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1 align Insured Product Guide

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3 leading the way in health care excellence and affordability healthy changes everything. Three powerful words that are helping to change health care in Western New York. But they are much more than an inspirational motto. BlueCross BlueShield of Western New York is leading the effort to transform our local health care system through partnerships that will improve the quality of care while controlling costs. The key is focusing on preventing illness instead of reacting to it, rewarding doctors and hospitals for quality outcomes instead of volume, and enhancing technology so that health professionals and insurers work together to eliminate waste. As the region s number one health insurer and part of an organization that insures nearly 1 in 3 Americans*, BlueCross BlueShield is uniquely positioned to drive this change with the vision, resources, and partnerships needed to lead the way. * Based on total combined membership of all licensees of the BlueCross BlueShield Association per enrollment data 3/31/2012 and the population of the United States per U.S. Census Bureau data 5/

4 affordable sustainable transformational 2

5 introducing align At BlueCross BlueShield, we know that lower-cost, higher quality health care is the number one benefit today s employer groups want for their employees. Yet, finding a health insurance product designed to deliver both isn t as easy as it sounds. Until now. The align product was designed to change the way health care is delivered for the better by bringing together the key people needed to make it happen, including: The region s largest health insurer, BlueCross BlueShield of Western New York The region s largest hospital system, Kaleida Health, plus other select hospitals and health care facilities An alliance of doctors and specialists committed to best practices for improving medical outcomes, increasing operational effciencies and reducing administrative burdens The result? A more integrated, better coordinated, and more cost-effcient health care delivery system. It s an affordable sustainable model that will transform health care both today and in the future. 3

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7 what makes align different? The align health insurance product is designed to enhance the way health care is delivered, by bringing together the key people needed to make this happen. Engage Physician-driven solutions with health plan support Physician access to comprehensive clinical and administrative resources Less administrative red tape so patients receive the right care at the right time Focused on improved quality and outcomes Coordinate Custom clinical care support teams to meet the specific needs of physicians and patients Break down barriers between physician, hospital, and health plan Commitment to improve physician-tophysician communication patientcentered care Innovate Reduce ineffciencies Improve technology and analytics 5

8 paying the price for health care inefficiencies. $700 billion The amount Americans pay for more care, rather than better care, annually $21 billion How much fewer emergency room visits could save annually $4 billion The price we spend on overused prescriptions annually Source: healthleadersmedia.com. 6

9 employer group benefits For employer groups, align is designed to: More effectively manage health care costs of employees and their dependents to help you. Help control rate increases for more accurate budgeting. Help save on claims costs. employee benefits For employees, align is designed to provide: Access to primary care doctors committed to coordinating all their health care needs from routine physicals to specialist visits. A team of health coaches and nurses provided by BlueCross BlueShield to further support your employees health care needs. Doctors empowered to handle your employees care needs without preauthorizations or red tape meaning faster, easier access to the required tests or specialists they need. Access to the region s largest hospital system, Kaleida Health, plus other select hospitals and health card facilities. 7

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11 align benefit levels Members in the align plan have access to a choice of doctors, specialists, and hospitals throughout Western New York that are focused on coordinated, quality health care with three benefit levels. align Optimum Choice align Flexible Choice Non-participating when your employees use doctors/hospitals available under align Optimum Choice, they pay the lowest cost-share align Optimum Choice includes a select group of doctors, specialists, hospitals, and other providers when your employees use doctors/hospitals available under align Flexible Choice, they pay a higher costshare (than Optimum Choice) align Flexible Choice includes any doctor, hospital, and provider in the BlueCross BlueShield of Western New York POS network (other than align Optimum Choice) when your employees use doctors/hospitals that are not contracted with BlueCross BlueShield of Western New York, they pay the highest cost-share and may be subject to balance billing employee support Member enrollment guide Online provider search and customer service to help find doctors and hospitals 24/7 Health Advocate 9

12 Nearly 1 in 3 Americans trust BlueCross BlueShield for their health insurance. Based on total combined membership of all licensees of the BlueCross BlueShield Association per enrollment data 3/31/2012 and the population of the United States per U.S. Census Bureau data 5/

13 a choice of doctors and hospitals Under the align Optimum Choice cost-share level, your employees will have access to: Primary Care Physicians and Specialists Select primary care physicians and specialists in the Optimum Physician Alliance (OPA) committed to high-quality coordinated care All Kaleida Health facilities Buffalo General Hospital/Gates Vascular Institute DeGraff Memorial Hospital Millard Fillmore Suburban Hospital Women s and Children s Hospital of Buffalo Hospitals Other Specialists and Specialty Types Other Erie County Medical Center Hospice and palliative care providers Intercommunity Memorial Hospital Niagara Falls Memorial Medical Center Olean General Hospital Roswell Park Cancer Institute United Memorial Medical Center Current participating pediatricians in the BlueCross BlueShield of Western New York network Current participating OB-GYNs in the BlueCross BlueShield of Western New York network Additional specialty providers Urgent Care Centers All MASH Urgent Care locations in Erie and Niagara counties Members in align also have the flexibility to see the balance of the largest BlueCross BlueShield of Western New York participating provider network at the align Flexible Choice cost-share level. 11

14 our health plans offer the following benefits: $0* copay on preventive care services Award-winning health and wellness programs for groups and individuals Worldwide coverage Discount programs available Out-of-network coverage Health Advocate coaching service A variety of prescription copay options * $0 copays available under align Optimum Choice cost- share. 12

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16 bcbswny.com BlueCross BlueShield of Western New York is a division of HealthNow New York Inc., an independent licensee of the BlueCross BlueShield Association. BlueCross, BlueShield and the Cross and Shield symbols are registered trademarks of the BlueCross BlueShield Association. Our patient and member advocacy program is administered by Health Advocate, Inc. Through our arrangement with Health Advocate, BlueCross BlueShield of Western New York members and their immediate families have access to Health Advocates health care patient advocacy service. Health Advocate is not affliated with any insurance or third party provider and does not replace health insurance coverage, provide medical care or recommend treatment. Express Scripts is an independent company that manages prescription drug benefits for BlueCross BlueShield of Western New York. WNY _ 7985_05_13 BCBS 898 R1

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