Enrollment Guide WASHINGTON COUNTY PUBLIC SCHOOLS. Washington County Public Schools Enrollment Guide C1

Size: px
Start display at page:

Download "Enrollment Guide WASHINGTON COUNTY PUBLIC SCHOOLS. Washington County Public Schools Enrollment Guide C1"

Transcription

1 Enrollment Guide WASHINGTON COUNTY PUBLIC SCHOOLS 2014 Washington County Public Schools Enrollment Guide C1

2 Table of Contents Welcome... 1 Exclusive Provider Organization (EPO)... 2 Preferred Provider Organization... 4 Maryland Point of Service... 6 Patient-Centered Medical Home... 9 Find a Doctor, Hospital or Urgent Care Summary of Benefits Health + Wellness My Account... 16

3 Welcome Welcome to your plan for healthy living From preventive services to maintain your health, to our extensive network of providers and resources, CareFirst BlueCross BlueShield (CareFirst) is there when you need care. We will work together to help you get well, stay well and achieve any wellness goals you have in mind. FREE My Account mobile app We know that health insurance is one of the most important decisions you make for you and your family and we thank you for choosing CareFirst. This guide will help you understand your plan benefits and all the services available to you as a CareFirst member. Please keep and refer to this guide while you are enrolled in this plan. How your plan works Find out how your health plan works and how you can access the highest level of coverage. Get our free app from your favorite app store by searching for CareFirst. Health care information is in the palm of your hand with CareFirst s new mobile app that allows you to manage your care, access claims information, view your ID cards and find a doctor or urgent care center any time of the day or night from your smartphones or tablets. What s covered See how your benefits are paid, including any deductibles, copayments or coinsurance amounts that may apply to your plan. Getting the most out of your plan Take advantage of the added features you have as a CareFirst member: Wellness discount program offering discounts on fitness gear, gym memberships, healthy eating options and more. Online access to quickly find a doctor or search for benefits and claims. My Care First wellness website with health calculators, tracking tools and podcast videos on specific health topics. Vitality magazine with healthy recipes, preventive health care tips, and articles on nutrition, physical fitness, and stress management. Washington County Public Schools Enrollment Guide 1

4 Exclusive Provider Organization (EPO) With the EPO, you have the strength of CareFirst Blue Cross and Blue Shield Plan credentialed network providers, but also a wide range of benefits, including preventive benefits which can help you treat conditions before they become serious. Some of these benefits include: child immunization diagnostic tests doctor s office visits emergency care home care and hospice care immunizations inpatient hospital care maternity care mammography screenings routine adult physicals routine gynecological visits speech, occupational, and physical therapy surgery well-child care X-rays Service that counts You can talk to our knowledgeable Customer Service representatives who will be happy to answer any questions you may have about claims and benefits. Peace of mind You can rest easy knowing that you have the most widely recognized and accepted insurance card in the country. When you need care Once you have enrolled in the EPO, and your benefits are effective, you are ready to use your health insurance plan. Whether you need routine care or specialty care, you will need to select a PCP in order to receive coverage. 2 Washington County Public Schools Enrollment Guide

5 Exclusive Provider Organization (EPO) Your benefits Step 1: Meet your deductible Your plan requires you to meet a deductible, for certain services. You will be responsible for the entire cost of your medical care up to the amount of your deductible for these services. Once your deductible is satisfied, your EPO coverage will become available to you. Some services, like office visits, have a copay instead of a deductible. You can refer to the chart on pages for further details. Step 2: Your EPO plan will start to pay for services After you satisfy your deductible, your EPO plan will start to pay for covered services. You will have to pay coinsurance or copays, where applicable, when you receive care. Step 3: Your out-of-pocket maximum Your out-of-pocket maximum is the maximum amount you will pay during your benefit period. Should you reach your out-of-pocket maximum, CareFirst will then pay 100% of the allowed benefit for most covered services for the remainder of the benefit period. Any amount you pay toward your deductible, coinsurance and copays will count toward your out-of-pocket maximum. You may choose a doctor who specializes in family practice, general practice, pediatrics or internal medicine as your PCP. Your entire family may select the same doctor, or each member may choose a different doctor, based on each person s age or medical needs. To select your PCP, please call CareFirst customer service at or call the local Hagerstown district office at To ensure that you have the most current provider information, we encourage you to visit our online provider directory at Referrals to specialists Your PCP will coordinate your medical care and provide treatment for a variety of medical conditions. Generally, your PCP will need to see you for a proper evaluation before issuing a written referral. You and your PCP can work together to select a specialist. CareFirst BlueCross BlueShield provides your benefits on a contract year basis. Your deductible period runs for a consecutive 12 months from July 1st through June 30 each year. Your primary care physician Establishing a relationship with one doctor is the best way for you to receive consistent, quality health care; therefore, you must select a PCP at the time of your enrollment into the EPO plan. It is important that you select a PCP. If you have not selected a PCP for yourself or a covered family member, all covered services will be denied. Your PCP will: Provide basic medical care treating illness and providing preventive care. Prescribe any medications that you may require. Maintain your medical history. Work with you to determine when you should see a specialist, assist in the selection of a specialist, and provide you with a written referral. Washington County Public Schools Enrollment Guide 3

6 Preferred Provider Organization A Referral-Free Go Anywhere Health Plan Designed for today s health conscious and busy families, the Preferred Provider Organization (PPO) plan offers one less thing to worry about during your busy day. Your PPO plan gives you the freedom to visit any provider you wish any time you wish. This means you can receive care from the provider of your choice without ever needing to select a primary care provider (PCP) or obtaining a PCP referral for specialist care. Benefits of PPO Access to our network of more than 23,000 doctors, specialists and hospitals in Maryland, Washington, D.C. and Northern Virginia. No primary care provider required, and no referrals to see a specialist. Take your health care benefits with you across the country and around the world. Receive coverage for preventive health care visits at no cost. Avoid balance billing when you receive care from a preferred provider. Enjoy the freedom to visit providers outside of the PPO network and still be covered but with a higher out-of-pocket cost. How your plan works In-network vs. out-of-network coverage The amount of coverage your PPO plan offers depends on whether you see a provider in the PPO network (preferred provider). You will always receive a higher level of benefits when you visit a preferred provider. However, the choice is entirely yours. That s the advantage of a PPO plan. In-network benefits provide a higher level of coverage. This means you have lower out-of-pocket costs when you choose a PPO network provider. You have the freedom to select any provider that participates with a Blue Cross and Blue Shield PPO plan across the country and receive benefits at the in-network level. No referrals. No PCPs. Coverage everywhere. 4 Washington County Public Schools Enrollment Guide

