BlueChoice HealthPlan Medicaid An Overview Community Outreach Perspective
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1 BlueChoice HealthPlan Medicaid An Overview Community Outreach Perspective 1
2 BlueChoice HealthPlan Medicaid In the Communities We Serve! 2
3 BlueChoice HealthPlan Medicaid Our focus is on preventive care. We work with community-based organizations, faith-based organizations, providers and businesses to help our members find local resources. We have a strong network of PCP and specialty providers. Our goal is to help people get the medical care they need and the respect they deserve. We help our members get their own doctors in their own communities. We serve more than 67,000 members statewide. 3
4 BlueChoice HealthPlan Medicaid Contacts SC BLUE SM Retail Centers: (Receive information on Blue plans, commercial and Medicaid) Columbia (803) Fax: (803) Toll Free: (855) 592-BLUE (2583) Greenville (864) Fax: (864) Toll Free: (855) 392-BLUE (2583) Mt. Pleasant (843) Fax: (843) Toll Free: (855)492-BLUE (2583) Monday - Friday: 9 a.m. 7 p.m. Saturday: 10 a.m. 6 p.m. Columbia@scblueretailcenters.com Monday - Friday: 9 a.m. 7 p.m. Saturday: 10 a.m. 6 p.m. Greenville@scblueretailcenters.com Monday - Friday: 9 a.m. 7 p.m. Saturday: 10 a.m. 6 p.m. Charleston@scblueretailcenters.com 4
5 BlueChoice HealthPlan Medicaid Contacts Website: Customer Care Center: (verify eligibility, benefits, claims status, general questions, etc.) Voice: Monday - Friday: 8 a.m. to 6 p.m. Fax: or TTY: ExpressScripts, Inc. (Pharmacy Benefits) ExpressScripts is an independent company that provides pharmacy benefits on behalf of BlueChoice HealthPlan Medicaid. Voice: Fax: Hour Nurseline Monday - Friday: 8 a.m. to 9 p.m. Saturday - Sunday: 8 a.m. to 6 p.m. Voice: TTY:
6 BlueChoice HealthPlan Medicaid Contacts LogistiCare: (schedule a ride to non emergency provider appointments, call three days in advance) Region 1: Monday - Friday: 8 a.m. 5 p.m. Abbeville, Anderson, Cherokee, Edgefield, Greenville, Greenwood, Laurens, McCormick, Oconee Pickens, Saluda, Spartanburg Region 2: Monday - Friday: 8 a.m. 5 p.m. Aiken, Allendale, Bamberg, Barnwell, Calhoun, Chester, Clarendon, Fairfield, Kershaw, Lancaster, Lee, Lexington, Newberry, Orangeburg, Richland, Sumter, Union, York Region 3: Monday - Friday: 8 a.m. 5 p.m. Beaufort, Berkeley, Charleston, Chesterfield, Colleton, Darlington, Dillon, Dorchester, Florence, Georgetown, Hampton, Horry, Jasper, Marion, Marlboro, Williamsburg 6
7 BlueChoice HealthPlan Medicaid Contacts South Carolina Healthy Connections Choices: (enrollment broker, re-determination) Customer service center: Monday - Friday: 8 a.m. 6 p.m. TTY: Fax: website: South Carolina Department of Health & Human Services (SCDHHS): (eligibility for Medicaid) Main line: (888) website: 7
8 BlueChoice HealthPlan Medicaid Contacts Remember that all contact information for BlueChoice HealthPlan Medicaid is different than our commercial product BlueChoice HealthPlan. Vision Service Plan (VSP): (VSP is an independent company that offers a vision network on behalf of BlueChoice HealthPlan Medicaid) Phone (800) Monday - Friday: 8 a.m. 10 p.m. 8
9 Provider Education Territory Map 9
10 Medicaid Eligibility Medicaid is a health and long-term care coverage program that is jointly financed by the state and federal government. Each state establishes and administers its own Medicaid program and determines the type, amount, duration and scope of services covered within broad federal guidelines. States must provide certain mandatory benefits and may choose to offer other optional benefits. 10
11 Medicaid Eligibility SCDHHS administers the Medicaid program in South Carolina. It ensures the availability of government-funded health care services for eligible members. SCDHHS Main line: (888) Website: SC Healthy Connections Choices line: (877) Website: Benefit Bank line: (800)
12 Identification Card In addition to this BlueChoice HealthPlan Medicaid ID Card, members are required to carry their SCDHHS-issued Healthy Connections ID cards. 12
13 Website The BlueChoice HealthPlan Medicaid website is different than the one for commercial BlueChoice. 13
