Your Health MATTERS. Member tools and resources. Plan administered by

Transcription

1 Your Health MATTERS Member tools and resources Plan administered by

2 Count on Blue Cross Blue Shield of Arizona (BCBSAZ) to help you and your family stay healthy. This booklet provides information on the member tools, programs and resources your plan offers to help you and your family stay healthy. If you have any questions about anything you see here, help is just a phone call away. Plan Choices and Support Network Ins and Outs...5 Using the Treatment Cost Estimator...6 Health and Wellness Where to go for healthcare Care Management...9 Nutrition Counseling...10 HealthyBlue Beginnings Maternity Support...11 Blue365 Discount Program...12 AZBlue Mobile App...13 Mi Consejero Azul Personalized Service for Spanish-speaking members

3 Plan choices THAT MEET YOUR NEEDS Choose from two great plans to cover you and your family: Plan Features PPO EPO Access to the BCBSAZ provider network in AZ, including the Mayo Clinic and Cancer Treatment Centers of America Access to network providers outside of AZ through BlueCard No referral required X X X X X X Benefits In and out-of-network benefits In-network benefits only (no out-of-network benefits except for emergency services) Getting care in Arizona and beyond BCBSAZ offers State of Arizona employees a large statewide network of providers, hospitals and clinics and employees will have access to contracted providers outside of Arizona through the national BlueCard program. From your neighborhood physician to a convenient retail clinic location, chances are good that your provider is included in BCBSAZ s vast network. BCBSAZ NETWORK PROVIDERS IN ARIZONA % of PCPs 93.4% of specialists 90.6% of hospitals BLUECARD NETWORK PROVIDERS NATIONALLY % of PCPs 92.1% of specialists 95.9% of hospitals 1 Internal BCBSAZ data. 2 BlueCard Data Sources: BCBS - Provider Data Repository (PDR), data as of: 1/28/16. 3

4 Support WHEN YOU NEED IT GREAT NEWS! State of Arizona employees have the opportunity to choose a plan that provides access to the great BCBSAZ network available last year. You can count on us as the one to turn to for support: from answering questions, getting timely claims, to finding solutions to any issues, and more. Our caring, knowledgeable reps are here to deliver the best experience for you. Member Satisfaction * 97% Local service with a personal touch When you have questions about your plan, our member services and claims teams: Are local, with centers in Phoenix, Chandler, Tucson and Flagstaff Have an average of 11 years of experience** Welcome walk-in customers Speak Spanish, with support through Mi Consejero Azul (My Blue Advisor) Personalized wellness extras Count on us to help you and your family stay healthy, too. Your plan includes free personalized tools, programs and resources to help you do that. My BluePrint an online health quiz that gives you immediate results and lets you set goals and track your progress over time Nurse On Call get answers to your health questions by phone or 24/7 Health Coaching reach a health goal with online, phone and one-on-one support Health Condition Management get help managing diabetes, asthma, COPD, coronary artery disease and congestive heart failure Care Management get expert help with your plan benefits and guidance through the healthcare system Blue365 get healthy discounts and save on fitness equipment, healthy eating, personal care services and more *Studies of Blue Cross Blue Shield of Arizona customers and group benefits administrators were conducted during the second and third quarter of 2016 by Thoroughbred Research, an independent research company. **Based on internal analysis of customer service and claim teams hire dates. 4

5 Network Ins and Outs WHAT S A NETWORK? It s a group of providers that have signed up to provide services to members of a particular health plan. Providers can be doctors, hospitals, clinics, pharmacies, laboratories, or other professionals or businesses that offer healthcare services. Health plans and networks go hand in hand. Are the doctors you want to see in the network for the plan you selected? If not, what happens if you see a doctor outside the network? These are questions you should consider before seeing a doctor. WHAT S THE DIFFERENCE? NETWORK PROVIDERS When you see providers that are part of your plan s network, they re called network providers. Some plans also refer to them as in-network providers. How did they become part of your network? By having a contract with your health insurer to serve the members in your plan. OUT-OF-NETWORK PROVIDERS Unlike network providers, out-of-network providers or non-contracted providers do not have a contract with your health insurer to serve members in your plan. You may pay more if you see them. And, it s possible their services may not be covered at all.* DON T PAY MORE THAN YOU SHOULD. Check that your providers are in your plan s network before you get services. How can you be smart about costs when it comes to healthcare? Always check that your doctor, specialist, or other service providers are in your plan s network before receiving services to avoid facing unexpected costs. Staying in-network means you can be confident your provider takes your insurance. Find out if the doctors you want are in your plan s network. Visit azblue.com/findadoctor. *BCBSAZ HMO plans do not cover services outside the network, except for emergency care, urgent care and limited special cases with BCBSAZ pre-approval. All plans are subject to limitations, exclusions, exceptions and cost-share requirements. BCBSAZ complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Spanish: Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Blue Cross Blue Shield of Arizona, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al Navajo: Díí kwe é atah nílínigíí Blue Cross Blue Shield of Arizona haada yit éego bína ídí[kidgo éí doodago Háida bíjá anilyeedígíí t áadoo le é yína ídí[kidgo beehaz áanii hól- díí t áá hazaadk ehjí háká a doowo[go bee haz ą doo bąąh ílínígóó. Ata halne ígíí koj bich į hodíilnih D /16 5

