New Staff Orientation 2017
MyBlueKC.com Website Agenda Added Value Services 2017 Medical Plan Options General Information Questions 2
Your 2017 Medical Plan Options 1 Traditional PPO (Preferred Provider Organization) No selection of PCP; In and Out of Network; National and International Coverage 1 Traditional PPO Plan Preferred-Care Blue 2 Consumer Driven Health Plans 3 HDHPs (High Deductible Health Plans) 2 Blue-Select Plus Plans 1 Preferred-Care Blue Plan Employee-Owned HSA (Health Savings Account) 3
Before You Search Log In 1 Log in to MyBlueKC.com. (if this is your first time logging in, click on Register Now. You will need your Blue KC member ID card to reference.) 2 1 2 After logging in, you will see the same menu screen at the top. Click Find a Doctor. 1 4
MyBlueKC.com 24/7 Member Access MyBlueKC.com Find a provider in your network View claims and benefits Print a temporary ID card Order a replacement card Wellness portal and other value-added programs Research Health Conditions 5
BlueCard PPO Network Coverage No Matter Where You Work, Live or Travel National Coverage International Coverage LOCATE A PROVIDER Domestic Network 6,776 Hospitals 1,177,194 Physicians Access in more than 200 countries 5,801 Hospitals 59,300 Physicians Go to MyBlueKC.com and log in Click Find a Doctor Select the Blue Card PPO/EPO network 6
Hospital Locator www.bluekc.com Hospital Name Preferred-Care Blue Network BlueSelect Plus Center Point Medical Center X NO Children s Mercy Hospitals X X KU Medical Center X X Lee s Summit Hospital X NO Liberty Hospital X X E M P L O Y E E B E N E F I T S 2 0 1 4 Menorah Medical Center X NO North Kansas City Hospital X X Olathe Medical Center X X Overland Park Regional X NO Providence Medical Center X NO Research Medical Center X NO Shawnee Mission Medical Center X X St. Joseph Medical Center NO NO St. Luke s (All Locations) X NO St. Mary s Medical Center NO NO Truman Medical Center (Hospital Hill and Lee s Summit) St. Joseph Medical Center and St. Mary s Medical Center are not available in Preferred-Care Blue and BlueSelect Plus as network hospitals X X
BlueSelect Plus Network Need to Know! BlueSelect Plus is best for members who live in the metropolitan Kansas City area. All other hospitals in Blue KC s service area considered out of network Hospitals included in the network: Children s Mercy (Hospital Hill and South) Liberty Hospital North Kansas City Hospital Olathe Medical Center Shawnee Mission Medical Center Truman Medical Center (Hospital Hill and Lakewood) University of Kansas Hospital This is a high performance network. Prior to choosing a health plan that uses BlueSelect Plus please confirm your provider is in this network. 2016 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 8
Blue Select Plus In Network (5 Counties): Missouri Platte, Clay, Jackson Kansas Wyandotte, Johnson No network providers in the other 27 counties in our service area. Out of Network Counties: Missouri - Atchison, Holt, Nodaway, Andrew, Worth, Gentry, Harrison, Mercer, Dekalb, Daviess, Grundy, Buchanan, Clinton, Caldwell, Livingston, Ray, Carroll, Lafayette, Saline, Cass, Johnson, Pettis, Bates, Henry, Benton, Vernon, St. Clair In network benefits are available in all other areas as long as a BlueCard provider is selected 2013 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association.
