 PCP Copay $35 Specialist Copay Full $100 cost is applied to deductible and then coinsurance when deductible is satisfied. Costs and expenses are for illustrative purposes only. 12

13 HOW THE PLAN WORKS BIRTH OF A CHILD Sample care costs Hospital charges (mother) $2,700 Routine obstetric care $2,100 Hospital charges (baby) $900 Anesthesia $900 Laboratory tests $500 Prescriptions $200 Radiology $200 Immunizations and preventive care $0 Total cost of care $7,500 Costs and expenses are for illustrative purposes only. 13

14 BIRTH OF A CHILD IF THE DEDUCTIBLE IS NOT MET Total cost of care = $7,500 PPO 500 PPO 1500 Deductible $1,500 Deductible $3,000 Out-of-pocket maximum $4,000 Out-of-pocket maximum $10,000 Copay $15 Copay $0 Coinsurance $1,200 Coinsurance $900 Plan pays $4,785 Plan pays $3,600 Out-of-pocket balance $1,285 Out-of-pocket balance $6,100 Costs and expenses are for illustrative purposes only. 14

15 PREVENTIVE CARE No cost-sharing when performed by a participating provider Detect potential health risks early Adult and childhood immunizations Annual gynecological exams Annual mammograms for women age 40+ Routine physicals Select screenings Please refer to your Certificate of Coverage for a detailed description of all benefits, limitations, definitions of terms, and exclusions that apply to your plan. 15

16 TELEHEALTH Connect with a doctor by tablet, smartphone, or computer from the comfort of your home or anywhere else in the U.S. 16

17 TELEHEALTH ACCESS Three ways to sign up Download the free Amwell app Visit amwell.com Call DOCS Use service key: CAPITALBLUE Doctors available 24/7/365 through Amwell mobile app or website; no appointment necessary On behalf of Capital BlueCross, American Well Corp. provides this online health care tool. American Well is an independent company. 17

18 PROGRAMS FOR YOUR HEALTH Nurse Line Precious Baby Prints Condition Management Case Management 18

19 Using MyPlan Advisor 19

20 MYPLAN ADVISOR WELCOME 20

21 MYPLAN ADVISOR STEP 1 21

22 MYPLAN ADVISOR STEP 2 22

23 MYPLAN ADVISOR STEP 3 23

24 MYPLAN ADVISOR STEP 4 24

25 MYPLAN ADVISOR STEP 5 25

26 More Than Health Insurance 26

27 BLUE365 EXCLUSIVE DISCOUNTS Fitness Your Way * Waived enrollment fee when you join by 10/31 using offer code AP17 National retailers Reebok, Sprint, Skechers, and more Health and wellness Hearing aids, LASIK, and nutrition plans *On behalf of Capital BlueCross, Tivity Health assists in the administration of fitness programs and 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. 27

28 MANAGE YOUR BENEFITS ONLINE Register at capbluecross.com View plan information and programs Request a replacement ID card Compare quality and treatment costs 28

29 EXPLANATION OF BENEFITS Access from your secure member account Explains claim payment and/or reason for adjustments to or denial of specific charges Reflects in-network and out-of-network claim information received and processed 29

30 CAPITAL BLUE CROSS LOOP Stay connected to your health plan Combines text with secure web messaging Get tips on health and wellness, ways to save money, and other features of your plan Accessible from a smartphone, tablet, or computer Signing up * is simple Text: capbluecross to Phone: *By signing up for the Capital BlueCross Loop, I authorize Capital BlueCross, its affiliates, subsidiaries and/or agents to text me for informational, transactional (e.g., billing), or marketing purposes including, without limitation, texts sent using an automatic dialing system. I understand that the provision of my phone number is not a condition of purchasing any goods or services, and I may opt out at any time. Message and data rates may apply. Please check with your wireless provider. 30

31 SEARCH & SAVE CENTER Your go-to resource for health care decisions Find a Provider Find in-network doctors and hospitals to help lower your costs Compare Treatment Costs * Look up costs for medical services from office visits to lab tests to inpatient procedures and compare them to what other health care providers charge Estimate Out-of-Pocket Costs See what your share of costs may be based upon your plan s benefits *Cost comparisons are built from a historical range of amounts paid to providers. This is not a recommendation or endorsement of any particular health care provider or its services and should not be construed as medical advice. Capital BlueCross does not guarantee that services will be available or will be any particular quality or cost. 31

32 CUSTOMER SERVICE By phone Use the number on the back of your member ID card anytime through Secure Mail Stop by Capital Blue Visit CapitalBlueStore.com for hours Capital Blue is brought to you by Capital BlueCross, an Independent Licensee of the BlueCross BlueShield Association, serving 21 counties in Central Pennsylvania and the Lehigh Valley. 32

33 Proud to be your partner in health. 33

34 Capital BlueCross is an Independent Licensee of the BlueCross BlueShield Association THANK YOU