2017 FALL ENROLLMENT BROCHURE RETIREES AND OTHERS ELIGIBLE FOR MEDICARE. (800)

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1 (800) FALL ENROLLMENT BROCHURE RETIREES AND OTHERS ELIGIBLE FOR MEDICARE Jan u a r y 1, D e ce mbe r 31, Call toll-free (800) Monday-Friday 7 a.m. 7 p.m. central time (CT) and Saturday 7 a.m. 3 p.m. CT

2 WHAT YOU NEED TO KNOW The HealthSelect SM Secondary medical plan This guide will help you understand your HealthSelect Secondary benefits. Blue Cross and Blue Shield of Texas (BCBSTX) is the administrator for HealthSelect SM of Texas medical plans, including HealthSelect Secondary, as of September 1, The Employees Retirement System of Texas (ERS) sets the benefits and pays the claims, while BCBSTX processes claims and provides customer service. HealthSelect Secondary is available to retirees and their eligible dependents enrolled in Medicare. HealthSelect Secondary pays for services only after Medicare has paid first. If you are required to pay a portion of the cost, you need to meet a deductible of $200 per person/$600 per family before HealthSelect Secondary begins to pay for services (other than preventive care). Here are some things to know: Medicare and HealthSelect Secondary deductibles run concurrently You do not need to choose a primary care physician (PCP) You do not need a referral from a PCP to see a specialist Preventive services like annual check-ups and preventive vaccinations are covered at 100% when you visit a doctor that accepts Medicare, even if you haven t met the deductible It s important to know how HealthSelect Secondary coverage works with Medicare. If you are retired from the State of Texas and are eligible for Medicare (due either to your age or a disabling condition) you should enroll in Medicare Part A and Medicare Part B.* If you do not have this coverage, you will have to pay the remaining charges. It is possible for you and family members with HealthSelect to have different coverage, depending on age and Medicare eligibility. For example, if you and your spouse are both enrolled in HealthSelect and you become eligible for Medicare, but your spouse is not eligible for Medicare, Medicare will be the primary benefit plan for you, and HealthSelect will continue to be the primary plan for your spouse. This is true until your spouse becomes eligible for Medicare. Your prescription benefits are managed separately. Go to to access information about your prescription drug benefits. * If you do not qualify for Medicare Part A free of charge, provide a copy of the SSA documentation that you do not qualify for free Part A to Blue Cross and Blue Shield of Texas. If you turned 65 and retired prior to September 1, 1992 you are not required to purchase Medicare Part B. 2

3 WE RE HERE TO HELP Resources for your convenience Personal Health Assistants* are just a phone call away Personal Health Assistants are trained to help you and your covered family members plan for better health care and save money by: Helping you better understand your plan s benefits and coverage Scheduling appointments Connecting you with a clinician Sharing information about web and mobile tools, and helping you use them Talk to a Personal Health Assistant Call toll-free (800) Monday Friday 7 a.m. 7 p.m. CT Saturday 7 a.m. 3 p.m. CT Talk to a nurse, anytime With the 24/7 Nurseline, you and your covered family members have access to registered nurses at any time, any day of the year.** Call toll-free at (800) Convenient web and mobile tools With Blue Access for Members SM and the BCBSTX mobile app, your benefits are at your fingertips, wherever you are. Register for Blue Access for Members using the information on your medical ID card. With Blue Access for Members, you can find a doctor, hospital or urgent care facility, view Explanation of Benefits (EOB) statements and more. To register, visit and click Log In in the top right of the website. To download the mobile app, text BCBSTX to *** * Member communications and information from Personal Health Assistants are not meant to replace the advice of health care professionals. Participants 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. Coverage is subject to the limitations, exclusions and terms of your plan. ** For medical emergencies, call /7 Nurseline is not a substitute for your doctor s care and advice. Talk to your doctor about any health questions or concerns. *** Message and data rates may apply. Read terms, conditions and privacy policy at bcbstx.com/mobile/text-messaging. 3

