Spending Smart, Living Well. Resources from Horizon BCBSNJ and PSEG

Transcription

1 Spending Smart, Living Well Resources from Horizon BCBSNJ and PSEG

2 In this Guide... 1 Your Horizon BCBSNJ Health Care Plan 2 Your Secure Member Online Services 3 Go Mobile 4 Visit Horizon Connect 5 Top Care at Blue Distinction Centers 6 24/7 Nurse Line Inside, you ll see all that s available to help you become a better health care consumer. Learn more about how your health plan works and how to make it work for you. 7 Need Help in a Hurry? 8 Putting Patients Front and Center 9 ABCs of EOBs 10 Get Rewarded on Your Path to Wellness 11 Saving Money Never Felt So Healthy 12 Health Plan Overview 13 Medicare Advantage Learn about the benefits, tools and services your Horizon Blue Cross Blue Shield of New Jersey health plan offers to help you spend smart, make good health decisions and live well. Member Services: BLUE (2583) Horizon Behavioral Health Customer Service: /7 Nurse Line: pseg.horizonblue.com

3 Your Horizon BCBSNJ Health Care Plan What s so great about getting your health benefits from Horizon BCBSNJ? Plenty! Our programs provide much more than just health insurance coverage when you are sick or need to visit a doctor. Being an educated and informed health care consumer means taking full advantage of your benefits so you can take control of your well-being. As a Horizon BCBSNJ member, you have access to: Helpful online tools to help manage your health. Access to our vast network of doctors, hospitals, facilities and other health care providers. Nurses who are available 24/7 to guide you with health information. p. 2 p. 6 Access to Urgent Care Centers and Retail Health Clinics when your condition needs urgent attention, but not emergency services. Patient-Centered Medical Homes (PCMHs) that allow your doctor to coordinate all of your health care needs so that you can be sure you are receiving the right care, at the right time, in the right place. An exclusive online destination to put you on the path to wellness. p. 8 Discounts on popular health and wellness products. Horizon BCBSNJ and PSEG care about you and your family s health. We are here to help when you need it. For more information about your benefits or other information, please visit pseg.horizonblue.com or call our PSEG Member Service team at BLUE (2583), Monday, Tuesday, Wednesday and Friday, between 8 a.m. and 8 p.m., Eastern Time (ET), and Thursday, between 9 a.m. and 8 p.m., ET. We look forward to helping you and your family get the health care services and information you need to spend smart and live well. 1 Need help? pseg.horizonblue.com or BLUE

4 Your Secure Member Online Services Medical plan information is just a click away For an easy, secure and quick way to track your health plan benefits and health information, use your Member Online Services at pseg.horizonblue.com. With Member Online Services, you can: View your benefits. Check your claims status and payments. Print or request ID cards. Tell us if you have other health insurance. Find an in-network doctor or hospital. Manage your account and preferences. Access your personal health record. To register for Member Online Services Visit pseg.horizonblue.com and click Register Today. If you need help accessing Member Online Services, Member_Portal@HorizonBlue.com. When using or registering for Member Online Services, please keep these tips in mind: You must have a valid address. Compatible with MS Windows and Mac OS. Supported by Internet Explorer (up to Version 8), Firefox 3, Chrome and Safari. Mobile supported by iphone OS, Android OS, Blackberry OS and Windows Mobile OS. Adobe Acrobat Reader 6 or higher needed to view some content. Safe and secure Member Online Services uses the latest technology to keep your information secure. By creating your account with a personal password, your information remains confidential. Your Member Website 2

5 Go Mobile Get the Horizon Blue App to manage your health on the go Connecting to your health care is easy. Just download* the Horizon Blue App to your Apple or Android device. With the Horizon Blue App, you can: See our provider directory Search for a provider based on specialty or ZIP code. Access map navigation to a provider s address. View detailed information for a provider. View your claims information View copayment, coinsurance and deductible for a specific claim. Search for claims within a date range. Get ID cards View or print the front and back of your ID card. Request a duplicate ID card. Notify us of other insurance you may have Add or update coordination of benefits (COB) information. View your benefits See product and coverage information. View benefits information such as copayment, coinsurance and deductible. Manage your account Modify your profile. Opt in or opt out for paperless Explanation of Benefits (EOBs), s or text alerts. Contact us Access a list of frequently used toll-free phone numbers. us your questions. To get the Horizon Blue App ** Scan this with your iphone. Scan this with your Android device. * There is no charge from Horizon BCBSNJ to download the Horizon Blue App, but rates from your wireless provider may apply. Data rates may apply, depending on your mobile plan/carrier. ** Download a free QR code reader from the Apple App Store or Google Play. 3 On the Go with Mobile

6 Visit Horizon Connect New Jersey s first health insurance retail center is here for you SM As New Jersey s largest and most trusted health insurance company, we are proud to offer personalized, face-to-face service at Horizon Connect in Moorestown. Horizon Connect is a one-stop resource that enables people to connect with us regarding their health plan needs. At Horizon Connect, you can: Attend our monthly events, such as information sessions, health and wellness activities and more! Go to Connect.HorizonBlue.com for our event schedule. Get and stay healthy with free wellness tools and health screenings. Speak with a Horizon Connect team member about your health plan coverage or needs. Get the most from your Horizon BCBSNJ benefits and services with confidential guidance. Visit us Monday through Friday, 9 a.m. to 7 p.m., and Saturday, 9 a.m. to 4 p.m., ET. Horizon Connect East Gate Square Shopping Center 1680 Nixon Drive Moorestown, New Jersey Connect.HorizonBlue.com For Your Reference 4

7 Top Care at Blue Distinction Centers Delivering quality health care for our members, every time The Blue Cross and Blue Shield Association awards Blue Distinction and Blue Distinction Centers+ status to medical facilities that demonstrate expertise and efficiency in delivering quality specialty care. Blue Distinction evaluation is based on what impacts care the most: Know-how and expertise of the medical team; Number of times the hospital has performed the procedure; Track record for procedure results. Blue Distinction Centers+ is awarded to hospitals that meet the same quality-focused criteria as well as cost-of-care measures. Several Horizon Hospital Network facilities have achieved recognition as Blue Distinction Centers or Blue Distinction Centers+. You can learn more about designated facilities throughout the country and search for designated facilities at bcbs.com/bluedistinction. Hospital Safety Score Indicators The Hospital Safety Score is a letter grade that reflects how safe hospitals are for patients. The following icons within our Provider Directory show the safety score of our network hospitals. A SPRING 2014 B SPRING 2014 HOSPITAL SAFETY SCORE HOSPITAL SAFETY SCORE Blue Distinction C SPRING 2014 D SPRING 2014 F SPRING 2014 HOSPITAL SAFETY SCORE HOSPITAL SAFETY SCORE HOSPITAL SAFETY SCORE 5 Get Top Medical Care

8 24/7 Nurse Line For our members and their families, help is just a phone call away Our 24/7 Nurse Line can give you peace of mind when coping with medical issues or if you need health guidance.* Just call to access caring registered nurses who have an average of 15 years of clinical experience. The nurses can help you: Get answers to your health questions 24 hours a day. Understand doctor-approved information to guide your health decisions. Understand if the Emergency Room, a doctor visit or self-care is right for your needs. Explore the risks, benefits and possible outcomes of treatment options. Get tips on nutrition and exercise. Learn about health screenings and immunizations. Online health advice at your fingertips With our 24/7 Live Chat, you can have an individual, secure and confidential online discussion with a nurse and get the information you want all from your computer. This service is available 24 hours, every day, through Member Online Services at pseg.horizonblue.com. * For informational purposes only. Nurses cannot diagnose problems or recommend specific treatment. They are not a substitute for your doctor s care. In an emergency, go to the nearest hospital or doctor or call 911 or your local emergency services number. For benefits information, including: enrollment questions authorizations explanation of benefits claim status claim filing and more call our Member Services Team at BLUE (2583) or use Member Online Services. Secure online chat Just sign in to Member Online Services at pseg.horizonblue.com. Select thetools & Resources tab and then select Nurse Chat from the lower right corner of the page. Health Help 24/7 6