7 Preferred Provider Organization (PPO) A Referral-Free Go Anywhere Health Plan Out-of-network benefits provide a lower level of coverage in exchange for the freedom to seek care from any provider you choose. If you receive services from a provider outside of the PPO network (non-preferred provider), you may have to: Pay the provider s actual charge at the time you receive care. File a claim for reimbursement. Satisfy a higher deductible and/or coinsurance amount. Hospital authorization/ Utilization management Preferred providers will obtain any necessary admission authorizations for in-area covered services. You will be responsible for obtaining authorization for services provided by non-preferred providers and out-of-area admissions. Call toll-free at (866) PREAUTH. Deductible and out-of-pocket limit After you satisfy your deductible (if applicable), CareFirst pays a percentage of the allowed benefit for covered services. You receive a higher level of reimbursement when you use a Preferred Provider. If you obtain care from a non-preferred Provider, but one who participates with CareFirst, you will be responsible for any applicable deductible, copayment and/or coinsurance amount up to the allowed benefit. However, if the provider is not a Preferred or Participating Provider, in addition to the copayment and/or coinsurance, you will also be responsible for the difference between the allowed benefit and the provider s billed charges. Once you reach your out-of-pocket limit, CareFirst pays 100% of the applicable allowed benefit for most covered services for the remainder of the calendar year. Expenses which count toward your out-of-pocket limit include the annual deductible, copay and coinsurance amounts. CareFirst BlueCross BlueShield provides your benefits on a contract year basis. Your deductible period runs for a consecutive 12 months from July 1st through June 30 each year. Out-of-area coverage You have the freedom to take your health care benefits with you across the country and around the world. BlueCard PPO, a program from the Blue Cross and Blue Shield Association, allows you to receive the same health care benefits when receiving care from a BlueCard preferred provider while living or traveling outside of your health plan s service area. The BlueCard program includes more than 6,100 hospitals and 600,000 other health care providers nationally. In-Network Option 1 Preferred Provider Network Option 2 Participating Provider Out-of-Network You benefit from: You benefit from: You benefit from: acceptance of CareFirst BlueCross BlueShield card nationwide direct reimbursement to provider no balance billing reduced out-of-pocket expenses access to the PPO Provider Directory deductible and coinsurance acceptance of CareFirst BlueCross BlueShield card nationwide direct reimbursement to provider no balance billing Option 3 Non-Participating Provider the ability to choose any doctor You are responsible for: You are responsible for: You are responsible for: copays and coinsurance in-network deductibles, where applicable deductible and coinsurance direct payment to provider balance-billed amount up to the provider s charge filing your claim Washington County Public Schools Enrollment Guide 5

8 Maryland Point of Service Maryland Point of Service aims to keep you healthy by emphasizing prevention, early detection and early treatment. That s one of the main advantages of your MPOS coverage. We work with you to help prevent illness and we encourage you to seek care when it is needed, rather than waiting. You can select your doctor from a network of physicians, specialists and hospitals located throughout Maryland, Washington, D.C., and Northern Virginia so now you can visit a doctor where you live, where you work or anywhere in between. Designed for today s health conscious and busy families, Maryland Point of Service offers one less thing to worry about during your busy day. As a member of CareFirst BlueCross BlueShield (CareFirst), you ll enjoy the protection of one of the area s leading health care insurers. CareFirst has been serving your neighbors for almost 70 years, so when your family s health is at stake, shouldn t you choose Blue? Benefits and Services Flexibility Maryland Point of Service (MPOS) offers two levels of benefits in one health plan. When you need medical care, you have the flexibility to see your primary care physician (PCP) or you may go out of the network and see any doctor you choose. Your choice determines whether benefits will be paid at the in-network or out-ofnetwork level. Coordinated care with the freedom to choose. Maternity and well-child care MPOS provides coverage for prenatal and postnatal visits as well as childhood immunizations and check-ups. We aim to start your children on the road to good health before they are born. Our Great Beginnings program for expectant mothers is designed to complement the prenatal care and education you receive from your doctor. When you enroll in Great Beginnings you will receive information related to your condition and your baby s development. A Great Beginnings nurse will contact you 6 Washington County Public Schools Enrollment Guide

9 Maryland Point of Service during each trimester to see how you are feeling and to answer your questions. We believe in giving baby and mother a healthy start, and want to encourage mothers to take advantage of these important services. Women s health / men s health In addition, Maryland Point of Service provides women s health coverage, such as PAP tests, and men s health coverage, which includes routine prostate screenings. Predictable copays When your PCP coordinates your care, you can rely on predictable copays and coinsurance for your primary care and specialist office visits and emergency room care, so there is no need to worry about unexpected doctor bills. Large network Doctors, specialists and hospitals are located throughout Maryland, Washington, D.C., and Northern Virginia. No hassle billing Maryland Point of Service requires little paperwork when your PCP coordinates your care. In addition, MPOS provides direct reimbursement to your doctor, which means no hassles and no claims to file. Out-of-area coverage When you require health care while away from home, you will be covered with your in-network benefits for emergency care. Emergency and urgent care Each MPOS doctor provides 24-hour-a-day availability so you are never out of reach of your PCP. If the condition is serious, but not life threatening, call your PCP and he or she will give you instructions on what to do next. Your doctor may refer you to an urgent care center. Urgent care centers are walk-in medical facilities equipped to handle minor emergencies. Urgent care centers allow you to be seen more quickly than emergency rooms and most have evening and weekend hours. A list of participating urgent care centers can be found in the provider directory or at In a life-threatening emergency, such as chest pain, unconsciousness or severe bleeding, we encourage you to go immediately to the nearest emergency room or call 911. Mental health care and substance abuse treatment Magellan Behavioral Health Services provides and coordinates all needed mental health care. Just call their toll free number for a referral and authorization if you need psychiatric or substance abuse treatment. Your primary care physician Establishing a relationship with one doctor is the best way for you to receive consistent, quality health care; therefore, you must select a PCP at the time of your enrollment into MPOS. It is important that you select a PCP. If you have not selected a PCP for yourself or a covered family member, all covered services will be denied. Your PCP will: Provide basic medical care treating illness and providing preventive care. Prescribe any medications that you may require. Maintain your medical history. Work with you to determine when you should see a specialist, assist in the selection of a specialist, and provide you with a written referral. You may choose a doctor who specializes in family practice, general practice, pediatrics or internal medicine as your PCP. Your entire family may select the same doctor, or each member may choose a different doctor, based on each person s age or medical needs. To select your PCP, please call CareFirst customer service at or call the local Hagerstown district office at To ensure that you have the most current provider information, we encourage you to visit our online provider directory at Referrals to specialists Your PCP will coordinate your medical care and provide treatment for a variety of medical conditions. Generally, your PCP will need to see you for a proper evaluation before issuing a written referral. You and your PCP can work together to select a specialist. Washington County Public Schools Enrollment Guide 7

10 Maryland Point of Service CareFirst BlueCross BlueShield provides your benefits on a contract year basis. Your deductible period runs for a consecutive 12 months from July 1st through June 30 each year. When you need care Case Management This voluntary program works with patients who have serious illnesses, chronic conditions and complex health care needs. It helps patients receive needed care by working with the patient, family and medical team to develop the best treatment plan. Case managers are medical review nurses who can help patients make the best use of their coverage, and can even authorize special benefits or programs when it s cost effective and in the best interest of the patient. Outpatient pretreatment certification Before receiving home care, hospice care, habilitative services, mental health care, substance abuse treatment, outpatient private duty nursing care, artificial insemination, in-vitro fertilization and certain surgical procedures; CareFirst must approve a plan of treatment. For physical, occupational or speech therapy, your provider is required to submit a plan of treatment by the tenth visit. Preconception and prenatal education program If you are trying to get pregnant or if you are already pregnant, free consultations with a health specialist are available. This information, advice and encouragement can help you prepare for pregnancy, your baby s birth and parenthood. Hospital precertification and review program Anytime you face hospitalization, the Hospital Precertification and Review Program works with your provider to determine the most appropriate place for your procedures and recovery. 8 Washington County Public Schools Enrollment Guide

