PROVIDERTIDBITS. Identification Card Guide. Preferred Care PPO Alpha Prefix: Varies. HMO Louisiana, Inc. Alpha Prefix: Varies TB

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1 Identification Card Guide Identification (ID) cards are useful tools for both and providers. They are designed to assist you in identifying the member s type of coverage. Always ask for a copy of the member s current ID card at each visit. Our network includes hospitals, physicians and allied providers. Members with benefit plans receive the highest level of benefits when they receive services from providers. A special logo distinguishes from our other. This logo is located at the top right corner of card as shown. The in a suitcase logo identifies the nationwide Program. For information, view the Provider Speed Guide, available online at >Education on Demand >Speed Guides. ID cards are issued to each member on the policy. ID cards are used for both medical and dental coverage when a dental network is indicated (see Page 4 for sample dental ID cards). HMO Louisiana, Inc. HMO Louisiana, Inc. is a wholly owned subsidiary of Blue Cross and Blue Shield of Louisiana. The HMO Louisiana provider network is a select group of physicians, hospitals and allied providers who provide services to individuals and employer groups seeking managed care benefit plans. In January 2016, our HMO Louisiana service expanded to be a statewide network. HMOLA HMO Louisiana allows to choose from both HMO and Point of Service (POS) benefit plans. Members pay a lower copayment when they receive services from primary care physicians (PCPs). For information, view the HMO Louisiana Provider Speed Guide, available online at >Education on Demand >Speed Guides. HMO Louisiana member ID cards are issued for each covered member and separate ID cards are issued for each covered dental member. The ID number is the same for both ID cards (see Page 4 for sample dental ID cards). This publication is provided by the Administration Division of Blue Cross and Blue Shield of Louisiana. If you have a question regarding this communication, 1

2 BlueConnect Alpha Prefix: XUF and XUG BlueConnect is a HMO Point of Service product available to groups and individuals in Jefferson, Orleans and St. Tammany parishes. Members with BlueConnect may choose each time they need care at the point of service whether to use a network provider or go out-of-network. Members receive the highest level of benefits when using network providers and with proper authorization when required. BlueConnect have a BlueConnect their ID card. The suitcase logo identifies the nationwide Program. BlueConnect must select a primary care phyician (PCP), which is listed on their ID card. Members pay a lower copayment when they receive services from PCPs. For information, view the BlueConnect Provider Speed Guide, available online at >Education on Demand >Speed Guides. Blue Connect ID cards are issued in each name. Separate dental ID cards are issued when the member has Blue Cross Dental dental coverage. When the member has Advantage Plus dental coverage, it is included on their medical ID card (see Page 4 for sample dental ID cards). Community Blue Alpha Prefix: XUD Community Blue is a HMO Point of Service product available to groups and individuals in the Baton Rouge Area: Ascension, East Baton Rouge and West Baton Rouge parishes; and Shrevport Area: Bossier and Caddo parishes only. Members may choose each time they need care at the point of service whether to use a network provider or go out-of-network. Members receive the highest level of benefits when using network providers and with proper authorization when required. Community Blue have a Community Blue their ID card. The suitcase logo identifies the nationwide Program. Community Blue must select a primary care phyician (PCP), which is listed on their ID card. Members pay a lower copayment when they receive services from PCPs. For information, view the Community Blue Provider Speed Guide, available online at >Education on Demand >Speed Guides. Community Blue ID cards are issued in each name. Separate dental ID cards are issued when the member has Blue Cross Dental dental coverage. When the member has Advantage Plus dental coverage, it is included on their medical ID card (see Page 4 for sample dental ID cards). This publication is provided by the Administration Division of Blue Cross and Blue Shield of Louisiana. If you have a question regarding this communication, 2