4 GET THE CARE YOU NEED Why a primary care physician is important You are not required to select a PCP for HealthSelect Secondary and referrals are not required to see a specialist. But, having a PCP is important and can be a boost to your health. Your PCP: Will get to know you your health history, your Can show you better ways to stay healthier medications and your lifestyle Will decide if you need any tests or if you should Can treat many non-urgent health issues like see a specialist ear infections, rashes, allergies, fevers, colds, Can help you with specialized care for a chronic flu and much more health issue, such as asthma, diabetes or Will address routine medical care, such as physicals a heart problem and yearly exams Preventive services covered at 100%* Preventive check-ups and screenings can detect illnesses and medical problems early and improve overall health for you and your family members. When you visit a Medicare-accepting provider, your HealthSelect plan covers preventive screenings and services at no cost to you. You have many preventive care benefits, including: Domestic violence screenings Preventive vaccinations Routine checkups Screenings Well-woman visits Learn more on immunization recommendations and schedules by visiting the Centers for Disease Control and Prevention website at * Under the Affordable Care Act, certain preventive and women s health services are paid at 100% (at no cost to the participant) dependent upon physician billing and diagnosis. In some cases, the participant will still be responsible for payment on some services. 4

5 BENEFITS CHART The following chart is a summary of your HealthSelect Secondary benefits. Benefits 1 HealthSelect Secondary Benefits 1 HealthSelect Secondary Calendar year deductible Coinsurance Maximum Office visits in conjunction with an illness or injury Specialty physician office visit Diagnostic tests and x-rays, including allergy testing Diagnostic mammography $200 per individual $600 per family $3,000 per person Mental health a. Outpatient physician or mental health provider office visits b. Hospital Mental health inpatient stay (semi-private room and days board, and intensive care unit) c. Outpatient facility care (partial hospitalization/day treatment and extensive outpatient treatment) $0 6 If provider doesn t accept Part A, then coverage is 30% 2, 3 HealthSelect Secondary Diagnostic lab services Preventive services (such as screening mammogram, physical, well woman exam, prostate cancer screening, etc.) $0 Office surgery and diagnostic procedures Immunizations $0 High-tech radiology (CT scan, MRI, and nuclear medicine) Allergy injections and serum Routine eye exam 30% 2,4 Routine hearing test 30% 2 Diagnostic speech and hearing testing Speech and hearing therapy Hearing aids Chiropractic care Urgent care clinic Emergency care 5 Inpatient hospital (semi-private room and days board, and intensive care unit) Outpatient surgery Skilled nursing facility Home health care Hospice Ambulance Private duty nursing $1,000 benefit allowance per ear every 3 years $0 6 If provider doesn t accept Part A, then coverage is 30% 2, 3 $0 plus 30% 2, 3 coinsurance No deductible Plan pays 100% $0 copay/30% 2, 3 coinsurance for home infusion therapy Plan pays 100% for all other home health care services with a maximum of 100 visits per calendar year $0 copay/30% 2,3 coinsurance. Emergency care only. Not applicable to non-emergent transportation services. 30% 2 Unlimited hours 1 Benefits are paid on allowable amounts; using providers who contract with Blue Cross and Blue Shield of Texas will protect you from liability for amounts over the allowable amount. 2 After payment of deductible. HealthSelect note: Medicare and HealthSelect deductibles run concurrently. Member may be responsible for some charges when the provider does not accept Medicare assignment. 3 Payment amount is dependent upon the coordination of benefits (COB) between HealthSelect and original Medicare. Sometimes this means your expense is $0, but charges will vary depending upon COB. Please reference your Summary of Benefits for more information. 4 One per calendar year. 5 Benefits shown do not apply to out-of-network freestanding ERs. For information about this coverage, see the Master Benefit Plan Document. 6 In the event that the provider/facility does not accept Medicare assignment (so the charges are not covered by Medicare and therefore not subject to COB), you may be responsible for copay(s) and/or a coinsurance. Please see your Summary of Benefits for more information. Under the Affordable Care Act, certain preventive health and women s services are paid at 100% (at no cost to the member) conditioned upon physician billing and diagnosis. In some cases, you may still be responsible for payment on some services. Some age requirements may apply. This comparison chart offers a general overview of benefits and their associated out-of-pocket expenses under HealthSelect plans. Contact a Personal Health Assistant for specific questions. Call toll-free at (800) , Monday Friday 7 a.m. 7 p.m. CT, or Saturday 7 a.m. 3 p.m. CT to speak with a Personal Health Assistant. 5

