Confidence comes with every card.

Healthy Blue LivingSM HMO

The plan that rewards healthy choices

Member Guide

Welcome back to Healthy Blue Living

Congratulations on beginning another year in our plan that helps

you stay or get healthy. Healthy Blue Living is one of only a few

health plans that focuses on your lifestyle choices and how they

affect your health and that rewards you with lower

out-of-pocket costs for living a healthy lifestyle.

Thank you for being a Healthy Blue Living member and making a

commitment to improving your health.

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Within the first

90 DAYSof plan year

Within the first

120 DAYSof plan year

See your doctor for a Blue Care Network Qualification Form visit*: After your appointment, your primary care physician will need to complete and electronically submit to us a qualification form that covers six health measures. If your results arent within the Healthy Blue Living wellness targets, work with your doctor to set goals to improve your health. See Page 2 to learn more about the six health measures.

Complete a health assessment*: Take an online health assessment by logging in to your account at bcbsm.com. If you dont have internet access, ask for a paper copy by calling 1-855-326-5098. See Page 4 for more details on the health assessment.

Join our tobacco-cessation program: If you use tobacco confirmed through your qualification form participation is required in this program until a new qualification form shows a negative cotinine test. See Page 4 for more information.

Join a BCN-sponsored weight-management program: If your qualification form shows you have a body mass index of 30 or more, youre required to enroll and participate at no extra cost in a BCN-sponsored weight-management program. See Page 5.

Being at the enhanced level is up to you

To stay at the enhanced level, which means everyone on your contract has lower out-of-pocket costs, you need to complete the following tasks within the first 90 and 120 days of your plan year. If you dont know when your plan year starts, talk to your employer. Or check your deadline dates by logging in to your member account at bcbsm.com; click My Coverage, then To-do List.

Healthy Blue Living requirements only apply to the enrollee (contract holder) of the plan. Dependents and covered spouses dont need to meet the requirements.

* If you scored all As on your qualification form, you may not need to complete another qualification form or health assessment this year. How often you must meet requirements varies by your age. See Page 3.

Blue Care Network is committed to helping you achieve your best health status. Rewards for participating in our wellness program, Healthy Blue Living, are available to all contract holders who meet all qualification requirements. If you think you might be unable to meet a standard or requirement for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. You can work with your BCN primary care physician to find an alternative thats right for you in light of your health status.

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The Blue Care Network Qualification Form

The qualification form helps you and your doctor get a snapshot of your health based on the six high-impact health measures below. Your primary care physician will electronically submit your qualification form after your appointment. You dont need to wait for the start of your plan year to see your primary care physician. Well accept a qualification form from an office visit occurring up to 180 days before your plan year begins.

To help you earn or stay at the enhanced level, score As and Bs on your qualification form. This means youre meeting the targets below or youve committed to treatment to improve a particular health measure.

6 health measures

* After one negative test, no testing is needed again. Self-reported tobacco users dont need the test.

** Consult with your Blue Care Network primary care physician before starting any regular exercise or weight-management program.

Even if you use tobacco or have a health condition such as diabetes, you can qualify for the enhanced level by following your doctors treatment plans and, if needed, participating in required BCN-sponsored programs.

Doesnt use (confirmed by primary care physician through blood or urine cotinine testing*)

Body mass index below 30

Below 140/90LDL-C below target (based on risk factors:

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The ABCs of your health

All As may change two rules for youYou dont need to complete a qualification form and health assessment every year if you scored all As on your most recent Healthy Blue Living health measures. Well send you a letter when its time to submit a new qualification form and health assessment.

Age Under 40 40 or older

How often Every three years Every two years

Each health measure on the Blue Care Network Qualification Form tracks your status using a simple A, B, C grading system.

If you score a C on any measure, everyone on your contract will be at the standard level.

Youre meeting the wellness target.

You have a health condition that might not be controlled, but youre participating in treatment to improve the condition.

Youre not meeting the wellness target and you havent committed to treatment to improve your condition.

A

B

C

Confirm that weve received your qualification form on time by:

Logging in to your account at bcbsm.com. Click My Coverage, then To-do List.

Calling the Customer Service number on the back of your BCN member ID card.

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Achieving a healthy lifestyle can be challenging. Thats why we provide valuable resources to help you reach your wellness goals. If you choose not to complete a requirement or participate in a required program, everyone on your contract will be placed at the standard level.

Health assessmentThe health assessment provides a picture of your health and helps you understand what steps you can take to improve or maintain it. Heres how to take the health assessment:

1. Log in to your member account at bcbsm.com.

2. Click on the Health & Wellness tab, which will take you to Blue Cross Health & Wellness, powered by WebMD Health Services.*

3. Click the Healthy Living tab.

4. Click Health Assessment.

The results of your health assessment will include:

A health score based on an analysis of your modifiable health risks

A list of your highest-risk areas

A Modifiable Risk Report and a Condition Risk Report

A list of the next steps you can take to improve your health

The assessment takes about 10 minutes to complete. You can take it before or after you see your primary care physician. To help you earn the enhanced level, complete the health assessment within the first 90 days of your plan year.

Note: If you dont have internet access, call 1-855-326-5098 to ask for a paper copy. Also, you must completely fill out the health assessment. Incomplete paper health assessments cant be processed.

* WebMD Health Services is an independent company supporting Blue Care Network by providing health and wellness services.

Working toward wellness

Tobacco useTobacco use is determined by a blood or urine test ordered by your primary care physician. Cotinine testing is required in the first year of enrollment. Once a negative test is received, we dont require it again.

To be at the enhanced level If your qualification form shows you use tobacco, you must enroll at no extra cost in Tobacco Cessation Coaching, powered by WebMD. Its a telephone-based program that includes five calls from a health coach over a 12-week period. If you arent ready to set a quit date within 30 days, youll be required to enroll in Lifestyle Coaching and participate until the end of your plan year or until you quit using tobacco. If this requirement applies to you, well send you a letter with more details and enrollment instructions.

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Weight managementTo be at the enhanced level If your qualification form shows your body mass index is 30 or more, youre required to enroll at no extra cost in one BCN-sponsored weight-management program within the first 120 days of your plan year. After we receive your qualification form showing your BMI is 30 or more, well mail you details about the programs and how to sign up for one. Or download the Healthy Blue Living weight-management guide at bcbsm.com/hblweight.

If your BMI is lower than 30, you can still participate in a weight-management program. We encourage members to be healthy, and you can participate at the member discount rate. See Page 7.

Auto renewal for a BCN-sponsored weight-management program If you were required to participate in a weight program in your previous plan year, and your qualification form still shows you have a BMI of 30 or more, you can continue in your program without re-selecting it. If you want to switch programs, you can call the Customer Service number on the back of your BCN ID card or log in to your account at bcbsm.com. Auto renewal applies only if you: 1) were compliant in the previous plan year; 2) are actively participating in a program; and 3) had your doctor submit an updated qualification form showing your BMI is still 30 or more.

DepressionDepression is one of the top causes of disability worldwide. People with depression are more likely to develop cardiovascular disease and diabetes.

A measurement tool is used to screen Healthy Blue Living members for depression. You can access mental health/substance abuse treatment services 24/7 by calling the number on the back of your BCN member ID card.

About your spouse or dependent

The enrollee (contract holder) of the plan is the only member on a contract who needs to complete the Healthy Blue Living requirements.

Even though covered spouses dont need to meet the requirements, they should still see their doctor regularly and take the health assessment to help them get or stay healthy. Make sure they select or have a primary care physician who participates with Blue Care Network.

BCN wont cover the cost of a weight-management program for covered spouses. However, they can still participate at the member discount rate through Blue365. See Page 7.

If your spouses primary coverage is Medicare, he or she cant be on your Healthy Blue Living contract. Individuals eligible for Medicare may be able to enroll in a Medicare product. Check with Medicare or your spouses employer for options.

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To keep or earn the enhanced level, check off these steps as you complete them. For more information, log in to your account at bcbsm.com or call the Customer Service number on the back of your BCN member ID card. Remember, some requirements are relaxed if you scored all As on your most recent qualification form. Refer to Page 3.

*If you have a tobacco-cessation or weight-management requirement, well send you a letter with enrollment steps.

Your Healthy Blue Living checklist

Within the first

90 DAYSof plan year

Within the first

120 DAYSof plan year

Visit your BCN primary care physician, and have him or her complete and electronically submit your Blue Care Network Qualification Form before the 91st day of your plan year.

Meet the six health measures or commit to your PCPs treatment plan to improve your health.

Complete your health assessment by logging in to your account at bcbsm.com. Or request a paper copy by calling 1-855-326-5098.

If you use tobacco, enroll and participate in our tobacco-cessation program.*

If your body mass index is 30 or more, participate in a BCN-sponsored weight-management program.*

Being on time can save you money

Many members drop to the standard level because they dont complete requirements on time. They have the same great plan, but with higher out-of-pocket costs.

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24-Hour Nurse Advice LineFor no extra cost, reach a registered nurse 24/7 toll-free at 1-855-624-5214 or 711 (TTY). A registered nurse can answer your health care questions, assess symptoms and provide self-care tips.

Digital Health AssistantSM programsAfter you complete your health assessment on the Blue Cross Health & Wellness site, youll receive recommendations for the Digital Health Assistant online coaching programs that are best for you. These include:

Conquer Stress

Eat Better

Enjoy Exercise

Lose Weight

Quit Tobacco

Feel Happier

The Digital Health Assistant programs help you set small, achievable goals that you commit to for one week. You can choose activities, create a plan and track your progress right on the Blue Cross Health & Wellness site.

Member discountsYou have access to national and Michigan-based discounts on a variety of health products and services from groceries and fitness gear to travel and gym memberships. Take advantage of these offers and more. To get started:

Log in to your member account at bcbsm.com.