9 Need Help in a Hurry? Know your best options for care When you and/or a family member need urgent care for a non-life-threatening condition, visiting a participating Urgent Care Center (UCC) or Retail Health Clinic in select chain pharmacies can be a valuable alternative to visiting the Emergency Room (ER). Type of Situation Emergency A medical condition that is so severe, it poses a risk to a person s life or long-term health. Urgent An unexpected medical condition that is not life-threatening but requires medical attention within 24 hours. Nonemergent A medical condition that is not life-threatening; may not need immediate medical attention and/or may be treated with self-care. When ER services are used for non-emergencies, we all pay the price. Here s PSEG s average cost for ER vs. UCC. Average Cost Paid by PSEG ER UCC Toe Fracture $179 $ 60 Stitches $250 $113 Overall Average Visit $417 $151 Examples Difficulty breathing. Heart attack or stroke. High fever. Loss of consciousness. Poisoning. Severe burns. Wounds that need stitches. Earache. Moderate fever. Sore throat. Sprains. Mild headache. Minor cold. Seasonal allergies. Small cuts or bruises. Where to Get Appropriate Care Dial 911 (or your local emergency services number) or proceed to the nearest ER. Referral is not required. Call your doctor first. You may also visit a participating Urgent Care Center or Retail Health Clinic without a referral. Call your doctor to see if an appointment is necessary. You may also visit a participating Urgent Care Center or Retail Health Clinic. You can receive care faster at a UCC or Retail Health Clinic, rather than the ER. Most UCCs and Retail Health Clinics have weekend and evening hours. Routine care is not covered at Urgent Care Centers. Routine care includes: Physical therapy services. Preventive care. Routine obstetric services. Sports physicals. Visit your doctor for routine and preventive care visits. Find a participating Urgent Care Center at pseg.horizonblue.com. Under I Want To... select Find an Urgent Care Center. 7 Options for Urgent Care

10 Putting Patients Front and Center Our newest programs focus on coordinated care for our members What is a Patient-Centered Medical Home (PCMH)? A PCMH isn t a place and it isn t an insurance plan. It s a medical practice that uses a team-based approach led by your doctor to make it easier for you to access the care, information and assistance you need, when you need it. What you can expect from a PCMH: One point of contact your doctor for all your health care needs. Team-based, coordinated care led by your doctor. Personalized and responsive care from your team. Access to care you need, when you need it. Better communications and access to the practice, even after normal office hours. Wellness and preventive care based on national guidelines. To find a doctor who participates in the PCMH program, search our Provider Directory at pseg.horizonblue.com. Doctors who have taken on this vital role have the Patient-Centered designation in their profile. Get the most out of your PCMH The most important member of your health care team is you! Your role includes honestly sharing your health concerns, needs and issues with your doctor and PCMH team. Then, the team can work closely with you to create a care plan that s right for your health and wellness goals. To get the most out of having the benefit of your new PCMH team: Follow through on recommended services, medications, checkups and counseling. Ask questions to get the information you need. Inform your health care team about changes in your health or if you ve stopped taking any medication. Review any personal care plans with your team regularly. You re Never Alone A PCMH keeps you at the center of your care. Your doctor and your care team welcome the chance to get to know you better, answer your questions and work with you to create a care plan based on your health goals. Patient-Centered Care 8

11 ABCs of EOBs Understand how your plan pays claims Horizon BCBSNJ provides an Explanation of Benefits (EOB) so you understand how your plan pays claims and your role in that process. An EOB will be available up to 15 days after the claim is processed and may show up to 25 claims, giving you a comprehensive view of the services you and/or your dependents have received. This sample EOB shows what to expect on your EOB. You can view, download and print your EOBs through Member Online Services at pseg.horizonblue.com. If you have questions about an EOB, just call Member Services at BLUE (2583). PO BOX 420 NEWARK, NJ CUSTOMER SERVICE DATE: 01/25/2014 PAGE 2 OF 2 EXPLANATION OF BENEFITS THIS IS NOT A BILL SUBSCRIBER NAME: JOHN DOE SUBSCRIBER ID: A SUMMARY INFORMATION PATIENT NAME RELATION CLAIM NUMBER GROUP NUMBER TOTAL CHARGE HORIZON PAID JOHN DOE SELF DETAIL INFORMATION DATE OF SERVICE PROVIDER TYPE OF SERVICE B C D E F G H I J K BILLED AMT ALLOWED AMT YOUR COINS/COPAY AMT YOUR DEDUCTIBLE OTHER CARRIER AMT PAYMENT AMT NOT COV AMT HORIZON PAID AMT MESSAGE CODE SUBSCRIBER RESPONSIBILITY 1/15/14 ANYTOWN COMMUNITY HEALTH TOTAL: A Date of Service B Type of Service C Billed Amount D Allowed Amount E Your Coinsurance/Copayment Amount F Your Deductible Amount G Other Carrier Payment Amount H Not Covered Amount I Horizon BCBSNJ Paid Amount J Message Code K Subscriber Responsibility The date that services were provided to the patient. A brief explanation of each service. Amount charged by the doctor or health care professional for each service on the claim. The amount we approved for payment based on your plan benefits prior to the deductible, coinsurance, copayment or other member cost sharing (if applicable). For services obtained out of network, the difference between billed and allowed amounts will be included in the amount shown as Subscriber Responsibility (K). The coinsurance or copayment amount that is your responsibility after you have met your deductible, if applicable. You pay this amount to the doctor or health care professional. The amount applied to this service under your benefits contract. You are responsible for paying this amount to the doctor or health care professional. The amount paid by another insurance carrier, including Medicare, if applicable. Any amount of the fee charged for the service that is not covered by your plan; expenses not covered or in excess of your benefits. You may be responsible for this amount in addition to any deductible, coinsurance or copayment. Examples of expenses that may appear in this column are costs above the negotiated rate when using an out-of-network doctor or amounts for duplicate services. The total amount paid by Horizon BCBSNJ for the services rendered. This amount may be paid to you, your doctor or health care professional or designated payee. A code in this column refers to specific messages below each claim that help explain how we calculated our payment. The balance due from you to the doctor or health care professional after the copayment, deductible, coinsurance and benefits are applied. 9 The ABCs of EOBs

