Post on 05-Dec-2014
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Middlebury College Health & Welfare Benefit Plan
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
Monterey2010 Employee Health/Dental/FSA PlanOpen Enrollment
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Today’s Presentation:
Today we’ll provide a brief introduction to CBA Blue and review:
- What’s new.
- High level review of your plans.
- The current open enrollment period.
- What you should expect next.
- What may be required of you.
We’ll save time for a question and answer session
at the conclusion of the meeting.
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
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Who is CBA Blue?
- CBA Blue is a Third Party Administrator located in South Burlington, Vermont.
- We are an affiliate of Blue Cross and Blue Shield of Vermont.
- We are your new Health, Dental, and FSA Plan Administrator effective January 1, 2010.
- We utilize the national BlueCard® network to provide our members access to inpatient, outpatient, and professional healthcare providers around the country.
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
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BlueCard® PPO Network
- BlueCard® is a national program that enables members of one Blue company to obtain healthcare services while traveling or living in another Blue company's service area.
- PPO Access in 50 states:
482,120 PCPs
828,414 Specialists
5,752 Hospital
- No Claim Forms
- No billing hassles
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
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What’s new?
- New Customer Service phone number
- New Claims Submission Address
- New Website – www.cbabluevt.com
- New Health Plan PPO Network – BlueCard®
- Plan Changes, we’ll review….
- New ID Card(s)
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
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Customer Service & Claims
New Customer Service information:
- Our hours of operation are M-F 8 am to 7 pm ET
(5 am to 4 pm PT)
- (888) 222-9206
- AT&T Language Line available.
- IVR system 7 days a week, 24 hours a day.
New Claims Submission address:
- CBA Blue
P.O. Box 2365
South Burlington, Vermont 05407-2365
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
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Website www.cbabluevt.com
From our Member Page you can:
Locate a Network Provider.
Register for secure member access to view your claim’s history, locate and print copies of your EOBs and view your plan details.
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
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Locate a Network Provider
Follow link from our Member Page, then:
Choose Guest Tab
Select PPO/EPO as your plan type , click continue.
Enter the city, state and radius you are willing to travel
Once you have your ID card, you will use the BlueCard® Provider Finder as a Member, by entering the first three alpha characters of your ID Number.
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
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High Level Health Plan Review
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
Benefit BlueCard® PPO Network
Deductible IndividualTwo-personFamily
$300$600$900
Out-of-Pocket Maximum IndividualTwo-personFamily
$1100$2200$3300
Employee Coinsurance 20%
Plan Coinsurance 80%
Office Visits (including services rendered at time of visit), Well Adult & Well Child Care, Outpatient Mental Health and Substance Abuse.
No Deductible, Plan Pays 80%
Member pays 20%
All other covered services (See Summary) Subject to Deductible, Then Plan Pays 80%
Member pays Deductible, Then 20% Until Out-of-Pocket Maximum is Satisfied
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Health Plan Pre-certification
© 2007 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
Your Health Plan Requires that the following
scheduled services are pre-certified prior to
delivery or within 48 hours after an emergency, or
Benefits may be reduced (call 1-800-204-5990):
- Inpatient Hospitalizations
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Care Management (Outreach)
© 2007 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
Your Health Plan also contains a nurse staffed
Confidential outbound coaching program called
HealthReach®. The program is designed to reach
out to high risk individuals and educate those
individuals on how to make better health decisions.
In this program, a Registered Nurse works one on
one with the member to identify and implement
important lifestyle and treatment modifications.
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Retail Prescription Benefits
Your prescription drug plan provides you access to
a pharmacy network managed for Middlebury
College by RESTAT. Retail (30 day) co-payments:
To locate a network pharmacy or access the
RESTAT formulary, go to www.restat.com .
Drug Category Co-payment
Generic $10
Preferred Brand $25
Non-Preferred Brand $40
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Mail Order Prescription Benefits
Your prescription drug plan provides you access to
a mail order program (90 day supply) managed for
Middlebury College by NEMOP:
To learn more about the Mail Order Program go to
www.nemoprx.com .
Drug Category Co-payment
Generic $20
Preferred Brand $50
Non-Preferred Brand $80
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Mail Order Split-Pill Incentive
With the split pill incentive program, you’re provided with pills/tablets that are double the prescribed dose. You receive 90 day supplies for one co-pay:
You will need to split the pill/tablet in half to receive the
correct dose. We will not send you any medication that
should not or cannot be split.
