2017 BCN Advantage HMO-POS Plan information for UAW Trust members

Transcription

1 2017 BCN Advantage HMO-POS Plan information for UAW Trust members BCN Advantage SM is an HMO-POS plan with a Medicare contract. Enrollment in BCN Advantage depends on contract renewal.

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3 Here, there and everywhere we ll help you on your journey Dear UAW Trust : When you join BCN Advantage SM, you ll discover benefits that can help you stay healthy and happy. We also want you to know that we re dedicated to helping you every step of the way. BCN Advantage is an all-in-one Medicare Advantage plan. You won t give up your Medicare benefits by joining BCN Advantage, because we re contracted with Medicare to administer all your health care benefits. We invite you to join us in 2017 to get the coverage you need. You ll have access to thousands of network doctors, wellness with preventive services at home or anywhere in the U.S. and access to emergency care worldwide. All from the company you know and trust. Thank you for putting your trust in us. Sincerely, Betsy Geis Director II Medicare Government Programs Jim Wixson UAW Retiree Medical Benefits Trust Account Blue Cross Blue Shield of Michigan

4 Our health care providers have you covered It s as easy as Look through our benefits. 2 Learn how BCN Advantage gives you more. 3 Questions about doctors or hospitals? Call us at , 8 a.m. to 5 p.m. Eastern time, Monday through Friday for up-to-date information, or visit to learn more.

5 Contents Our growing network of providers...2 Summary of frequently used benefits and cost sharing...4 Understanding important terms...5 Get the card that gives you more...10 CMS star rating...12 BCN Advantage service area map...13 Contact information... Back cover Our website is 1

6 Our growing network of providers is ready to meet your health care needs We offer more than 4,900 primary care physicians, over 19,000 specialists and 121 hospitals in our service area, including Bronson and Spectrum hospitals, health centers and physicians. 1 Stay healthy We offer educational materials, reminders and other support for members with chronic conditions, such as depression, diabetes, chronic obstructive pulmonary disease, heart disease, heart failure and kidney disease. Proud to serve more than 1 million autoworkers, retirees and their family members 2 With more than 2,200 UAW-represented staff members here at Blue Cross Blue Shield of Michigan, we re proud to say we ve worked with the UAW Retiree Medical Benefits Trust since the Trust was formed. 3 As a Michigan-based plan, we ve been closely connected to the automotive industry for many years, and take pride in providing members like you with high quality, affordable care. For 2017, the UAW Trust has once again selected BCN Advantage HMO-POS as a Medicare Advantage health plan option for its Medicare-eligible members. The UAW Trust provides health care benefits for UAW retirees and their dependents. BCN Advantage is designed to promote healthy living, give you access to the doctors and hospitals you want, and get you the most value for your health care dollar. 1 Source: June 2016 BCN Statewide Provider Count report 2 Source: Blue Cross Blue Shield Association, National Labor Office 2015 Fall newsletter 2 3 Employee Labor Relations

7 Important terms/definitions Hospital care Call/nursing telephone support Hospital and other services Plan benefits Important terms/definitions Hospital care Call/nursing telephone support Hospital and other services Plan benefits Beyond original medicare Other services The choice is yours Beyond original medicare Other services Mental health and substance abuse treatment Leaving the hospital Mental health and substance abuse treatment Leaving the hospital Questions Benefits (see what s under the hood) Questions member, once you become eligible SilverSneakers Zero percent coinsurancedeductible, coinsurance and dollar Prescription drugs Preventive care maximums for Medicare you ll automatically be enrolled in BCN Advantage. If you wish Hospital and other services Plan benefits care Preventive Ready to join drugs Prescription Deductible, coinsurance and dollar maximums Internet/bcbsm.com/online/live Missouri MyBlue Medicare Magazine Outpatient diagnostic services Physician office services Leaving the hospital Questions Customer service Outpatient diagnostic services Surgical services Surgical services hearing hearing through Friday to discuss your options. Mental health and substance abuse treatment Missouri a.m. to 4:30 p.m.coaching Eastern time, Monday Physician office services Reasons to join Unlimited office visits with low copayments Care Connect at , 8:30 MyBlue Medicare Magazine Reasons to join to enroll in another plan, call Retiree Internet/bcbsm.com/online/live coaching DME As a UAW retiree and current BCN Call/nursing telephone support SilverSneakers DME Pne More than 24,000 physicians in 68 counties throughout Michigan* DME Pneumonia TTY users should call 711. Plan changes will become effective the Everyday savings Tobacco cessation Emergency services Everyday savings Coping with heart failure or COPD Tobacco cessation first day of the second month following Preventive care Prescription drugs Deductible, coinsurance and dollar maximums the date of your change request, Hospital care no earlier than Jan. 1, Call/nursing telephone support Hospital and other services Facing a complex medical condition Emergency services Reasons to join Where am i covered Research monitors Coping with heart failure or COPD Facing a complex medical condi- Where am i covered Research monitors tion choice of plan. If for any reason you Complete flexibility in your change your mind after switching to BCN Advantage, you can switch to a plan that you re eligible for. Plan benefits Missouri Customer service Physician office services Outpatient diagnostic services Surgical services hearing *Source: June 2016 Statewide BCN Provider Count report Pneumonia 3