12 Get Rewarded on Your Path to Wellness Horizon BCBSNJ offers a no-cost social network to help you get healthy Do you walk or do yoga to better your health? Do you read books to better your mind? Do you volunteer to better your soul? Horizon BCBSNJ members get exclusive access to CaféWell, an online destination for health-based activities designed to motivate you and improve your well-being. This social network provides you with tips and tricks to help you reach your health goals. And there s absolutely no cost to you! On HorizonBlue.com/CafeWell, you can: Join other members in online wellness challenges. Track progress for improving your health and well-being. Discover tips, tricks and articles to get smarter about health. Make connections with CaféWell health and nutrition experts. Take control of your health in a secure online environment. Sign up for free 1. Go to HorizonBlue.com/CafeWell. 2. Follow the prompts. Verify that you are a Horizon BCBSNJ member. 3. Answer a few questions so content can be suggested for you. 4. Explore and connect with others on your quest to better health. 5. Stay active in the CaféWell community for best results and for chances to be rewarded for your progress. CaféWell holds frequent challenges and contests to keep you motivated! Join today to take advantage of this free wellness service from Horizon BCBSNJ! Wellness Destination You can access HorizonBlue.com/CafeWell through a computer, smartphone or tablet, anytime, anywhere that fits your lifestyle. 10

13 Saving Money Never Felt So Healthy Members get exclusive access to shop with Blue365 Horizon BCBSNJ wants to help you take care of yourself every day of the year. That s why we offer Blue365, an online destination featuring healthy deals and discounts exclusively for our members and their families. Registering for Blue365 is quick and easy. Just visit Blue365deals.com/HorizonBCBS. Please have your Horizon BCBSNJ member ID card handy when you register. Complete the required information and click Sign Up so you can start shopping for valuable health and wellness products and services. After you register, special offers from top national brands in fitness, nutrition, personal care and more will be ed to you every week, so you can keep up with the latest deals and offers. Visit Blue365deals.com/HorizonBCBS to find deals on: Fitness Find a fitness plan that works for you with discounts offered by numerous vendors. Learn more on the Fitness Deals page. Healthy Eating Whether you re trying to slim down or boost your energy, discounts and resources make eating right more affordable. Browse Healthy Eating Deals. Living A well-balanced life doesn't have to cost a fortune. To help enhance your life, visit the Living Deals page. Personal Care Find discounts on ways to keep your senses sharp and help your body work its best. Just browse Personal Care Deals. Wellness We make it easy for you to reach a healthier state of mind through the helpful information on the Wellness Deals page. 11 Shopping Benefits

14 Health Plan Overview A snapshot of Horizon BCBSNJ plans with PSEG PSEG offers several Horizon BCBSNJ plans. Each has its own costs and benefits so please check your enrollment materials for detailed information. You should know: All plans offer prescription drug benefits. For an overview of medical benefits, go to pseg.horizonblue.com/plans. For detailed plan descriptions, go to then to the Resources tab and click Legal Documents and find: Summaries of Benefits and Coverage (SBC). Summary Plan Descriptions. Click or Call PSEG Benefits Express MYPSEG1 ( ) Representatives can help with your PSEG benefits from 8 a.m. to 5 p.m., ET, Monday through Friday. pseg.horizonblue.com Make this your first stop for Horizon BCBSNJ health and benefits information and tools. Express Scripts expres-scripts.com For all your prescription drug questions and needs, such as finding participating pharmacies and setting up prescription mail service. Best Doctors members.bestdoctors.com For help making medical decisions, including choosing the right doctor for your needs. (Available only to retirees enrolled in the High Deductible Health Savings Plan.) MyPSEGbenefits.com For detailed information about your plans, benefits overview and other PSEG programs and services available to you. For Your Reference 12