3 Blue Advantage (HMO) Alpha Prefix: XUM Blue Advantage (HMO) is our Medicare Advantage and Prescription Drug (MA-PD) plan available to residing in the parishes of Ascension, East Baton Rouge, Jefferson, Lafayette, Livingston, Orleans, St. Charles, St. James, St. John the Baptist, St. Helena, St. Landry, St. Tammany, Washington and West Baton Rouge. Blue Advantage provides each member with an identification card. This card contains demographic information about the covered member, as well as important coverage information such as PCP name and phone number, copayment or coinsurance responsibilities and important phone numbers. We encourage you to confirm with each time you see them, if you are their PCP. The date on the card represents their effective date with the plan, not necessarily the effective date with the PCP. You may confirm member eligibility, current assigned PCP, deductible, maximum out-of-pocket and coordination of benefits information via our online Blue Advantage Provider Portal, which is accessible through ilinkblue ( by clicking on the Blue Advantage menu option. Copayment/ Coinsurance PCP name & number MA-PD Blue Advantage from HMO Louisiana, Inc. is an HMO plan with a Medicare contract. HMO Louisiana is a subsidiary of Blue Cross and Blue Shield of Louisiana, independent licensees of the Blue Cross and Blue Shield Association. Federal Employee Program (FEP) Alpha Prefix: R (followed by eight digits) The Federal Employee Program (FEP) provides benefits to federal employees and their dependents. These access the. FEP have two (2) benefit plans to choose from: 1. Standard Option - receive the highest level of benefits when they receive care from in-network providers and reduced benefits when they receive care from out-of-network providers. 2. Basic Option - receive no benefits when they receive care from out-of-network providers except for select situations such as emergency care. Standard Option FEP on ID ID has an R then eight digits FEP on ID ID has an R then eight digits Basic Option This publication is provided by the Administration Division of Blue Cross and Blue Shield of Louisiana. If you have a question regarding this communication, 3

4 Blue Cross Dental Members with a medical benefits are issued one medical ID card that also indicates the Blue Cross Dental. This dental network is administered directly by Blue Cross and Blue Shield of Louisiana and providers must be directly contracted with Blue Cross to be in-network for these. Members with HMO Louisiana medical benefits and Blue Cross Dental dental coverage are issued two separate ID cards, one for medical and one for dental. Dental ID with no prefix Advantage Plus Members with a or HMO Louisiana medical ID card that indicates the Advantage Plus have dental coverage that is administered for Blue Cross by United Concordia Dental. Providers must be directly contracted with United Concordia Dental to be in-network for these. Dental ID with no prefix Stand-Alone Vision Alpha Prefix: none When available, group may waive medical coverage from Blue Cross but still choose a stand-alone vision product from Blue Cross. These recieve a non-medical, vision ID card. These ID cards are issued per subscriber. Claim-filing instructions are listed on the of card. ID with no prefix This publication is provided by the Administration Division of Blue Cross and Blue Shield of Louisiana. If you have a question regarding this communication, 4

5 BlueChoice 65 Alpha Prefix: XUP BlueChoice 65 is a series of Medicare supplement plans. It is designed to pay for many of the expenses Medicare doesn t pay. Some of the options in this series include: Part A deductible coverage Part B deductible coverage, coinsurance and excess charges Skilled nursing coinsurance Product name on ID BlueChoice 65 Select Alpha Prefix: XUP BlueChoice 65 Select plans feature lower premiums and a select network of hospitals that have agreed to waive the Part A deductible and coinsurance. Product name on ID Please note: BlueChoice 65 refers to certain contracts and is not connected with or endorsed by the U.S. government or the federal Medicare program. Health Savings Account Debit Cards Members are issued a debit card separate from their Member ID card Members with a BlueSaver policy may also open a health savings account (HSA). When open a MySmart$aver HSA, they are issued a HSA debit card in addition to their member ID card. The HSA debit card includes the Blue Cross logo along with the VISA logo. The card works like any other debit card and allows to pay for qualified medical expenses and out-of-pocket expenses by swiping the card through any debit card swipe terminal. The funds will be deducted automatically from the member s HSA account. If your office currently accepts credit card payments, there is no additional cost or equipment necessary. Product name on debit card Visa Logo This publication is provided by the Administration Division of Blue Cross and Blue Shield of Louisiana. If you have a question regarding this communication, 5

