New Mexico BlueHMO Preferred SM

Transcription

1 New Mexico BlueHMO Preferred SM (Formally Lovelace Health Plan administered by Blue Cross and Blue Shield of New Mexico) Group: Member Guide Open Enrollment November 9 - December 14

2 Dear Federal Employee: Thank you for your continued loyalty as our member under the New Mexico BlueHMO Preferred health plan. We know that you have many choices when it comes to health care. Please contact us directly if you have any questions related to your benefit choices with Blue Cross and Blue Shield of New Mexico (BCBSNM), during the upcoming Open Season, which begins November 9 through December 14, Blue Cross and Blue Shield of New Mexico continues to provide the highest quality customer service to our members under the New Mexico BlueHMO Preferred. We are proud to continue being a health care plan choice for your health care benefits under the Federal Employee Health Benefit program. Your designated Customer Service Unit s toll-free telephone number is , which is also located on the back of your medical ID card. We look forward to continue serving you as a BCBSNM member. Sincerely, Kurt Shipley, President Blue Cross and Blue Shield of New Mexico 2

3 Welcome This guide will help you: Understand how your plan works Get the most from your New Mexico BlueHMO Preferred c/o Blue Cross and Blue Shield of New Mexico Navigate the online tools at bcbsnm.com Find a health care provider in the BCBSNM network Glossary of Health Plan Terms Understanding health insurance isn t always easy. Here are some common terms that are helpful to understand. Claim form: A form you may have to fill out and submit to your health insurance carrier for payment of benefits under that health care plan for noncontracted providers. Coinsurance: A percentage of a covered charge that you are required to pay toward a service covered by your plan. Deductible: A fixed amount of the eligible expenses you are required to pay before reimbursement by your health plan begins. Provider Finder: Provider Finder from BCBSNM is an innovation for helping members estimate and manage their costs and select providers with meaningful quality ratings. Network: The group of doctors, hospitals, and other medical care professionals that a health care plan has contracted with to deliver medical services to its members. BCBSNM PO Box Alexander Rd., NE Albuquerque, NM ATTN: Federal DSU Phone: Website: For more information call or go to New Mexico BlueHMO Preferred 3

4 Benefit Highlights New Mexico BlueHMO Preferred Summary of Benefits and Coverage are available at or by calling customer service at Individual Out of Pocket Maximum Medical $2500 Pharmacy $3500 Type of Service Your Cost In-Network Primary Care Services Adult Child (up to age 26) Specialty Physician Service Annual Deductible for Hospital Services Inpatient Hospital Services Outpatient Hospital Surgical Services Emergency Room Care Urgent Care Maternity Care Initial Visit All other visits Hospital Delivery Davis Vision One exam every calendar year One pair of glasses or one set of contact lenses every calendar year Outpatient Prescription Drugs (30-day Supply) Formulary generic drugs Formulary brand name drugs (with no generic equivalent) Non-formulary drugs (or brand name formulary drugs with generic equivalent) Formulary Specialty Drugs $20 (per visit) No Charge $35 (per visit) $250 $250 (per admission) after deductible is satisfied $100 (Per admission) after deductible is satisfied $100 (per visit) $40 (per visit) $20 (pcp)/$35 (specialist) No Charge $250 (Per admission) after deductible is satisfied $5 (per visit) No Charge Up to $150 plan allowance $5 $35 $60 50% (min $50; max $250) 4

5 2016 Rate Information Enrollment Premiums Type of Enrollment Enrollment Code Gov t Share Non-Postal Premium Postal Premium Biweekly Monthly Biweekly Your Share Gov t Share Your Share Category 1 your share Category 2 your share High Option Self Only Q11 $ $ $ $ $98.43 $ High Option Employee +1 Q13 $ $ $ $ $ $ High Option Self and Family Q12 $ $ $1, $ $ $ Postal Categories and Rates Non-Postal rates apply to most non-postal employees. If you are in a special enrollment category, contact the agency that maintains your health benefits enrollment. Postal rates apply to United States Postal Service employees. Postal Category 1 rates apply to career bargaining unit employees. Postal Category 2 rates apply to career non-bargaining unit employees. For Further Assistance, Postal Service employees should call: Human Resources Shared Service Center , option 5 (TTY: ) Postal rates do not apply to non-career postal employees, postal retirees, or associate members of any postal employee organization who are not career postal employees. Refer to the applicable Guide to Federal Benefits. Premiums for Tribal employees are shown under the monthly non-postal column. The amount shown under employee contribution is the maximum you will pay. Your Tribal employer may choose to contribute a higher portion of your premium. Please contact your Tribal Benefits Officer for exact rates. New Mexico BlueHMO Preferred 5

6 Blue Access for Members sm Blue Access for Members (BAM), our member portal, offers you information on your health and health plan in one convenient location. To register for BAM, go to bcbsnm.com and select Register Now in the BAM log-in box. With your BCBSNM ID card handy, follow the on-screen registration instructions. Create a user name and password for instant and secure access to your personal information. After logging in, from your personal home page you can: Check your claims, including payment status and amounts, and sort/print claim information Don t have access to a computer or need to talk to a Customer Advocate? Call: This toll-free number is also on the back of your member ID card. Confirm who is covered under your plan Download and print various forms Locate a doctor or hospital in your plans network using Provider Finder Research and estimate costs for common health care services with the Member Liability Estimator tool Request a new or replacement ID card and print a temporary card Customer Service 6

7 Provider Finder Insight for important health care decisions In life. In one place. Provider Finder from Blue Cross and Blue Shield of New Mexico is a new member tool for helping members estimate and manage their costs and select providers with quality ratings. Use Provider Finder either online or from a mobile device to: Find a network primary care physician, specialist or hospital Filter search results by doctor, specialty, ZIP code, language and gender even get directions from Google Maps Estimate the cost of a provider s procedures, treatments and tests and gauge out-of-pocket expenses View patient feedback or add a provider review Check the quality, certifications and recognitions for doctors Make an appointment to consult with a provider in select geographic areas It s easy and immediate and available at bcbsnm.com, or a mobile phone Web browser for members and non-members. Provider Finder delivers information that puts you in charge. Do you want to know more about your network providers? Do you want to know the actual cost and your share of a medical procedure? How do you choose where to go for medical services? New Mexico BlueHMO Preferred 7

8 24/7 Nurseline & Additional Programs 24/7 Nurseline Health concerns don t always follow a 9-to-5 schedule. Fortunately, registered nurses are on call at to answer your health questions, wherever you may be, 24 hours a day, seven days a week. The 24/7 Nurseline s registered nurses can understand your health concerns and give general health tips. Get trusted guidance on possible emergency care, urgent care, family care and more. The toll-free Nurseline can help you or a covered family member get answers to health problem questions, such as: Asthma, back pain or chronic health issues Dizziness or severe headaches High fever A baby s nonstop crying Could your child s fever or sore throat turn into something more serious? Is your 1 a.m. asthma attack cause for a trip to the emergency room? The 24/7 Nurseline can help you figure out if you should call your doctor, go to the emergency room, or treat the problem yourself. Cuts or burns Sore throat Plus, when you call, you can access an audio library of more than 1,000 health topics from allergies to women s health with more than 600 topics available in Spanish. Note: For medical emergencies, call 911 or your local emergency services first. This program is not a substitute for a doctor s care. Talk to your doctor about any health questions or concerns. Special Beginnings Maternity Program Special Beginnings can help you better understand and manage your pregnancy. Available at no additional cost, this maternity program supports you from early pregnancy until six weeks after delivery through: Pregnancy risk factor identification to determine the risk level of your pregnancy and appropriate range for ongoing communication/monitoring Educational material on various pregnancy and infant care related topics Personal telephone contact with program staff to address your needs and concerns and to coordinate care with your physician Assistance in managing high-risk conditions such as gestational diabetes and preeclampsia Take good care of yourself and your baby enroll in Special Beginnings today! Enrollment is easy and confidential. Just call , 7 a.m. to 5:30 p.m., MT. Note: Special Beginnings is not a substitute for professional medical guidance. It is important to share any health concerns with your physician. 8

9 Well ontarget A New Way to Experience Wellness Well ontarget offers personalized tools and resources to help all members no matter where you may be on the path to health and wellness. Well ontarget is designed to give you the support you need to make healthy choices. All while rewarding you for your hard work. Well ontarget Member Wellness Portal The heart of Well ontarget is the member portal, available at wellontarget.com. It uses the latest technology to offer you an enhanced online experience. This engaging portal links you to a suite of innovative programs and tools. onmytime Self-directed Courses Online courses let you work at your own pace to reach your health goals. Learn more on nutrition, fitness, weight management, tobacco cessation and stress. Track your progress as you make your way through each lesson. Reach your milestones and earn Blue Points SM. Health and Wellness Content The health library teaches and empowers through evidence-based, user-friendly articles. Healthy Living We know that maintaining a healthy lifestyle can sometimes be challenging. Health Living is a new incentive program designed to help people become engaged in heir own healthcare. As you complete an annual onmyway Health Assessment( TM **) you will earn a $50 gift card redeemable at National Retailers, such as Walgreens, Whole Food Markets, and Dick s Sporting Goods. Tools and Trackers Interactive tools help keep you on course while making wellness fun. Use a food and exercise diary, symptom checker and health trackers. Wellness is more than healthy eating and working out. It involves making healthy choices that enrich your mind, body and spirit. onmyteam Wellness Coaching Certified wellness coaches offer you guidance in nutrition, fitness and stress management. You can interact with your coach by phone or send a secured message through the portal. onmyway TM Health Assessment (HA) The HA features adaptable questions to learn more about you. After you take the HA, you will get a personal wellness report. This private record offers tips for living your healthiest life. Your answers will be used to tailor the Well ontarget portal with the programs that can help you reach your goals. New Mexico BlueHMO Preferred 9

10 Well ontarget Blue Points* Program Blue Points will help motivate you to maintain a healthy lifestyle. Earn points by taking part in wellness activities. Points can be redeemed in the new online shopping mall. Real-time granting of points lets you instantly use your points. To earn a larger reward, you can add to your point total at checkout. Fitness Tracking Earn Blue Points for tracking your fitness activity using popular fitness devices and mobile apps. Online Wellness Challenges Challenge yourself with wellness, stress management, fitness and nutrition challenges. Team challenges let you join forces with others to compete in monthly contests. Start experiencing the new wellness today by logging on to wellontarget.com. If you have any questions about the Well ontarget program, call Customer Service at Fitness Program** Fitness can be easy, fun and affordable. The Fitness Program is a flexible membership program. Gain unlimited access to a nationwide network of fitness centers. With more than 9,000 gyms on hand, you can work out at any place or at any time. Choose a gym close to home and one near your office. Other program perks are: No long-term contract required. Membership is month to month. Monthly fees are $25 per month per member, with a one-time enrollment fee of $25. Automatic withdrawal of monthly fee. Online tools for locating gyms and tracking visits. Earn 2,500 bonus Blue Points for joining the Fitness Program. Earn additional points with weekly visits. Access to discounts through a nationwide Complementary and Alternative Medicine (CAM) network of 40,000 health and well-being providers such as massage therapists, personal trainers and nutrition counselors. Sign up for the Fitness Program today! Call toll-free at BLUE (2583), Monday through Friday, 8 a.m. 9 p.m. in any continental U.S. time zone. * Blue Points Program Rules are subject to change without prior notice. See the Program Rules on the Well ontarget Member Wellness Portal for further information. Your company may have additional reward programs in place to encourage you to take advantage of certain preventive care and wellness activities or for making healthy changes. Check your employee benefits. ** The Fitness Program is provided by Healthways, Inc., an independent contractor which administers the Prime Network of fitness centers. The Prime Network is made up of independently-owned and managed fitness centers. 10

11 Blue Points sm With the Blue Points program, you will be able to earn points by regularly participating in a range of healthy activities. You can then redeem your points for popular health and wellness merchandise and services. Blue Points offers you many features: Instant recognition of points Real-time granting of points 2 gives you instant notice of your healthy efforts. Easily manage your points The interactive portal makes it easy to understand how many points are available to be earned. You can also track the total number of points earned year-to-date. All of your point data will be displayed on one screen. Get more Blue Points The Blue Points program gives you the option to supplement your Blue Points balance using a credit card to redeem your points for a larger reward. Expanded selection of rewards Redeem your hard-earned points in an expanded online Shopping Mall. Reward categories include Apparel, Books, Health & Personal Care, Jewelry, Electronics, Music and Sporting Goods. In addition, check out the Rewards on Sale section for discounted merchandise Blue Points and Well ontarget feature convenient online tools and personalized services that help support, inform and motivate you on a journey of wellness. New Mexico BlueHMO Preferred 11

12 Blue Points sm Look how quickly your Blue Points can add up! Sample activities that help you earn Blue Points include: Completing the onmyway TM Health Assessment (once every six months) Taking all 12 lessons of a Self-directed Course Tracking progress in the online tools on the Well ontarget Member Wellness Portal Enrolling in the Fitness Program 3 Adding weekly Fitness Program visits to your routine Completing any Self-directed Course Milestone Assessment Participating in a Biometric Screening through the Well ontarget program Connecting compatible fitness device or app Tracking progress using compatible fitness device or app 2,500 points every 6 months 1,000 points per quarter 10 points, maximum 70 points per week 2,500 points up to 300 points each week up to 250 points per month 2,500 points per year 2,675 points 55 points per day Log on to wellontarget.com to access all the interactive tools and programs you need to start racking up Blue Points. Check out the online Shopping Mall with an expanded array of rewards to help motivate you to earn more points. 12

