INDIVIDUAL HEALTH PLANS

Transcription

1 INDIVIDUAL HEALTH PLANS

2 TABLE OF CONTENTS We have Manitoba covered...2 Is a Manitoba Blue Cross plan right for you?...3 Why choose Manitoba Blue Cross?...4 Our Plans...5 Basic Blue Plan Medi-Blue Plan Medi-Blue Deluxe Plan Plus Plan Plus Plan Deluxe GenX Plan Value Added mybluecross...18 My Good Health...19 Walk-In Customer Service Centre...20 Call Centre...20 Blue Advantage Application Procedure...22 Conversion Privilege...23 Payment Schedule...23

3 This brochure is intended to assist you in understanding the terms and benefits of Manitoba Blue Cross Individual Health Plans, and does not, in itself, constitute an agreement. For exact conditions, please see your Coverage Provisions. 1

4 WE HAVE MANITOBA COVERED We have Manitoba covered. Manitoba Blue Cross covers over 548,000 Manitobans. That s more Manitobans than any other carrier. We dedicate the time, energy and resources into understanding the needs of our plan members, and the dynamics affecting their lives. As a not-for-profit organization, we ensure that every dollar made is reinvested back into our infrastructure, our people and our province, with the goal of expanding our community impact, broadening our health care knowledge and providing better, more comprehensive care for our members. 2

5 Is a Manitoba Blue Cross plan right for you? Manitoba Blue Cross plans have been created to cover health and dental costs that exceed services covered by Manitoba Health, Healthy Living and Seniors. Our plans ensure that Manitobans have the coverage they want and the peace of mind they need. We cover Manitobans who are: Retired In between jobs Self-employed Students Employed part-time Contract workers Professionals not covered by their employer IS A MANITOBA BLUE CROSS PLAN RIGHT FOR YOU? Manitoba Blue Cross plans are available to all residents of Manitoba who are covered by Manitoba Health, Healthy Living and Seniors. Our plans have no age limit and no medical examination is required to receive coverage (though a medical questionnaire is required for the Deluxe plans). If you choose family coverage, your spouse (or common-law spouse) and dependent children under the age of 21 (unmarried and unemployed) will all be covered. Coverage you want and peace of mind you need. 3

6 WHY CHOOSE MANITOBA BLUE CROSS? Why choose Manitoba Blue Cross? We re local. We are focused on helping the community and have a firm understanding of the health care needs of Manitobans. We are a not-for-profit organization that puts the needs of Manitobans first. We offer personalized service by phone, or in person. We are the only carrier in Manitoba with a walk-in customer service centre to give you personalized face-to-face service. We do our best to make using our coverage easy for our members and have made arrangements with a number of service providers to reimburse them directly, saving you from paying costs up front and waiting for reimbursement. Our mybluecross site provides easy self-service features including Online Claims Submission and access to coverage details and claims status. The health and well-being of Manitobans is important to us. We provide all of our plan members with access to My Good Health, a health resource site to help get you on the road to better health. Our Blue Advantage program helps our members save on products, services, and health and wellness items. 4

7 Our Plans We understand that depending on age and life situation, Manitobans will have varying health care needs. That is why Manitoba Blue Cross has six unique health and dental plans. Each plan has been specifically designed to accommodate these varying needs. OUR PLANS From basic services, like ambulance and stretcher service, to more comprehensive coverage, ranging from physiotherapy to cardiac rehabilitation to major dental, Manitoba Blue Cross plans were created with the needs of Manitobans in mind. Plans designed to accommodate varying needs. 5

8 BASIC BLUE PLAN BASIC BLUE Are you looking for a plan to simply cover the basics? Basic Blue is our most basic plan and covers ambulance and hospital benefits only. This plan is a good option for individuals who are primarily concerned about ambulance and semi-private hospital coverage. Benefits covered include: Ambulance/Hospital Benefits Air ambulance Emergency ambulance Hostel care Semi-private hospital room Stretcher service (medical van) Treat and release coverage Note: 3-month unpaid waiting period applies to Basic Blue Plan. We ve made arrangements to pay hospital and ambulance coverage directly 6

9 Manitoba Blue Cross plans were created with the needs of Manitobans in mind BASIC BLUE PLAN 7

10 MEDI-BLUE PLAN MEDI-BLUE Do you need coverage for extended health care but don t require dental coverage? Medi-Blue is an intermediate plan designed for people who want the assurance of knowing they have a solid mix of health care benefits but do not require dental coverage. Benefits covered include: Extended Health Benefits Accidental dental Assisted care Athletic therapy Cardiac rehabilitation Foot care Medical appliances Nutritional counselling Occupational therapy Orthopedic shoes Physiotherapy Prescription drugs Private duty nursing Prosthetic and remedial equipment Psychological counselling Travel health care Additional coverage for U.S. or international travel is recommended. Contact us or talk to your agent if you need further information about our travel health plans. 8

11 Ambulance/Hospital Benefits Air ambulance Emergency ambulance Hostel care Semi-private hospital room Stretcher service (medical van) Treat and release coverage MEDI-BLUE PLAN Accidental Death and Dismemberment Up to $5,000 accidental death and dismemberment benefit. Note: 3-month unpaid waiting period applies to Medi-Blue Plan. 9

12 MEDI-BLUE DELUXE PLAN MEDI-BLUE DELUXE Does Medi-Blue sound appealing, but you re looking for a little more coverage? The Medi-Blue Deluxe Plan offers the same benefits as Medi-Blue with some additional benefits. This plan also offers higher benefit maximums for prescription drugs and private duty nursing. Benefits include the same coverage offered by Medi-Blue and: Blood pressure monitors BlueNet drug card Day surgery assisted care Foot orthotics Hearing aids Increased maximum for prescription drugs Increased maximum for private duty nursing BlueNet point-of-sale drug card With your BlueNet card, claims are automatically processed when you present your card at a participating pharmacy. The BlueNet system will notify the pharmacist if the drug is covered under your plan or if you have reached your prescription drug maximum. Note: 3-month unpaid waiting period applies to Medi-Blue Deluxe Plan. 10

13 We are a not-for-profit organization that puts the needs of Manitobans first MEDI-BLUE DELUXE PLAN 11

14 PLUS PLAN PLUS PLAN Looking for coverage that is similar to an employer-sponsored plan? The Plus Plan provides a highly comprehensive benefits package similar to benefits provided under an employer-sponsored group plan, including dental coverage. Benefits covered include: Extended Health Benefits Accidental dental Assisted care Athletic therapy BlueNet drug card Cardiac rehabilitation Foot care Medical appliances Nutritional counselling Occupational therapy Orthopedic shoes Physiotherapy Prescription drugs Private duty nursing Prosthetic and remedial equipment Psychological counselling Specialist referral Travel health care Tutorial allowance Vision care Additional coverage for U.S. or international travel is recommended. Contact us or talk to your agent if you need further information about our travel health plans. 12

15 Ambulance/Hospital Benefits Air ambulance Emergency ambulance Hostel care Semi-private hospital room Stretcher service (medical van) Treat and release coverage PLUS PLAN BlueNet point-of-sale drug card With your BlueNet card, claims are automatically processed when you present your card at a participating pharmacy. The BlueNet system will notify the pharmacist if the drug is covered under your plan or if you have reached your prescription drug maximum. Dental Benefits Basic services Major services Orthodontics Accidental Death and Dismemberment Up to $10,000 accidental death and dismemberment benefit. Note: 3-month paid waiting period applies to Plus Plan. 13

16 PLUS PLAN DELUXE PLUS PLAN DELUXE Do you like the benefits offered with Plus Plan but would like additional benefits and coverage? Plus Plan Deluxe is the most comprehensive benefit package that Manitoba Blue Cross offers to individuals. In addition to the full range of benefits offered by the Plus Plan, the Plus Plan Deluxe provides further benefits and enhanced coverage for some of our most requested benefits. Benefits include the same coverage offered by Plus Plan and: Blood pressure monitors Day surgery assisted care Foot orthotics Increased maximum for prescription drugs Increased maximum for hearing aids Note: 3-month paid waiting period applies to Plus Plan Deluxe. 14

17 We cover more Manitobans than any other carrier PLUS PLAN DELUXE 15

18 GENX PLAN GENX Are you under 30 and looking for affordable coverage? The GenX Plan has been designed to cover young adults under 30 who may not be receiving benefits from their employer. This plan offers a full range of benefits at an affordable rate. GENX plan provides affordable coverage for Manitobans under 30 16

19 Benefits covered include: Extended Health Benefits Accidental dental Athletic therapy Eye exams Occupational therapy Physiotherapy Prescription drugs Prosthetic & remedial equipment Tutorial allowance GENX PLAN Ambulance/Hospital Benefits Air ambulance Emergency ambulance Hostel care Semi-private hospital room Stretcher service (medical van) Treat and release coverage Dental Benefits Basic services Major services Orthodontics Accidental Death and Dismemberment Up to $10,000 accidental death and dismemberment benefit. Note: 3-month paid waiting period applies to GenX Plan. 17

20 VALUE ADDED Value Added At Manitoba Blue Cross, customer service is a priority. We understand that how people communicate depends on the individual, and so we provide a number of ways for you to connect with us. mybluecross mybluecross is an electronic service offered by Manitoba Blue Cross to allow you access to your plan information online anytime, anywhere. You will have quick access to: Online Claims Submission Send us your claims electronically. Visit our website for details. Direct Deposit Have claim payments deposited directly into your bank account. Receive your payments faster by no longer waiting for a cheque in the mail. Plan Information Benefit Details Benefit Eligibility Claim Information Claim Forms Temporary ID Cards Receipts for income tax purposes 18

21 Take control of your health and well-being today! My Good Health, an online health resource site, is available to all Manitoba Blue Cross plan members in mybluecross. My Good Health is full of information to get you on the road to better health. Here are some of the great things you can do at My Good Health: Discover new prevention and treatment options Learn the details of drugs prescribed to you Find out more about natural products and remedies Calculate your health risks Count calories Test your health knowledge Check your symptoms Sign up for our health e-newsletter Access community support VALUE ADDED Registration is easy. Just go to mb.bluecross. ca. Look for the mybluecross icon and click Register. 19

22 VALUE ADDED Walk-In Customer Service Centre Many people feel more comfortable with faceto-face service and Manitoba Blue Cross is the only coverage provider in the province to offer a walk-in customer service centre. Conveniently located at 599 Empress Street, across from Polo Park Shopping Centre in Winnipeg, we see approximately 45,000 people walk through our doors annually. Call Centre We also have a number of information services representatives on hand to answer the over 400,000 phone call inquiries we receive each year with a system in place to ensure that you are given consistent information and your call is answered effectively, efficiently and in a timely manner. 20

23 We realize, even with Extended Health Care coverage, it can still be difficult to pay for products and services that exceed the coverage of a benefit plan. For this reason, we introduced our Blue Advantage program, which allows Blue Cross plan members to save on products and services offered by participating providers across Canada. These savings are available to all of our members, regardless of your group or individual plan coverage. Just present your Blue Cross ID card and mention the Blue Advantage program to the participating provider. VALUE ADDED What products and services are available? Vision care products Medical supplies and equipment Dental products Hearing products and services Items that favour health and wellness, including discounts on magazine subscriptions, gym memberships, vitamins and supplements For a current list of participating providers and types of savings visit the Blue Advantage website at blueadvantage.ca 21

24 APPLICATION PROCEDURE Application Procedure Applying for a Manitoba Blue Cross plan can be done any of the following ways: Through your agent Online at mb.bluecross.ca In person at 599 Empress Street in Winnipeg By calling our offices at or USE.BLUE ( ) to request an application Coverage will become effective the first of the month following three months from the date the application is received. If you are a new resident to Manitoba, or have recently lost benefits with an employer group, please contact our office as enrollment procedures may differ. 22

25 Conversion Privilege If you had coverage with a different carrier or an employer group plan you may be eligible for Manitoba Blue Cross coverage immediately. There is no waiting period providing you apply within 60 days of losing your previous coverage. Your coverage will become effective the first of the month following the termination date of your previous coverage. (A letter from the previous carrier or your employer is required unless the coverage was with Manitoba Blue Cross.) Payment Schedule Making payments for your plan is hassle-free through Pre-Authorized Debit (PAD). Payments will be made through your bank account on a schedule that works best for you. You have the option to pay for your plan on a monthly, quarterly, semi-annual or annual basis. CONVERSION PRIVILEGE/ PAYMENT SCHEDULE Recently retired or switching coverage from another carrier? Ask us about our conversion privilege 23

26 BASIC BLUE MEDI-BLUE MEDI-BLUE DELUXE GENX PLUS PLAN PLUS PLAN DELUXE DENTAL BENEFITS Basic Major Orthodontic Treatment (commenced prior to child s 17th birthday) 80% of prevailing fee guide 80% of prevailing fee guide 80% of prevailing fee guide Annual Maximum $300 $600 ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS Underwritten by Blue Cross Life Insurance Company of Canada $5,000 $10,000 CONTRACT MAXIMUMS Ambulance Benefits No Overall Lifetime Maximum Extended Health Benefits $5,000 annual, $40,000 lifetime/person $40,000 lifetime/person Dental Benefits No Overall Lifetime Maximum This information is intended to provide an overview of the benefits provided. (In all cases the coverage provisions shall prevail.)

27 EXTENDED HEALTH BENEFITS Co-insurance 20% 10% Accidental Dental Artificial Limbs/Eyes Assisted Care Athletic/Occupational Therapy Blood Pressure Monitor included under special equipment maximum $40/day (14 day maximum) per hospitalization 80% of eligible expenses $250/5 years $1000 per accident $250/calendar year -combined included under special equipment maximum 90% of eligible expenses $40/day (14 day maximum) per hospitalization BlueNet (POS) no coinsurance yes yes Braces, cervical collars, elastic stockings Breast Prostheses & Surgical Bras (single/double) Cardiac Rehabilitation Clinical Psychology 80% of eligible expenses 90% of eligible expenses $250/5 years $400/$800 per calendar year $400/$800 per calendar year $500 lifetime maximum $450/calendar year $500 lifetime maximum $450/calendar year Crutches, splints, casts & canes 80% of eligible expenses 90% of eligible expenses Day Surgery - Assisted Care Eye Exam Hearing Aids no coinsurance Hospital Bed Hospital In-patient Allowance (no coinsurance) Nutritional Counselling Orthopedic Shoes Orthotics Physiotherapy Podiatry/Foot Care by Nurses Prescription Drugs no coinsurance Private Duty Nursing Respirator Special Equipment including medical devices used to aid daily living Specialist Referral Travel Protection BASIC BLUE MEDI-BLUE MEDI-BLUE DELUXE GENX PLUS PLAN PLUS PLAN DELUXE AMBULANCE/HOSPITAL BENEFITS Emergency Ambulance No maximum; services provided by a participating operator within Manitoba. Non Emergency Ambulance No maximum; services must be recommended by the attending physician if patient cannot walk and cannot be transported by any other means. Treat No Transport Ambulance Ambulance called to scene and provides treatment but does not transport to hospital. Air Ambulance $5000/trip; annual maximum $10,000/person. Out of Province Ambulance $500 maximum/trip. Hospital - Semi Private Room Maximum 60 days/hospital/calendar year/person. Stretcher Service (Medical Van) $400 lifetime maximum/person. Hostel Care Available for those requiring medical treatment/diagnostic testing in a hospital located outside a 60 kilometer radius of your home. Hospital Allowance In the event that semi-private accommodations are unavailable; $20/day, maximum 60 days/calendar year/person. $160/calendar year per certificate $2000/calendar year $20-$40/day; maximum $200/surgery $300 every 5 calendar years $1000 lifetime maximum $450/calendar year $200/calendar year $450/calendar year $1000 lifetime maximum $250 lifetime maximum $1000/calendar year maximum $100/calendar year $400/calendar year per certificate $2500/calendar year 1 Eye Exam every 24 months $450/calendar year $130/calendar year per certificate $500 every 5 calendar years $10/day per hospitalized illness $200/calendar year per certificate $1000 lifetime maximum $450/calendar year $200/calendar year $450/calendar year $3000/calendar year $1000 lifetime maximum $250 lifetime maximum $20-$40/day; maximum $400/surgery $800 every 5 calendar years $10/day per hospitalized illness $100/calendar year $800/calendar year per certificate $0.30/km; $200 per calendar year for treatment not available within a 150km radius of your residence. $2500/calendar year maximum Tutorial Benefits Vision Care - no coinsurance Walker Wheelchair Wigs $500 lifetime maximum $1000 lifetime maximum $1000 lifetime maximum $15/hour; maximum $1500 per illness $100/24 months $500 lifetime maximum $1000 lifetime maximum $1000 lifetime maximum

28 IN PERSON 599 Empress Street 9:00 a.m. - 5:30 p.m. Monday through Friday BY TELEPHONE Customer Service Centre 8:00 a.m. - 5:30 p.m. Monday through Friday Toll-free at (1.800.USE.BLUE) (within Manitoba only) 8:00 a.m. - 5:30 p.m. Monday through Friday BY MAIL Manitoba Blue Cross PO Box 1046 Stn Main Winnipeg MB R3C 2X7 mb.bluecross.ca MBC M 02/2016 *The Blue Cross symbol and name, Colour of Caring, mybluecross and BlueAdvantage are registered marks of the Canadian Association of Blue Cross Plans, independently licensed by Manitoba Blue Cross.* Blue Shield is a registered trade-mark of the Blue Cross Blue Shield Association. My Good Health is a registered trade-mark of Pacific Blue Cross and used with permission.