6 Using the Treatment Cost Estimator Now you can look up your bottom-line costs for different conditions you and your doctor can decide which treatment option works best for you, and you ll know how much it costs Log into your member account at azblue.com/member. Click Get Estimates for Healthcare Costs. a. Hit Continue after reading the Important Notice. ONCE YOU RE ON THE SEARCH TOOL SITE 6 Expand Type the location an address or city you want to search. Type the treatment (e.g., procedure, diagnosis, body part). A list will show as you type. Click what you want to search (e.g., ACL Repair) under the category you re searching. A list of related search terms will appear in categories such as Provider Name, Specialty, Cost Estimates By Provider, and others. For an overview of the treatment, select a result in the Total Cost Estimates category. Then click Search. the treatment type you want (e.g., Surgical Center vs. Outpatient Hospital). The expanded view shows a timeline and expected costs at each step of treatment. Expand wherever you see SAVE ##% to see how you can save money. 7 Under SAVE ##%, click Get estimated costs at facilities near you. Results show where in your plan network you can get the service (and for how much). Sort results by your preference: Location, name or cost. Click the cost beside the healthcare provider s name to see how your bottom-line out-of-pocket cost was calculated. Results are estimates based on the average costs for the treatment for BCBSAZ members. Your actual cost may vary. D

7 HEALTH AND WELLNESS Where to go for healthcare Sometimes we brush off feeling sick we power through it. Other times, we re confident a good night s sleep is all we need. But what happens when it s more than that and you need medical care? There are a lot of options for getting the care you need. So how do you choose? PRIMARY CARE PROVIDER (PCP) RETAIL CLINIC URGENT CARE EMERGENCY ROOM (ER) Symptoms Is it something that can wait? Feel bad but can t get in to see your doctor? When to go When you need routine, nonemergency care or help managing an acute or chronic condition, or help with a referral to a specialist. If you have a non-lifethreatening illness or injury and can t get in to see your primary care provider. Not feeling well, and it s on the weekend? If it s the weekend or an evening, and your doctor isn t available, urgent care can help with nonlife- threatening medical issues that could become worse if not treated immediately. Think it could be a matter of life or limb 1? When you have a serious medical condition that could be life- or limb-threatening. Reasons to go Colds and flus Sinus, ear or eye infections High fever Headache Skin irritations/rashes Minor cuts and burns Sprains Minor fractures Physical exams, vaccines and health screenings Colds and flus Sinus, ear or eye infections Rashes Flu shots or other vaccines Wait time Minimal, depending on the office. Typically short. May have online check-in. Colds and flus High fever Headache Spreading skin irritations/ rashes Minor cuts and burns Sprains Minor fractures Usually shorter than the ER, plus some clinics let you sign in online and then notify you when it nears your appointment time. Cost $$ $ $$ $$$ How to get care Call your doctor or healthcare provider to make an appointment. No appointment needed, however calling ahead or scheduling online is always a good idea. Download the AZBlue mobile app 2 to find locations that are covered by your plan. Severe chest pain Difficulty breathing Ingestion of objects or poisons Major trauma or injury (such as a car crash) Seizures Severe burns Severe diarrhea Uncontrollable bleeding or vomiting blood Animal bites Unconsciousness Depends on the time of day, but if your situation is a true emergency, you ll be seen/ evaluated promptly. In an emergency, call 911 or have a friend or family member drive you to the nearest location. 7

