MIIA - Blue Cross Blue Shield Proposed Benefits

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MIIA - Blue Cross Blue Shield Proposed Benefits

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Title: MIIA - Blue Cross Blue Shield Proposed Benefits


1
MIIA - Blue Cross Blue Shield Proposed Benefits
2
Plan Offerings
  • HMO Blue New England (HMO)
  • Blue Care Elect Preferred (PPO)

3
HMO Blue New England HMO Blue
  • Use HMO Blue Network Providers
  • PCP Required Change Anytime
  • Referrals To Network Specialists
  • No Referrals For OB/GYN Care, Chiropractic
    Care, Outpatient Behavioral Health Visits,
    Routine Vision Exam, Emergency Or Out-Of-Area
    Urgent Care

3
4
Blue Care Elect Preferred (PPO)
  • No Primary Care Physician Needed
  • No Referrals Needed For Specialty Care
  • National Network Ability to have services
    rendered out of state at the same out of pocket
    cost as HMO members

5
Find A Blue Cross Network Provider
  • Visit www.bluecrossma.com
  • Call Physician Selection Service 1-800-821-1388
  • Ask Your Providers If They Are In The HMO Blue
    Network

6
Proposed Changes
  • Addition of a plan year deductible for some
    services - 250 Per Individual, 750 Per Family
  • Primary Care Physician Office Visits
  • Specialist Office Visits
  • Emergency Room Visits
  • MRI, CT and PET Scans
  • Prescription Drugs

7
Services That Are Not Subject to the Deductible
  • SERVICES THAT ARE NOT SUBJECT TO DEDUCTIBLE
  • Preventive Visits, Related Tests Immunizations
    You Pay 0 (no change)
  • Diagnostic PCP, OB/GYN, Nurse Practitioner
    Visits You Pay 20 (today you pay 10 to 20
    per visit)
  • Mental Health Office Visits You Pay 15 (today
    you pay 10)
  • Other Professional Providers Specialist Visits
    You Pay 35. (today you pay 25)
  • Prescription Drugs You Pay 10/25/50 for a 30
    day supply, 20/50/110 through Mail Service.
    (today you have a 10/20/40 for retail, 20/40/90
    mail.)
  • Chiropractic Visits You pay 20 (today you pay
    15)
  • Short Term Rehabilitation Therapy You Pay 20
    (today you pay 15)
  • Speech, hearing, and language disorder treatment
    You Pay 20 (today you pay 15)

7
8
Services Subject To The Deductible
  • After You Pay 250/750. Plan Year Deductible,
    Then
  • Diagnostic Labs, X-Rays Other Tests You Pay
    0 (today you have no deductible)
  • CT, Pet Scans and MRI - 100 per category of
    tests ( today you pay 0 with no deductible)
  • Emergency Room You Pay 100 (today you pay 100
    with no deductible).
  • Inpatient Admissions You Pay 300 at a lower
    cost hospital, 700 at a higher cost hospital.
    (today you pay 200 for Lower cost hospitals and
    400 for higher cost hospital with no deductible)
  • Surgical Day Care You Pay 150 per admission
    after deductible (today you pay 150 and have no
    deductible)
  • Hospice and Home Health Care - 0 after
    deductible (today you pay nothing with no
    deductible)
  • Durable Medical Equipment You Pay 0 after
    Deductible (today you pay 0 with no deductible)
  • Prosthetic Devices You pay Nothing after
    deductible (today you pay 20 co-insurance)

8
9
Why Change?
  • Benefits will not change for a period agreed upon
    by management and labor)
  • No hidden out of pocket costs
  • No off anniversary rates increases
  • Deductible is plan year not calendar year

10
Out-Of-Pocket Maximum
  • Current Plan
  • 600 Enhanced Tier admission out of pocket
    maximum
  • 1200 out of pocket maximum for Standard or basic
    tier admission
  • 300. out of pocket maximum for Surgical Day Care
    Admissions.
  • New Plan
  • 1200 out of pocket maximum for all inpatient
    admissions
  • 600 out of pocket maximum for surgical day care
    admissions

11
Healthy Living
  • 150 Fitness Benefit
  • 150 Weight Loss Benefit
  • Childbirth Class Benefit
  • Living Healthy Babies
  • Blue Care Line 1-888-247-BLUE (2583)
  • Living Healthy Vision Discounts
  • Living Healthy Naturally Discounts
  • Safe Beginnings Discounts

12
Member Central Account
  • Visit www.bluecrossma.com
  • Create An Online Account, Then You Can
  • Change Your PCP
  • Request An ID Card
  • Review Your Plan Benefits
  • Review Your Claims
  • Track Your Deductible Coinsurance
  • Enroll In My Blue Health

13
Questions?
  • For Provider Information Or Questions
  • On Your Membership, Benefits, Referrals Or Claims
  • Call Member Service Toll-free Number On ID Card
  • Monday - Friday, 8 a.m. - 6 p.m.
  • Or Visit www.bluecrossma.com