lower cost quality care simplified experience

Transcription

1 CA R E L I V E S H E R E

2 lower cost quality care simplified experience Bringing care back to healthcare For many, healthcare experiences fall short of their expectations. But, when we say, Care Lives Here, we mean every word. From the moment you walk in the door, we want to exceed your expectations and create something different a healthcare experience that makes you feel more alive, less stressed and reassured that the best people are there to take care of you no matter what. With innovative offerings like Spira Care by Blue Cross and Blue Shield of Kansas City, our members enjoy access to comprehensive, personal primary care at convenient Care Centers, as well as access to all the benefits of the BlueSelect Plus network. SPIRACARE.COM

3 COMPREHENSIVE SERVICES Routine Preventive Care Adult & Pediatric Primary Care Chronic Condition Management Behavioral Health Consultation Digital X-Rays* Lab Draws CONVENIENT BENEFITS Common Prescriptions Filled On-Site Specialist Referrals & Scheduling Patient Wellness Follow-Ups Outside-of-Care Center Support Extended Full-Service Hours Access to A Healthier You Platform Online Scheduling Online Care Team Communication *X-rays are available at select locations only, but are at no additional cost to members. WHAT CAN CARE GUIDES DO FOR YOU? Care Guides are real people and personal guides, many with nursing and benefit backgrounds, to help you on your health journey. They can coordinate care, answer questions and explain benefits. Now members have a single point of contact for both care and coverage questions. It truly is care with you at the center.

4 Care at every step. As a Spira Care member, you will have access to first-class nurses and doctors, as well as a committed Care Guide Team dedicated to simplifying and enhancing your health journey. Understanding Costs Your doctor prescribed a blood test and a CT scan, but how much will they cost? And where should you go to have them done? Your Care Guide is ready to provide you with answers to these questions and more, ensuring you have the information you need to make smart healthcare choices for you and your wallet. Coordinating Care Imagine you ve recently been discharged from the hospital. Your Care Guide calls to see how you re feeling and follow up on treatment needs. It s a little something we call proactive outreach, and it can be a big help. Explaining Benefits You need to visit a specialist outside of your Spira Care Center? Naturally, you have questions. Is the specialist you chose in-network? Have you reached your deductible? Your Care Guide is available to answer your benefit questions.

5 BUILDING ON THE BLUESELECT PLUS NETWORK Spira Care is a combined care and insurance offering developed by Blue Cross and Blue Shield of Kansas City. In addition to Spira Care Centers, members will have access to the BlueSelect Plus network within the Kansas City metro area. 3,000+ Physicians & Specialists 11,000 Access Points In- & Out-of-Network Emergency Room Coverage Higher Quality Care Lower Overall Cost 9 LEADING HOSPITALS Children s Mercy Hospital Children s Mercy Hospital South Liberty Hospital North Kansas City Hospital Olathe Medical Center Shawnee Mission Medical Center Truman Medical Center Hospital Hill Truman Medical Center Lakewood University of Kansas Hospital Spira Care is built on an Exclusive Provider Organization (EPO) insurance model. Members must receive all care from in-network providers (BlueSelect Plus network in the Kansas City area or BlueCard network outside the 32-county service area) except for emergency services. Non-emergency services received out-of-network will not be covered.

6 Seamless. Personal. Care. Wherever you are on your health journey, Spira Care is in your corner. We ve created two distinct and simple Spira Care options, Spira Care and Spira Care (HSA Eligible), to support you and your family s unique care needs. Visit SpiraCare.com to learn more. QUINN Enrolled in Spira Care Age 35 Training for a marathon Mother of two Quinn s Care Quinn receives all-in-one personal care at Spira Care. That means ongoing well-woman care and nutrition recommendations, as well as strep throat tests for her son and X-rays after her daughter s soccer injury. And, thanks to Spira Care s inviting waiting area full of books and snacks, her young family loves how welcome they feel during their Care Center visits. NO COST At the Care Center: Adult & Pediatric Primary Care, Specialist Referrals & Scheduling, Digital X-Rays She still has the option to take her son to his favorite pediatrician for his asthma care, and these visits are applied toward a simple annual deductible. The convenience of the no additional cost Care Centers combined with the flexibility of the BlueSelect Plus network makes Spira Care the ideal choice for Quinn and her family.

7 DAVE Enrolled in Spira Care Age 58 Recently diagnosed with cancer Little experience with insurance Dave has always been fairly healthy, so he s never had a reason to pay close attention to his health plan. However, a thyroid cancer diagnosis earlier this year has turned his world upside down. He currently has numerous bills from specialists, feels overwhelmed, confused and truly has no idea what to do next. With Spira Care, Dave s Care Guide not only answers his questions regarding claims, benefits and ongoing Care Center check-ups, but will also help coordinate specialist care within the BlueSelect Plus network. Dave regularly meets with his primary care doctor and the behavioral health clinician to manage his care and learn how to handle the stress that comes with his diagnosis. These services are at no additional cost, and all oncologist appointments are applied toward a simple annual deductible. Dave s Care NO COST At the Care Center: Adult Primary Care, Behavioral Health Consultation, Lab Draws, Specialist Referrals & Scheduling