11 Patient-Centered Medical Home Focusing on You and Your Health Whether you re trying to get healthy or stay healthy, you need the best care available. That s why the CareFirst BlueCross BlueShield family of health plans has created a program to improve health care quality and help slow rising health care costs over time. Our Patient-Centered Medical Home (PCMH) program focuses on the relationship between you and your primary care provider (PCP) whether a physician or nurse practitioner (NP). It s designed to provide your PCP 1 with a more complete view of your health needs, as well as the care you re receiving from other providers. As the leader of your health care team, your PCP will be able to use this information to better manage and coordinate your care, a key to better health. Treating your overall health Whether you see your PCP for preventive care, or you need more care, your PCP is expected to: Coordinate your care with all your health care providers, including specialists, labs, pharmacies, and mental health facilities to help you get access to, and receive, the most appropriate care available in the most affordable settings. Identify and address any impact the care you receive for one health issue may have on another. Review all of your medications and possible drug interactions with you. Review your health records for duplicate tests or services already ordered or performed by another provider. Why a PCP is important to your health By visiting your PCP for routine visits as recommended, you can build a relationship, and your PCP will get to know you and your medical history. A PCP is concerned with your overall health. If you have an urgent health issue, having a PCP who knows your health history often makes it easier and faster to get the care you need. Your PCP can sometimes provide advice over the phone or fit you in for a visit. That helps you avoid long lines and expensive charges at the emergency room. When you visit your PCP for screenings and preventive services, he or she can detect health concerns in the early stages, when they are easier and less costly to treat. 1 The doctors and other medical providers, who provide your care, are independent providers making their own medical determinations and are not employed by either CareFirst BlueCross BlueShield or CareFirst BlueChoice, Inc. Washington County Public Schools Enrollment Guide 9

12 Patient-Centered Medical Home Focusing on You and Your Health If you have a chronic condition, or are at risk for one, your PCP may: Create a Care Plan based on your health needs with specific follow-up activities to help you manage your health. Provide access to a care coordinator, who is a registered nurse (RN), so you have the support you need, answers to your questions and information about your care. Extra care for certain health issues When you participate in PCMH, your PCP will take specific steps to coordinate and manage your care. If you have certain health issues, your PCP will create an online record of your health needs with specific follow-up activities. Your care coordinator is expected to: Assist your PCP by coordinating your care and answering your questions. Follow up with you to make sure you re not having problems following your treatment plan. For example, if you have diabetes, the care coordinator can help you take steps to better understand and control your diabetes. Assist you in obtaining services and equipment necessary to manage your health condition. It s your choice PCMH is a voluntary program. When you participate: You pay no additional premium. There is no change in your benefits. There is no change to your health plan requirements. You can opt-out at any time without penalty and without changing your PCP and/or NP. How do I get started? Simply sign the Election to Participate form and return it to your PCP. You can get the form from your PCP, or you can download it from the Forms section at By signing the election form, you agree to give your PCP access to your health information on file with CareFirst. This includes data from claims and notes from any CareFirst programs in which you have participated. 10 Washington County Public Schools Enrollment Guide

13 Find a Doctor, Hospital or Urgent Care It s easy to find the most up-to-date information on health care providers and facilities who participate with CareFirst BlueCross BlueShield (CareFirst). Whether you need a doctor or a facility, can help you find what you re looking for based on your specific needs. We make it easy for you to find the doctors you need at The site is updated weekly, so you always have the most up-to-date information available. The most up-to-date information Go to From here you can: Find a doctor or provider in your plan. Search for a doctor by name. Select a Primary Care Physician. Click Find Providers tab on to: Learn more about our Directory. Change your PCP. Research a Doctor or Hospital. Learn about Specialists. Washington County Public Schools Enrollment Guide 11

14 Summary of Benefits Washington County Public Schools SERVICES ANNUAL DEDUCTIBLE Individual Individual & Child Individual & Adult Family ANNUAL OUT-OF-POCKET LIMIT Individual Individual & Child Individual & Adult Family $100 $1,000 $2,000 $2,000 $2,000 EPO In-Network You Pay Maryland Point of Services (MPOS) $100 In-Network You Pay Out-of-Network You Pay $400 $400 $400 $1,000 $2,000 $2,000 $2,000 $100 LIFETIME MAXIMUM None None None PREVENTIVE SERVICES Well-Child Care 0-17 years Adult Physical Examination (1 per benefit period) Routine GYN Visits (1 per benefit period) Preferred Provider Organization (PPO) In-Network You Pay $400 $400 $400 $1,000 $2,000 $2,000 $2,000 No Benefit No Benefit No Benefit No Benefit No Benefit No Benefit Out-of-Network You Pay Mammograms 30%, Cancer Screening (Pap Test, Prostate and Colorectal) OFFICE VISITS, LABS AND TESTING 30%, Office Visits for Illness $20 per visit $20 per visit Deductible, then 30% Diagnostic Services X-ray and Lab Tests Allergy Testing Allergy Shots Outpatient Physical, Speech and Occupational Therapy in office (limited to 60 visits/benefit period combined) Deductible, then 30% Deductible, then 30% $20 per visit $20 per visit Deductible, then 30% Outpatient Chiropractic $20 per visit $20 per visit Deductible, then 30% EMERGENCY CARE AND URGENT CARE $20 per visit 30%, 30%, 30%, 30%, 30%, $20 per visit 30%, $20 per visit 30%, Physician s Office $20 per visit $20 per visit $20 per visit $20 per visit $20 per visit Urgent Care Center $20 per visit $20 per visit $20 per visit $20 per visit $20 per visit Hospital Emergency Room Ambulance (if medically necessary) $20 Physician; $50 Facility $20 Physician; $50 Facility $20 Physician; $50 Facility $20 Physician; $50 Facility $20 Physician; $50 Facility * No copayments or coinsurance. Members are liable for the difference between CareFirst s allowed benefit and the providers charge for services rendered by a non-participating provider. 12 Washington County Public Schools Enrollment Guide

15 Summary of Benefits Washington County Public Schools SERVICES HOSPITALIZATION Inpatient Facility Services Outpatient Facility Services Inpatient Physician Services Outpatient Physician Services Home Health Care (90 days unlimited visits per benefit period/40 visits home health aid per benefit period) Hospice (210 day lifetime max) Skilled Nursing Facility (60 days per benefit period) MATERNITY Prenatal and Postnatal Office Visits Delivery and Facility Services Nursery Care of Newborn Artificial Insemination and In Vitro Fertilization Procedures (limited to 2 combined attempts per lifetime) MENTAL HEALTH AND SUBSTANCE ABUSE Inpatient Facility Services Inpatient Physician Services Office Visits for Mental Health and Substance Abuse EPO In-Network You Pay $100 per admission copay Maryland Point of Services (MPOS) In-Network You Pay $100 per admission copay Out-of-Network You Pay Deductible, then 30% $25 per visit $25 per visit Deductible, then 30% Deductible, then 30% $20 per visit $20 per visit Deductible, then 30% $100 per admission copay Benefits available to same extent as benefits provided for other illnesses $100 per admission copay $100 per admission copay Benefits available to same extent as benefits provided for other illnesses $100 per admission copay Deductible, then 30% Deductible, then 30% Deductible, then 30% Deductible, then 30% Deductible, then 30% 30% of Allowed Benefit 30% of Allowed Benefit $20 per visit $20 per visit Deductible, then 30% Partial Hospitalization $25 per visit Deductible, then 30% Medication Management Visit MISCELLANEOUS Durable Medical Equipment $20 per visit $20 per visit Deductible, then 30% Acupuncture $20 per visit $20 per visit Deductible, then 30% Transplants Covered as stated in the Evidence of Coverage Covered as stated in the Evidence of Coverage Covered as stated in the Evidence of Coverage Preferred Provider Organization (PPO) In-Network You Pay $100 per admission copay Out-of-Network You Pay 30%, $30 per visit 30%, 30%, $30 per visit 30%, $100 per admission copay Benefits available to same extent as benefits provided for other illnesses $100 per admission copay 30%, 30%, 30%, 30%, 30%, 30%, 30% 30% $20 per visit 30%, $30 per visit 30%, $20 per visit 30%, 30%, $20 per visit 30%, Covered as stated in the Evidence of Coverage Covered as stated in the Evidence of Coverage * No copayments or coinsurance. Members are liable for the difference between CareFirst s allowed benefit and the providers charge for services rendered by a non-participating provider. Washington County Public Schools Enrollment Guide 13

