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1 Helping SISC III SELF-INSURED SCHOOLS OF CALIFORNIA Self-Insured of California: Helping Access+ HMO SaveNet 2013/2014 Enrollment Guide

2 Blue Shield of California offers health benefits to school districts that are members of Self-Insured of California (SISC) Blue Shield offers you healthcare coverage with access to, large provider networks, and a wide range of proven programs and services that help you get the most value from your plan. We invite you to consider a Blue Shield plan for you and your family. Helping SISC III SELF-INSURED SCHOOLS OF CALIFORNIA Powered by public school employees Self-Insured of California (SISC) was established in We operate as a public school Joint Powers Authority (JPA) administered by the Kern County Superintendent of Office. Our staff members are certificated and classified public school employees. Just like schools, SISC is subject to the Brown Act. We are a transparent operation. All board meetings are open to the public and our financial statements are a matter of public record. SISC is run in the best interests of our membership. We do not receive sales commissions. Our focus is on the value we provide to our members not a profit margin. Helping Joining together with other schools provides SISC members with the most stable long-term insurance solutions available. Our commitment to controlling costs is reflected in our mission of providing affordable rates and continued access to quality health care. Blue Shield of California, an independent member of the Blue Shield Association, is committed to care, not profit. Blue Shield has been part of California s healthcare landscape since 1939, and remain passionate about not only improving the health and wellness of our members, but also giving back to the communities where we live and work. As a not-for-profit health plan, we re dedicated to providing Californians with access to high-quality health care at an affordable price. Find out more! Blue Shield has created a website just for you: blueshieldca.com/sisc. Get information about your health benefits, find providers, and learn more about additional programs.

3 Helping SISC III SELF-INSURED SCHOOLS OF CALIFORNIA Learn about the Blue Shield Access+ HMO SaveNet plan With the Access+ HMO SaveNet SM plan, you get the comprehensive benefits, self-referral to specialists,* and value-added services available with the Access+ HMO plan. You will also need to select your Personal Physician, who is responsible for the overall coordination of your care. To learn how to find and select a Personal Physician, see page 4. We re here to help To enroll in the Access+ HMO SaveNet plan, you and all your eligible dependents must enroll in the same plan and live or work within the Access+ HMO SaveNet service area. If you have any questions, simply contact your dedicated Blue Shield Member Services team at (800) for personal assistance, from 7 a.m. to 7 p.m., Monday through Friday. Access+ HMO SaveNet service area Contra Costa County, except for ZIP codes 94525, 94530, 94547, 94564, 94569, 94572, 94801, 94802, 94803, 94804, 94805, 94806, 94807, 94808, 94820, and Kern County Los Angeles County, except for ZIP codes 93535, 93539,93584, 93586, and Orange County Riverside County, except for ZIP codes 92225, 92226, 92239, and Sacramento County San Bernardino County, except for ZIP codes 92242, 92252, 92267, 92277, 92278, 92280, 92304, 92309, 92319, 92323, 92332, 92338, 92363, 92364, 92366, 92398, 93555, 93558, 93562, and San Diego County, except for ZIP codes 91905, 91906, 91934, 91963, 91980, 91987, 92004, and San Francisco County San Luis Obispo County San Mateo County Santa Clara County Santa Cruz County Ventura County Yolo County Enrolling in the Access+ HMO SaveNet plan if you are currently in treatment If you are currently receiving care for acute and serious chronic conditions, pregnancy and newborn care, planned surgeries, or terminal illnesses from a provider that is not in the Blue Shield HMO SaveNet network, continuation of care may be available to you during your transition to the Access+ HMO SaveNet plan. Continuation of care allows you to continue to see your current non-network provider during the course of your treatment while still receiving the network level of benefits. For more information, please call Blue Shield Member Services at (800) Behavioral health Your behavioral health benefits include inpatient and outpatient mental health and substance abuse care for issues such as: Depression Mental illness Alcohol/drug abuse Marriage and family counseling The services are provided by Blue Shield s mental health service administrator (MHSA) network. Access+ HMO SaveNet members only have access to MHSA network providers. Care away from home Through the BlueCard Program, Access+ HMO SaveNet members can access emergency and urgent care services across the country and around the world. While you can receive urgent care services from any provider, using the BlueCard Program can be more costeffective and may eliminate the need for you to pay for the services when they are rendered and submit a claim for reimbursement. You can locate a BlueCard provider anytime by calling (800) 810-BLUE or by going to the Find a Provider section of blueshieldca.com/sisc. The Away From Home Care program gives students, long-term travelers, workers on extended out-of-state assignments, and families living apart the convenience and flexibility of coverage for extended periods across the country. To learn more about Away From Home Care and whether your family is eligible, call Blue Shield Member Services at (800) Please note that Away From Home Care is not available in all areas and states, and benefits from the host plan may differ from benefits in the Access+ HMO SaveNet plan. * To use this option, members must select a Personal Physician who is affiliated with a medical group or IPA that is an Access+ provider group, which offers the Access+ Specialist SM feature. Members should then select a specialist within that medical group or IPA. Access+ Specialist visits for mental health services must be provided by an MHSA network participating provider. blueshieldca.com/sisc 3