8 HEALTH AND WELLNESS AZBlue Find a Doctor Tool Log on to azblue.com/findadoctor to search for providers, retail clinics and urgent care locations in your plan s network. PLEASE NOTE: It s important to use doctors and facilities in your plan s network to help keep your costs down. If you visit a doctor or facility that is not part of your plan s network, your plan may not cover your care. Or, your out-of-pocket costs could be much higher. Not sure where to go? Call Nurse On Call at It s part of your plan, so there s no additional cost. Talk to a trained nurse about your symptoms and they will help you decide where to go. This service is also available to family members on your Blue Cross Blue Shield of Arizona (BCBSAZ) plan. 1 In an emergency call Your wireless plan s phone and data rates may apply. Search for AZBlue in the Google Play or Apple App stores. Apple, the Apple logo, ipad, and iphone are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Google Play is a trademark of Google Inc. QUESTIONS? CALL OR VISIT azblue.com/healthyblue Blue Cross Blue Shield of Arizona members should always consult with their healthcare provider about medical care or treatment. Recommendations, advice, services or online resources are not a substitute for the advice, opinion or recommendation of a member s healthcare provider. Services or treatment options may not be covered under BCBSAZ benefit plans. Members under age 18 will need parental consent to use the Nurse on Call service. D /2017 8

9 CARE MANAGEMENT Get help with a complex or unexpected health issue It s easy to take our health for granted. Then life throws us an unexpected challenge like a cancer diagnosis or a serious accident. Fortunately, our Care Managers are here to help and it s at no cost to you. Our Care Management team will help you: UNDERSTAND WHAT YOUR HEALTH PLAN INCLUDES GET REFERRALS TO IN-NETWORK DOCTORS YOU NEED FIND SPECIAL EQUIPMENT LIKE WHEELCHAIRS OR WALKERS MAKE THE BEST CHOICES FOR YOUR CARE KNOW THE COST OF MEDICATIONS Lean on our team If you or a family member are coping with a complex medical condition, or dealing with a catastrophic illness or a traumatic injury, a care manager may be of help. TO LEARN MORE, CALL OR GET MORE INFORMATION AT azblue.com/healthyblue Members should always consult with their healthcare providers regarding medical care or treatment, as recommendations, services or resources are not a substitute for the advice or recommendation of a member s physician or healthcare provider. D /2017 9

10 NUTRITION COUNSELING Get Help Improving Your Diet Low energy. Digestion Problems. Headaches. Feeling blah. You might be able to improve these issues through changes in what you eat. That s because your food choices are about more than vitamins and nutrients. They go beyond a number on a scale or a pants size. These choices can directly affect how you feel every day and whether you have the energy to do all the things you love. But it can be hard to know what healthy eating really is, right? Let us help. Nutrition counseling may be included in your benefits, and it could allow you to meet one-on-one with a nutrition counselor who can: DISCUSS YOUR CURRENT ENERGY LEVEL AND HEALTH GOALS TALK THROUGH WHAT YOU EAT AND YOUR COOKING HABITS HELP YOU UNDERSTAND HOW YOUR FOOD CHOICES AFFECT YOUR HEALTH TEACH YOU ABOUT SIMPLE CHANGES THAT CAN HAVE A BIG IMPACT ON HOW YOU FEEL EVERY DAY You may be eligible for nutrition counseling if you have been diagnosed with one or more of the following 1 : Coronary artery disease Eating disorders Heart failure High cholesterol Hypertension Obesity Pre-diabetes Renal failure/renal disease Find a Dietitian Log on to your member portal at azblue.com/member Click on FIND A DOCTOR on the left navigation Search for REGISTERED DIETITIAN Select a provider in your plan s network and call for an appointment You may need a referral from your doctor to verify diagnosed conditions. Be sure to choose a provider in your plan s network to avoid unexpected costs. QUESTIONS? CALL THE NUMBER ON YOUR ID CARD Blue Cross Blue Shield of Arizona. 1 Limitations and exclusions may apply. Some health plans cover spouse and dependents for nutrition counseling for these diagnoses, check with your plan administrator for more information. D /

11 HealthyBlue Beginnings Maternity support at no additional cost Whether you are thinking about becoming pregnant, or are pregnant already, HealthyBlue Beginnings provides resources to guide you every step of the way. After all, a healthy pregnancy is good for you and your baby. HealthyBlue Beginnings offers eligible members who enroll: Preconception program with education, counseling and a free pregnancy kit Maternity nurse toll-free telephone support line, 24/7 Helpful maternity information at azblue.com/healthyblue Comprehensive guide for all stages of pregnancy Help from a nurse when high-risk maternity care is needed Post-maternity support line until your baby is six weeks old Find out how you can receive a GIFT $100 CARD! Get a $100 BABIES R Us Gift Card Enroll by the 16th week of your pregnancy and complete the surveys to get a $100 Babies R Us Gift Card. TO LEARN MORE, CALL OR GET MORE INFORMATION AT azblue.com/healthyblue 11