6 Large Groups with Unique Benefits Office of Group Benefits (OGB) Benefit Plans Blue Cross administers benefits for the Office of Group Benefits (OGB s) state of Louisiana employees, retirees and dependents. Effective March 1, 2015, five new benefit plans are available: Pelican HRA 1000, Pelican HSA 775, Local, Local Plus and Open Access. These products are self-insured plans that utilize our networks of doctors, hospitals and other medical care providers as well as Blue Providers nationwide. Pelican HRA 1000 (Active Employees & Retirees with and without Medicare) This benefit is a consumer-driven benefit plan (CDHP) paired with a health reimbursement arrangement (HRA). This benefit plan utilizes the OGB network, which is our network. Pelican HSA 775 (Active Employees Only) This benefit plan is a consumer-driven benefit plan that is paired with a health savings account (HSA) option. The Pelican HSA 775 benefit plan utilizes the OGB, which is our network. Local (Active Employees & Retirees with and without Medicare) This benefit plan utilizes our BlueConnect or Community Blue provider networks. Local is an HMO Point of Service product that allows to choose each time they need care at the point of service whether to use a PCP (Primary Physician) or a specialist without a referral. This benefit plan is only available as follows: BlueConnect (New Orleans Area) Jefferson, Orleans and St. Tammany parishes. Community Blue (Baton Rouge & Shreveport Areas) Ascension, Bossier, Caddo, East Baton Rouge and West Baton Rouge parishes. Local in Jefferson, Orleans and St. Tammany parishes do not have coverage if they choose to see Community Blue providers just as Local in the Community Blue Parishes do not have coverage if they choose to see BlueConnect providers. With Local, there is no coverage for services performed by non-network providers. Please refer your patients to providers within their network to ensure they receive the highest level of benefits available. Pelican HRA 1000 Pelican HSA 775 Local - BlueConnect Local - Community Blue Pelican HRA 1000 Pelican HSA 775 BlueConnect Local Community Blue Local This publication is provided by the Administration Division of Blue Cross and Blue Shield of Louisiana. If you have a question regarding this communication, 6

7 Large Groups with Unique Benefits Office of Group Benefits (OGB) Benefit Plans (continued) Local Plus (Active Employees & Retirees with and without Medicare) This benefit plan has an HMO benefit design but through a network. Members with this benefit plan are not limited to a localarea only network. Members who choose the Local Plus benefit plan will instead have access to the OGB network, which is our statewide network. With Local Plus, there is no coverage for services performed by non-network providers. Open Access (Active Employees & Retirees with and without Medicare) This benefit plan is OGB s benefit plan. Members with this benefit plan have access to the OGB network, which is our statewide network. Local Plus Open Access Local Plus Open Access LSU Student Health Alpha Prefix: XUP Blue Cross is the carrier for LSUHSC s Student Health Plan. Students may choose from three benefit plans: Base Plan - annual benefit maximum of $55,000 Buy-up Plan - annual benefit maximum of $250,000 Needle Stick Only Plan The Needle Stick Only Plan offers coverage to eligible students for testing and prophylactic treatment of blood-borne diseases following at-risk contact with blood or other bodily fluids from human or animal sources. This contact may include, but is not limited to needle sticks. This plan does not cover any inpatient admission, additional or follow-up testing, pharmacy services or any antiviral, antibiotic or follow-up treatment. Base & Buy-up Needle Stick Only Office copay Limited benefits on ID end This publication is provided by the Administration Division of Blue Cross and Blue Shield of Louisiana. If you have a question regarding this communication, 7