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Welcome. Annual Enrollment. Health Care Coverage For You and Your Family A&M Care Plan. What’s New for 9/1/2013 Plan Year. No changes to the A&M Care Plan or 65 Plus Plan Integrated Provider Finder 365 Discount Program Well on Target Portal. PPO Features A&M Care Plan.
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Welcome Annual Enrollment Health Care CoverageFor YouandYour Family A&M Care Plan
What’s New for 9/1/2013 Plan Year No changes to the A&M Care Plan or 65 Plus Plan Integrated Provider Finder 365 Discount Program Well on Target Portal
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
Available More Hospitals and Doctors For a current listing of all providers see our website at: www.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
Preventive Coverage Stay Healthy by Getting Regular Check-ups $50.00 deductible credit for all members and dependents who complete an annual physical 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
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 theNetwork 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 with a spouse, if covered age 65 and older (or disabled) and enrolled in Medicare Parts A&B • Working for the A&M System, if at all, less than 50% time for less than 4.5 months during the plan year
Other Programs and Services
Condition and Decision Support If you have a chroniccondition, we offer support • Blue Care Advisors – clinical professionals– can help you manage chronic health conditions like: • 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.
Tobacco Cessation and Weight Management Programs • Self-Paced Approach • Online program and resources available • Secure e-mail outreach to keep members on track • Lifestyle Management Support • Counseling and coaching with licensed Wellness Coaches • 24/7 Nurseline • Referrals when appropriate • Blue365® Discounts • Jenny Craig • Life Time Fitness • Davis Vision • Proctor& Gamble Dental Products
Making wellness simpler, more affordable and more accessible for members Register online at blue365deals.com/BCBSTX/ Under the My Coverage tab
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 Explanation of 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, 24/7 Nurseline • … and more • Log and perform protected transactions 24 hours a day, 7 days a week* 14
Blue Access Homepage Access Provider Finder to locate doctors & hospitals My Health tab links you to health and wellness content, articles, videos, and My Care Profile My Coverage includes benefit highlights, spending accounts, as well as deductibles and out-of-pocket and copay summaries for Medical, 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
Our new wellness is for EVERYONE Introducing More robust, completely integrated A new way to experience wellness • Health Assessment • Self Directed Courses • Trackers and Tools • Health and Wellness Content • Food and Exercise Diary • Life Points Reward • Fitness Program • Dedicated Coach Page
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 www.bcbstx.com Know Your RisksManage Your Health Examines the member’s overall health and wellbeing and provides a personalized report showing areas where you can improve Complete all topics under the HA and receive a $50.00 deductible credit for members and dependents ages 18 and over
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)
Benefits Value Advisor BCBSTX wants to help you maximize your benefits and plan for your health care • Now you can speak to a BCBSTX Benefits Value Advisor who helps you find quality providers for health care services such as: • CAT, CT scans or MRIs • Hip or joint replacement • Colonoscopy or endoscopy procedures • Back, knee, shoulder, spinal or bariatric surgery • Benefits Value Advisors can also help you plan for your health care: • Helping you understand your benefits • Providing a cost estimate for health services • Scheduling a doctor or procedure appointments • To reach a Benefits Value Advisor, call your customer service number on the back of your ID card 1-866-295-1212
The NEW Integrated Provider Finder® • Online provider search engine and care decision support tool bcbstx.com 20 • Combines realmember cost, quality, patient experience, and advanced demographics information in one easy-to-use site. • BlueCard® PPO cost & quality data integrates with real-time benefits information to deliver an accuratepicture of member share • Retail experience with responsive, easy-to-navigate web design with multiple access points • Available to members and non-members*
What if I Have Questions • Personalized Service 8 am – 8 pm • Our Philosophy – “Take the Member Out of the Middle” • Call your dedicated customer serviceteam for: • Benefit information • Network provider information • Membership and eligibility • Inquiries (telephone and e-mail) • ID card requests • Claims inquiries • Help with online tools 866-295-1212 Toll-free Customer Service