Welcome. Open Enrollment. A&M Care Plans. Health Care Coverage For You and Your Family

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1 Open Enrollment Health Care Coverage For You and Your Family A&M Care Plans Welcome A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2 What s New for 9/1/2011 Plan Year New Plan Option Deductible Out-of-Pocket Maximums Coinsurance Deductible is excluded from the Out-of-Pocket maximum Most Preventive Services are now covered at 100% Dollar Maximums have been changed to comparable Annual 60 Visits for Home Health and Annual 60 Days for Skilled Nursing Dependents will be covered until age 26 $50.00 Deductible Credit for all members and dependents who complete an annual physical $50.00 Deductible Credit for all members and dependents ages 18 and over who complete a Health Risk Assessment (HRA) 2

3 Why Blue Cross and Blue Shield? Blue Cross and Blue Shield is one of the most trusted brands, recognized as a symbol of security and quality 97 million Americans (1 in 3) are covered by Blue Cross and Blue Shield Scott & White providers and facilities are in the Blue Choice Network Blue Extras Discount Programs The Texas A&M University System dedicated customer service unit Provider Finder Out-of-state providers 3

4 PPO Features A&M Care Plan Administered by Blue Cross and Blue Shield of Texas (BCBSTX) No primary care physician (PCP) required; no referrals required to see a specialist Select any provider for care within the PPO network or outside the network When you receive care inside the network Highest level of benefits No claims to file No balance billing for amounts over the BCBSTX allowed amount When you receive care outside the network May have to file own claims Can be balance billed Worldwide coverage for emergency and non-emergency care 4

5 Your BlueChoice PPO Benefits In- and Out-of-Network Deductible Benefits A& M Care In-Network / Out-of-Network Plan Member Share 65 + Plan Individual $700 / $1,400 $500 Family $2,100 / $4,200 Out-of-Pocket Maximum Individual $5,000 / $10,000 $1,400 Family $10,000 / $20,000 Office Visit (primary care / specialist) Most Lab and X-ray paid at 100% $30/$45 per visit / 50% after deductible 20% after deductible Preventive Services 100% / Not covered Covered in full after deductible In-Patient Hospital Emergency Room Emergency Visits Non-emergency Chiropractic 30 visits per plan year Maternity Care Doctor Lab/X-Ray/MRIs, Pet Scans and diagnostic procedures 30% after deductible / 50% after deductible 30% after deductible / 30% after deductible 30% after deductible / 50% after deductible $45 per visit / 50% after deductible $30 initial visit only / 50% after deductible 30% after deductible / 50% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible All other covered services 30% after deductible 20% after deductible

6 Preventive Coverage Stay Healthy by Getting Regular Check-ups What s covered? Recommended routine gender- and age-specific preventive care, such as physical and OB/GYN exams, mammograms and other cancer screenings, well-child care and immunizations both facility and professional services $50.00 deductible credit for all members and dependents who complete an annual physical Coverage provided in-network at 100% with no copay, no deductible Remember: Lab tests related to an illness or condition are not considered preventive and may pay differently

7 More Hospitals and Doctors For a current listing of all providers see our website at: Offers names, addresses, and map directions. For World Wide Assistance Call BLUE (2583) Or Collect In-network coverage is available when traveling or living worldwide Available 24 Hours a Day, Seven Days a Week 7

8 Retiree Information Retirees under age 65 Are Considered Network and use the Network providers Retirees over age 65 Choose from: A&M Care Plan 65 Plus you must be: Age 65 and enrolled in Medicare Parts A&B or disabled under 65 and enrolled in Medicare Parts A&B You and your covered spouse are both age 65 and older (or disabled) and enrolled in Medicare Parts A&B If you are working for the Texas A&M University System, you are working six months or less in the plan year Remember: Enroll in BOTH Medicare parts A & B. When you receive your Medicare Card, notify BCBSTX and your Human Resource Office of your Medicare number which includes an alpha character. If you use a Provider that accepts Medicare or is a BCBSTX provider, you cannot be balance billed. 8