Click Member Discounts with Blue365 on the right side of the page.

First-time visitors will need to verify information.

Informative publicationsWatch your mail in the spring and fall for our award-winning Good Health magazine. Its filled with health and wellness articles, recipes and health care coverage information.

For additional health and wellness information online, follow us at facebook.com/MiBCN and AHealthierMichigan.org.

Outstanding customer serviceOur dedicated Customer Service representatives are trained to answer your health plan questions and are just a toll-free phone call away. Call the number on the back of your BCN member ID card.

Wellness resources to help you succeed

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How do I find out the 90th and 120th day of my plan year for the requirements?If you dont know when your plan year begins, talk to your employer. Your to-do list in your online member account also shows your deadline dates for the Healthy Blue Living plan requirements; log in as a member at bcbsm.com, click My Coverage, then click To-do List.

For example: If your plan year begins on January 1, then your 90-day requirements would be due by March 31, and your 120-day requirements would be due by April 30.

I misplaced the Blue Care Network Member Handbook I got in the mail when I enrolled. How can I get another one? Request a copy by calling the Customer Service number on the back of your Blue Care Network ID card.

My plan year is about to start. How soon can I go to my doctor for my qualification form visit? You dont need to wait for the start of your plan year. Well accept a qualification form from an office visit occurring up to 180 days before your plan year begins.

How long will it take to fill out the health assessment online? It usually takes about 10 minutes to complete. If you dont have internet access, ask for a paper copy by calling 1-855-326-5098.

Why should I take a paper copy to my appointment if my doctor must submit the qualification form electronically?We provide a paper qualification form only as a sample of the information your doctor submits electronically. It may be helpful for you to take this with you to remind your doctor that youre a Healthy Blue Living member. We dont accept paper qualification forms from members or doctors. You can download and print the sample qualification form by logging in to your account at bcbsm.com; click My Coverage, then To-do List.

Its been less than 12 months since my last physical. Can I have another one so soon? We dont limit the number of times you can visit your doctor to have a qualification form completed. Theres no copay for your qualification form visit, even if youre returning to your primary care physician after a recent physical.

I quit smoking and lost weight. How can I stop participating in the tobacco-cessation and weight-management programs? Return to your primary care physician for another qualification form visit. Once we receive a qualification form showing a negative cotinine test, youll no longer need to participate in our tobacco-cessation program. Once we receive a qualification form showing your BMI is below 30, youll no longer need to participate in our weight-management program.

Healthy Blue Living FAQs

We speak your language If you, or someone youre helping, needs assistance, you have the right to get help and information in your language at no cost. To talk to an interpreter, call the Customer Service number on the back of your card.

Si usted, o alguien a quien usted est ayudando, necesita asistencia, tiene derecho a obtener ayuda e informacin en su idioma sin costo alguno. Para hablar con un intrprete, llame al nmero telefnico de Servicio al cliente, que aparece en la parte trasera de su tarjeta.

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Falls Sie oder jemand, dem Sie helfen, Untersttzung bentigt, haben Sie das Recht, kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer des Kundendienstes auf der Rckseite Ihrer Karte an.

Se tu o qualcuno che stai aiutando avete bisogno di assistenza, hai il diritto di ottenere aiuto e informazioni nella tua lingua gratuitamente. Per parlare con un interprete, rivolgiti al Servizio Assistenza al numero indicato sul retro della tua scheda.

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Ukoliko Vama ili nekome kome Vi pomaete treba pomo, imate pravo da besplatno dobijete pomo i informacije na Vaem jeziku. Da biste razgovarali sa prevodiocem, pozovite broj korisnike slube sa zadnje strane kartice.

Kung ikaw, o ang iyong tinutulungan, ay nangangailangan ng tulong, may karapatan ka na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin, tumawag sa numero ng Customer Service sa likod ng iyong tarheta.

Important disclosure Blue Cross Blue Shield of Michigan and Blue Care Network comply with Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross Blue Shield of Michigan and Blue Care Network provide free auxiliary aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and information in other formats. If you need these services, call the Customer Service number on the back of your card. If you believe that Blue Cross Blue Shield of Michigan or Blue Care Network has failed to provide services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance in person, by mail, fax, or email with: Office of Civil Rights Coordinator, 600 E. Lafayette Blvd., MC 1302, Detroit, MI 48226, phone: 888-605-6461, TTY: 711, fax: 866-559-0578, email: CivilRights@bcbsm.com. If you need help filing a grievance, the Office of Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health & Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail, phone, or email at: U.S. Department of Health & Human Services, 200 Independence Ave, S.W., Washington, D.C. 20201, phone: 800-368-1019, TTD: 800-537-7697, email: OCRComplaint@hhs.gov. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Find us online:bcbsm.com | news.bcbsm.com | facebook.com/MiBCN

ahealthiermichigan.org | twitter.com/bcbsm | youtube.com/bcbsmnews

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Blue Care Network is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.