16 Health + Wellness Whether you re looking for health and wellness tips, discounts on health and wellness services, or support to manage a health condition, we have the resources to help you get on the path to good health. With our Health + Wellness program you can: Get healthy with programs that target specific health or lifestyle issues. Deal with unexpected health issues or medical emergencies with help from our case management program. Live with a condition with the help of a coordinated health care team, by participating in our Patient-Centered Medical Home program. Access online tools and services to help you get healthy and stay healthy. Health and wellness tools Health Education Take an active role in managing your health by visiting My Care First at Find nearly 300 interactive health-related tools, a multi-media section with more than 400 podcasts, and recipes to search by food group or dietary restrictions. Plus, there are videos and tutorials on chronic diseases and an encyclopedia with information on more than 3,000 conditions. Vitality Magazine Our member magazine has the tools to help you achieve a healthier lifestyle. Vitality provides information about your health care plan and a variety of health and wellness topics, including nutrition, physical fitness and preventive health. All issues are available online at Health and wellness programs and resources help you and your family live a healthy life. 14 Washington County Public Schools Enrollment Guide

17 Wellness discount program Blue365 is an exciting program that offers exclusive health and wellness deals that will keep you healthy and happy, every day of the year. Blue365 delivers great discounts from top national and local retailers on fitness gear, gym memberships, family activities, healthy eating options and much more. Visit to learn more. Symptom Checker App Find out when to manage symptoms at home and when to seek medical care, locate the nearest emergency room, or look up the prescribed dosage of common over-thecounter medicines. This iphone app can be downloaded at Pedometer App Count your steps, distance traveled, and calories burned for each workout with the CareFirst Ready, Step, Go! app. This free app is available to anyone who has an iphone, ipod Touch, or Android smartphone. Visit your favorite app store and search for Ready, Step, Go!. Health News Get the latest information to help you, and your family, maintain a healthy lifestyle. Sign up for our monthly electronic member newsletter at to receive health-related articles and recipes. Getting healthy Utilization Management Our program ensures you ll receive the most appropriate care when you need it. If you have to be hospitalized, or need therapy, our team will review your case, help coordinate care with your provider and assist with discharge planning. If necessary, our team will also approve additional inpatient hospital days. Case Management If you have a serious illness or injury, our Case Management program can help you navigate through the health care system and provide support along the way. Our Case Managers, who are registered nurses, will: Work closely with you and your doctors to develop a personalized treatment plan. Coordinate necessary services. Contact you regularly to see how you re doing. Answer any of your questions. Suggest available community resources. Our Case Management program is voluntary and confidential. To enroll or for more information, call (888) Support during your pregnancy Our Case Managers strive to help you and your baby stay healthy during pregnancy. Once enrolled, the Case Manager will provide education and information on prenatal care and pregnancy. For more information, call (888) Washington County Public Schools Enrollment Guide 15

18 My Account Online Access to Your Claims View personalized information on your claims and out-of-pocket costs online with My Account. Simply log on to for real-time information about your plan. Features of My Account View your deductible status and out-of-pocket costs for your current and previous plan year. Review up to one year of medical claims total charges, benefits paid and costs for a specific date range Request an ID card Sign up for electronic communications and get your information faster and more securely Signing up is easy Visit click on Register Now and set up your User ID and Password. You ll just need information from your member ID card. Additional tools Depending on your specific health plan, you may have access to the following services through My Account: Download claim forms Find in-netwok providers Mobile access View the most-visited information in My Account on your smartphone or tablet. Our mobile site is available from any browser-equipped mobile device. To try out the app, visit your favorite app store, search for CareFirst and install the CareFirst app on your device. Enjoy access to: Find A Provider Search for nearby urgent care and ER facilities, based on your current location (as determined by your device s GPS). Searchable claims information Who s eligible and covered under your policy View your ID cards (App users can also print and ID cards) Register for My Account and maintain your security and notification preferences. For more information on our mobile site and app, visit 16 Washington County Public Schools Enrollment Guide

19

20 CareFirst BlueCross BlueShield CareFirst BlueChoice, Inc Mill Run Circle Owings Mills, MD Health benefits administered by: CONNECT WITH US: BOK5378-1N (4/14) CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association. Registered trademark of the Blue Cross and Blue Shield Association. Registered trademark of CareFirst of Maryland, Inc.

CareFirst BlueChoice. District of Columbia

CareFirst BlueChoice. District of Columbia CareFirst BlueChoice District of Columbia Welcome We are pleased to offer you enrollment in our CareFirst BlueChoice Health Maintenance Organization (HMO) plan. Designed for today s health conscious and

More information

Your Health Benefit Options. Active Employees/Retirees Under 65 Active Employees ANNE ARUNDEL COUNTY HEALTHCARE PARTNERSHIP

Your Health Benefit Options. Active Employees/Retirees Under 65 Active Employees ANNE ARUNDEL COUNTY HEALTHCARE PARTNERSHIP Health Benefit Options 2018 Your Health Benefit Options Active Employees/Retirees Under 65 Active Employees 2017-2018 ANNE ARUNDEL COUNTY HEALTHCARE PARTNERSHIP Government, Public Library, PUBLIC Community

More information

BlueChoice HMO HSA/HRA Silver 2000 Integrated Deductible

BlueChoice HMO HSA/HRA Silver 2000 Integrated Deductible BlueChoice HMO HSA/HRA Silver 2000 Integrated Deductible Summary of Benefits Services In-Network You Pay 1 FIRSTHELP 24/7 NURSE ADVICE LINE Free advice from a registered nurse. Visit www.carefirst.com/needcare

More information

Congressional Regional Plan BlueChoice HMO Referral Gold 80 Non-Integrated Deductible

Congressional Regional Plan BlueChoice HMO Referral Gold 80 Non-Integrated Deductible Congressional Regional Plan BlueChoice HMO Referral Gold 80 Non-Integrated Deductible Summary of Benefits Services In-Network You Pay 1 FIRSTHELP 24/7 NURSE ADVICE LINE Free advice from a registered nurse.

More information

Health Benefit Options Actives ANNE ARUNDEL COUNTY PUBLIC SCHOOLS

Health Benefit Options Actives ANNE ARUNDEL COUNTY PUBLIC SCHOOLS Health Benefit Options 2018 Actives ANNE ARUNDEL COUNTY PUBLIC SCHOOLS Contents Welcome... 1 Take the Call.... 2 Know Before You Go.... 4 Away From Home Care... 6 BlueCard & Global Core... 7 Find a Doctor,

More information

PPO. Preferred Provider Organization. Flexible. Easy to use. No Referrals.

PPO. Preferred Provider Organization. Flexible. Easy to use. No Referrals. PPO Preferred Provider Organization Flexible. Easy to use. No Referrals. PPO is issued by Capital Advantage Assurance Company (pending approval of its licensing application) or by Capital Advantage Insurance

More information

Medical Plans Benefit Guide

Medical Plans Benefit Guide Medical Plans Benefit Guide Employers with 1-50 employees 1.1.01 Provider network built for value and quality... Wellness rewards...3 Medical Travel Support and Air or Surface Transportation... Support

More information

Health plans for New Hampshire small businesses Available through the Health Insurance Marketplace

Health plans for New Hampshire small businesses Available through the Health Insurance Marketplace Health plans for New Hampshire small businesses Available through the Health Insurance Marketplace 1 38476NHEENABS Rev. 09/14 We can help you navigate the health care road We re here to help. In fact,

More information

Anthem Blue Cross Effective: January 1, 2018 Your Plan: University of California CORE Plan Your Network: Anthem Prudent Buyer PPO

Anthem Blue Cross Effective: January 1, 2018 Your Plan: University of California CORE Plan Your Network: Anthem Prudent Buyer PPO Anthem Blue Cross Effective: January 1, 2018 Your Plan: University of California CORE Plan Your Network: This summary of benefits is a brief outline of coverage, designed to help you with the selection

More information

Welcome to Regence! Meet your employer health plan

Welcome to Regence! Meet your employer health plan is an Independent Licensee of the Blue Cross and Blue Shield Association Regence BlueCross BlueShield of Utah Welcome to Regence! Meet your employer health plan 1 Health insurance is a big, wonderful benefit.