9 Retiree Coordination of Benefits A&M Care Plan and 65 Plus A&M Care Plan deductible not met A&M Care Plan deductible is met Charge $ $ Medicare paid 80% $ $ Patient Share 20% $ $ A&M Care Plan Deductible $ MET Applied to Deductible $ Zero BCBSTX would have paid Zero $ A&M Care Plan Payment Zero $ Patient s Responsibility $ Zero Plans calculate the normal plan benefits, then pay that amount, or the difference after Medicare has paid, whichever is less. Your coinsurance will continue until you meet the out-of-pocket maximum, then pay at 100%. A&M Care 65 Plus = $1,400 A&M Care Plan = $5000 individual/$10,000 Family 9

10 Other Programs and Services

11 Condition and Decision Support If you have a chronic condition, we offer support Blue Care Advisors clinical professionals can help you manage chronic health conditions like: Asthma, coronary disease, diabetes and COPD Understand and follow your physician s orders Review medications, side effects, compliance, refills and current services Establish goals with caregivers, scheduling follow-ups as appropriate If you are identified as being at risk or having one of the managed chronic conditions, one of our Blue Care Advisors will contact you

12 Tobacco Cessation and Weight Management Programs Self-Paced Approach Online program and resources available in the Personal Health Manager Secure outreach to keep members on track BlueExtras SM Discounts Lifestyle Management Support Counseling and coaching with licensed Wellness Coaches 24/7 Nurseline Referrals when appropriate Jenny Craig Seattle Sutton s Healthy Eating Life Time Fitness Yoga Vitamins Meditation Acupuncture and more!

13 BlueExtras SM Discounts Weight Management Eat right with Jenny Craig and get discounts on membership and foods Hearing Discounts on hearing aids for members, parents and even grandparents Vision Discounts on eyewear, laser correction surgery and contact lenses at major retailers through Davis Vision Complementary Alternative Medicine Acupuncture, health clubs and spas, naturopaths, massage therapy, and more Seattle Sutton s Healthy Eating Discounts on Seattle Sutton s freshly prepared, calorie-controlled meals. National home delivery program makes it easy to stay healthy. Look for further information about the BlueExtras Discount Program at 13

14 24/7 Nurseline Around-the-Clock Advice and Information by Phone /7 access to registered nurses for health conditions such as: High fevers Earaches Cuts and bruises 1,200 audio health library topics Referral of members with care needs to the appropriate program Follow-up calls for emergency care needs Available in English and Spanish 14

15 Blue Access for Members SM (BAM) Member Account Management Resources Personal Health Manager Health Risk Assessment Blue Access for Members SM Member Care Profile Blue Points SM Incentives BlueExtras SM Discounts Treatment Cost Advisor TM Experience. Wellness. Online. Hospital Comparison Tool *Depending on coverage type 15

16 Health Risk Assessment Powerful Health and Wellness Tool Interactive and user-friendly health assessment tool Personal Health Risk Assessment (HRA) designed to be completed in 10 to 15 minutes Choose your assessment topic, such as health and wellbeing or fitness and physical activity Know Your Risks Manage Your Health Examines the member s overall health and wellbeing and provides a personalized report showing areas where you can improve Complete the HRA and receive a $50.00 deductible credit for all members and dependents ages 18 and over 16

17 If You Need A Temporary ID Click on I m a Member Click on the Need a User Name? Register Now link Register in Blue Access for Members SM using your ID number

18 If You Need A Temporary ID Click on Get a Temporary ID Card in the Quick Links Print your temporary ID card You can also order new or replacement ID cards

19 What If I Am Under a Doctor s Care on September 1, 2011? Transition of care applies to those members moving from another health plan, who are in the midst of medical care, utilizing a provider who is not part of the BCBSTX network If approved, benefits would be paid at the in-network level for a specified period of time for: Cancer treatment / therapies Treatment for a terminal illness Third trimester of pregnancy Cardiac rehabilitation Submit Transition of Care form prior to effective date You will receive confirmation of approval by U.S. mail Completion of the form is not a guarantee of coverage

20 What if I Have Questions Personalized Service 8am 8pm Our Philosophy Take the Member Out of the Middle Call your dedicated customer service team for: Benefit information Network provider information Membership and eligibility Inquiries (telephone and ) ID card requests Claims inquiries Help with online tools Toll-free Customer Service 20