Routine Preventive Services In-Network routine preventive services and the related office visit for routine preventive services covered at 100% Annual Physicals Well women exams & mammograms Childhood Immunizations PSA tests Colorectal cancer exams Generic contraceptive drugs at 100% Breastfeeding support, supplies (pumps) and counseling at 100% Services MUST be preventive Services MUST be done in a different calendar year All services received from an out-of-network provider are subject to the out-of-network deductible and coinsurance, except for childhood immunizations, which are paid at 100%. 2016 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 10
Traditional PPO Preferred-Care Blue $500 Deductible Plan
Traditional PPO Preferred-Care Blue BlueKC.com In-Network Out-of-Network Deductible: Individual/Family $500 / $1,000 Coinsurance (your share): 20% 40% Inpatient or Outpatient Services Deductible then 20% Deductible then 40% MRI, MRA, CT and PET Scans Physician s Office, Imaging Center, Outpatient Setting, Hospital Deductible then 20% Deductible then 40% Office Visits PCP: $35 copay* (IM, FP, GP, PED) Specialists: $70* copay* (all others) Deductible then 40% Routine Vision Care Urgent Care (Minute Clinics, Take Care Centers) $35 copay One vision exam per year Deductible then 40% $70 copay Deductible then 40% Emergency Room $150 copay, then deductible then 20% (copay waived if admitted) Out-of-Pocket Maximum:** Individual $4,500 $9,000 Out-of-Pocket Maximum:** Family *Copay includes office charge & lab services in physician s office or independent Lab. $9,000 $18,000 12 **Out-of-Pocket Maximum includes all medical and Rx copays.
Prescription Drug Coverage Traditional PPO Plan Certain drugs may require prior authorization, have quantity limitations or require step therapy (Generics First). Refer to BlueKC.com for additional details. 34 day supply In-network pharmacy Tier 1: $10 Tier 2: $60 Tier 3: $80 Value Base Rx: $0/ $0/ $40 102-day supply Express Scripts mail-order Tier 1: $30 Tier 2: $180 Tier 3: $240 Value Base Rx: $0/ $0/ $120 Rx copays help satisfy out-of-pocket maximum. 13
Value-Based Incentive Program Blue KC offers a unique Value Based Incentive Program for members with Diabetes and Coronary Artery Disease How Do I participate in the Value-Based Incentive Program? 1. You must be willing to participate in the Healthy Companion disease management program. 2. You must actively obtain screenings for your condition. 3. You must agree to online or telephonic assessment with a Healthy Companion nurse. By participating in the program you can receive waived or reduced copays for selected medications or supplies specifically related to these conditions. TO ENROLL, call the customer service number on your member ID card This program is NOT available to members enrolled in the QHDHP until after the Deductible is met. 14
BlueSaver Plans Qualified High Deductible Health Plans + Health Savings Account BlueSelect Plus $3,500 Deductible Plan BlueSelect Plus $2,600 Deductible Plan Preferred-Care Blue $2,600 Deductible Plan
Consumer Driven Health Plans High-Deductible BlueSaver Plans + HSA 1 2 High-Deductible BlueSaver Plans Lower monthly premium No copayments for medical services; you pay entire cost until deductible is met, then services are covered at 20 percent. No copayments at the pharmacy; you pay the entire cost until deductible is met; then prescription drugs are covered at by Rx copays. Owned by you Helps pay for eligible medical, dental and vision expenses Tax savings Health Savings Account (HSA) No use it or lose it rule UMB will administer your HSA. 16
BlueSaver PPO Qualified High Deductible Health Plan BlueSelect Plus In-Network Out-of-Network Embedded Deductible: Individual Deductible: Family $3,500 $7,000 $7,000 $14,000 Coinsurance (your share): 20% 50% Inpatient or Outpatient Services Deductible then 20% Deductible then 50% Radiology, Hi-Tech Scans Deductible then 20% Deductible then 50% Office Visits Deductible then 20% Deductible then 50% Urgent Care Deductible then 20% Deductible then 50% Emergency Room Deductible then 20% Prescription Drugs Out-of-Pocket Maximum*: Individual Out-of-Pocket Maximum*: Family Deductible then: Retail: $10 /$60 / $80 Mail-Order: $30 / $180 / $240 Deductible then 50% after copays $6,000 $30,000 $12,000 $60,000 *Out-of-Pocket Maximum includes all medical and Rx costs/ copays. 17