8 Jake s Care At the Care Center: Adult Primary Care, Behavioral Health Consultation, Lab Draws JAKE Enrolled in Spira Care (HSA Eligible) Age 45 Recently promoted Since taking on greater responsibilities at work, Jake loves the fact that he doesn t have to worry about budgeting for his primary care services with his Spira Care (HSA Eligible) plan. Jake deposits tax-free earnings into his Health Savings Account (HSA) and uses those funds to pay for his qualified medical expenses including an affordable charge for any doctor visit at a Spira Care Center. Jake s preventive care services are still covered at 100 percent and once he has met his out-ofpocket maximum, any future healthcare needs at Spira Care or in the BlueSelect Plus network are at no additional cost to Jake. Jake has enough on his plate, so being able to visit Spira Care during extended hours makes it convenient to schedule an appointment with his Care Team on his way home from work.

9 TINA Enrolled in Spira Care (HSA Eligible) Age 29 Avid Rock Climber Has three children Financial planning is important to Tina and her family. With the Spira Care (HSA Eligible) plan, Tina knew her employer would make a one-time contribution into her Health Savings Account and she could designate a monthly pre-tax contribution to help pay for expected and unexpected healthcare needs. With her HSA, Tina has peace of mind knowing she has money saved in an account that will follow her family wherever they go. In addition to her family s preventive visits which are covered at 100 percent, the Spira Care Team helps Tina s husband manage his diabetes, where he meets several times a year with his doctor and pays an affordable charge per visit. Any lab draws or tests ordered from those visits are included and can be done at the Care Center. Tina s family finds Spira Care convenient, simple to use and supportive of their family s healthcare needs. Tina s Care At the Care Center: Adult & Pediatric Primary Care, Lab Draws

10 Q: How do I know if the combination of Spira Care and BlueSelect Plus is right for me? A: This offering is crafted for members looking to simplify and personalize their healthcare experience. If you and your family s health needs in the next year will largely fall within primary care, including labs, X-rays* and routine behavioral health consultations, you can enjoy the peace of mind that comes with choosing Spira Care, where you ll have the support of a Care Team and assistance with any services needed outside the Care Center and in the BlueSelect Plus network. Q: What prescriptions are filled at Spira Care? A: Spira Care offers the convenience of on-site prescription services for approximately 50 of the top generic prescriptions at your regular copay level. Q: What about prescriptions that can t be filled at Spira Care? A: Your Care Team will facilitate prescription services through convenient mail order or at your preferred pharmacy at your regular cost-sharing level. Q: Where can I go for urgent or emergency care outside of a Care Center? A: For emergency and life-threatening situations, members will be covered both in and out of the BlueSelect Plus network. Within the Kansas City metro area, BlueSelect Plus partners with nine hospitals and several urgent care centers to keep you well around the clock. Outside the 32-county Blue KC service area, you will have access to a nationwide BlueCard network as well. Q: I already have a primary care or pediatric physician I love. Can I still go there? A: While this plan is ideal for members who utilize the Care Centers, members still have access to more than 3,000 providers in the BlueSelect Plus network. Members will also have the nationwide coverage of the BlueCard network outside the 32-county Blue KC service area. *X-rays are available at select locations only, but are at no additional cost to members.

11 Q: What happens if I go to a physician out-of-network? A: Spira Care is built on an Exclusive Provider Organization (EPO) insurance model. Members must receive all care from in-network providers (BlueSelect Plus network in the Kansas City area or BlueCard network outside the 32-county service area) except for emergency services. Non-emergency services received outof-network will not be covered. Q: When is Spira Care open? Are walk-in appointments available? A: Spira Care offers extended hours at all Care Center locations. For details about a specific Care Center, visit SpiraCare.com. While appointments are preferred, we understand that life doesn t always go according to plan, so we ll do our best to accommodate walk-in appointments whenever possible. Q: Are there plans to expand Spira Care and build new Care Centers in the future? A: Yes, there are plans to extend Spira Care as our membership grows, adding more convenient Care Centers throughout the metro area in both Kansas and Missouri.

12 With Spira Care, our employees are paying less for healthcare premiums and taking home more of their hard-earned dollars. We have confidence that they are getting great care at a center that keeps costs in check. - Employer group offering Spira Care Spira Care is best in class! I have never had a better, more customized experience with a healthcare provider. I felt like a priority and getting to know me was an important expectation of the Care Team. - Spira Care Member The care was fantastic. My doctor wanted to take the time to listen to me. On past doctor visits at previous (non-spira Care) locations, the situation was more of a here s what ya got, here s what ya need after listening to me for 30 seconds. At Spira Care, my doctor took the time to talk with me and didn t cut me off. It was so great to get some much-needed questions about my health answered. - Spira Care Member by SPIRA SpiraCare.com 2018 Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association SPC1000

13 Spira Care Personal care with no deductibles, no copays.* SPIRA CARE is a combined care and insurance offering developed by Blue Cross and Blue Shield of Kansas City and designed by members from start to finish to provide comprehensive, integrated care with no deductibles, no copays* and no additional cost for any procedures you may receive at the Care Centers. Fast Facts No copays*, no deductibles and no additional costs for procedures at the Care Centers Labs and X-rays** at the Care Centers included Access to a team of Care Guides Convenient Care Center locations around the KC metro Lower Cost Steady, personal, integrated primary care improves member health and lowers short- and long-term healthcare costs to employers and members. Quality Care Every member has a complete Care Team including Care Guides keeping care smart, intuitive and personal. Simplified Experience Healthcare can be complex. We simplify it by providing complete primary care and health-plan support all in one place and at no additional cost.