6 THE CONVENIENCE OF VIRTUAL VISITS Get the care you need for minor illnesses and injuries without having to leave your home or go to the doctor s office! Virtual visits offer convenient, quality care if you can t make it to your regular doctor, you become ill while traveling, or as an alternative to visiting a hospital emergency room or urgent care facility for non-emergency health conditions. Since Medicare does not cover virtual visits, you will first have to meet your annual deductible under HealthSelect Secondary. After you meet your annual deductible, then virtual visits will be covered at 30% coinsurance. How virtual visits work Consult with a board-certified doctor online from a computer or mobile device using secure live audio and video technology. You can either consult a doctor right away or make an appointment. Doctors diagnose and treat a wide range of non-emergency medical conditions, such as cold, flu, sinus problems, sore throat, pink eye and bronchitis. Most visits take about minutes and doctors can write a prescription, if needed, for you to pick up at a local pharmacy. The service is available 24-hours a day, 7 days a week, including nights, weekends and holidays. You can choose between Doctor On Demand and MDLIVE.* Doctor On Demand offers virtual visits via video and MDLIVE offers virtual visits via video or telephone. Go to to learn more about virtual visits. There are links to websites for Doctor On Demand and MDLIVE. You will need to set up an account before you consult with a doctor. Please note: Virtual visits are not recommended for conditions requiring an exam or test, complex or chronic conditions, and sprains, broken bones or injuries requiring bandaging. * In the event of an emergency, this service should not take the place of an emergency room or urgent care center. MDLIVE and Doctor On Demand doctors do not take the place of your primary care doctor. MDLIVE and Doctor On Demand are independent companies that operate and administer the virtual visit program and are solely responsible for their operations and that of their contracted providers. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. The telemedicine services made available through Doctor On Demand are provided by licensed physicians practicing within a group of independently owned professional practices collectively known as Doctor On Demand Professionals. These professional practices provide services via the Doctor On Demand telehealth platform. Doctor On Demand, Inc. does not itself provide any physician, mental health or other healthcare provider services. MDLIVE is not an insurance product nor a prescription fulfillment warehouse. MDLIVE does not guarantee that a prescription will be written. MDLIVE and Doctor On Demand do not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. Internet/Wi-Fi connection is needed for computer access. Data charges may apply when using your tablet or smartphone. Check your phone carrier s plan for details. MDLIVE operates subject to state regulations and may not be available in certain states. Non-emergency medical service in Idaho, Montana, New Mexico and Oklahoma is limited to interactive audio/video (video only), along with the ability to prescribe. Non-emergency medical service in Arkansas is limited to interactive audio/video (video only) for initial consultation, along with the ability to prescribe. Service availability depends on location at the time of consultation. 6

7 HOLISTIC HEALTH MANAGEMENT Health care that is as individualized and unique as you are Because everyone is unique and requires a customized solution for success, we take a holistic approach to your well-being. Holistic Health Management is a team-based and member-centric approach to help HealthSelect of Texas participants realize their personal health potential by serving as your champion through the health care journey. You are an individual and one size does not fit all. That s why a holistic approach can support and help you manage you assessing what happened yesterday, what s happening today and looking toward a healthier tomorrow. How it works A dedicated clinician works with you and your eligible dependents, looking at a range of identified health concerns regardless of condition. Your clinician is supported by a multi-functional, integrated team including medical directors, nurses, mental health providers, Personal Health Assistants and social workers, working with a collaborative approach to meet your needs. For example, if you are managing diabetes, your clinician would assess your needs and help manage your care. Your clinician will be sure you know where to get your diabetic supplies and be a supportive resource to help answer your questions. There are a few ways to get started. In some cases, you may receive outreach from a clinician. Or if you have concerns you would like to discuss, you can reach out to a Personal Health Assistant who can talk with you and connect you with a clinician. Ask a Personal Health Assistant to connect you with a clinician Call toll-free (800) Monday Friday 7 a.m. 7 p.m. CT Saturday 7 a.m. 3 p.m. CT 7

8 HEALTH AND WELLNESS PROGRAMS A new way to experience wellness BCBSTX s Well ontarget online portal offers personalized tools and resources to help you no matter where you may be on the path to health and wellness. Learn more about nutrition, fitness, losing weight, quitting smoking and managing stress with selfdirected courses Take advantage of a food and exercise diary, symptom checker and health trackers Talk to certified health coaches that can help you make plans and put you in touch with a registered dietitian Well ontarget's mobile app, AlwaysOn, allows you to track your health from your mobile phone. Download AlwaysOn from Google Play or Apple store. Open the app and click on New User Registration. Then follow the prompts to verify information from your member ID. Log in to Blue Access for Members to access Well ontarget. Take advantage of discounts With Blue365, you may save money on health and wellness products and services from top retailers that are not covered by insurance.* Go to blue365deals.com/bcbstx for more information on the discounts available. * Blue365 is a discount program only for BCBSTX members. This is NOT insurance. Some of the services offered through this program may be covered under your health plan. Check your Master Benefit Plan Document or call BCBSTX toll-free at (800) for specific benefit facts. Use of Blue365 does not change your monthly payment, nor do costs of the services or products count toward any maximums and/ or plan deductibles. Discounts are only given through vendors who take part in this program. BCBSTX does not guarantee or make any claims or recommendations about the program s services or products. You may want to talk to your doctor before using these services and products. BCBSTX reserves the right to stop or change this program at any time without notice. 8

9 GET FIT A nationwide fitness program The Fitness Program is a flexible membership program. You can access more than 9,000 fitness centers with no contract required.* With easy online enrollment, automatic monthly payment withdrawal and unlimited access to a nationwide network of participating fitness centers, the Fitness Program makes staying active convenient. Program perks No yearly program or gym contract: Participation is month-to-month. The membership fee is $25 per month with a $25 enrollment fee Alternative medicine discounts: Save money with health and well-being providers, such as massage therapists, trainers and nutrition coaches** Easy to pay: After you sign up, it s easy to set up an automatic credit card or bank account withdrawal to pay your monthly fee To register, search for a location or learn more about the Fitness Program, log in to your Blue Access for Members account and click Fitness Program under Quick Links or call (888) 762-BLUE (2583) toll-free, Monday Friday, 8 a.m. 9 p.m., in any U.S. time zone. * The one-time enrollment fee and monthly membership fee for the Fitness Program are both subject to applicable taxes. The Fitness Program is provided by Tivity Health, an independent contractor that administers the Prime Network of fitness centers. The Prime Network is made up of independently owned and operated fitness centers. The HealthSelect Fitness Program is provided as a value-added benefit to HealthSelect participants in addition to your health plan. It is NOT insurance. Use of the HealthSelect Fitness Program does not change monthly payments, nor do costs of the services or products count toward any HealthSelect plan maximums and/or plan deductibles. Fitness center access is provided only by vendors that take part in this program. ** You must be a Fitness Program member to take advantage of these discounts. 9

10 Health care coverage is important for everyone. We provide free communication aids and services for anyone with a disability or who needs language assistance. We do not discriminate on the basis of race, color, national origin, sex, gender identity, age or disability. To receive language or communication assistance free of charge, please call us at If you believe we have failed to provide a service, or think we have discriminated in another way, contact us to file a grievance. Office of Civil Rights Coordinator Phone: (voic ) 300 E. Randolph St. TTY/TDD: th Floor Fax: Chicago, Illinois CivilRightsCoordinator@hcsc.net You may file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at: U.S. Dept. of Health & Human Services Phone: Independence Avenue SW TTY/TDD: Room 509F, HHH Building 1019 Complaint Portal: Washington, DC Complaint Forms: Do you need this guide in Spanish? This guide is available online at in Spanish. Go to the En español link to access Spanish content. You can print the guide from the online PDF. Necesita esta guía en español? Esta guía está disponible en línea en español en Visite el enlace En español para ver contenido en español. Puede imprimir la guía usando el archivo PDF digital. 10

11 bcbstx.com 11

12 CONTACT INFORMATION HealthSelect website: Talk to a Personal Health Assistant Call toll-free (800) Monday Friday 7 a.m. 7 p.m. CT and Saturday 7 a.m. 3 p.m. CT 24/7 Nurseline (800) Blue Cross and Blue Shield of Texas is the third-party administrator for the HealthSelect SM of Texas and Consumer Directed HealthSelect SM plans. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Blue Cross, Blue Shield and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans

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