12 Blue365 DISCOUNT PROGRAM Saving money never felt so healthy Blue Cross Blue Shield of Arizona (BCBSAZ) wants to help you take care of yourself every day of the year. That s why we created Blue365, an online destination featuring healthy deals and discounts exclusively for our members. Top brands with discounts just for you Take advantage of special offers from national brands. You can make good choices and save money, too. And registration is quick and easy. Go to Blue365Deals.com/BCBSAZ and have your Blue Cross Blue Shield member ID card handy. In a couple of minutes you will be registered and ready to shop. See special offers from top national brands in fitness, nutrition, personal care, and more. And each week, we will send a deal of the week straight to your box Blue Cross and Blue Shield Association All Rights Reserved. The Blue Cross and Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield Plans. Blue365 offers access to savings on items that members may purchase directly from independent vendors, which are different from items that are covered under the policies with their Blue Cross and/or Blue Shield Company (each a Blue Company ), its contracts with Medicare, or any other applicable federal healthcare program. The products and services described herein are neither offered nor guaranteed under Members Blue Company s contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither any local Blue Company nor BCBSA recommend, endorse, warrant or guarantee any specific Blue365 vendor or item. Blue365 services are offered by independent companies that do not provide Blue Cross and/or Blue Shield products or services and are solely responsible for the services provided. These companies are not affiliated with BCBSAZ. Discounts may be rescinded or canceled at any time without notice. There is no guarantee of the percentage or level of savings on services or products. Lower prices may be available on the same products or services through other programs or vendors. Limitations and restrictions apply to each program. GET MORE INFORMATION AT Blue365Deals.com/BCBSAZ 12

13 AZBlue Mobile App Now members can access valuable information to make healthcare decisions directly from their smartphone. Access your ID card and it to your doctor s office right from the app Quickly locate the closest in-network urgent care provider Review your coverage summary for you and your family Download the free application today through the Google Play Store (Android devices) and App Store (Apple devices). Simply search for AZBlue and download the app that gives you instant access to helpful Blue Cross Blue Shield of Arizona plan information. My ID Card Access your ID card when you need it and it to your doctor s office. My Coverage Summary See plan deductibles and dependent list for medical and dental. Urgent Care Locator Quickly find in-network urgent care providers, mapped by ZIP code or current location. 1 Contact Us Send us an or call us at the touch of a button. TO LEARN MORE, VISIT azblue.com 1 Always remember to dial 911 for emergency medical services. Your wireless plan s phone and data rates may apply. Apple, the Apple logo, ipad, and iphone are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Google Play is a trademark of Google Inc. 13

14 Personalized service and guidance for our Spanish-speaking customers Whether you re looking for detailed information about claims, benefits and enrollment or just need help finding a doctor or hospital, Mi Consejero Azul (My Blue Advisor) was designed just for you. Mi Consejero Azul provides one place for you to call with questions or for guidance on a variety of health coverage issues. When you contact Mi Consejero Azul, you ll be treated with patience, kindness and respect. And because Blue Cross Blue Shield of Arizona features local customer service, you ll be speaking to someone right here in our community, just like your friends and neighbors. Mi Consejero Azul is staffed by some of our finest customer service representatives and they provide personalized assistance to every caller. They were chosen based on their extensive experience and background. So, not only will they speak Spanish, but they re also better equipped to understand your concerns and questions. Confused about your benefits and what they include? Looking for assistance with a billing question? Trying to find a doctor or hospital? With Mi Consejero Azul, you simply call a dedicated phone line and we will find answers for you on issues like these and much more. It s part of our Mi Salud, a Mi Manera program and we think it makes a big difference to our Spanish-speaking customers. To find out more about Mi Consejero Azul, CALL OR TOLL FREE AT EXT

15 Things That Are Important to Me When Choosing a Health Plan 15

16 See why we re Arizonans trusted choice for more than 75 years. Select your plan today! CALL OR VISIT adoa.azblue.com Blue Cross Blue Shield of Arizona complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Blue Cross Blue Shield of Arizona, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al Díí kwe é atah nílínigíí Blue Cross Blue Shield of Arizona haada yit éego bína ídí[kidgo éí doodago Háida bíjá anilyeedígíí t áadoo le é yína ídí[kidgo beehaz áanii hól- díí t áá hazaadk ehjí háká a doowo[go bee haz ą doo bąąh ílínígóó. Ata halne ígíí koj bich į hodíilnih