More information

Member s Responsibility: Deductible, Copays, Coinsurance and Maximums

Member s Responsibility: Deductible, Copays, Coinsurance and Maximums Benefits-at-a-Glance for GradCare 2018 This is intended as an easy-to-read summary. It is not a contract. Refer to the Your Benefits chapter in the Certificate for an official description of benefits.

More information

Super Blue Plus 2000 WVHTC High Option-B (Non-Grandfathered) $200 Deductible

Super Blue Plus 2000 WVHTC High Option-B (Non-Grandfathered) $200 Deductible BENEFIT HIGHLIGHTS 1 Super Blue Plus 2000 WVHTC High Option-B (Non-Grandfathered) $200 Group Effective Date December 1, 2017 Benefit Period (used for and Coinsurance limits) January 1 through December

More information

member handbook blueshieldca.com/bscbluegroove

member handbook blueshieldca.com/bscbluegroove member handbook blueshieldca.com/bscbluegroove With Main Groove, you get a Personal Physician from our medical provider network, and predictable, lower outof-pocket costs than with Basic Groove, plus access

More information

Health plans for Maine small businesses Available through the Health Insurance Marketplace

Health plans for Maine small businesses Available through the Health Insurance Marketplace Health plans for Maine small businesses Available through the Health Insurance Marketplace Effective January 1, 2016 We can help you navigate the health care road We re here to help. In fact, for more

More information

ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018

ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018 ST. MARY S HEALTHCARE SYSTEM, INC. Case # GA6476 BlueChoice HMO Benefit Summary Effective: January 1, 2018 All benefits are subject to the calendar year deductible, except those with in-network copayments,

More information

MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015

MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015 MERCY MEDICAL CENTER - DUBUQUE TRADITIONAL PPO PLAN $10/20%/40% RX PROVIDED BY PREFERRED HEALTH CHOICES EFFECTIVE JANUARY 1, 2015 DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS facilities and Aligned

More information

Schedule of Benefits-EPO

Schedule of Benefits-EPO Schedule of Benefits-EPO [Plan Information] [Health Plan:] [Ambetter Balanced Care 3 (2018)-Standard Silver On Exchange Plan] [Primary Member:] [John Doe] [Member ID:] [01213456] [Date of Birth:] [08/12/62]

More information

Blue Cross provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.

Blue Cross provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims. HOPE COLLEGE - HOURLY ORANGE 007013084/0011/0012/0013/0014/0015/0016/0017 Simply Blue PPO HSA ASC Effective Date: On or after July 2018 Benefits-at-a-glance This is intended as an easy-to-read summary

More information

Anthem Blue Cross Your Plan: Core PPO Your Network: National PPO (BlueCard PPO)

Anthem Blue Cross Your Plan: Core PPO Your Network: National PPO (BlueCard PPO) Anthem Blue Cross Your Plan: Core PPO Your Network: National PPO (BlueCard PPO) This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does

More information

Kaiser Permanente (No. and So. California) 2018 Union

Kaiser Permanente (No. and So. California) 2018 Union Kaiser Permanente (No. and So. California) General Information Lifetime Maximum Benefit Annual Maximum Benefit Coinsurance Percentage Precertification Requirements Precertification Penalty Health Savings

More information

PLAN DESIGN AND BENEFITS - PA POS 4.2 with $5/$15/$30 RX PARTICIPATING PROVIDERS

PLAN DESIGN AND BENEFITS - PA POS 4.2 with $5/$15/$30 RX PARTICIPATING PROVIDERS PLAN FEATURES Deductible (per calendar year) PHYSICIAN SERVICES Primary Care Physician Visits Specialist Office Visits Maternity OB Visits Allergy Treatment Allergy Testing PREVENTIVE CARE Routine Adult

More information

The Power of Blue. PPO Program

The Power of Blue. PPO Program 2018 The Power of Blue PPO Program Get to know your health insurance plan Feeling your best means taking care of your health needs and your well-being. Our comprehensive benefits, tools, and support help

More information

Central Care Plan Medical and Prescription Plan Comparison Grid

Central Care Plan Medical and Prescription Plan Comparison Grid Medical Plan Carrier/Network Annual Deductible (Benefit Plan Year: 7/1-6/30) Coinsurance (Percent Copays) Note: Coinsurance s apply once the has been met. Flat Dollar Copays Central Care Plan $200 per

More information

Anthem Blue Cross Your Plan: Modified Classic HMO 15/30/250 Admit/125 OP Your Network: California Care HMO

Anthem Blue Cross Your Plan: Modified Classic HMO 15/30/250 Admit/125 OP Your Network: California Care HMO Anthem Blue Cross Your Plan: Modified Classic HMO 15/30/250 Admit/125 OP Your : California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process.

More information

Central Care Plan Medical and Prescription Plan Comparison Grid

Central Care Plan Medical and Prescription Plan Comparison Grid Medical Plan Carrier/Network Annual Deductible (Benefit Plan Year: 7/1 6/30) Coinsurance (Percent Copays) Note: Coinsurance amounts apply once the has been met. Flat Dollar Copays $400 per member $800

More information

BETTER INFORMED. BETTER TOGETHER.

BETTER INFORMED. BETTER TOGETHER. BETTER INFORMED. BETTER TOGETHER. easy to get appointments free to focus on my patients excellent prenatal care test results online I can choose my doctor wide range of specialists I m part of the decision

More information

For Large Groups Health Benefit Single Plan (HSA-Compatible)

For Large Groups Health Benefit Single Plan (HSA-Compatible) Financial Features (DED 1 ) (PBP 2 ) (DED is the amount the member is responsible for before Florida Blue pays) Out-of-Network Inpatient Hospital Facility Services Per Admission (PAD) Coinsurance (Coinsurance

More information

Good health is part of the plan.

Good health is part of the plan. Good health is part of the plan. Presbyterian Health Plan has a long tradition of providing quality health care to State of New Mexico employees and their families. For 108 years, Presbyterian has been

More information

total health and wellness Programs exclusively for our Blue Shield members For small businesses with 2 to 50 eligible employees

total health and wellness Programs exclusively for our Blue Shield members For small businesses with 2 to 50 eligible employees total health and wellness Programs exclusively for our Blue Shield members For small businesses with 2 to 50 eligible employees total health and wellness Whether you want to ease stress, lose weight, or

More information

High Deductible Health Plan (HDHP)

High Deductible Health Plan (HDHP) High Deductible Health Plan (HDHP) BeneFIts Summary Effective July 1, 2012 or October 1, 2012 Benefit Highlights How The Plan Works...1 Summary Of Benefits...4 Special Programs...7 Approval Of Care At

More information

BluePreferred. Your Health Benefits

BluePreferred. Your Health Benefits BluePreferred Your Health Benefits www.carefirst.com C ON NE CT WITH U S: CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical

More information

Self-Insured Schools of California: Schools Helping Schools

Self-Insured Schools of California: Schools Helping Schools Self-Insured Schools of California: Schools Helping Schools Blue Shield of California Access+ HMO Plan 2016/2017 Enrollment Guide Blue Shield of California offers health benefits to school districts that

More information

RSNA EMPLOYEE BENEFIT TRUST PLAN II S2502 NON GRANDFATHERED PLAN BENEFIT SHEET

RSNA EMPLOYEE BENEFIT TRUST PLAN II S2502 NON GRANDFATHERED PLAN BENEFIT SHEET BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children birth to age 26 Filing Limit 1 year from date of service Mailing Address & PPO Company. Remit claims to:

More information

BCBSM provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.