Drug Category Co-payment
Generic $10
Preferred Brand $25
Non-Preferred Brand $40
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Prescription Benefits
Your prescription drug includes an out-pocket-
maximum (including both retail and mail). Once met the
Plan will pay prescriptions at 100%.
• The Plan’s prescription program utilizes a Step Therapy Program.
In some cases the health plan may require that you have tried a
“first-step” drug, before approving a second-level drug.
Enrollment Level Maximum Out-of-Pocket
Individual $400
Two-Person $800
Family $1200
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High Level Dental Plan Review
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
Benefit
Calendar Year DeductibleApplies to Class 2, 3, & 4
$25 Per Individual
Class One: Diagnostic CareOral Exams, Cleanings, etc.
Plan Pays 100%
Class Two: Basic CareFillings, Periodontics, Extractions, Oral Surgery, X-rays, etc.
Plan Pays 80%
Class Three: Major CareDentures, Crowns, Bridges, Inlays, Onlays, Implants, etc.
Plan Pays 80%
Class Four: Orthodontic Care ($2000 per Member Lifetime Maximum)Study Models, Appliances, etc.
Plan Pays 80%
Calendar Year MaximumApplies to Class 1, 2, and 3
$2,000
Eligible Employees may elect to enroll in the
Middlebury College Flexible Spending Program (FSA).
• A Health Care Account allows you to save money from your paycheck on a tax-free basis to cover certain medical (including some OTC expenses) and dental expenses not otherwise covered by your health plan.
• A Dependent Care Account affords you tax-free savings to cover certain costs associated with providing your dependent care while you are at work.
Remember, estimate wisely, any money that is left unspent at
the end of the plan year is forfeited.
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Flexible Spending Accounts
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
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Flexible Spending Accounts
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
Category Without FSA With FSA
Gross Monthly Salary $2500.00 $2500.00
Qualifying Health Care Expenses $0.00 $200.00
Qualifying Dependent Care Expenses $0.00 $350.00
Total Qualifying Expenses $0.00 $550.00
Gross Taxable Income $2500.00 $1950.00
Income Tax @20% plus FICA @7.65% $691.25 $539.18
Net Spendable Income $1808.75 $1420.82
Post-Tax Health Care Expenses $200.00 $0.00
Post-Tax Dependent Care Expenses $350.00 $0.00
Total Post-Tax Expense $550.00 $0.00
Net Spendable Income $1258.75 $1410.82
Increase in Monthly Spending Income N/A $152.07
Increase in Annual Spending Income N/A $1824.84
Members who enroll in the Middlebury College Flexible
Spending Program will receive a Benefits Card. The
Card can be used at both healthcare and non-
healthcare merchants who have an industry standard
healthcare inventory approval (IIAS) system in place.
• A listing of IIAS merchants can be found at www.cbabluevt.com Remember to keep your receipts. For some expenses, we may need to verify the eligibility of the expense.
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Flexible Spending Accounts
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
How to use your card for medical/dental/OTC
expenses:
1. Prescriptions/OTC- present your medical ID card to the pharmacist first, next present your FSA card to pay the applicable co-payment at point-of-sale.
2. Medical- present only your medical card at time of service. Wait until you have received an Explanation of Benefits from CBA Blue and a balance forward statement from your physician. Make sure they match and then write your card number on the statement and remit as payment.
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Flexible Spending Accounts
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
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Open Enrollment
Now is the time to:
- Join the plan(s)!
- Change your current elections.
- Change your enrollment level (i.e. single to family).
- Add or delete dependents from your coverage.
* Should you wish to enroll or make changes, please complete your electronic enrollment process by November 15 to ensure new ID card delivery in time for January 1, 2010.
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What should I expect next?
Arriving in your mailbox soon….- New CBA Blue Medical/Dental Identification Card(s)
arriving prior to the 1st of January. Be sure to present your new card to your providers beginning Jan 1.
- New Mastercard® Benefits Card for those who enroll in FSA also arriving prior to the 1st of January.
- Remember, claims incurred prior to Jan 1. should be sent to your previous administrator…claims incurred Jan 1. and forward should be sent to CBA Blue.
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.
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Open Forum
Questions and Answers
© 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved.