WELCOME TO BAPTIST HEALTH PLAN SELECT

Transcription

1 WELCOME TO BAPTIST HEALTH PLAN SELECT 2016 Member Guide RA10/15.755

2 We re excited to welcome you to Baptist Health Plan. Here at Baptist Health Plan, we are committed to making a significant impact on the lives of Kentuckians and all the communities we serve. It is a mission near and dear to our hearts. Your network of Baptist Health and non-baptist Health providers is dedicated to partnering with you and helping you stay well and live better. Thank you for choosing Baptist Health Plan Select, and welcome to our family. Sincerely, James Fritz President Baptist Health Plan 2

3 In the following pages, you will learn more about your new plan and find information about the benefits offered by Baptist Health Plan Select. Your Member ID Card... 3 Member Services...4 Care Advising services...4 Preventive care services /7 Nurse Line... 6 Why it s important to have a primary care physician... 6 Your Baptist Health Plan Select benefits... 7 Your Member ID Card Carry this card with you at all times and present it to your healthcare provider at the point of service. Your covered dependents will receive their own ID cards. 3

4 Member Services Give us a call. We are happy to help. As a Baptist Health Plan Select member, you can Customer Service at CSinfo@BaptistHealthPlan.com or call from 8:30 a.m. 5:30 p.m. ET, Monday Friday. A team of dedicated professionals is here to answer your questions and help you understand your benefits. Our goal is to get you the answers you need in just one call. Our Customer Service team can help you Find a network provider Get answers to benefit questions and better understand how your plan works Check to see if a prescription drug is covered Get reminders for important preventive care to help you manage your health Members who enrolled in Baptist Health Plan Select through the Kentucky Health Benefit Exchange (KHBE) will need to contact KHBE directly by calling 855.4KYNECT ( ) for assistance with the following issues and concerns: Eligibility determinations Eligibility and demographic information Plans purchased (rates/premiums and tax credits/cost-share reductions) Enrollments/cancellations/disenrollments/updates to information Federal payments (tax credits/cost-share reductions due and paid to issuers by CMS) Care Advising Services Your Personal Approach to Health (PATH) PATH helps manage the challenges that come along with difficult and complex health conditions. If you participate in this service, you will have a personalized care team who will work with you to create a step-by-step plan for your health needs. This team is led by your primary care physician (PCP), and it may also include a nutritionist, pharmacist, caregivers and community resources. This coordinated approach can help reduce your healthcare costs. A Registered Nurse, known as your care advisor, will work closely with you and your doctor to help guide you through your care plan. You can meet with your care advisor in person, over the phone or by . Another benefit: because your care advisor lives and works in Kentucky, he or she can offer personalized tips and point you to helpful resources in your area. Plus, you can always come into your doctor s office for regular appointments and for more in-depth discussions with both your doctor and care advisor as needed. 4

5 Preventive Care Services One of the best things you can do for your health is to use preventive services. We help patients stay well by offering preventive services available at no additional cost. A partial list of preventive care services includes Annual wellness exam Immunizations (e.g., flu and pneumonia) Smoking and tobacco use cessation (counseling to stop smoking or tobacco use) Preventive screenings and exams (e.g., mammogram, Pap test and colorectal screening) The U.S. Preventive Services Task Force publishes recommendations on the preventive care services individuals should receive. Below are a few examples of important preventive care services. Important Note: The following list of immunizations, screenings and criteria is not a comprehensive list. Please talk to your physician about the preventive care services, including the immunizations and screenings, you should receive. Immunizations Influenza virus vaccine (annual) Pneumococcal pneumonia vaccine (one time) Tetanus vaccine (every 10 years) Zoster (shingles) vaccine (one time) Screenings * Breast cancer screening (mammogram every one to two years) Blood pressure screening Colon cancer screening (up to age 75) Diabetes screening * A separate copay may apply if you receive additional medical services during the same visit as your screening exam. High cholesterol screening HIV screening Osteoporosis screening (bone mass measurement) Pap test and pelvic exam Prostate cancer screening Our personalized, local Care Advising services are there for you every step of the way. Keep reading to learn about Preventive Care Services 24/7 Nurse Line Primary Care Providers 5

6 24/7 Nurse Line Twenty-four hours a day/7 days a week, Baptist Health Plan Select members have immediate access to healthcare advice through the NurseFirst SM service. Experienced registered nurses are available around the clock to provide you with prompt and efficient service. If you have questions about a new diagnosis or medication, or need advice about an urgent symptom or illness, nurses are available. To speak to a nurse, simply call Baptist Health Plan Select members can talk to a registered nurse in the middle of the day or night about Medication side effects or dosing questions Pains, cramps or upset stomach Fevers and common colds Cuts or bruises Determining the need to call a doctor or go to the emergency room Finding the closest in-network after-hours clinic Locating providers when you are out of town Why it s important to have a primary care physician At Baptist Health Plan, we believe in the importance of building strong doctor-patient relationships. That s why we make every effort to help connect each of our members with a PCP. Having a PCP can make a very positive impact on your health and wellness. Your doctor can be and should be a trusted advisor for you, not only helping you when you re sick, but working with you to find ways to feel your best. By getting to know you and treating you holistically, your PCP can become an important advocate for your care and help identify potential health risks early. If you re looking for a new provider, we can help you find the right match for your healthcare needs. We re here to support you in any way we can just visit BaptistHealthPlan.com or give us a call at Once you choose a provider, please take a moment to let us know. 6

7 Your Baptist Health Plan Select benefits In addition to medical coverage, Baptist Health Plan Select also provides coverage to help make taking the drugs you need as simple and affordable as possible. As a member you Get coverage for thousands of the brand-name and generic drugs you use most Have access to pharmacies nationwide For complete benefits information for your specific plan, please refer to your plan information or visit BaptistHealthPlan.com. Important Phone Numbers Service Phone Number Member Services NurseFirst SM Pharmacy Services Optum Behavioral Health Kentucky Health Benefit Exchange 855.4KYNECT ( ) 7

8 The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on Jan. 1 of each year. To reach the Kentucky Health Benefit Exchange, please call 855.4KYNECT ( ). Baptist Health Plan is underwritten by Bluegrass Family Health, Inc. Copyright 2015 Baptist Health Plan. All rights reserved. BPT