BCBSM provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims. Michigan Catholic Conference Group Number: 71755 Package Code(s): 010 Section Code(s): 1000, 2000 PPO - PPO1, Hearing, Vision ( Exam only) Effective Date: 01/01/2018 Benefits-at-a-glance This is intended

More information

GIC Employees/Retirees without Medicare

GIC Employees/Retirees without Medicare GIC Active Employees & Retirees without Medicare 7/1/18 GIC Employees/Retirees without Medicare HMO Summary of Benefits Chart This chart provides a summary of key services offered by your Health New England

More information

Anthem Blue Cross Effective: January 1, 2017 Your Plan: University of California High Option Supplement to Medicare

Anthem Blue Cross Effective: January 1, 2017 Your Plan: University of California High Option Supplement to Medicare Anthem Blue Cross Effective: January 1, 2017 Your Plan: University of California High Option Supplement to Medicare Please Note: this medical plan is a complement to your existing Medicare plan. Medicare

More information

Health Benefit Options Retirees Under 65 ANNE ARUNDEL COUNTY PUBLIC SCHOOLS

Health Benefit Options Retirees Under 65 ANNE ARUNDEL COUNTY PUBLIC SCHOOLS Health Benefit Options 2018 Retirees Under 65 ANNE ARUNDEL COUNTY PUBLIC SCHOOLS Contents Welcome... 1 Take the Call.... 2 Know Before You Go.... 4 Away From Home Care... 6 BlueCard & Global Core... 7

More information

WELCOME to Kaiser Permanente

WELCOME to Kaiser Permanente WELCOME to Kaiser Permanente PPO PLAN RESOURCE GUIDE Colorado kp.org/kpic-colorado Greetings Subscriber name, we re glad to be your partner on this journey, and we look forward to a long and healthy relationship

More information

Blue Options. Health Plan Information Guide. What should I know about my benefits? What happens next? Where do I go to get assistance?

Blue Options. Health Plan Information Guide. What should I know about my benefits? What happens next? Where do I go to get assistance? Blue Options Health Plan Information Guide What happens next? What should I know about my benefits? Where do I go to get assistance? Welcome At Florida Blue, we provide you with guidance and support because

More information

Blue Care Network Geared perfectly for your needs. Enroll by calling Retiree Health Care Connect (contact information inside)

Blue Care Network Geared perfectly for your needs. Enroll by calling Retiree Health Care Connect (contact information inside) Blue Care Network Geared perfectly for your needs Enroll by calling Retiree Health Care Connect (contact information inside) November 2011 Dear UAW Trust Member: The UAW Retiree Medical Benefits Trust

More information

SUMMARY OF P-5-5 BENEFITS AND SCHEDULE OF COPAYMENTS

SUMMARY OF P-5-5 BENEFITS AND SCHEDULE OF COPAYMENTS SUMMARY OF P-5-5 BENEFITS AND SCHEDULE OF COPAYMENTS THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE

More information

FCPS BENEFITS COMPARISON FOR PLAN YEAR 2018 Active Employees and Retirees Under 65

FCPS BENEFITS COMPARISON FOR PLAN YEAR 2018 Active Employees and Retirees Under 65 BENEFIT Medical Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Individual Annual Deductible $250 $500 $250 $500 None Family Annual Deductible $500 $1,000 $500 $1,000 None Medical Plan

More information

Kaiser Permanente Group Plan 301 Benefit and Payment Chart

Kaiser Permanente Group Plan 301 Benefit and Payment Chart 301 Kaiser Permanente Group Plan 301 Benefit and Payment Chart 10119 CITY AND COUNTY OF SAN FRANCISCO About this chart This benefit and payment chart: Is a summary of covered services and other benefits.

More information

Schedule of Benefits

Schedule of Benefits Schedule of Benefits ANTHEM Small Business Health Options Program (SHOP) This is a brief schedule of benefits. Refer to your Anthem Certificate of Coverage (Booklet) for complete details on benefits, conditions,

More information

Blue Shield of California s PPO Plan

Blue Shield of California s PPO Plan Blue Shield of California s PPO Plan If keeping your relationship with your current doctors is important, our PPO plan may be a good choice for you. You can continue to see your doctors, even if they aren

More information

Choice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members

Choice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members Choice PPO Retired Employees Health Program Non-Medicare Eligible Retired Members DEDUCTIBLE (per calendar year) Annual in-network deductible must be paid first for the following services: Imaging, hospital

More information

Vivity offered by Anthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your Network: Vivity

Vivity offered by Anthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your Network: Vivity Vivity offered by Anthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your : Vivity This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary

More information

Chapter 2 Provider Responsibilities Unit 5: Specialist Basics

Chapter 2 Provider Responsibilities Unit 5: Specialist Basics Chapter 2 Provider Responsibilities Unit 5: Specialist Basics In This Unit Topic See Page Unit 5: Specialist Basics Participation in the Highmark s Networks as a Specialist 2 Specialist and Personal Physician

More information

Blue Shield of California

Blue Shield of California An independent member of the Blue Shield Association City of San Jose Custom ASO PPO 100 90/70 Active Employees Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage

More information

Kaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION

Kaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION Kaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION 2019 Summary of Important Changes for Contract Renewals for the Kaiser Permanente Group Plan (These changes are subject to regulatory

More information

BlueChoice Opt-Out Open Access

BlueChoice Opt-Out Open Access BlueChoice Opt-Out Open Access Summary of Benefits Services In-Network You Pay 1 Out-of-Network You Pay 1 24/7 FIRSTHELP NURSE ADVICE LINE Free advice from a registered nurse BLUE REWARDS Visit www.carefirst.com/bluerewards

More information

Medicare Plus Blue SM Group PPO. Resource Guide. Put your coverage to work. Michigan Public School Employees Retirement System

Medicare Plus Blue SM Group PPO. Resource Guide. Put your coverage to work. Michigan Public School Employees Retirement System 2018 Medicare Plus Blue SM Group PPO Resource Guide Put your coverage to work Michigan Public School Employees Retirement System www.bcbsm.com/mpsers Make your coverage work for you We want you to know

More information

CALIFORNIA Small Group HMO Aetna Health of California, Inc. Plan Effective Date: 04/01/2007. Aetna Value Network* HMO $30/$40

CALIFORNIA Small Group HMO Aetna Health of California, Inc. Plan Effective Date: 04/01/2007. Aetna Value Network* HMO $30/$40 PLAN FEATURES Deductible (per calendar year) Member Coinsurance Lifetime Maximum Primary Care Physician Selection Referral Requirement PHYSICIAN SERVICES CALIFORNIA Small Group HMO Primary Care Physician

More information

BlueChoice Advantage Medical Plan. Eligible Employees and Non-Medicare Retirees Effective January 1, 2018 FAIRFAX COUNTY PUBLIC SCHOOLS

BlueChoice Advantage Medical Plan. Eligible Employees and Non-Medicare Retirees Effective January 1, 2018 FAIRFAX COUNTY PUBLIC SCHOOLS BlueChoice Advantage Medical Plan FAIRFAX COUNTY PUBLIC SCHOOLS Eligible Employees and Non-Medicare Retirees Effective January 1, 2018 Fairfax County Public Schools BlueChoice Advantage Medical Plan C1

More information

Blue Choice. Hospital/$50, Physician's Office/Lesser of $50 or 20%; physician $40, facility $50. $35/trip $100/trip $50/trip $100/trip $100/trip

Blue Choice. Hospital/$50, Physician's Office/Lesser of $50 or 20%; physician $40, facility $50. $35/trip $100/trip $50/trip $100/trip $100/trip HOSPITAL SERVICES Hospital Inpatient : Paid in full No cost No cost No cost No cost Hospital Outpatient Hospital $40 or $60 per visit, : $20 per visit Hospital/$50, Physician's Office/Lesser of $50 or

More information

YOUR TRUSTED HEALTH COMPANION. A plan for life.

