MIIA - Blue Cross Blue Shield Proposed Benefits
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Transcript of MIIA - Blue Cross Blue Shield Proposed Benefits
MIIA - Blue Cross Blue Shield Proposed Benefits
Plan Offerings
• HMO Blue New England (HMO)
• Blue Care Elect Preferred (PPO)
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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
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
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
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
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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)
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Services Subject To The
DeductibleAfter 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)
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
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
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
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
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