4 If you don t have access to the Internet or need help, simply contact your dedicated Blue Shield Member Services team at (800) for personal assistance or to request a provider directory. Find a network provider It s easy to find a provider online Go to blueshieldca.com/sisc. Select Find a Provider. Select the type of provider you are looking for under Find an Access+ HMO SaveNet Provider You will then be directed to the Blue Shield website. If you re looking for a Personal Physician, select Advanced Search and choose HMO Personal Physicians under Doctor Type or Specialty. To find your physician s provider and medical group/ipa number (needed when you enroll in the Access+ HMO SaveNet plan for the first time), click on the physician s name. Choosing a Personal Physician When you enroll in the HMO SaveNet plan for the first time, you will need to choose a Personal Physician (primary care physician) for you and your enrolled dependents. Each enrolled family member can choose a different Personal Physician. If you do not select a Personal Physician at the time of enrollment, Blue Shield will automatically assign a Personal Physician to you and your enrolled family members. When enrolling in the Access+ HMO SaveNet plan, you will need your Personal Physician s provider number and medical group/ipa number. Follow the instructions above to find these numbers. If you are selecting a new Personal Physician, make sure that the physician you choose is accepting new patients. It s always best to phone the physician s office and ask about becoming a new patient. Once you have chosen a new Personal Physician, you ll need to transfer your medical records from your previous doctor to your new Personal Physician. Your new Personal Physician can provide the proper form for you to complete and sign. This form will need to be mailed to your previous doctor, who will then send copies of your medical records to your new Personal Physician. Find out your provider s quality of care rankings You can easily access quality scores, efficiency indicators, patient satisfaction scores, and cost information for many physicians, HMO medical groups, and hospitals. To see a provider s performance profile, simply click on the name of the doctor, HMO medical group, or hospital from your search results. 4 Blue Shield of California

5 Understand your pharmacy benefits Express Scripts pharmacy benefits Pharmacy benefits for the Access+ HMO SaveNet plan are administered by Express Scripts. * Members who take stabilized doses of covered long-term maintenance medications like those used to treat an ongoing condition such as high blood pressure or high cholesterol can save money by ordering them through the Express Scripts mail order pharmacy instead of using a retail pharmacy. With the mail order pharmacy: You get up to a 90-day supply delivered directly to you with free standard shipping. You can easily order refills online, over the phone, or by mail. You have 24-hour phone access to pharmacists who are ready to help you and available to focus exclusively on your medications. Multiple safety and advanced quality checks are in place to make sure you get the right medication. If you have any questions about your pharmacy benefits, just call the Express Scripts specialist pharmacists at (800) They re available 24 hours a day, seven days a week to help you understand and manage medications used to treat a wide variety of conditions. Save money on generic prescriptions at Costco SISC has partenered with Costco to offer Access+ HMO SaveNet plan members the option to fill generic prescriptions at Costco for a $0 copayment. You do not need to be a Costco member to use the Costco pharmacy. It s simple to fill generic prescriptions at Costco; just follow the steps below: 1. Take your prescription for a generic medication to a Costco pharmacy. 2. Present the pharmacist with your Access+ HMO SaveNet member ID card. Note: Some narcotic pain medications and cough medications are excluded. * Express Scripts is independent from Blue Shield of California. blueshieldca.com/sisc 5