YOUR TRUSTED HEALTH COMPANION. A plan for life. YOUR TRUSTED HEALTH COMPANION A plan for life. Being healthy is about more than preventing illness. It s achieving the best possible quality of life, physically and emotionally. That s what CDPHP is all

More information

Self-Insured Schools of California: Schools Helping Schools

Self-Insured Schools of California: Schools Helping Schools Self-Insured Schools of California: Schools Helping Schools SISC PPO Plan for South Orange County Community College District Administered by Blue Shield of California 2016/2017 Enrollment Guide Blue Shield

More information

Vivity offered by Anthem Blue Cross Your Plan: Custom Classic HMO 25/45/500 Admit /250 OP Your Network: Vivity

Vivity offered by Anthem Blue Cross Your Plan: Custom Classic HMO 25/45/500 Admit /250 OP Your Network: Vivity Vivity offered by Anthem Blue Cross Your Plan: Custom Classic HMO 25/45/500 Admit /250 OP Your : Vivity This summary of benefits is a brief outline of coverage, designed to help you with the selection

More information

Blue Shield PPO Plan Frequently Asked Questions

Blue Shield PPO Plan Frequently Asked Questions Blue Shield PPO Plan Frequently Asked Questions If you have any questions about your plan benefits, call your dedicated Blue Shield Member Services team at (855) 724-7698. They are available to assist

More information

SENIOR MED, LLC EMPLOYEE BENEFIT PLAN MEDICAL BENEFITS SCHEDULE LOW PLAN Effective April 1, 2014

SENIOR MED, LLC EMPLOYEE BENEFIT PLAN MEDICAL BENEFITS SCHEDULE LOW PLAN Effective April 1, 2014 LOW PLAN MAXIMUM BENEFIT AMOUNT: Aggregate Annual Limit NETWORK PROVIDERS NOTE: Benefits are only covered at Network Providers. No coverage is available at NON-NETWORK Providers, except where indicated

More information

Anthem Blue Cross Your Plan: Modified Classic HMO 20/40/250 Admit /125 OP Your Network: California Care HMO

Anthem Blue Cross Your Plan: Modified Classic HMO 20/40/250 Admit /125 OP Your Network: California Care HMO Anthem Blue Cross Your Plan: Modified Classic HMO 20/40/250 Admit /125 OP Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection

More information

Anthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your Network: California Care HMO

Anthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your Network: California Care HMO Anthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your : California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary

More information

Gold Access+ HMO $30 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix)

Gold Access+ HMO $30 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Gold Access+ HMO $30 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2015 THIS MATRIX IS INTENDED TO BE USED

More information

CA Group Business 2-50 Employees

CA Group Business 2-50 Employees PLAN FEATURES Network Primary Care Physician Selection Deductible (per calendar year) Member Coinsurance Copay Maximum (per calendar year) Lifetime Maximum Referral Requirement PHYSICIAN SERVICES Primary

More information

Excellus BluePPO Option K

Excellus BluePPO Option K Excellus BluePPO Option K Contraceptives Only Benefit Time Period: 01/01/2018-12/31/2018 NYS Automobile Dealers Assoc. General Information Cost Sharing Expenses Deductible - Single $0 $1,000 Deductible

More information

$10 copay. $10 copay. $10 copay $5 copay $10 copay $5 copay. $10 copay. No charge. No charge. No charge

$10 copay. $10 copay. $10 copay $5 copay $10 copay $5 copay. $10 copay. No charge. No charge. No charge PLAN FEATURES * ** Deductible (per calendar ) Member Coinsurance Copay Maximum (per calendar ) Lifetime Maximum Unlimited Primary Care Physician Selection Required Upon enrollment to a Vitalidad Plus plan,

More information

PREFERRED CARE. combination of family members; however no single individual within the family will be subject to more than the individual

PREFERRED CARE. combination of family members; however no single individual within the family will be subject to more than the individual PLAN FEATURES Deductible (per plan year) $500 Individual $1,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. The family Deductible is a cumulative Deductible

More information

BENEFITS KNOW. your Benefits Guide Administered by Florida Blue. Do you have questions about your medical or prescription drug coverage?

BENEFITS KNOW. your Benefits Guide Administered by Florida Blue. Do you have questions about your medical or prescription drug coverage? 2013 BENEFITS GUIDE 2013 Benefits Guide Administered by Florida Blue We are pleased to announce that effective January 1, 2013 Florida Blue wiii be providing your medical and pharmacy Benefit options.

More information

Getting the Most from Your COVA CARE PLAN

Getting the Most from Your COVA CARE PLAN Getting the Most from Your COVA CARE PLAN July 1, 2014 through June 30, 2015 Commonwealth of Virginia Your COVA CARE PLAN TABLE OF CONTENTS What s In Your COVA Care Plan?.... 2 Let s Dive In - Medical

More information

Platinum Local Access+ HMO $25 OffEx

Platinum Local Access+ HMO $25 OffEx Platinum Local Access+ HMO $25 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2015 THIS MATRIX IS INTENDED

More information

EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan

EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan 2018 EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan Summary Table of Benefits Select Medicare Supplement Plan PLAN REIMBURSEMENT METHOD DEDUCTIBLE - Individual Medicare

More information

UNIVERSITY OF MICHIGAN BZK Effective Date: 01/01/2018

UNIVERSITY OF MICHIGAN BZK Effective Date: 01/01/2018 UNIVERSITY OF MICHIGAN 68712000 0070051870000-06BZK Effective Date: 01/01/2018 This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional

More information

Blue Shield Trio HMO Plan Frequently Asked Questions

Blue Shield Trio HMO Plan Frequently Asked Questions Blue Shield Trio HMO Plan Frequently Asked Questions If you have any questions about your health plan benefits, call your dedicated Shield Concierge team at (855) 747-5800. The team is available to assist

More information

Blue Cross Premier Bronze

Blue Cross Premier Bronze An individual PPO health plan from Blue Cross Blue Shield of Michigan. You will have a broad choice of doctors and hospitals within BCBSM s unsurpassed statewide PPO network including nationwide coverage.

More information

go with ^ Blue Shield PPO plan with Health Savings Account Blue Shield EPO plan Effective January 1, 2015 HIGHLIGHTS Plan overview 1

go with ^ Blue Shield PPO plan with Health Savings Account Blue Shield EPO plan Effective January 1, 2015 HIGHLIGHTS Plan overview 1 go with ^ Blue Shield PPO plan with Health Savings Account Blue Shield EPO plan Effective January 1, 2015 HIGHLIGHTS Plan overview 1 Pharmacy benefits 9 How to find a provider 10 Programs and services

More information

Direct Care Deductible 2000 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond

Direct Care Deductible 2000 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond Direct Care Deductible 2000 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond The Fallon difference Direct Care is a Limited Provider Network. With Direct Care Deductible 2000 Hybrid,

More information

total health and wellness

total health and wellness total health and wellness Programs exclusively for our Blue Shield members total health and wellness Whether you want to ease stress, lose weight, or quit smoking we ll help you reach your goals. Our health

More information

WILLIS KNIGHTON MEDICAL CENTER S2763 NON GRANDFATHERED PLAN BENEFIT SHEET

WILLIS KNIGHTON MEDICAL CENTER S2763 NON GRANDFATHERED PLAN BENEFIT SHEET BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Customized COB Dependents Children birth to 26 Filing Limit 12 months For employees that work in a WKHS location within the primary HealthPlus

