Wyandotte High School

1. Wyandotte High School Health Insurance Plans

2. Health Insurance Plans • HMO (Health Maintenance Organization) • Select a Primary Care Physician (PCP) • No Referral for Network Specialist • In-Network Only • PPO (Preferred Provider Organization) • Freedom of Choice – You select your Primary Care Physician • In and Out of Network /National and International Coverage • Consumer Driven Health Plan - • QHDHP (Qualified High Deductible Health Plan) • In and Out-of Network /National and International Coverage • Employee Owned Health Savings or Personal Care Account • HSA or PCA to Pay for Medical, Drug, Vision, & Dental Expenses

3. Medical Plans Con’t • HMO (Health Maintenance Organization) - a plan prepaid by an individual or by a company for its employees, that provides treatment, preventive care, and hospitalization to each participating member • PPO (Preferred Provider Organization) -a comprehensive health plan offered to employees that allows them to choose their own physicians and hospitals within certain limits. • CDHP (Consumer Driven Health Plan) must be tied to a tax-exempt health savings account (HSA) or health reimbursement account (HRA), in which you or your employer deposit money to use for medical expenses. The HSA is used by the employee to pay medical expenses on a pre-tax basis

4. Health Care Definitions • Deductible - The amount for which the insured is liable for before an insurance company will make payment. First responsibility in a calendar year • Coinsurance - A cost-sharing agreement between the insured and the insurer under a health policy which pays a percentage of the covered costs after the deductible has been paid. at the time the service is rendered. • Out of pocket maximum - The most you will have to pay in a year for deductibles and coinsurance for covered benefits. • Copay - The amount an insured person is expected to pay for a medical expense at the time of the visit. A flat fee charge regardless of services rendered (Example: $20) • Pre-existing Condition- a health condition (other than a pregnancy) or medical problem that was diagnosed or treated before enrollment in a new health plan or insurance policy; also written pre-existing condition. On the PPO plan - Pre-existing Exclusion Period does not apply to children under age 19. • Basic Coverage Limit- Lowest amount of coverage for which an insurance policy can be written, as prescribed in the insurance legislation or as set by the insurance company.

5. Before We Get Started…. • Health Care Reform What’s covered now? And what’s covered in the future? • Dependents are covered to the end of the calendar year they turn 26 regardless of student status • 100% Coverage on Preventive Care • Network and Non-network Emergency Services paid the same • Unlimited Lifetime Maximum • On the PPO plan - Pre-existing Exclusion Period does not apply to children under age 19 • No Calendar Year Maximum on DME (Durable Medical Equipment) • Unlimited Lifetime Maximum on Organ Transplants • BlueKC.com will provide current information and Frequently Asked Questions

6. HMO

7. Traditional HMO Plan Blue-Care Blue www.BlueKC.com St. Luke’s Hospitals ARE NOT in the Blue-Care network Centerpoint Medical Center Children’s Mercy Hospitals KU Medical Center Lee’s Summit Hospital Menorah Medical Center North Kansas City Olathe Medical Center Overland Park Regional Providence Medical Center Research Medical Center Shawnee Mission Medical Cente

8. PPO

9. Preferred-Care Blue (PPO) • 53 Metro Area Hospitals Including: Liberty, St. Joseph, St. Mary’s and Truman Hospitals are not in the Preferred-Care Blue Network

10. Urgent Care Receive care for non-life threatening conditions. You are responsible for the copay when using Urgent Care Facilities Use Walgreen Take-Care Centers or CVS Minute Clinics If you are outside of the service area, contact your Primary Care Provider prior to treatment. – (HMO Plan Only) Emergency Care Go to the nearest Emergency Room or call “911”. Receive treatment and pay the copay. Contact your PCP – within 48 hours (or as soon as reasonably possible) after you receive medical attention. Urgent Care and Emergency Care

11. Travel with Your PPO Health Plans As a Member, you can take your healthcare benefits with you across the country and around the world. The PPO Program gives you access to over 6,000 hospitals and 800,000 physicians around the country, giving you the peace of mind that you can take charge of your health, wherever you are. Visit our website at www.bluekc.com click Find BlueKC Doctors, Hospitals and Pharmacies, clickBlueCard Provider Directory, click Continue. Login using the ID number on the front of your BCBSKC ID Card. or call (800) 810-BLUE (2583) to receive a complete list of network hospitals and physicians.

12. Prescription Drugs

13. Routine Preventive Care

14. What Can I Do? Use Urgent Care Centers/Take-Care Facilities Always Use Network Providers Annual Preventive Exams Traveling? Do your homework. Find a network provider in that area. Take Medication as Prescribed by Physician or according to Manufacturers Guidelines Ask your doctor for prescription drug samples Ask your Doctor or Pharmacist if there is a generic substitute for a name brand prescription Consider Your Overall Health ..diet, exercise, personal habits… Not sure? Ask Questions!

15. Questions & Answers Thank you!