2016 Health plans for individuals and families

Transcription

1 2016 Health plans for individuals and families

2 THE COVERAGE YOU WANT. A NAME YOU CAN TRUST. With Blue Cross and Blue Shield of Minnesota and Blue Plus, it s easy to choose a plan that s right for you and your family. You want coverage that fits your lifestyle. Blue Cross has plans to keep your family healthy. With access to more than 98 percent of doctors and hospitals in Minnesota and more than 90 percent of providers across the nation, Blue Cross gives you confidence to tackle whatever life brings. Enjoy the peace of mind that comes with the strength and stability of a Blue Cross health plan. Why Blue Cross is a smart choice Easy access to the largest network of health care providers across the nation and worldwide No referrals needed to see an in-network specialist Discounts on your gym membership Plans come with online health and wellbeing tools to help keep you well Most claims paid within 15 days High member satisfaction with Blue Cross individual plans* *2015 Individual New Member/Disband Survey, Blue Cross and Blue Shield of Minnesota. pthe company you know and trust for health plans now offers dental coverage. Protect your oral health with one of the Blue Cross Dental plans, featuring United Concordia s Advantage Plus 2.0 dental provider network. When you choose from a wide range of plans, you ll get routine preventive care covered at no additional cost. You ll also enjoy: In-network coverage that includes more than 100,000 participating dentists and 321,000 offices nationwide Online access to your account and ability to find a participating dentist Discounts for benefits and services not covered under the plan when using an in-network provider One carrier for both medical and dental inquiries Optional e-billing Compatibility with health savings accounts (HSAs) or flexible spending accounts (FSAs) A personalized website to manage your health With mybluecross, taking care of your health is easy and convenient. Whether you re looking for a doctor or exploring your plan s benefits, mybluecross has instant answers to many of your questions. And, it is available to you and your family 24 hours a day, seven days a week. Once you register for an account, you can: View claims and Explanations of Health Care Benefits (EOBs) Manage your health spending account Send secure s to customer service* View, print, or order member ID cards View s and out-of-pocket expenses * s are usually answered within 24 hours, Monday through Friday. United Concordia Companies, Inc. is an independent company providing dental benefit management services.

3 Choosing a health plan With Blue Cross and Blue Shield of Minnesota and Blue Plus, it s easy to find a health plan that fits your needs. The chart below will help determine which plan is right for you. Are you eligible for a subsidy? Look for Blue Cross or Blue Plus plans on the MNsure exchange at mnsure.org No Do you prefer to pay more for the largest network of doctors/hospitals or would you rather save money with a smaller network? Largest network Save money Over 30 How old are you? Where do you live? BlueAccess SM Under 30 Metro Twin Cities Western or north-central Minnesota Southeastern or south-central Minnesota Northeastern or north-central Minnesota Enjoy easy access to the most health care providers BlueSave SM Get the largest network but pay less with coverage for young adults BluePrint SM featuring allina health network BlueConnect SM featuring sanford health network Blue plus with mayo clinic These plans provide the confidence and convenience of a network close to home. Blue plus with st. luke s Staying well Individual and family plans include preventive care to keep you feeling your best. Yearly preventive exams and certain cancer screenings are examples of what s usually covered 100 percent when you see an in-network provider. 1

4 2016 health plans for individuals and families In-network Benefits BlueSave Catastrophic BlueAccess BlueAccess BlueAccess BlueAccess BlueAccess BlueAccess Plan numbers* 256/ / / / / / /461 Metal Level Catastrophic Bronze Bronze Silver Silver Silver Silver Deductible Per person (unless otherwise noted) Per family Compatible with HSA No $4,700 $9,400 $1,800 $3,600 No $2,700 $5,400 $4,000 $8,000 Coinsurance 0% 20% 0% 40% 15% 0% 20% Out-of-pocket maximum Per person (unless otherwise noted) Per family Prescription drugs Preferred generic Preferred brand Non-preferred Office visits Health care provider, or urgent care clinic Specialist Retail clinic Preventive care 0% after First 3 office visits (all office visits combined) are ); then are ) 2 2 ) ) $40 copay $60 copay $20 copay ) ) $4,000 $8,000 ) $3,000 $6,000 No for all generics (preferred and non-preferred) and 20% coinsurance for all brand (preferred and non-preferred) First 3 office visits (all office visits combined) are ); then are 2 ) Online doctor visit First 3 office visits (all office visits combined) are ); then are 2 First 3 visits are free**; then are $40/$60 copay First 3 office visits (all office visits combined) are ); then are 2 * Plan numbers in the 200 series are available off-exchange, plan numbers in the 400 series are available through MNsure. **Included in the cost of the plan This is only a summary. The contract and certificate include complete details of what is and isn t covered. Services not covered include adult eyewear, adult dental, custodial care, bariatric surgery, infertility, hearing aids, items primarily used for a nonmedical purpose, over-the-counter drugs (except as specified in the Certificate of Coverage), nutritional supplements, services that are cosmetic, experimental, not medically necessary, or covered by workers compensation or no-fault auto insurance. We feature a large network of health care providers. Each provider is an independent contractor and is not our agent. Nonparticipating providers do not have contracts with Blue Cross and Blue Shield of Minnesota. Benefits are effective January 1,

5 BlueAccess BlueCONNECT BlueCONNECT BlueCONNECT BluePrint BluePrint BluePrint 240/ / / / / / / /470 Gold Bronze Silver Gold Bronze Silver Gold Bronze Blue Plus with Mayo Clinic $2,000 single $4,000 family Non-embedded $4,700 $9,400 $2,000 $6,000 $1,500 $4,500 $4,700 $9,400 No No $2,000 $6,000 $1,500 $4,500 No No 0% 20% 20% 20% 20% 20% 20% 0% $2,000 single $4,000 family $2,500 $7,500 $2,500 $7, $15 copay $60 copay 2 First office visit combined) is 0% (no ); the (no ); the 2 (no ); the (no ); the ) ) ) ) ) ) ) ) 2 First office visit combined) is 0% (no ); the (no ); the 2 (no ); the (no ); the Consumer Price Index Annual Adjustment: The, copay and out-of-pocket maximum amounts are subject to annual adjustments. These adjustments are based on the medical care component of the Consumer Price Index (CPI) published by the U.S. Department of Labor. These annual adjustments are effective on the annual renewal date. Your out-of-pocket costs depend on the network status of your provider. To check network status, visit bluecrossmn.com. Lowest out-of-pocket costs: in-network providers. Higher out-of-pocket costs: out-of-network participating providers. Highest out-of-pocket costs: out-of-network nonparticipating providers. (You are responsible for the difference between Blue Cross allowed amount and the amount billed by nonparticipating providers. This is in addition to any applicable, copay or coinsurance. Benefit payments are calculated on Blue Cross allowed amount, which is typically lower than the amount billed by the provider.) 3

6 Blue Plus with Mayo Clinic Blue Plus with Mayo Clinic Blue Plus with St. Luke s Blue Plus with St. Luke s Blue Plus with St. Luke s Blue Cross and Blue Shield, a Multi-state Plan 271/ / / / / Silver Gold Bronze Silver Gold Silver Gold Blue Cross and Blue Shield, a Multi-state Plan $2,700 $5,400 $1,500 $4,500 No $2,700 $5,400 $1,500 $4,500 $0 $0 $0 $0 No No No 15% 20% 0% 15% 20% 50% 50% $2,500 $7,500 $6,500 $2,500 $7,500 $6,500 $13,000 $2,800 $5,600 5 ) 5 ) (no ); then are 2 (no ); then are 2 5 ) 5 ) ) ) ) ) ) ) ) (no ); then are 2 (no ); then are 2 5 ) 5 ) Single s and out-of-pocket maximums apply to single coverage only. Specialty drug coverage varies by plan. Please see Benefit Highlights for additional detail. BluePrint, BlueConnect, Blue Plus with Mayo Clinic and Blue Plus with St. Luke s are offered through Blue Plus, an affiliate of Blue Cross and Blue Shield of Minnesota. Each health care provider is an independent contractor and is not our agent. Sanford Health is an independent, non-profit company that provides network access to health care services. Allina Health is an independent company that provides network access to health care services. Allina Health Network is a subsidiary of Allina Health. Mayo Clinic is an independent, nonprofit healthcare provider. St. Luke s Hospital of Duluth is an independent company that provides network access to health care services.

7 Clearwater Kanabec Washington Chisago Minnesota, you re covered No matter where you live in Minnesota, Blue Cross has plan options that work with the providers in your community for the care you need. See the service map below for plans available in your area. Kittson Roseau Marshall Pennington Red Lake Polk Norman Mahnomen Lake of the Woods Beltrami Koochiching Itasca St. Louis Lake Cook Our health plans The following plans are available statewide: BlueAccess SM (Aware network) Enjoy easy access to the most health care providers BlueSave SM (Aware network) Our most affordable coverage for young adults Clay Wilkin Becker Otter Tail Hubbard Wadena Cass Crow Wing Aitkin Carlton Multi-State Plan (Aware network) An affordable, no plan for those willing to pay more when using health care Traverse Big Stone Lac Qui Parle Grant Douglas Stevens Yellow Medicine Lincoln Pipestone Lyon Swift Pope Chippewa Murray Redwood Todd Kandiyohi Renville Stearns Meeker Brown Morrison McLeod Sibley Nicollet Benton Sherburne Wright Carver Rock Nobles Jackson Martin Faribault Mille Lacs Hennepin Le Sueur Scott Isanti Anoka Rice Ramsey Dakota Pine Goodhue Wabasha Cottonwood Blue Earth Steele Watonwan Waseca Dodge Olmsted Freeborn Mower Winona Fillmore Houston The following plans provide the confidence and convenience of a network close to home. In order to purchase one of these plans, you must reside in that plan s service area. BlueConnect SM (Sanford Health Network) BluePrint SM (Allina Health Network) Blue Plus with Mayo Clinic (Mayo Clinic Network) Blue Plus with St. Luke s (St. Luke s Network) All plans offer the BlueCard PPO network when outside the Minnesota service area. Travel with confidence With Blue Cross, you ll carry the most recognized health care card in the world. With the BlueCard PPO network, you re covered at more than 92 percent of doctors and 96 percent of hospitals nationwide. You also get access to doctors and hospitals in more than 200 countries with BlueCard Worldwide.