8 l and other services ives to hospital care Plan benefits 2017 Summary of frequently used benefits and cost sharing the hospital Questions DME Deductible, copayments, coinsurance and dollar maximums ion drugs Reasons to join Deductible Note: Deductible does not apply Missouri to Protected Customer Class. service Protected Class members are responsible for copays only. Deductible, coinsurance and dollar maximums $400 per member $675 per family Percent coinsurance t diagnostic services Surgical services hearing None Maximum out of pocket Pneumonia $1,000 (includes deductible and fixed dollar copays all coinsurance is 0%) th heart failure or COPD Facing a complex medical condition Where am i covered Dollar maximums Research monitors None 4 Payment amounts are based on the Blue Care Network approved amount, less any applicable deductible and copay amounts required by the plan. This coverage is provided in keeping with a contract with the federal government. Services must be provided and arranged by the member s primary care physician or health care plan.

9 Understanding important terms $$$$ Insurance pays 100% (your copays may apply) Deductible met $$ Deductible (you pay 100%) In network: $400 per member $675 per family Medical costs Deductible The amount you pay annually before your plan begins to pay. This doesn t apply to services that require a copay. Copay A fixed amount you pay to receive a medical service, usually at the time of service (office visits, emergency room, urgent care). In-network A provider contracted with Blue Care Network to be part of the Blue Care Network network. If you see an out-of-network provider, you re responsible for the cost of all services. Out-of-network A provider who doesn t have a contract to be a part of the Blue Care Network network. If you see an out-of-network provider, you re responsible for the cost of all services. 5

10 2017 Summary of frequently used benefits Preventive services* re Call/nursing telephone support Hospital and other services Routine eye exam VSP: $25 copay covered once every 12 months Health maintenance exam Covered 100% Annual gynecological examplan benefits Covered 100% re Call/nursing telephone support Hospital and other services ices ces Plan benefits Medical nutritional therapy Covered 100% Diabetes self-management training Covered 100% Mental health and substance abuse Leaving the hospital Questions DME Pap smear screening laboratory services only Covered 100% treatment Immunizations Covered 100% Mental health and substance abuse Leaving the hospital Questions DME Prostate specific antigen screening laboratory services only Covered 100% treatment Mammography screening Covered 100% Preventive care Prescription drugs Deductible, coinsurance and dollar Reasons to join Annual colorectal cancer screening Covered 100% maximums Physician office services Preventive care Prescription drugs Deductible, coinsurance and dollar maximums Reasons to join Missouri Customer service icare Magazine Physician office services Outpatient diagnostic services Surgical services hearing Primary care physician office visits Specialist visits when referred care Magazine Physician office services Outpatient diagnostic services Surgical services hearing Missouri Covered $25 copay per visit Covered -- $35; Protected Class $25 copay per visit Pneumonia Customer service Emergency medical care ation Emergency services Coping with heart failure or COPD Facing a complex medical condition Where am i covered Pneumonia Research monitors ation Emergency services Coping with heart failure or COPD Facing a complex medical condi- Where am i covered Hospital emergency room tion copay waived if admitted; inpatient hospital benefits apply Urgent care center Ambulance services medically necessary Research monitors Covered $50 copay per visit; Ford Protected Class $0 copay per visit Covered $25 copay per visit; Ford Protected Class $0 copay per visit Covered 100% after deductible, ground and air service 6 * For all preventive services that are covered at no cost under Original Medicare, we also cover the service at no cost to you. However, if you also are treated or monitored for an existing medical condition during the visit when you receive the preventive service, a copay will apply for the care received for the existing medical condition.