More information

2019 Select HMO. Benefit guide. One of the most affordable CalPERS HMO plans CAMENABC Rev. 07/18

2019 Select HMO. Benefit guide. One of the most affordable CalPERS HMO plans CAMENABC Rev. 07/18 2019 Select HMO Benefit guide One of the most affordable CalPERS HMO plans 40184CAMENABC Rev. 07/18 Why choose the Select HMO plan? We re glad you re taking time to check out all that Anthem has to offer

More information

Anthem Blue Cross Your Plan: BC PPO Exclusive Plan

Anthem Blue Cross Your Plan: BC PPO Exclusive Plan Anthem Blue Cross Your Plan: BC PPO Exclusive Plan This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not reflect each and every

More information

NY EPO OA 1-09 v Page 1

NY EPO OA 1-09 v Page 1 PLAN FEATURES Deductible (per calendar year) Member Coinsurance (applies to all expenses unless otherwise stated) Maximum Out-of-Pocket Limit (per calendar year) Lifetime Maximum (per member lifetime)

More information

TRADITIONAL PPO PLAN FT. LAUDERDALE $10/20%/40% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC.

TRADITIONAL PPO PLAN FT. LAUDERDALE $10/20%/40% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. TRADITIONAL PPO PLAN FT. LAUDERDALE $10/20%/40% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible

More information

Aetna Health of California, Inc.

Aetna Health of California, Inc. Easily locate PrimeCare participating providers at www.aetna.com/docfind/primecare PLAN FEATURES Deductible (per calendar year) Member Coinsurance Lifetime Maximum Primary Care Physician Selection Referral

More information

Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived

Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived PLAN FEATURES Deductible (per calendar year) $1,500 Individual $1,500 Individual $3,000 Family $3,000 Family All covered expenses, including prescription drugs, accumulate toward both the preferred and

More information

Freedom Blue PPO SM Summary of Benefits

Freedom Blue PPO SM Summary of Benefits Freedom Blue PPO SM Summary of Benefits R9943-206-CO-308 10/05 Introduction to the Summary of Benefits for Freedom Blue PPO Plan January 1, 2006 - December 31, 2006 California YOU HAVE CHOICES IN YOUR

More information

HEALTH SAVINGS PPO PLAN (WITH HSA) - BOISE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE June 1, 2017 AETNA INC. CPOS II

HEALTH SAVINGS PPO PLAN (WITH HSA) - BOISE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE June 1, 2017 AETNA INC. CPOS II HEALTH SAVINGS PPO PLAN (WITH HSA) - BOISE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE June 1, 2017 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible -

More information

Benefit Name In Network Out of Network Limits and Additional Information. Benefit Name In Network Out of Network Limits and Additional Information

Benefit Name In Network Out of Network Limits and Additional Information. Benefit Name In Network Out of Network Limits and Additional Information Excellus BluePPO $5/$35/$70, $0 gen for kids Integrated Rx, No Ded Prev Rx Benefit Time Period: 01/01/2018-12/31/2018 NYSADA General Information Cost Sharing Expenses Deductible - Single $2,600 $2,600

More information

HEALTH SAVINGS PPO PLAN (WITH HSA) FT. LAUDERDALE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JUNE 1, 2017 AETNA INC.

HEALTH SAVINGS PPO PLAN (WITH HSA) FT. LAUDERDALE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JUNE 1, 2017 AETNA INC. HEALTH SAVINGS PPO PLAN (WITH HSA) FT. LAUDERDALE PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JUNE 1, 2017 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned Deductible

More information

Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived 30% after deductible

Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived 30% after deductible PLAN FEATURES NON- Deductible (per calendar year) $500 Individual $750 Individual $1,500 Family $2,250 Family All covered expenses, excluding prescription drugs, accumulate toward both the preferred and

More information

HOME BANK - S2395 NON-GRANDFATHERED CONSUMER DRIVEN HEALTH PLAN BENEFIT SHEET

HOME BANK - S2395 NON-GRANDFATHERED CONSUMER DRIVEN HEALTH PLAN BENEFIT SHEET CONSUMER DRIVEN HEALTH PLAN BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children birth to 26 180 days from incurred Filing Limit date, except when 180 days would

More information

Irvine Unified School District ASO PPO /50

Irvine Unified School District ASO PPO /50 An Independent member of the Blue Shield Association Irvine Unified School District ASO PPO 500 90/50 Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix) THIS

More information

For Large Groups Health Benefit Summary Plan 05301

For Large Groups Health Benefit Summary Plan 05301 This is a lower premium plan that offers comprehensive insurance coverage. These plans are designed to help you know your costs upfront with a copayment for the services you use most. Your cost share will

More information

ESSENTIAL ASSIST PPO PLAN (WITH HRA) $10/25%/50% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC.

ESSENTIAL ASSIST PPO PLAN (WITH HRA) $10/25%/50% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. ESSENTIAL ASSIST PPO PLAN (WITH HRA) $10/25%/50% RX PROVIDED BY AETNA LIFE INSURANCE COMPANY EFFECTIVE JANUARY 1, 2018 AETNA INC. CPOS II DEDUCTIBLE, COPAYS/COINSURANCE AND DOLLAR MAXIMUMS and Aligned

More information

Benefit Name In Network Out of Network Limits and Additional Information. N/A Pharmacy. N/A Pharmacy

Benefit Name In Network Out of Network Limits and Additional Information. N/A Pharmacy. N/A Pharmacy Excellus BluePPO Drug Coverage Excluded Benefit Time Period: 01/01/2018-12/31/2018 HOBART & WILLIAM SMITH COLLEGES General Information Cost Sharing Expenses Deductible - Single $0 $500 Deductible - Family

More information

Highlights of your Health Care Coverage

Highlights of your Health Care Coverage Highlights of your Health Care Coverage Any deductibles, copays, and coinsurance percentages shown are amounts for which you're responsible. Medical Benefits apply after the calendar-year deductible is

More information

Summary of Benefits CCPOA (Basic) Custom Access+ HMO

Summary of Benefits CCPOA (Basic) Custom Access+ HMO Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits CCPOA (Basic) Custom Access+ HMO CCPOA Effective January 1, 2019 HMO Benefit Plan This Summary of Benefits

More information

Benefit Name In Network Out of Network Limits and Additional Information. Benefit Name In Network Out of Network Limits and Additional Information

Benefit Name In Network Out of Network Limits and Additional Information. Benefit Name In Network Out of Network Limits and Additional Information Excellus BluePPO $5/$35/$70, $0 gen for kids Integrated Rx, No Ded Prev Rx Benefit Time Period: 01/01/2018-12/31/2018 NYSADA General Information Cost Sharing Expenses Deductible - Single $3,500 $3,500

More information

Select Care Deductible 1200 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond

Select Care Deductible 1200 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond Select Care Deductible 1200 Hybrid Benefit Summary Benefits effective January 1, 2018 and beyond The Fallon difference With Select Care Deductible 1200 Hybrid, you get everything you need to live a healthy

More information

Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived

Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived PLAN FEATURES Deductible (per calendar year) $1,500 Individual $1,500 Individual $3,000 Family $3,000 Family All covered expenses, including prescription drugs, accumulate toward both the preferred and

More information

CONRAD INDUSTRIES, INC. S2489 NON GRANDFATHERED PLAN BENEFIT SHEET

CONRAD INDUSTRIES, INC. S2489 NON GRANDFATHERED PLAN BENEFIT SHEET BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children to age 26 Filing Limit 12 months from date of service Mailing Address & PPO Company. PPO Co.: PPO CIGNA

More information