BlueSaver PPO Qualified High Deductible Health Plan BlueSelect Plus In-Network Out-of-Network Embedded Deductible: Individual Deductible: Family $2,600 $5,200 $5,200 $10,400 Coinsurance (your share): 20% 50% Inpatient or Outpatient Services Deductible then 20% Deductible then 50% Radiology, Hi-Tech Scans Deductible then 20% Deductible then 50% Office Visits Deductible then 20% Deductible then 50% Urgent Care Deductible then 20% Deductible then 50% Emergency Room Deductible then 20% Prescription Drugs Deductible then: Retail: $10 /$60 / $80 Mail-Order: $30 / $180 / $240 Deductible then 50% after copays Out-of-Pocket Maximum*: Individual $4,000 $20,000 Out-of-Pocket Maximum*: Family *Out-of-Pocket Maximum includes all medical and Rx costs/ copays. $8,000 $40,000 18
BlueSaver PPO Qualified High Deductible Health Plan Preferred-Care Blue In-Network Out-of-Network Embedded Deductible: Individual $2,600 Deductible: Family $5,200 Coinsurance (your share): 20% 40% Inpatient or Outpatient Services Deductible then 20% Deductible then 40% Radiology, Hi-Tech Scans Deductible then 20% Deductible then 40% Office Visits Deductible then 20% Deductible then 40% Urgent Care Deductible then 20% Deductible then 40% Emergency Room Deductible then 20% Prescription Drugs Deductible then: Retail: $10 /$60 / $80 Mail-Order: $30 / $180 / $240 Deductible then 50% after copays Out-of-Pocket Maximum*: Individual Out-of-Pocket Maximum*: Family $4,000 $8,000 $8,000 $16,000 *Out-of-Pocket Maximum includes all medical and Rx costs/ copays. 19
Claim Flow Example 1 2 3 4 Full cost of a doctor visit is $140 Blue KC has negotiated a fee of $65 using network doctors You pay nothing at the visit* Your doctor sends a bill for $140 to your home, but you don t pay it 5 You receive the Explanation of Benefits (EOB) from Blue KC indicating that you owe $65 6 You pay your doctor $65 (this amount goes towards your deductible) *At your physician s discretion 20
Prescription Flow Example 1 2 3 4 Allergy Medication $150 Blue KC has negotiated a fee of $135 using network Pharmacies (CVS, Wal-Mart, Target, Walgreens). You pay $135 at the pharmacy. $135 goes towards your deductible. 5 After you MEET your deductible; prescriptions are covered at 100 percent. Always show your Blue KC member ID card at the pharmacy Prescription Drugs are credited to your deductible at the time of your purchase 21
What is an HSA? A Health Savings Account (HSA) that can help you manage your expenses today and in the future. It s yours to: Own. The HSA is always yours, even if you change jobs, re-enroll in one of the Traditional HMO or PPO plans, become unemployed or retire. Grow. Your unused balance rolls over from year to year. Save. HSA s provide tax-free contributions and tax-free withdrawals and tax-free earnings from investment options. Choose. Use for current expenses, save for the future or explore investment options. 22
HSA Eligibility You must be covered by the $2,600 High Deductible Health Plan (HDHP); You cannot have any other coverage such as: A plan that is not an HSA-qualified HDHP Spouse s plan that is not a HDHP Medicare or Medicaid Tricare Coverage (military health care) Health Flexible Spending Account (FSA not to include the District s Limited Flexible Spending Account) Health Reimbursement Arrangement (HRA) You cannot be claimed as a dependent on someone else s tax return. It is the accountholder s responsibility to maintain compliance under these regulations. 23
HSA Contributions Money may be contributed to your HSA by you, or anyone else, as long as the total doesn t exceed the IRS annual maximum: 2017 Max: $3,400 individual -- $6,750 family 2018 max: 3,450 individual -- $6,900 family Catch up contribution of an additional $1,000 if 55 years of age or older. No expenses may be reimbursed for services incurred before the HSA is set up, regardless of when the QHDP was effective. 24
HSA Qualified Expenses Use the HSA funds to pay for IRS qualified medical expenses permitted under Federal Tax law including: Medical out-of-pocket expenses Dental treatments Hearing aids including batteries Prescription drugs Eye exams, eyeglasses, and contact lenses Chiropractic Care and Acupuncture Premiums for qualified long term care insurance and COBRA Medicare premiums Health plan coverage while receiving Federal or State unemployment benefits Pay for expenses for yourself and your spouse or tax dependents (even if they are not covered by your health plan) 25