11 Diagnostic services Laboratory and pathology tests Diagnostic tests and X-rays Radiation therapy Covered 100%; office visit copay may apply per member, per visit Covered 100% after deductible Covered 100% after deductible Maternity services provided by a physician Prenatal and postnatal care Delivery and nursery care Covered $25 copay per visit Covered in full for professional services after deductible er Hospital care Customer service Plan benefits Inpatient physician care, Alternatives general to hospital care nursing care, hospital services and supplies itions Hospital care Call/nursing telephone support Hospital and other services Outpatient surgery Covered 100% after deductible, unlimited days Covered 100% after deductible care Other services Mental health and substance abuse treatment Leaving the hospital Questions DME one support Hospital and other services Skilled nursing care Hospice care Plan benefits Home health care Preventive care Prescription drugs Deductible, coinsurance and dollar Reasons to join maximums Missouri Covered 100% after deductible, up to 100 days per benefit period, renewable after 60 days of nonconfinement Customer service Covered 100% after deductible Covered 100% after deductible ubstance abuse Leaving the hospital Questions DME line/live MyBlue Medicare Magazine Physician office services Outpatient diagnostic services Surgical services hearing Pneumonia Prescription drugs Deductible, coinsurance and dollar Reasons to join Tobacco cessation Emergency maximums services Coping with heart failure or COPD Facing a complex medical condi- Where am i covered 7

12 2017 Summary of frequently used benefits Surgical services Surgery includes all related surgical services and anesthesia Human organ transplants Covered 100% after deductible Covered 100% after deductible, subject to medical criteria Mental health care and substance abuse treatment Inpatient mental health care Substance abuse care Outpatient mental health care Outpatient substance abuse care Inpatient substance care covered at 100%, up to 190 days per Medicare lifetime maximum. Additional renewable 45 days per episode of illness after Medicare benefit is exhausted and 60 days of nonconfinement. Approval required. Covered 100%, unlimited days Covered 100%, unlimited visits Covered 100%, unlimited visits ice Helping you keep your eyes on the road Get a routine eye exam every 12 months Receive a 20 percent discount on glasses For details, call VSP Vision Care at or visit online 8

13 Other services Allergy testing and therapy Allergy injections Chiropractic spinal manipulation when referred Outpatient physical, speech and occupational therapy Infertility treatment Covered 100% after deductible Covered 100%; office visit copay may apply per member, per visit Covered $20 copay per visit Covered 100%, after deductible (no visit limit) Not covered exclusion includes infertility drugs, in vitro fertilization and artificial insemination Durable medical equipment Covered 100% Prosthetic and orthotic appliances Covered 100% Hearing aid hearing examination and aid covered once every 36 months Covered in full standard hearing aid; office visit copay may apply for examination; binaural hearing aids every 36 months if younger than 19 SilverSneakers fitness program Covered 100% This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply. The provider network may change at any time. You will receive notice when necessary. This plan may not be available to you in 2018 because, by law, plan sponsors can choose not to renew their contracts with CMS or reduce their service areas, and CMS may also refuse to renew a contract, thus resulting in a termination or nonrenewal. You must receive all routine care from plan providers. You must have both Medicare Part A and Part B to enroll. For more information, call BCN Advantage at from 8 a.m. to 5 p.m. Monday through Friday. TTY users call 711. The provider network may change at any time. You will receive notice when necessary. You may call MEDICARE ( ), or visit for more information about Medciare benefits and services, including general information about the health or prescription drug benefits. TTY users can call Hours are 24 hours a day, seven days a week. 9