14 COMPREHENSIVE SERVICES Routine Preventive Care CONVENIENT BENEFITS Common Prescriptions Filled On-Site* Adult & Pediatric Primary Care Specialist Referrals & Scheduling Chronic Condition Management Patient Wellness Follow-Ups Behavioral Health Consultations Outside-of-Care Center Support Digital X-Rays** Extended Full-Service Hours Lab Draws Access to A Healthier You Platform Online Scheduling Online Care Team Communication *For Spira Care members, there are no additional costs for any procedure provided at Spira Care Centers, but select prescriptions will be offered on-site at your regular copay level. **X-rays are available at select locations only, but are at no additional cost to members. SPC1001

15 Spira Care (HSA Eligible) Integrated primary care with an affordable charge per office visit We recognized that for many people, a Health Savings Account (HSA) offering is very important, and that led us to create Spira Care (HSA Eligible), a novel, simple, no-surprises option that provides affordable, convenient Care Center visits paired with a Health Savings Account. Spira Care (HSA Eligible) A member will incur an affordable charge for an office visit at Spira Care. Once their out-of-pocket maximum is reached, a member will have no additional fees for services at Spira Care or in the BlueSelect Plus network. Preventive services are still covered at 100 percent. FAST FACTS An HSA allows members to use tax-free HSA dollars to pay for qualified medical expenses Members can have part of their pre-tax earnings deposited into an HSA Unused HSA dollars can be rolled over at the end of each calendar year All preventive services are 100% covered The affordable charge for a doctor s visit covers any follow-up services from that visit like labs and X-rays** Employee contributions allow you to save up for future medical expenses Unused HSA funds roll over each year and follow you for life Access to a team of Care Guides Convenient Care Center locations around the KC metro Simplified Experience If you tend to not need a lot of healthcare beyond routine check-ups, Spira Care (HSA Eligible) could be a great option since you can save for any future healthcare expenses. If you re nearing retirement, an HSA could be beneficial because it allows you to use your money to offset the costs of medical care or healthcare once you retire.

16 COMPREHENSIVE SERVICES Routine Preventive Care CONVENIENT BENEFITS Common Prescriptions Filled On-Site* Adult & Pediatric Primary Care Specialist Referrals & Scheduling Chronic Condition Management Patient Wellness Follow-Ups Behavioral Health Consultations Outside-of-Care Center Support Digital X-Rays** Extended Full-Service Hours Lab Draws Access to A Healthier You Platform Online Scheduling Online Care Team Communication *Spira Care (HSA Eligible), non-preventive services have an affordable charge as required by law. Select prescriptions will be offered on-site at your regular copay level. **X-rays are available at select locations only, but are at no additional cost to members. SPC1002

17 Spira Care Centers Care Lives Here THERE S A SPIRA CARE CENTER NEAR YOU. Crossroads Opening January 2019 Lee s Summit Opening January 2019 Spira Care Crossroads 1916 Grand Boulevard Kansas City, MO Spira Care Lee s Summit 760 NW Blue Parkway Lee s Summit, MO Liberty Opening January 2019 Olathe Shawnee Wyandotte Coming in 2019 Spira Care Liberty 8350 N Church Road Kansas City, MO Spira Care Olathe W 135th Street, Suite 200 Olathe, KS Spira Care Shawnee Shawnee Mission Parkway Shawnee, KS Keep an eye out for more information on our Wyandotte location!

18 SPIRA CARE & BLUESELECT PLUS NETWORK Spira Care Centers for primary care needs paired with the BlueSelect Plus network for any needs outside the Care Centers. Care Lives Here Liberty Hospital Spira Care Wyandotte Spira Care Crossroads Children s Mercy Hospital North Kansas City Hospital Spira Care Liberty Truman Medical Center - Hospital Hill Spira Care Shawnee Shawnee Mission Medical Center University of Kansas Hospital Truman Medical Center - Lakewood Spira Care Olathe Olathe Medical Center Children s Mercy Hospital - South Spira Care Lee s Summit To learn about the Care Teams at the Care Centers and for hours, visit SpiraCare.com. Spira Care is built on an Exclusive Provider Organization (EPO) insurance model. Members must receive all care from in-network providers (BlueSelect Plus network in the Kansas City area or BlueCard network outside the 32-county service area) except for emergency services. Non-emergency services received out-of-network will not be covered. SPC1003