13 Blue365 Discounts to Make Health and Wellness More Affordable Blue365 is just one more advantage of being a Blue Cross and Blue Shield of New Mexico (BCBSNM) member. With this program, you may save money on health and wellness products and services from top retailers that are not covered by insurance. There are no claims to file and no referrals or pre-authorizations. Once you sign up for Blue365 at blue365deals.com/bcbsnm, weekly Featured Deals will be ed to you. These deals offer special savings for a short period of time. Below are some of the ongoing deals offered to Blue365 members. Davis Vision SM TruVision Members may save on eyeglasses as well as contact lenses, exams and accessories. Davis Vision is made up of national and regional retail stores as well as local eye doctors. Members may get possible savings on laser vision correction through the TLC/TruVision group. TruHearing Beltone Members may get possible savings on hearing tests, evaluations and hearing aids. Discounts may also be available for your employees immediate family members. Blue365 Offers members and covered dependents access to savings on a number of health care and wellness products and services. To learn more, visit the Blue365 website at blue365deals.com/bcbsnm. Procter & Gamble (P&G) Dental Products Members may get savings on dental packages with Oral B power toothbrushes and Crest products. Packages may include items such as an electric toothbrush, mouth rinse, teeth whiteners and floss. Dental Solutions SM Blue365 members may get dental savings with Dental Solutions. They may receive a dental discount card that provides access to discounts of up to 50 percent at more than 61,000 dentists and more than 185,000 locations.* New Mexico BlueHMO Preferred 13

14 Blue365 CORD:USE CorCell Members can protect their family s cord blood at a stateof- the-art laboratory using high-quality cord blood banking practices and technologies. Cord blood contains stem cells (like those in bone marrow) that have the ability to develop into additional cells and can be used to treat possible life-threatening diseases in the future. Members may save on cord blood processing and storage fees. Jenny Craig Seattle Sutton s Nutrisystem Members may reach their weight loss goals with savings from leading programs. They may save on healthy meals, membership fees (where applicable), nutritional products and services. See all the Blue365 deals and learn more at blue365deals.com/bcbsnm. The relationship between all Blue365 vendors and Blue Cross and Blue Shield of New Mexico (BCBSNM) is that of independent contractors. BCBSNM makes no endorsement, representations or warranties regarding any products or services offered by the above-mentioned vendors. * Dental Solutions requires a $9.95 signup and $6 monthly fee. Blue365 is a discount program only for BCBSNM members. This is NOT insurance. Some of the services offered through this program may be covered under your health plan. Please check your benefit booklet or call the customer service number on the back of your ID card for specific benefit facts. Use of Blue365 does not change your monthly payment, nor do costs of the services or products count toward any maximums and/or plan deductibles. Discounts are only given through vendors who take part in this program. BCBSNM does not guarantee or make any claims or recommendations about the program s services or products. You may want to talk to your doctor before using these services and products. BCBSNM reserves the right to stop or change this program at any time without notice. Retrofit SM Blue365 members receive 15 percent off Retrofit s online, private weight loss coaching sessions. Retrofit includes the use of a wireless Fitbit device and smart scale, one-on-one videoconferencing with a personal team of experts and unlimited online support. Members enjoy flexibility in scheduling and the ability to meet with coaches anywhere there is an Internet connection. Reebok SKECHERS Reebok, a trusted brand for more than 100 years, makestop athletic equipment for all people, from professional athletes to kids playing soccer. SKECHERS, an awardwinning leader in the footwear industry, offers exclusive pricing on select Performance, Sport, Work and Corporate Casual styles. Blue365 members enjoy 20 percent off plus free shipping for their online orders. SeniorLink Care With SeniorLink Care, Blue365 members may find support to help their aging family members or friends lead fulfilling and comfortable lives. From planning care to helping caregivers, SeniorLink Care assists older adults and their loved ones in finding the programs and services they may need most. Members can save on a three- or 12-month membership. Handstand Kids Handstand Kids brings the family together in the kitchen, spending more time cooking and eating healthy, delicious meals. The Handstand Kids Cookbook series features the languages and cuisines of Italy, Mexico, China and many other countries. Every book also introduces the language and culture of each country. Members may save up to 25 percent on cooking accessories and Cookbook Kits. 14

15 Notes: New Mexico BlueHMO Preferred 15

16 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Blue Cross, Blue Shield and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. All trademarks and service marks are property of their respective owners