15 Medicare Advantage For PSEG Retirees Age 65 and Older Medicare Advantage (MA) Group health plans are part of the Medicare program but are offered through health insurance companies like Horizon Healthcare of New Jersey, Inc. This type of plan was created by the federal government to enable health care companies offer you all the benefits of Original Medicare plus more, including discounts not offered by Original Medicare. These plans give you solid coverage for a variety of health care services, low out-of-pocket costs, discounts on services not offered by Medicare and the ability to use providers both in and out of Horizon BCBSNJ s large provider network. These group plan options provide much richer benefits than the Medicare health plans available on an individual basis (outside of the group). Beneficiaries who are eligible for Medicare Part A and have enrolled in Medicare Part B, live in New Jersey and do not have end-stage renal disease (ESRD) may qualify for these plans. Horizon Medicare Advantage Health Plans offer: Richer benefits than those available on a individual basis. No pre-existing condition limitations Low out-of-pocket costs Routine vision and dental care benefits. Access to the 24/7 Nurse Line Access to one of the area s largest networks With a Horizon Medicare Advantage Group plan, you have access to an extensive number of doctors, health care providers and hospitals across New Jersey. In most cases, you can keep the same doctors, health care specialists and hospitals you use with your under-age-65 Horizon BCBSNJ group coverage. Security of having coverage with one of New Jersey s largest insurers With Horizon Healthcare of New Jersey, Inc. you can rest assured knowing that your coverage comes from a dependable, local company that has proudly served the people of New Jersey. For more than 80 years, we have earned our customers trust by meeting their health care needs and providing peace of mind. Horizon Medicare Blue Access Group (HMO-POS) This plan is open to any members who live in New Jersey. PCP selection is not required. Members of this plan can save on the cost of their health care by using the Horizon Medicare Blue Managed Care network without referrals. Some of the benefits include: 13 $0 for preventive care services (no copayment or coinsurance). 100 percent inpatient and outpatient coverage. 100 percent coverage for Durable Medical Equipment. Benefits for hearing coverage. Dental discounts. Unlimited chiropractic coverage. Vision hardware reimbursement. There are no limitations for pre-existing conditions and this option also comes with an internal account management team dedicated to you. Working with Medicare to provide you with great benefits!

16 pseg.horizonblue.com The Blue Cross and Blue Shield names and symbols, Blue365, BlueCard and Blue Distinction are registered marks of the Blue Cross and Blue Shield Association. The Horizon name and symbols, and PRECIOUS ADDITIONS are registered marks, and Horizon Connect is a service mark, of Horizon Blue Cross Blue Shield of New Jersey. Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross and Blue Shield Association. Android TM and YouTube TM are trademarks of Google, Inc. CaféWell is a registered trademark of Welltok, Inc. Facebook is a registered mark of Facebook, Inc. iphone is a registered mark of Apple, Inc. WebMD is a registered mark of WebMD, Inc. All other trademarks and trade names are the property of their respective owners Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey CMC _Retirees (1014) Find the Health Care You Need Almost Anywhere Need care in New Jersey? As a Horizon BCBSNJ member, you have access to the largest network in New Jersey of qualified doctors, laboratories and hospitals. Depending on your plan, in New Jersey you may choose from: More than 30,000 physicians and other health care professionals.* 74 hospitals/95 locations in New Jersey, New York, Pennsylvania and Delaware.* Horizon BCBSNJ offers interactive tools and resources to help you find an in-network provider based on your plan, compare hospitals based on specific diagnoses and procedures and more. Visit pseg.horizonblue.com to get started. Living or traveling outside of New Jersey? Ninety-one percent of doctors and 96 percent of hospitals in the United States participate in BlueCard.* To find doctors and hospitals available to you through the BlueCard Program: 1. Have your Horizon BCBSNJ ID card on hand. 2. Visit HorizonBlue.com/Directory and click Providers Outside of NJ. 3. Follow the directions and click Start Search. You may also call BlueCard Access at BLUE (2583) for the names and addresses of doctors and hospitals in the area where you or your covered dependent need care. * Network numbers are current at the time of printing.