Preventative Guidelines

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2 Preventative Guidelines Well Care Services-determined by age and gender Services paid at 100 percent, meaning- at no cost to you. Ages: Newborn-18 years of age Adults: 19 years and up Diagnostic Checkups & Screenings Counseling Immunizations

3 Status of CT Scan Providers Alachua County-To have a CT scan, you must present to a hospital facility and have the procedure completed as an outpatient procedure for a $150 co-pay (Option 1) $250 co-pay (Option 2). Florida Blue s Provider Relations is working to contract with Imaging Providers offering this service. Floridablue.com

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5 Care Consultants Answers to health care questions Educational materials Coordination of care between doctors Cost estimates Support for the member, family and caregivers ( )

6 Healthy Addition Prenatal education program Operated by Nurses Important for those with high-risk pregnancies Free educational materials and complimentary gifts ( )

7 Nurseline-Health Dialog 24-hour access: For general or more urgent health care questions, you may contact the Nurseline 24-hours/day. Offers helpful resources that may benefit you on the plan. Help to manage chronic conditions. ( )

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9 Diabetes Prevention Program My Healthy Turnaround Lifestyle Change Program Specialized program for Type 2 Diabetes 16 week course with a Trained Lifestyle Coach Learn to incorporate healthy eating and physical activity SWEETS

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11 Medication Guide/Tier Changes Quarterly, FL Blue updates it medication guides online Prescriptions can change tiers throughout the year (generic, preferred and non-preferred). To ensure your tier levels for your Rxs, please visit: Floridablue.com/Pharmacy/Medication Guides

12 Specialty Pharmacy Self-Administered Drugs Certain Rx must be purchased from Caremark in order to receive the lowest cost. This is covered under your pharmacy benefit only. Provider-Administered Specialty Medications These meds are purchased by your physician and administered in office. The physician is reimbursed through your medical benefit, so there is no additional cost to the member.

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14 Behavioral Health Services Treatment Facilities (In-Network): Outpatient ER -$100 Hospital-$150 Physician Services-$0 Mental Health Providers Specialist Office-DED + 20% Family Physicians-$15 Other Health Professionals-$50 per visit Inpatient Facility Services-$750 Physicians & Other Health Licensed Professionals-$0

15 Employee Assistance Program As an employee, you are entitled to three (3) visits at no cost to you for counseling services Your spouse/family may attend these sessions Current provider is Clinical Psychology Associates of North Central Florida (offices in Gainesville & Ocala) (352) ******Provider is not an in-network FL Blue provider

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17 Travel Abroad Blue Card Worldwide Program Access to doctors and hospitals in more than 200 countries Verify your international benefits before you leave the US Carry your ID card with you Always use a Blue Card PPO physician or hospital Call the Blue Card Customer Service Center and an Assistance Coordinator & a medical professional will assist in arranging an appointment or hospitalization, as needed *Hospitalization must be pre-authorized

18 Blue Nationwide Access to Blue affiliates in each state Make sure to carry your ID card Always use a Blue Card PPO physician or hospital Call the Blue Card Customer Service Center The Blue Affiliate rates may differ from FL Blue.

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20 My Blue Service/Member Website Access to medical & pharmacy claims information Tracking of your CYD Assesses your costs savings Provides payment information for each provider Allows you to view your annual statements for the past two years Floridablue.com Register 24-hour access to information Educational videos

21 FL Blue Mobile App Apps for Android or iphones Text messaging available Also download from scanner image on electronic communications received from FL Blue Receive announcements about annual events, local health fairs, healthy lifestyle tips Coverage details, pay bills, find providers, locate FL Blue Centers, etc.

22 365 Discounts Discounts on: Vision services Healthy eating (ex. Jenny Craig) Sports gear and sports wear Gym Memberships Wellness And more--monthly offers

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24 125 Company s Latest Upload claims directly to its site Upload receipts that are needed for verification Submit your Direct Deposit information Access lists of what is allowed under the Flex Spending Plans 125Company.com

25 PRIMARY CARE VISITS General Practice, Family Practice, Internal Medicine, or Pediatrician No Deductible $15 Co-pay SPECIALIST VISITS Any provider NOT General Practice, Family Practice, Internal Medicine, or Pediatrician $600 Calendar Year Deductible 20% Co-insurance

26 Prescription Plan $150 deductible for all prescriptions Mail Order encouraged for all Maintenance Meds- 3 month supply for price of 2

27 EMERGENCY & URGENT CARE Emergency Room $250 Co-pay-$600 CYD & 20% co-insurance For Physician Charges Urgent Care Center No Deductible $30 Co-pay Convenient Care Centers Located within pharmacies-upgraded services $15 Co-pay

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30 COBRA Under COBRA the Consolidated Omnibus Reconciliation Act of 1985, Title X, terminated employees and their eligible dependents may continue group health plan coverage. Coverage for up to 18 months from the date of termination (voluntary/involuntary) May be extended up to 36 months for life events such as death or divorce.

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32 Adding Dependents to theplan Children/Spouses -Social Security Number (a copy of card not needed) -Children under guardianship--legal documentation -Birth Certificate -Marriage License -Valid Driver s License/ State ID or other legal document showing Date of Birth Certified Domestic Partners (CDP) An approved CDP must be on file in order to add a CDP or his/her dependents to the plan. (In order for children to be covered under a CDP s plan, the children must reside with the Employee and CDP.) Grandchildren The parent of the child must also be on the plan. Newborn grandchildren may be covered up to 18 months. Overaged Disabled Dependents Current year s medical documentation demonstrating the dependent is physically or mentally unable to work.

33 REMINDERS Quest Labs is the only in-network 2015 Benefit Booklet Summary Plan Description (SPD)