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PPO Features A&M Care Plan

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

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PPO Features A&M Care Plan

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  1. 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 • Receive lower level of benefits and can be balanced billed • Worldwide coverage for emergency and non-emergency care

  2. What’s New? Effective 9/1/2014 for A&M Care Plan

  3. Available More Hospitals and Doctors For a current listing of all providers see our website at: bcbstx.com Offers names, addresses, map and directions. For World Wide Assistance Call 1-800-810-BLUE (2583)Or Collect 1-804-673-1177 In-network coverage is available when traveling or living worldwide 24 Hours a Day, Seven Days a Week

  4. Your BlueChoice PPO Benefits

  5. Preventive Coverage Stay Healthy by Getting Regular Check-ups Get an annual physical and reduce your monthly premium! Remember:Lab tests related to an illness or condition are not considered preventive and may pay differently What’s covered? Recommended routine gender- and age-specific preventive care, such as annual physical, OB/GYN exams, mammograms and other cancer screenings, well-child care and immunizations– both facility and professional services Preventive coverage provided in-network at 100% with no copay, no deductible

  6. 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. Retiree Information Retirees under age 65 Areconsidered Networkand can 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 • Working for the A&M System, if at all, less than 50% time or for less than 4.5 months during the plan year • If covering a spouse, spouse must be age 65 or older (or disabled) and enrolled in Medicare Parts A&B

  7. Retiree Coordination of Benefits

  8. Benefits Value Advisor Sameprocedure,lowercost1 1. Benefits Value Advisors offer cost estimates for various providers, facilities and procedures. Lower pricing and cost savings are dependent on the provider or facility of your choosing. • Now you can speak to a BCBSTX Benefits Value Advisor who helps you find quality providers for health care servicessuch as: • Imaging services (X-rays/MRIs/CT scans) • Maternity services • Joint replacement surgery • Back surgery • Benefits Value Advisors can also help you planfor your health care by: • Helping you understand your benefits • Finding in-network providers • Scheduling visits • Requesting preauthorization • Helping you access online educational tools

  9. Benefits Value Advisor Cost comparison for an MRI at two different providers: Costs can vary by $2,000 for the same procedure depending on where you go!* One call can result in big savings! Just call the number on the back of your member ID card to reach a Benefits Value Advisor. *Example cost data from Tarrant county. Member communications and information from Benefits Value Advisors are not meant to replace the advice of health care professionals. Members are encouraged to seek the advice of their doctors to discuss their health care needs. Decisions regarding course and place of treatment remain with the member and his or her health care providers. Cost estimates are just an estimate. In addition to your usual deductibles, copayments and/or coinsurance, the actual cost of the services may vary based on a number of factors including the date of service, the actual procedure performed and what services were billed by the provider and your particular benefit plan. Coverage is subject to the limitations and exclusions of your plan.

  10. Condition Management If you have a chroniccondition, we offer support • Blue Care®Advisors – clinical professionals– can help you manage chronic health conditions such as: • Asthma, coronary disease, diabetes, COPD or low back pain • 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.

  11. Lifestyle Management Support • Other Resources • Counseling and coaching with licensed Wellness Coaches • 24/7 Nurseline • Well onTarget® • Blue 365® • Referrals when appropriate • Jenny Craig® • Life Time Fitness® • Proctor & Gamble Dental Products • Vision Plans • And more… • Tobacco Cessation and Weight Management Programs • Personal telephone coaching • Secure email outreach • Self-paced online courses • Tobacco cessation resources • Weight management resources

  12. 24/7 Nurseline

  13. A New Way to Experience Wellness Access Well onTarget by logging in to Blue Access for Members and get support to make healthy choices • Health Assessment (HA) • Self-Paced Courses • Trackers • Food and Exercise Diary • Health and Wellness Content • Fitness Program • ComplementaryandAlternative Medicine

  14. Making wellness simpler, more affordable and more accessible for members Register online at blue365deals.com/BCBSTX/ Under theMy Coverage tab

  15. Blue Access for MEMBERSSM • Save time with self-service support tools and health and wellness resources on a convenient and secure online site • Check claims and claims history • View, save or print Explanationof Benefits (EOBs) • Sign up for electronic EOBs, and turn off paper • View benefits and covered dependents • Check coverage details • Manage mobile and texting preferences • Request new ID cards or print temporary ID cards • Access health and wellness information and guides • Get details on wellness, discounts… and more

  16. Blue Access Homepage Access Provider Finder®to locate doctors, specialists, facilities, directions and Blue Distinction Centers® My Health tab links you to health and wellness content, articles, videos, and My Care Profile My Coverage shows who’s covered on your plan, YTD spending for each family member, cost estimator, deductible discounts and ID card request. From My Coverage page, click on Incentives, then Visit Site to view completed activities so you can make sure that your Wellness Exam Incentive has been recorded. Quick Links for easy access to Health Assessment, Fitness Program, Member Discounts, or to get an ID card Form Finder easier to view and find specific forms for members My Claim Activity displays recent claims, or go to the Claims Center for all your claim details

  17. Health AssessmentPowerful Health and Wellness Tool • User-friendly health assessment tool • Personal Health Assessment designed to be completed in 10 to 15 minutes • Choose your assessment topic, such as health and wellbeing or fitness and physical activity • All topics must be completed to receive credit Know Your RisksManage Your Health Examines the member’s overall health and wellbeing and provides a personalized report showing areas where you can improve bcbstx.com Complete all topics under the HA and receive a $50deductible credit for members and dependents ages 18 and over

  18. Blue Access MobileSMOverview Current Mobile Offerings • Mobile Web (public) • Blue Access for MembersSM (secure) • Text Messaging (static and dynamic) • Provider Finder® App (iPhone and Android) 20

  19. Provider Finder® puts you in charge bcbstx.com Use Provider Finder to: • Find a network primary care physician, specialist or hospital • Search results by doctor, specialty, ZIP code, language and gender – even get directions from Google Maps™ • Estimate the cost of a provider’s procedures, treatments and tests • Determine if a Blue Distinction Center for Specialty Care® is an option for treatment • View patient feedback or add your review for a provider • View quality, certifications and recognitions for doctors

  20. What if I Have Questions • Personalized Service 8 am – 8 pm • 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 email) • ID card requests • Claims inquiries • Help with online tools 866-295-1212 Toll-free Customer Service

  21. Your ID Card • Need Assistance? • Call the Customer Service number on the back of the ID card to: • Ask about benefits and claims • Talk to a Benefits Value Advisor (BVA) to locate facilities for MRIs, CTs, maternity services, hip/knee/spine surgeries, and more

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