Blue Shield of California Wellness Programs and Services
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1 Blue Shield of California Wellness Programs and Services Helping you and your family on the way to better health
2 The support you need for a healthier life Blue Shield s wellness programs and resources are designed to help improve the health of you and your family. Whether you are healthy or have an acute or chronic condition, Blue Shield can help you on your way to better health. contents Prevention Health Improvement Connect Shows you how to stay well by helping identify health risks early and offering support and resources on maintaining healthier habits. You can choose from a variety of programs to help reach your personal goals. Pages 1 and 2 Prevention Program Wellvolution Wellness discount program* Whether you re expecting a baby or have a health condition, you may have lots of questions. We give you the extra attention, information, and support you need to be as healthy and active as possible. Pages 3 and 4 Disease management Prenatal Program Transitions of Care Program Case management Puts you in control of your healthcare decisions with access to health resources and expert consultations around the clock. Pages 5 and back cover NurseHelp 24/7 24/7 online resources * Please see page 2 for more information on Blue Shield s wellness discount program.
3 healthy living I total health and wellness Prevention Program Be proactive about your health Through Blue Shield, you can get the information you need to stay on top of your health needs by having access to prevention resources, along with related health topics. You can download specific age- and gender-appropriate preventive screening recommendations by going to blueshieldca.com/preventive. Wellvolution Healthy habits can lead to a lifetime of personal rewards Wellness has evolved! We know we could be healthier, but life is busy and things get in the way. Introducing Wellvolution, SM a well-being solution for real people with real lives. Wellvolution is an easy, social, and fun approach to wellness. Participate on the go, from your computer, smartphone, or tablet, and invite your family and friends to join the fun and support your health goals. Daily Challenge Daily Challenge is an easy way to include some healthy activity in even the busiest lifestyle. In just a few minutes you can connect with friends as you complete simple, everyday actions. Every day you ll get an to perform one simple wellness-related task that s fun to do. Connect and build a support network with friends and family as you explore activities to improve many areas of your well-being. Well-Being Assessment Well-being is personal and so is our confidential Well-Being Assessment. Physical health, diet and lifestyle, emotional health, life satisfaction, work environment, and access to care all impact our sense of well-being. Take a quick self-check and receive a personalized report offering you support and challenges in the areas you most want to improve. The answers from your Well- Being Assessment will not be shared with anyone else without your explicit consent. Go to mywellvolution.com to start your well-being journey today! Prevention Our wellness programs help you to make better lifestyle choices, so you can take control of your health and avoid unnecessary expenses. Daily Challenge is a registered trademark of MeYouHealth. MeYouHealth is a wholly owned subsidiary of Healthways, Inc. Wellvolution is a service mark of Blue Shield of California. Blue Shield and the Shield symbol are registered marks of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans. 1
4 Wellness discount program Strive for a balanced life while saving money Do you want to lose weight or get in shape? Or de-stress with a soothing massage? Here are some programs 1 and discounts available to health plan participants. For details, visit blueshieldca.com/wellnessdiscounts. Programs Discounts available to health plan participants Diet and exercise 24 Hour Fitness, ClubSport, and Renaissance ClubSport 2 Weight Watchers Discounts on membership fees and gym fees, including waived enrollment and processing fees. Get discounts on Weight Watchers three- and 12-month subscriptions, monthly passes, and at-home kits. Alternative Care Discount Program 2 Acupuncture Chiropractic Massage therapy 25% discounts for services. Vision Exams, lenses, and frame discounts LASIK Take 20% off the published retail prices when you use a participating provider in the Discount Vision Program network 2 for exams, frames, lenses, and more. Take advantage of competitive prices on contact lenses, 3 sunglasses, readers, and eyecare accessories, with free shipping on orders over $50. 15% discount on LASIK surgery at NVISION Laser Eye Centers located in Southern California and Sacramento. Save on LASIK surgery at more than 45 QualSight LASIK surgery centers in California. Services include pre-screening, a pre-operative exam, and post-operative visits. 1 These discount program services are not a covered benefit of Blue Shield of California or CSAC health plans, and none of the terms or conditions of Blue Shield or CSAC health plans apply. 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, presentations, 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 and Disclosure (EOC&D) form or Benefit Booklet. 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 Provider Network and MESVisionOptics.com 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 NVISION Laser Eye Centers Note: No genetic information, including family medical history, is gathered, shared, or used from these programs. 2 The Discount Provider Network is available throughout California. Coverage in other states may be limited. Find participating providers by going to blueshieldca.com/fap. 3 Requires a prescription from your doctor or licensed optical professional. 2
5 living better I total health and wellness Disease management Personalized coaching and support If you have certain chronic diagnoses, our disease management programs are designed to help improve your quality of life by showing you how to take an active role in managing your condition. You can receive interactive online support, educational materials, and access to a nurse any time you have questions. If you need extra support, you can receive additional telephone outreach from a nurse, while others receive more direct interaction with care managers and management tools such as symptom-monitoring kits. We care about you as a whole person, and that s why we use a team of nurses, pharmacists, nutritionists/dieticians, and mental health professionals to help you with your total well-being. Disease management programs provide support for: Heart failure Asthma Diabetes Coronary artery disease (CAD) Chronic obstructive pulmonary disease (COPD) Home monitoring tools available for higher-risk participants: Weight scale and symptom-monitoring kit Peak flow meter and symptom-monitoring kit Glucose meter and symptom-monitoring kit Blood pressure cuff and symptom-monitoring kit Symptom-monitoring kit Once enrolled in our disease management programs, you also have 24/7 access to the online Care Center. The Care Center gives you interactive online tools, displays uploaded biometric data from home monitoring, and stores your self-reported health history enabling better self-management and communication with your nurse care manager. Health Improvement Whether you re expecting a baby or living with a chronic condition, we ll show you how to avoid complications and feel better. Our programs provide practical tools and support and make a difference in the overall quality of your health care and your health. 3
