A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

PPO Features A&M Care Plan

• Administered by Blue Cross and Blue Shield of Texas (BCBSTX)

• No primary care physician (PCP) required; no referrals required to see a specialist

• Select any provider for care within the PPO network or outside the network

• When you receive care inside the network– Highest level of benefits– No claims to file– No balance billing for amounts over the BCBSTX allowed amount

• When you receive care outside the network– May have to file own claims– Receive lower level of benefits and can be balanced billed

• Worldwide coverage for emergency and non-emergency care

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What’s New?

CHANGE FROM CHANGE TO

Coinsurance Plan pays 70%You pay 30%

Plan pays 80%You pay 20%

Copays DO NOT apply to the out-of-pocket maximum

DO apply to the out-of-pocket maximum

No benefits changes for the 65+ Plan

Effective 9/1/2014 for A&M Care Plan

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More Hospitals and Doctors

Available

For a current listing of all providerssee our website at:

bcbstx.com

Offers names, addresses, map and directions.

For World Wide Assistance

Call 1-800-810-BLUE (2583)Or Collect 1-804-673-1177In-network coverage is available when

traveling or living worldwide

24 Hours a Day, Seven Days a Week

BENEFITSMEMBER SHARE

A&M Care In-Network / Out-of-Network Plan 65+ Plan

Deductible – Individual $700 / $1,400 $500

Deductible – Family $2,100 / $4,200 –

Out-of-Pocket Maximum – Individual $5,000 / $10,000 $1,400

Out-of-Pocket Maximum – Family $10,000 / $20,000 –

Office Visit (primary care / specialist)Most Lab and X-ray paid at 100%

$30/$45 per visit / 50% after deductible 20% after deductible

Preventive Services 100% covered / Not covered 100% paid after deductible

Inpatient Hospital 20% after deductible / 50% after deductible 20% after deductible

Emergency Room20% after deductible / 20% after deductible

(50% after deductible for non-emergency)

20% after deductible20% after deductible

Chiropractic – 30 visits per plan year $45 per visit / 50% after deductible 20% after deductible

Maternity Care – Doctor $30 initial visit only / 50% after deductible 20% after deductible

Diagnostic Procedures/MRIs and PET scans 20% after deductible / 50% after deductible 20% after deductible

All other covered services 20% after deductible/50% after deductible

20% after deductible

Retirees over age 65 are not eligible for copays, your benefits are secondary to Medicare

Your BlueChoice PPO Benefits

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Preventive Coverage

What’s covered?Recommended routine gender- and age-specific preventive care, such as annual physical, OB/GYN exams, mammograms and other cancer screenings, well-child care and immunizations – both facility and professional services

Preventive coverage provided in-network at 100% with no copay, no deductible

Stay Healthy by Getting Regular Check-ups

Remember: Lab tests related to an illness or condition are not considered preventive and may pay differently

Get an annual physical and reduce

your monthly premium!

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Retiree Information

Retirees under age 65Are considered Network and can use the Network providers

Remember: • Enroll in BOTH Medicare

parts A & B.• When you receive your

Medicare Card, notify BCBSTX and your Human Resource Office of your Medicare number which includes an alpha character.

• If you use a Provider that accepts Medicare or is a BCBSTX provider, you cannot be balance billed.

Retirees over age 65Choose from:

• A&M Care Plan

• 65 Plus – you must be:

– Age 65 and enrolled in Medicare Parts A&B or disabled under 65 and enrolled in Medicare Parts A&B

– Working for the A&M System, if at all, less than 50% time or for less than 4.5 months during the plan year

– If covering a spouse, spouse must be age 65 or older (or disabled) and enrolled in Medicare Parts A&B

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Retiree Coordination of Benefits

 Example A&M CARE PLAN (deductible not met)

A&M CARE PLAN (deductible is met)

Charge $500 $500

Medicare paid 80% $400 $400

Patient Share 20% $100 $100

A&M Care Plan Deductible $700 MET

Applied to Deductible $500 Zero

BCBSTX Would Have Paid Zero $350

A&M Care Plan Payment Zero $100

Patient’s Responsibility $100 Zero

Plans calculate the normal plan benefits, then pay that amount, or the difference after Medicare has paid, whichever is less.

Your coinsurance will continue until you meet the out-of-pocket maximum, then plan pays at 100%.A&M Care 65 Plus = $1,400

A&M Care Plan = $5,000 individual/$10,000 Family

• Now you can speak to a BCBSTX Benefits Value Advisor who helps you find quality providers for health care services such as:

– Imaging services (X-rays/MRIs/CT scans)– Maternity services– Joint replacement surgery– Back surgery

• Benefits Value Advisors can also help you plan for your health care by:

– Helping you understand your benefits– Finding in-network providers– Scheduling visits– Requesting preauthorization– Helping you access online

educational tools

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Benefits Value Advisor

1. Benefits Value Advisors offer cost estimates for various providers, facilities and procedures. Lower pricing and cost savings are dependent on the provider or facility of your choosing.

Same procedure, lower cost1

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Benefits Value Advisor

Cost comparison for an MRI at two different providers:

*Example cost data from Tarrant county.

Member communications and information from Benefits Value Advisors are not meant to replace the advice of health care professionals. Members are encouraged to seek the advice of their doctors to discuss their health care needs. Decisions regarding course and place of treatment remain with the member and his or her health care providers. Cost estimates are just an estimate. In addition to your usual deductibles, copayments and/or coinsurance, the actual cost of the services may vary based on a number of factors including the date of service, the actual procedure performed and what services were billed by the provider and your particular benefit plan. Coverage is subject to the limitations and exclusions of your plan.

