Ways Your Health Plan Works for You

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1 Ways Your Health Plan Works for You

2 We re always at your service We help keep you healthy We help you get the healthcare you need

3 Welcome to Blue Cross & Blue Shield of Rhode Island. We want you to be healthy and part of keeping yourself healthy is taking an active role in your own care. This brochure provides information about how you can make the most of your Blue Cross & Blue Shield of Rhode Island (BCBSRI) health plan, and take full advantage of all the benefits and services it has to offer.

4 We re always at your service. 1We re here to help you get the most from your health plan online, in person, or on the phone. Online In person On the phone

5 Online BCBSRI.com is at your service 24 hours a day. Use BCBSRI.com to: Find a doctor or other healthcare provider. Get information about your benefits and see your claims history. Send a secure message to our Customer Service Department (response within one business day). Participate in online wellness programs. And more. In person Visit us at 15 LaSalle Square, Providence, Rhode Island, Monday through Friday, 8:15 a.m. to 4:30 p.m. On the phone Customer service representatives can answer your questions about benefits, claims, and other topics related to your coverage. Within Rhode Island Outside Rhode Island BlueCHiP Coordinated Health Plan (401) All other BCBSRI Plans (401) Telecommunications Device for the Deaf (TDD) Customer service hours: Monday through Friday, 8:00 a.m. to 8:00 p.m., and Saturday, 8:00 a.m. to 2:00 p.m., Eastern Time.

6 We help keep you healthy. 2We want you to be as healthy as possible, and we offer a number of valuable resources to help. Choices BCBSRI.com Blue365 TM Wellness programs for your healthcare needs

7 Choices As a BCBSRI member, you ll receive a copy of Choices, our informative member magazine four times a year. Each issue is packed with articles about general health, specific conditions, fitness, nutrition, healthy recipes, and more. The Member Update in the middle of the magazine contains important information that s specific to your health plan. BCBSRI.com Take advantage of health tools and online wellness programs that you can participate in from the comfort of your own home. To use these members-only resources and access your Blue365 TM discounts, you need to log in with a secure user name and password. Register today! To register for a free BCBSRI.com account, click on Register at the top of the home page and follow the instructions. Blue365 TM Your BCBSRI membership is your ticket to discounts on a variety of products and services you can use to improve and maintain your health every day. Leading national companies in a wide range of categories have created special offers and discounts just for Blue Cross and Blue Shield members through Blue365. Get savings on products and services such as: Fitness Nutrition and weight loss LASIK Travel And more Log in to BCBSRI.com to take advantage of these valuable savings! Wellness programs for your healthcare needs If you have a chronic condition, such as asthma, diabetes, or heart disease, you can do a lot to keep yourself healthy and we can help you stay on track. Our health coaches are licensed professionals who will work with you one-on-one by telephone to provide support and answer questions. You ll also receive a kit of informative materials to help you learn more about managing your condition. BCBSRI offers programs for: Asthma Diabetes High-risk Pregnancy High Blood Pressure Coronary Artery Disease Heart Failure For more information about our programs, please call Customer Service.

8 3 Your BCBSRI member ID card is recognized by thousands of doctors, hospitals, and dentists around the country. When you show your card to a healthcare provider in the network, you re assured of receiving covered services with no claims to submit. You re just responsible for paying any applicable deductibles, coinsurance, and/or copayments at the time of service. Your card even shows your copayment amounts for certain services. We help you get the healthcare you need. Easy access to healthcare Choosing a personal physician More about your health plan

9 Easy access to healthcare We recommend that you establish a relationship with a personal physician, even if your plan doesn t require you to get referrals to see specialists. Your personal physician can be an important member of your healthcare team. He or she will work together with you to identify your health needs and prevent minor illnesses from becoming serious conditions. If you need specialty care, your personal physician can recommend a doctor who can best address your needs. Your personal physician will also stay informed about your diagnosis and treatment, including any medications you may need to take, even after you go to a specialist. This can help to ensure you receive the right care for all your medical issues, without overlap or potentially harmful interactions. (It is especially important if you have complex health issues and see more than one specialist.) Choosing a personal physician Most likely, your personal physician is already in our network. If you don t already have a personal physician, you can find one by: Getting recommendations from family, friends, or other doctors, then checking the Provider Finder on BCBSRI.com to see if they participate with BCBSRI. More about your health plan To get the most from your plan, it s important to know how your plan works, including your benefits as well as your member rights and responsibilities. You can find this information in your subscriber agreement or benefit booklet, on BCBSRI.com, by calling Customer Service, or by speaking with your employer s benefit administrator. (continued on next page)

10 Ensuring appropriate care To ensure that you receive care in an appropriate setting and that the services you will receive are medically necessary, BCBSRI recommends that you call for preauthorization before receiving some services. When you visit network providers and facilities that participate directly with BCBSRI, they will make the call for you. If you visit non-participating providers or facilities, or providers or facilities that participate with another Blue Cross and Blue Shield network, we recommend that you call Customer Service to start the preauthorization process before you schedule services. For a list of services for which we recommend preauthorization, and for preauthorization phone numbers, please visit BCBSRI.com or call Customer Service. Limitations and exclusions There are certain limitations and exclusions to your medical policy. For a complete list of covered benefits and exclusions, please refer to your subscriber agreement or benefit booklet or call Customer Service. Your rights and responsibilities It s important for you to know your rights and responsibilities what you can expect from us, and what you need to do as a BCBSRI member. You can find a list of your rights and responsibilities on BCBSRI.com. If you have any questions, you can always call Customer Service. Our representatives will be happy to explain any issue you have questions or concerns about. If you ever feel that any of your rights as a member have been overlooked, please let us know.

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12 Customer service representatives can answer your questions about benefits, claims, and other topics related to your coverage. BCBSRI.com is at your service 24 hours a day Westminster Street Providence, RI Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. 5/09 SAL BR