8 HEALTHY habits. HELPFUL RESOURCES. The best time to think about your health is before you get sick. Good health is about taking time for your health every day and creating habits to help you stay well. Blue Cross has identified seven areas that impact your health and wellbeing: managing stress, eating right, staying active, managing a healthy weight, quitting tobacco, maintaining a healthy pregnancy and making informed health care decisions. The tools and resources below are integrated into your health plan to help you create healthy habits and reach your healthy goals. Managing stress eating right Staying active Managing weight Looking for answers? Health Guides Get answers to your questions about your health plan benefits or get connected to a nurse for questions about health care. Online health assessment Answer questions that give you a snapshot of your current health status based on your health history and health behaviors. Provider cost and quality Get recommendations on doctors, hospitals and prescriptions based on cost and quality, making you a wiser health care consumer. Online health and wellbeing resources Access a library of articles, videos, quizzes and calculators about health conditions, diseases, procedures and prescriptions. Seeking support? Health coaching Get one-on-one coaching to help address your health goals and concerns such as maintaining a healthy weight and staying physically active. Available online or over the telephone. Quitting tobacco support Develop and maintain a quit plan with support from a Quit Coach. Saving money? Fitness membership discounts Get up to a $20 discount for working out 12 days or more per month at a participating fitness center. Under the weather? Online care Save yourself a trip to the doctor. Meet face-to-face with a board-certified doctor online from the convenience of home, work or even vacation. You can also see a psychiatrist, psychologist, or a lactation consultant. Available 24 hours a day, seven days a week. Nurse line Talk to a nurse 24 hours a day, seven days a week to help you get answers to your health-related questions. Quitting tobacco Maintaining a healthy pregnancy Making healthy decisions Health and wellbeing offerings vary by plan. For more information on our health and wellbeing programs, go to bluecrossmn.com or talk to your agent. 4

9 Words to know when choosing a health plan Deductible The amount you pay toward eligible health care expenses each year before insurance begins to pay. The plan begins paying benefits that require cost sharing for the first family member who meets the per-person. The family must then be met by one or more of the remaining family members and then the plan pays benefits for all covered family members. Non-embedded The plan begins paying benefits that require cost sharing when the entire family is met. The can be met by one or a combination of several family members. Single s apply to single coverage only. Dependent A spouse, domestic partner or child who is enrolled in your plan. Coinsurance A set percentage of the allowed amount you pay toward health care after your has been met. For example, if the coinsurance is 20 percent, Blue Cross pays 80 percent of the allowed amount after the is met, and you pay 20 percent of the allowed amount when you use a participating provider. Copay The amount you pay for plans with copays, each time you receive a service or prescription. Out-of-pocket maximum The most you will pay in coinsurance, copays and s for covered health care services and prescription drugs each year. HSA Abbreviated term for Health Savings Account. HSAs work like a bank account but they offer tax advantages. An HSA is used to cover s, coinsurance, copays and certain non-covered services. Personalized help is easy with Blue Cross Blue Cross is here to help you find the health plan that best meets your and your family s needs: Visit bluecrossmn.com Talk to an agent (find an agent at bluecrossmn.com/findanagent), or call us at (TTY 711) Attend a free community meeting to learn what to keep in mind when choosing a plan. Go to bluecrossmn.com for locations and dates Visit the Blue Cross and Blue Shield of Minnesota retail centers in Edina or Roseville. Go to bluecrossmn.com/store to make an appointment Checklist for choosing the right plan: Compare premiums. How much do you want to pay for your monthly premium? Compare networks. Plans with a large network can cost more than plans with smaller networks. Which network includes your favorite doctor? Compare s, copays, coinsurance and out-of-pocket maximums. How much do you want to share in the cost of your health care? Compare prescription drug coverage. Plans cover generic and brand name drugs differently. Do you want a health savings account? Some plans with higher s are eligible for health savings accounts. 5

10 bluecrossmn.com As Minnesota s health care leader, we live fearless. We believe good health is for everyone not just our members. It s a big vision. And that s why we re investing in the communities we serve and empowering individuals to make smart choices about their health. Live fearless with the peace of mind that comes from knowing you re protected by the strength and stability of Blue Cross. We invite you to join us. Blue Cross offers a variety of plans designed to meet your health care needs. You can enroll in plans directly through Blue Cross, through one of our licensed agents, or through MNsure, the health insurance marketplace. To learn more about your plan choices call (651) or toll free This information is available in other ways for people with disabilities or who need it translated to another language by calling (toll-free). For TTY, call 711. If you want free help translating this information, call the above number. Si desea ayuda gratis para traducir esta información, llame al número que aparece arriba. Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association. F9940R05 (9/15)