Health Savings Accounts (HSAs) Maximize Your Tax Savings Three Ways to Maximize Your Tax Savings 1 2 3 Contributions to an HSA are tax-free (they can be made through payroll deduction on a pretax basis when you open an account with UMB). As long as the funds are used to pay for qualified medical expenses, they are spent tax-free. The money in this account (including interest and investment earnings) grows tax-free. 26
Withdrawing Funds from Your UMB HSA Use your UMB Blue KC branded HSA Visa debit card Conveniently pay for qualified expenses directly from your HSA. Allow medical providers to submit your claims to Blue KC before you use your card so that you receive the Blue KC negotiated pricing and discounts and so the claim will go towards your deductible. Prescription drugs are priced at the time of receipt so your discounted out of pocket liability is known immediately. Reimburse yourself for expenses made with another form of payment or use bill pay to pay the bill from your provider. UMB s online reimbursement transfer and bill pay tools (no fee) No time limit to reimburse yourself Expenses must be incurred AFTER your HSA is set up Withdrawals can only be made AFTER money is deposited into your account. 27
General Information
KEY DIFFERENCES (IN-NETWORK) Traditional PPO Preferred-Care Blue BSP QHDHP $3,500 BSP - QHDHP $2,600 PCB QHDHP $2,600 HSA Eligible? NO YES YES YES Deductible $500 indv / $1,000 fam $3,500 indv / $7,000 fam $2,600 indv / $5,200 fam $2,600 indv / $5,200 fam Coinsurance Member pays: 20% BlueKC pays: 80% Member pays: 20% BlueKC pays: 80% Member pays: 20% BlueKC pays: 80% Member pays: 20% BlueKC pays: 80% Out-of Pocket Maximum* $4,500 indv / $9,000 fam $6,000 indv / $12,000 fam $4,000 indv / $8,000 fam $4,000 indv / $8,000 fam Office Visits PCP: $35 copay Specialist: $70 copay Deductible then 20% Deductible then 20% Deductible then 20% Telehealth $39 copay $39 charge $39 charge $39 charge Preventive Care 0% 0% 0% 0% Routine Vision Care $35 copay Deductible then 20% Deductible then 20% Deductible then 20% Inpatient Outpatient Hospital Services Deductible then 20% Deductible then 20% Deductible then 20% Deductible then 20% MRI, CT, PET Scans Deductible then 20% Deductible then 20% Deductible then 20% Deductible then 20% Urgent Care $70 copay Deductible then 20% Deductible then 20% Deductible then 20% Emergency Room $150 copay then deductible then 20% Deductible then 20% Deductible then 20% Deductible then 20% Prescription Drugs Retail: $10 / $60/ $80 Mail-Order: $30/$180/$240 Deductible then: Retail: $10 / $60/ $80 Mail-Order: $30/$180/$240 Deductible then: Retail: $10 / $60/ $80 Mail-Order: $30/$180/$240 Deductible then: Retail: $10 / $60/ $80 Mail-Order: $30/$180/$240 2016 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. *Out-of-Pocket Maximum: The amount members pay each year toward covered services before Blue KC pays 100% of benefits. This includes total of deductible, coinsurance, office visit copays and Rx drugs. 29
Which Plan is Right for Me? What services and medications do you expect to use? Review past Explanation of Benefits (EOB s) Talk to your providers and pharmacists Price your prescription drugs Run the numbers Compare premium deductions Annualize the premium Premiums are deducted pre-tax; so are HSA contributions Your personal situation Do you have money saved (or can you save) to pay for medical expenses? Do you want predictable costs? Are you looking for greater tax benefits? What is your risk tolerance? Are you a record keeper? Are you a saver? Are you covering your spouse and/or dependents? Are you considering retirement or eligible for Medicare? 2016 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 30
Qualifying Event Changes Unless you have a qualified status change, you cannot make changes to elected benefits until next enrollment period. Qualifying Events: birth of a child, adoption, marriage, death, divorce, loss of coverage (if you or your spouse/dependents are covered under another plan and then lose that coverage). You have 31 days from event to notify HR and complete/submit appropriate paperwork. Otherwise you will have to wait until the next annual enrollment to make changes. Adding a Newborn (Single Coverage or currently covering Dependents) Request coverage within 31 days following the birth The baby WILL NOT be automatically enrolled for you After you complete the enrollment request, the child will be added retroactive to his/her birth date Additional premiums may apply 31
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