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HMO Blue New England Options v.4 Deductible Plan

HMO Blue New England Options v.4 Deductible Plan.

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HMO Blue New England Options v.4 Deductible Plan

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  1. HMO Blue New England Options v.4 Deductible Plan This health plan includes a tiered provider network called HMO Blue New England Options v.4. Members in this plan pay different levels of cost share (copayments, coinsurance, and/or deductibles) depending on the benefits tier of the provider furnishing the services. A provider’s benefits tier may change. Overall changes to the benefits tiers of providers will happen no more than once each calendar year. For help in finding the benefits tier of a provider, visit the online provider search tool at www.bluecrossma.com and search for HMO Blue New England Options v.4.

  2. HMO Blue NE Options v.4 Deductible Plan Use HMO Blue New England Network Providers Choose PCP - Change Effective 1st of Month Referrals to Network Specialists No Referrals For: OB/GYN, Chiropractic or Outpatient Behavioral Health Visits, Routine Vision Exam, Emergency or Out-of-Area Urgent Care 2

  3. HMO Blue NE Options v.4 Deductible Plan • Supports Our Promise to Put Our Members’ Health First • Provides Cost Share Incentives to Encourage Use of High-Quality, Lower-Cost Providers • Plan Design Encourages You to Become More Engaged in Making Health Care Decisions • You Can Control What You Pay For PCP Visits & Hospital Services

  4. HMO Blue NE Options v.4 Deductible Plan PCPs & General Hospitals in Massachusetts Network* Ranked in 3 Benefit Tiers: • Enhanced - Hospitals and PCPs that meet the standards for quality and low cost. - You Pay Lowest Cost Share • Standard - Hospitals and PCPs that meet the standards for quality and moderate cost. Hospitals that do not meet the standards for quality but meet the standards for low or moderate cost.  - You Pay Standard Cost Share • Basic - Scored Below Benchmarks For Quality and/or Moderate Cost - You Pay Highest Cost Share *Providers in NH, ME, VT, RI & CT Covered as Enhanced

  5. Find Your Providers’ Tiers • Go to Blue Options Resource Center at www.bluecrossma.com/blueoptions/or Call Member Service - Find Provider’s Tier - Find How Provider Scored on Each Benchmark - Find PCP’s Hospital Affiliations

  6. Preventive Visits Preventive Visits, Related Tests & Immunizations Covered in Full – No Copayment! • Well-Child Care Visits • Routine Adult Physical Exams • Routine GYN Exams • Routine Vision Exams • Routine Hearing Exams • Family Planning Services - Office Visits

  7. Tiered Benefits • PCP Office Visits - $15/$25/$50 • Plan-Year Deductible (General Hospital Services Only) - Enhanced Hospitals: No Deductible - Standard Hospitals: $500/$1,000 - Basic Hospitals: $2,000/$4,000

  8. General Hospital Benefits • General Hospital Inpatient & Surgical Day Care Admissions - $150/$150*/$1,000* • Emergency Room Visits/Admissions: $150 (Any Hospital) • General Hospital Outpatient MRIs, Nuclear Cardiac Imaging Tests, PET & CT Scans - $50/$50*/$450* * After Deductible

  9. General Hospital Benefits • General Hospital Outpatient Chemotherapy, Radiation Therapy & Dialysis - Nothing/Nothing/Nothing (No Deductible) • General Hospital Outpatient Physical, Occupational, Speech Therapy & Cardiac Rehabilitation - $50/$50/$50 (No Deductible) • Other General Hospital Tests & Medical Visits - Nothing/Nothing*/Nothing* * After Deductible

  10. Other Services Not Tiered • Outpatient Behavioral Health Visits: $15 • All Other Outpatient Professional Providers’ & Specialists’ Visits: $50 • Outpatient MRIs, Nuclear Cardiac Imaging Tests, PET & CT Scans (At Other Than a General Hospital): $50 • Day Surgery at an Ambulatory Surgical Facility (At Other Than a General Hospital): $150

  11. Other Services Not Tiered • Inpatient Admissions to Chronic Disease, Mental Health & Substance Abuse Treatment Hospitals: $150 • Retail Rx: $15/$30/$50 • Mail Service Rx: $30/$60/$150 • All Other Services Covered in Full

  12. Out-of-Pocket Maximum $5,000/$10,000 Plan-Year Out-of-Pocket Maximum Includes: • Deductible • Copayments Over $100 (Except Rx)

  13. Considerations • PCP’s Tier • Covering PCP’s Tier • PCP’s Hospital Affiliations • Hospitals Used by Specialists to Whom PCP Refers • Go to www.bluecrossma.com/blueoptions/ or Call Member Service to find a new PCP

  14. Healthier Living • $150 Fitness Benefit • $150 Weight Loss Benefit • Living Healthy Babies! • Childbirth Class Benefit • Blue Care Line: 1-888-247-BLUE (2583) • Blue365 – Health & Wellness Resources/Discounts • Living Healthy Vision Discounts • Living Healthy Naturally Discounts • Safe Beginnings Discounts

  15. Member Central Accountwww.bluecrossma.com Create an Online Account, Then You Can: • Change Your PCP • Request an ID Card • Review Your Benefits • Review Your Claims • Enroll in My Blue Health

  16. Questions? For Provider Information or Questions About Membership, Benefits, Referrals or Claims Call Member Service Number on ID Card Monday - Friday, 8 a.m.- 6 p.m. or Visit www.bluecrossma.com

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