14 Get the card that gives you more Your BCN Advantage ID card gives you: Important terms/definitions Hospital care Call/nursing telephone support Hospital and other services Exceptional health and wellness support, including MyBlue SM Concierge, which provides personalized, one-on-one service including: Plan benefits Missouri Pneumonia Customer service Explanation of your benefits Beyond original medicare Other services Mental health and substance abuse treatment Leaving the hospital Questions DME A fast connection to our care management and customer service teams Guidance on preventive measures and services Research monitors Support on proactive steps to maintain and improve Reasons to join your health SilverSneakers Preventive care Prescription drugs Deductible, coinsurance and dollar maximums Easy online tools that help you take charge of your health Missouri Customer service Internet/bcbsm.com/online/live coaching MyBlue Medicare Magazine Physician office services Outpatient diagnostic services Surgical services hearing Pneumonia Everyday savings Tobacco cessation Emergency services Coping with heart failure or COPD Facing a complex medical condition Where am i covered Research monitors 10

15 Important terms/definitions Hospital care Call/nursing telephone support Hospital and other services Plan benefits Access to our 24/7 Nurse Help Line Beyond original medicare Other services Mental health and substance abuse Leaving the hospital Questions DME treatment itions Hospital care Call/nursing telephone support Hospital and other services Plan benefits Healthways SilverSneakers fitness program at more than 13,000 fitness locations: Reasons to join SilverSneakers group exercise maximums classes, exercise equipment, pool, sauna and other available amenities SilverSneakers Preventive care Prescription drugs Deductible, coinsurance and dollar are Other services Mental health and substance abuse treatment Classes designed for your fitness level, along with informative seminars Leaving the hospital Questions DME Missouri Customer service Internet/bcbsm.com/online/live coaching MyBlue Medicare Magazine Physician office services Outpatient diagnostic services Surgical services hearing Fitness services must be provided at SilverSneakers participating locations. You can find a location or request Pneumonia SilverSneakers Steps information at or call , Monday through Friday, Reasons to join maximums from 8 a.m. to 8 p.m. TTY users call 711. Preventive care Prescription drugs Deductible, coinsurance and dollar Everyday savings Tobacco cessation Emergency services Coping with heart failure or COPD Facing a complex medical condition Missouri Where am i covered Customer service Research monitors ine/live MyBlue Medicare Magazine Physician office services Outpatient diagnostic services Surgical services hearing Pneumonia Tobacco cessation Emergency services Coping with heart failure or COPD Facing a complex medical condition Where am i covered Research monitors Healthways is an independent company not associated with the Blue Cross and Blue Shield Association. Blue Care Network contracts with Healthways to offer the SilverSneakers fitness program benefit. SilverSneakers is a registered mark of Healthways, Inc. 11

16 CMS star rating program Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next. The 2016 Medicare Star Ratings for Blue Cross, out of a possible BCN Advantage HMO and HMO-POS received a star rating. 12

17 BCN Advantage HMO-POS service area Schoolcraft Luce Mackinac Emmet Charlevoix Cheboygan Presque Isle Leelanau Benzie Grand Traverse Antrim Otsego Montmorency Alpena Kalkaska Crawford Oscoda Alcona BCN Advantage service area BCN Advantage is open to Trust members residing in the 68-county area shown on the map. You must receive routine care from plan providers in this area. Manistee Mason Oceana Muskegon Newaygo Ottawa Lake Allegan Wexford Osceola Clare Gladwin Mecosta Kent Missaukee Roscommon Montcalm Barry Ionia Isabella Eaton Gratiot Clinton Midland Ogemaw Arenac Bay Saginaw Shiawassee Iosco Genesee Ingham Livingston Tuscola Huron Lapeer Oakland Sanilac Macomb St. Clair Van Buren Kalamazoo Calhoun Jackson Washtenaw Wayne St. Joseph Branch Hillsdale Monroe St. Joseph ZIP codes served:

18 Multi-language interpreter services English: We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at Someone who speaks English/Language can help you. This is a free service. Spanish: Tenemos servicios de intérprete sin costo alguno para responder cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un intérprete, por favor llame al Alguien que hable español le podrá ayudar. Este es un servicio gratuito. Chinese Mandarin: 我们提供免费的翻译服务, 帮助您解答关于健康或药物保险的任何疑问 如果您需要此翻译服务, 请致电 我们的中文工作人员很乐意帮助您 这是一项免费服务 Chinese Cantonese: 您對我們的健康或藥物保險可能存有疑問, 為此我們提供免費的翻譯服務 如需翻譯服務, 請致電 我們講中文的人員將樂意為您提供幫助 這是一項免費服務 Tagalog: Mayroon kaming libreng serbisyo sa pagsasaling-wika upang masagot ang anumang mga katanungan ninyo hinggil sa aming planong pangkalusugan o panggamot. Upang makakuha ng tagasaling-wika, tawagan lamang kami sa Maaari kayong tulungan ng isang nakakapagsalita ng Tagalog. Ito ay libreng serbisyo. French: Nous proposons des services gratuits d'interprétation pour répondre à toutes vos questions relatives à notre régime de santé ou d'assurance-médicaments. Pour accéder au service d'interprétation, il vous suffit de nous appeler au Un interlocuteur parlant Français pourra vous aider. Ce service est gratuit. Vietnamese: Chúng tôi có dịch vụ thông dịch miễn phí để trả lời các câu hỏi về chương sức khỏe và chương trình thuốc men. Nếu quí vị cần thông dịch viên xin gọi sẽ có nhân viên nói tiếng Việt giúp đỡ quí vị. Đây là dịch vụ miễn phí. German: Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu unserem Gesundheits- und Arzneimittelplan. Unsere Dolmetscher erreichen Sie unter Man wird Ihnen dort auf Deutsch weiterhelfen. Dieser Service ist kostenlos. Korean: 당사는의료보험또는약품보험에관한질문에답해드리고자무료통역서비스를제공하고있습니다. 통역서비스를이용하려면전화 번으로문의해주십시오. 한국어를하는담당자가도와드릴것입니다. 이서비스는무료로운영됩니다. 14

19 Russian: Если у вас возникнут вопросы относительно страхового или медикаментного плана, вы можете воспользоваться нашими бесплатными услугами переводчиков. Чтобы воспользоваться услугами переводчика, позвоните нам по телефону Вам окажет помощь сотрудник, который говорит по-pусски. Данная услуга бесплатная. Arabic: إننا نقدم خدمات المترجم الفوري المجانية لإلجابة عن أي أسئلة تتعلق بالصحة أو جدول األدوية لدينا. للحصول على مترجم فوري ليس عليك سوى االتصال بنا على سيقوم شخص ما يتحدث العربية بمساعدتك. ھذه خدمة مجانية. Hindi: हम र स व स थ य य दव क य जन क ब र म आपक कस भ क जव ब द न क लए हम र प स म फ त द भ षय स व ए उपलब ध ह. एक द भ षय करन क लए, बस हम पर फ न कर. क ज ह द ब लत ह आपक मदद कर सकत ह. यह एक म फ त स व ह. Italian: È disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sul nostro piano sanitario e farmaceutico. Per un interprete, contattare il numero Un nostro incaricato che parla Italianovi fornirà l'assistenza necessaria. È un servizio gratuito. Portugués: Dispomos de serviços de interpretação gratuitos para responder a qualquer questão que tenha acerca do nosso plano de saúde ou de medicação. Para obter um intérprete, contacte-nos através do número Irá encontrar alguém que fale o idioma Português para o ajudar. Este serviço é gratuito. French Creole: Nou genyen sèvis entèprèt gratis pou reponn tout kesyon ou ta genyen konsènan plan medikal oswa dwòg nou an. Pou jwenn yon entèprèt, jis rele nou nan Yon moun ki pale Kreyòl kapab ede w. Sa a se yon sèvis ki gratis. Polish: Umożliwiamy bezpłatne skorzystanie z usług tłumacza ustnego, który pomoże w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania leków. Aby skorzystać z pomocy tłumacza znającego język polski, należy zadzwonić pod numer Ta usługa jest bezpłatna. Japanese: 当社の健康健康保険と薬品処方薬プランに関するご質問にお答えするために 無料の通訳サービスがありますございます 通訳をご用命になるには にお電話ください 日本語を話す人者が支援いたします これは無料のサービスです 15

20 Contact information Questions prior to enrolling? a.m. to 5 p.m., Eastern time Monday through Friday. TTY users call Want to enroll? Call Retiree Health Care Connect :30 a.m. to 4:30 p.m. Eastern time Monday through Friday TTY users call 711. Current member questions? UAW Retiree Medical Benefits Trust Service Center TTY users call 711. SilverSneakers questions? TTY users call CB SEP 16 H5883_S_17URMBTprekitbroc FVNR 0716 Blue Cross Blue Shield of Michigan is proudly represented by the UAW R055687