14 Available Resources Benefits & Services Information Community Events Calendar Eligibility, Re-enrollment Information Evidence of Coverage Manual (EOC) Forms Health Education Member Update Newsletters Pharmacy Information Provider Directory 14
15 Covered Benefits BlueChoice HealthPlan Medicaid is required to offer at a minimum the same benefits as the state. Plans can choose to offer additional benefits. A complete description of core services can be found in the Member Handbook (Evidence of Coverage) and/or the Provider Manual, both of which are posted on our website. 15
16 Value Added Benefits In addition to the core benefits offered, BlueChoice HealthPlan Medicaid also offers several value-added benefits: No Copay for Urgent Care Future Moms Program Discounts on Health & Wellness Programs Low Copays for Generic & Name-Brand Medicine No Cost for Check-ups, Circumcisions and Flu Shots Free Manual Breast Pumps Gift Cards 24-Hour Nurseline ConditionCare Program 16
17 ConditionCare Our ConditionCare program is designed to provide targeted and individualized support for members dealing with chronic conditions. With ConditionCare, members receive: 24-hour, toll-free access to a nurse who will answer questions. Support from nurse coaches, pharmacists, dietitians, doctors and other health care professionals to help members reach their health goals. Educational guides and tools to help members learn more about their conditions, such as: Asthma (pediatric and adult) Chronic Obstructive Pulmonary Disease (COPD) Congestive Heart Failure (CHF) Coronary Artery Disease (CAD) Diabetes (pediatric and adult) Pregnancy Before delivery and after 17
18 Copays Benefit Copay Primary Care Visits, RHCs and FQHCs $3.30 Specialists Visits (including optometrists) $3.30 Medical Equipment $3.40 Chiropractor $1.15 Home Health (Limited to 50 visits) $3.30 Prescription Drugs (Brand and Generic) $3.40 Outpatient Hospital $3.40 Inpatient Hospital $
19 Copay Exceptions These beneficiaries are exempt from copay requirements: Children under 19 years of age Pregnant women Institutionalized individuals Individuals receiving services in the emergency room Individuals receiving Medicaid hospice services Members of a federally recognized Indian Tribe (exempt when services are rendered by the Catawba Service Unit in Rock Hill and when referred to a specialist by Catawba) 19
20 Copay Exceptions These services are not subject to copayments: Medical equipment and supplies provided by the Department of Health and Environmental Control (DHEC) Family planning End Stage Renal Disease services Infusion centers 20
21 Community Involvement Health-Related Events & National Observances Black History Month Feb National Dental Health Month Feb National Heart Month Feb American Diabetes Associate Alert Day March 25, 2014 Doctor s Day March 30, 2014 Nutrition Month March
22 Community Action Winter Warm Up Aiken County There were up to 100 participants for this event. The children and families enjoyed fun-filled fitness activities, light, festive refreshments, health screenings, lots of useful information from the vendors, and much more. 22
23 Community Action Winter Wonderland Florence County Well more than 150 parents and children attended the event. Participants enjoyed a fun, festive event which included a snack shack where children prepared healthy snacks, a nutritious prize wheel, a fitness challenge course, storytelling, giveaways, a visit from Santa and more. 23
24 Community Action Shots Our member outreach team supported the 9 th Annual Kids Jamboree in Florence, SC. Event organizers reported having about 16,000 participants this year. More than 400 visited our interactive exhibit booth throughout the two-day event. The community enjoyed many fun-filled family activities, such as a petting zoo, amusement park rides and games. Families enjoyed our healthy facts trivia prize wheel while gaining knowledge about benefits and services. 24
25 Thank you for your participation! Contact Information: Donna Williams, Community Relations Manager Direct: Office: BlueChoice HealthPlan Medicaid is an independent licensee of the Blue Cross and Blue Shield Association. Healthy Connections is administered for BlueChoice HealthPlan Medicaid by WellPoint Partnership Plan, LLC, an independent company. 25
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