6 Prenatal Program Waiting for a bundle of joy? We want you and your baby to be healthy. With our Prenatal Program, you ll receive 24/7 maternity nurse support, know what to expect while you re pregnant, and learn ways to stay healthy after the baby is born. You ll receive an educational packet that includes one of the best-selling pregnancy and parenting books, a prenatal planner, and access to free text-messaging reminders, as well as materials that offer practical advice and helpful tips. A nurse will call you to provide ongoing pregnancy assessments and support, and those needing extra support will get personalized coaching. You can join by logging in to blueshieldca.com/prenatal or calling (888) Transitions of Care Program Supportive preparation and healing Facing a hospital stay for surgery or an acute condition can be daunting, and worrying about recovery may add to the apprehension. If you are preparing for particular types of conditions, you ll automatically be offered the Transitions of Care Program. With the Transitions of Care Program, a Blue Shield registered nurse will contact you to answer your questions and concerns and help ensure your preparation and recovery are as smooth and comfortable as possible. The nurse will continue providing information and support before and after discharge, and will review your post-discharge needs including pain control, mobility issues, prescriptions, and follow-up care to ensure that they are being met. In addition to helping you remain informed, calm, and comfortable, this program can help you avoid time-consuming and costly ER visits. For guided imagery, you will receive a CD or audiotape prior to surgery to help with relaxation and healing. For more information, you can log in to blueshieldca.com and click on Transitions of Care Program under Condition Management in the Be Well section, or call Member Services at (855) Case management Personalized patient care Our case managers help ensure that you have access to the right care at the right time. Case managers provide education, care coordination, and personal support to members when they need it most. Programs include: Blue Shield Integrated Case Management Helps ensure you ll get access to the right care at the right time through coordinated care management if you have an acute or complex condition. Transplant Management Through the Transplant Management program, you will receive personalized information and assistance from a transplant care manager who will monitor you throughout inpatient and outpatient treatment. High Risk Case Management When you are very ill, you ll need customized patient support to help you with highly complex conditions. This program helps participants with challenging health, emotional, social, and end-of-life issues, and participants with catastrophic illnesses and injuries. Our High Risk Case Management programs scored a 96% rating for participant satisfaction*. These programs include: Neonatal Intensive Care Unit ( NICU ) Case Management Promotes the highest-quality medical management, including onsite visits for newborns with complex medical conditions, extremely low birth weight, or requiring major surgery. Complex Case Management Provides support, including onsite visits for participants with complex conditions requiring a wide range of specialty care with numerous providers. Catastrophic Injury Case Management Case manager support and onsite visits for those with multiple traumas, brain injuries, or serious burns. Chronic Complex Case Management Case manager telephonic support for high-risk members with advanced chronic diseases such as cancer and renal disease. * Blue Shield of California Satisfaction Survey Report,
7 24/7 support I total health and wellness NurseHelp 24/7 Talk to a registered nurse anytime Maybe you have stomach cramps and need some advice on the weekend. Or your child is running a temperature late at night. NurseHelp 24/7 SM connects you to a registered nurse who can answer your health questions right away. This service offers you aroundthe-clock support online or by phone from nurses who can give reliable information about minor illnesses and injuries, chronic conditions, medical tests, medications, and preventive care. You can call NurseHelp 24/7 at (877) , or chat online with a nurse by logging in to blueshieldca.com and selecting Be Well. Connect We know questions don t always arise during business hours. That s why we offer helpful resources around the clock. We provide access to professional advice and referrals to personal counseling whenever you need it, and a useful website that makes it easy to find answers on your own. 5
8 24/7 online resources Just visit blueshieldca.com/csac. At blueshieldca.com/csac, you have convenient 24-hour access to information on your health benefits plus a wide range of wellness resources, including: Health Plan Log In provides password-protected access to your benefits and health plan details, including copayment amounts, claims, and more. You can also print temporary Blue Shield member ID cards, change your Personal Physician (Access+ HMO only), and download forms. Medical Benefits offers helpful overviews of the Blue Shield Access+ HMO, EIAHealth HDHP, EIAHealth EPO, and EIAHealth PPO plans and information for participants enrolling in these plans for the first time. Pharmacy Benefits provides helpful information on your pharmacy benefits, including mail-service prescriptions and network pharmacy locations. Find a Provider makes it easy to locate network physicians, hospitals, urgent care centers, and other healthcare providers. Simply select the link that corresponds to your health plan. Health Programs and Wellness Discounts provides easy access to a range of programs and services, including NurseHelp 24/7, and prenatal and condition management. Wellness Resources offers a wide variety of wellness information on how to eat well, get more exercise, relax, and stay healthy. Frequently Asked Questions provides answers to questions such as How do I find a network provider? and How do I order a new Blue Shield member ID card? Contact Us provides a list of key phone numbers such as Blue Shield Member Services, NurseHelp 24/7, and more. FPO RECYCLE BUG Blue Shield of California is an independent member of the Blue Shield Association A41239-CSAC (8/15) If you have any questions about these health and wellness programs, go to blueshieldca.com/csac, or you can call Blue Shield Member Services at (855) We are ready to help you.
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