Costs can vary by $2,000 for the same procedure depending on where you go!*

PROVIDER A – KNEE MRI PROVIDER B – KNEE MRI

$374* $2,573*

One call can result in big savings!Just call the number on the back of your member ID card to reach a Benefits Value Advisor.

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Blue Care® Advisors – clinical professionals – can help you manage chronic health conditions such as:

Asthma, coronary disease, diabetes, COPD or low back pain • Understand and follow your physician’s orders• Review medications, side effects, compliance, refills and current

services• Establish goals with caregivers, scheduling follow-ups as

appropriate

If you have a chronic condition, we offer support

If you are identified as being at risk or having one of the managed chronic conditions, one of our Blue Care Advisors will contact you.

Condition Management

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Tobacco Cessation and Weight Management Programs • Personal telephone coaching• Secure email outreach • Self-paced online courses• Tobacco cessation

resources • Weight management

resources

Lifestyle Management Support

Other Resources• Counseling and coaching with

licensed Wellness Coaches

• 24/7 Nurseline

• Well onTarget®

• Blue 365®

• Referrals when appropriate

• Jenny Craig®

• Life Time Fitness®

• Proctor & Gamble Dental Products

• Vision Plans

• And more…

24/7 Nurseline

Around-the-Clock Advice and Information by Phone

1-800-581-0368• 24/7 access to registered nurses for

health conditions such as:‒ High fevers‒ Earaches‒ Cuts and bruises

• 1,200 audio health library topics• Referral of members with care needs to

the appropriate program• Follow-up calls for emergency care

needs• Available in English and Spanish

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A New Way to Experience Wellness

Access Well onTarget by logging in to Blue Access for Members and get support to make healthy choiceso Health Assessment (HA)

o Self-Paced Courses

o Trackers

o Food and Exercise Diary

o Health and Wellness Content

o Fitness Program

o Complementary and Alternative Medicine

Making wellness simpler, more affordable and more accessible for members

Vision Care and Eyewear– Discounts on eyewear, contact lenses and laser vision correction surgery

Dental Products – Discounts on Procter & Gamble oral care bundles

Hearing Aids – Discounts on hearing aids for members, parents and grandparents

Life Time®´ Fitness – Enrollment fee will be waived for new members who join one of the Life Time Fitness clubs nationwide

Weight Management – Discounts at Jenny Craig®´

on membership and foodAnd more

Under the My Coverage tab Register online atblue365deals.com/BCBSTX/

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Save time with self-service support tools and health and wellness resources on a convenient and secure online site

• Check claims and claims history

• View, save or print Explanation of Benefits (EOBs)

• Sign up for electronic EOBs, and turn off paper

• View benefits and covered dependents

• Check coverage details

• Manage mobile and texting preferences

• Request new ID cards or print temporary ID cards

• Access health and wellness information and guides

• Get details on wellness, discounts… and more

Blue Access for MEMBERSSM

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My Claim Activity displays recent claims, or go to the Claims Center for all your claim details

Form Finder easier to view and find specific forms for members

Quick Links for easy access to Health Assessment, Fitness Program, Member Discounts, or to get an ID card

Access Provider Finder® to locate doctors, specialists, facilities, directions and Blue Distinction Centers®

Blue Access Homepage

My Health tab links you to health and wellness content, articles, videos, and My Care Profile

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My Coverage shows who’s covered on your plan, YTD spending for each family member, cost estimator, deductible discounts and ID card request. From My Coverage page, click on Incentives, then Visit Site to view completed activities so you can make sure that your Wellness Exam Incentive has been recorded.

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User-friendly health assessment tool• Personal Health Assessment designed

to be completed in 10 to 15 minutes • Choose your assessment topic, such

as health and wellbeing or fitness and physical activity

• All topics must be completed to receive credit

Health AssessmentPowerful Health and Wellness Tool

bcbstx.com

Complete all topics under the HA and receive a $50 deductible credit for members and dependents ages 18 and over

Know Your RisksManage Your HealthExamines the member’s overall health and wellbeing and provides a personalized report showing areas where you can improve

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Blue Access MobileSM Overview

Current Mobile Offerings• Mobile Web (public)• Blue Access for MembersSM (secure)• Text Messaging (static and dynamic)• Provider Finder® App (iPhone and Android)

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Provider Finder® puts you in charge

Use Provider Finder to:o Find a network primary care physician, specialist or

hospital

o Search results by doctor, specialty, ZIP code, language and gender – even get directions from Google Maps™

o Estimate the cost of a provider’s procedures, treatments and tests

o Determine if a Blue Distinction Center for Specialty Care® is an option for treatment

o View patient feedback or add your review for a provider

o View quality, certifications and recognitions for doctors

bcbstx.com21

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What if I Have Questions

Toll-freeCustomer Service

866-295-1212

Personalized Service 8 am – 8 pm• Our Philosophy – “Take the Member

Out of the Middle”• Call your dedicated customer service

team for:‒ Benefit information‒ Network provider information‒ Membership and eligibility ‒ Inquiries (telephone and email)‒ ID card requests‒ Claims inquiries‒ Help with online tools

Your ID Card

Need Assistance?Call the Customer Service number on the back of the ID card to: • Ask about benefits and

claims • Talk to a Benefits Value

Advisor (BVA) to locate facilities for MRIs, CTs, maternity services, hip/knee/spine surgeries, and more

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