6 Discover more Helpful programs, services, and resources are available to you over the phone and online to help you and your family stay healthy. NurseHelp 24/7 Speak with registered nurses anytime, day or night, and get answers to your health-related questions, or go online to have a one-on-one personal chat with a registered nurse anytime. The NurseHelp 24/7 SM phone number is conveniently located on the back of your Access+ HMO SaveNet member ID card. Prenatal Program This program gives expectant parents 24/7 access to experienced maternity nurses as well as prenatal information including a popular pregnancy or parenting book at no additional cost. Some materials are also available in Spanish. Members can enroll by logging in to blueshieldca.com or calling (877) Condition management programs These programs offer nurse support as well as education and self-management tools for members with asthma, diabetes, coronary artery disease, heart failure, and chronic obstructive pulmonary disease. Members can apply to the programs by logging in to blueshieldca.com or calling (866) Wellness discount program Blue Shield offers a variety of member discounts on popular programs 1 that can help you save money and get healthier. Weight Watchers Get discounts on three- and 12-month subscriptions, monthly passes, and at-home kits. 24 Hour Fitness 2 Enjoy waived enrollment fees and discounts on monthly membership dues. ClubSport and Renaissance ClubSport 2 Get a 60% discount on enrollment when joining with a month-to-month agreement. Enrollment fees are waived when joining with a 12-month agreement. (There is a one-time $25 processing fee when you enroll.) Alternative Care Discount Program 2 Save up to 25% on acupuncture, massage therapy, and chiropractic services, plus get discounts on health and wellness products, with free shipping on most items. Vision services Get 20% off the published retail prices when you use a participating provider 3 in the Discount Vision Program network for exams, frames, lenses, and more. QualSight LASIK Members in California receive a 20% discount off providers usual and customary fees on traditional and custom LASIK surgery. TLCVision LASIK 4 Get 15% off providers usual and customary fees for LASIK and PRK correction surgery through a TLCVision or NVision network provider in California. Members who live outside California get a 10% discount off providers usual and customary fees from TLCVision providers. 6 Blue Shield of California

7 Health Smarts is SISC s health improvement program for members and their families. By providing customized resources and information in the areas of nutrition, fitness, preventive care, and condition management, Health Smarts helps you take charge of your health and well-being. Through Health Smarts, you and your family have access to tools and resources designed to provide the incentives and support needed to keep you in good health. These include: Onsite health activities* Health assessment* Online health coaching* Condition management *If available in your district. The networks of practitioners and facilities in the discount programs are managed by the external program administrators identified below, including any screening and credentialing of providers. Blue Shield does not review the services provided by discount program providers for medical necessity or efficacy. Nor does Blue Shield make any recommendations, representations, claims, or guarantees regarding the practitioners, their availability, fees, services, or products. Some services offered through the discount program may already be included as part of the Blue Shield plan covered benefits. Members should access those covered services prior to using the discount program. Members who are not satisfied with products or services received from the discount program may use Blue Shield s grievance process described in the Grievance Process section of the Evidence of Coverage. Blue Shield reserves the right to terminate this program at any time without notice. Discount programs administered by or arranged through the following independent companies: Alternative Care Discount Program American Specialty Health Systems, Inc. and American Specialty Health Networks, Inc. Discount Vision Program MESVision Weight control Weight Watchers North America Fitness facilities 24 Hour Fitness, ClubSport, and Renaissance ClubSport LASIK Laser Eye Care of California, LLC, QualSight, Inc., and TLCVision Corporation Note: No genetic information, including family medical history, is gathered, shared, or used from these programs. 1 These discount program services are not a covered benefit of Blue Shield health plans, and none of the terms or conditions of Blue Shield health plans apply. Discount program services are available to all members with a Blue Shield medical plan Hour Fitness, ClubSport/Renaissance ClubSport, and Alternative Care Discount Program are not available in all states. Members should contact their local 24 Hour Fitness or ClubSport gym, or American Specialty Health (ASH) provider to determine whether a Blue Shield of California discount applies. To find an ASH provider, call (877) or go to blueshieldca.com/findaprovider. 3 For Discount Vision Program providers in California, go to blueshieldca.com and search for Routine Care Discount Vision Program. For providers outside California, go to ecndiscount.com. 4 TLC Centers are not available in all states. To find a TLC Center near you, call (877) TLC blueshieldca.com/sisc 7

8 Helping SISC III SELF-INSURED SCHOOLS OF CALIFORNIA SISC (661) sisc.kern.org/hw Blue Shield is here to help Member Services...(800) a.m. to 7 p.m., Monday through Friday BlueCard Program... (800) 810-BLUE NurseHelp 24/7...(877) Prenatal Program... (877) Condition management programs...(866) Blue Shield of California Privacy Office...(888) To learn more about your health benefits, Blue Shield programs and services, and to find providers, go to blueshieldca.com/sisc. An independent member of the Blue Shield Association A37282-SISC-SN (3/13)

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