What You Need to Know about Member Identification Cards

Transcription

1 What You Need to Know about Member Identification Cards January

2 This guide will give you an overview of the various BlueCross BlueShield of South Carolina and BlueChoice HealthPlan member identification (ID) cards, the symbols on these cards and how to use the information on the ID cards. When members arrive at your office or facility, remember to ask to see their current member identification cards at each visit. This will help you to identify the product the member has and get health plan contact information. It will also help you with claims processing. Remember, ID cards are for identification purposes only. They do not guarantee eligibility or payment of your claim. You should always verify patient eligibility by using My Insurance Manager SM on our websites, or January

3 State Health Plan State Health Plan (SHP) Network Group product lines access the broad commercial BlueCross State Health Plan Network. The MUSC Health Plan alpha prefix is ZCK. The State Health Plan and State Savings Plan alpha prefix is ZCS. New cards reflect the Public Employee Benefit Authority (PEBA) logo. The suitcase on the front of the card, lower right, indicates the network members access when out of state. January

4 BlueCross BlueShield of South Carolina Preferred Blue Network Federal Employee Program (FEP) Group product lines access the broad commercial BlueCross Network (Preferred Blue ). Cards reflect the Federal Employee Program product name. ID numbers begin with the letter R. There are two plans, Basic and Standard. The plan name on the front of the card, upper right corner, distinguishes the Basic plan. Basic plan members do not have out-of-network benefits. The Standard plan operates as a traditional preferred provider organization (PPO). January

5 BlueCross BlueShield of South Carolina Preferred Blue Network BlueCross BlueShield Large Group PPO Group product lines access the broad commercial BlueCross Network (Preferred Blue ). There are multiple alpha prefixes for these plans. The suitcase on the front of the card, lower right, indicates the network members access when out of state. Plan benefits vary. January

6 BlueCross BlueShield of South Carolina Preferred Blue Network BlueCross BlueShield Small Group PPO Group product lines access the broad commercial BlueCross Network (Preferred Blue ). The alpha prefix is ZCY. Note: ZCY prefix may also represent an individual PPO policy. Plan benefits vary. The suitcase on the front of the card, lower right, indicates the network members access when out of state. ZCY January

7 Medicare Advantage Plans Medicare Advantage Networks Individual product lines access various Medicare Advantage networks: o Health maintenance organization (HMO) o Medical savings account (MSA) o Private fee-for-service (PFFS) o Point of service (POS) o Medicare Advantage preferred provider organization (MA PPO) The alpha prefix is ZCT. Product names are Medicare Blue SM and Medicare Blue SM Saver. The suitcase on the front of the card, lower right, indicates the network. January

8 BlueChoice HealthPlan Medicaid BlueChoice HealthPlan Medicaid Network Individual product lines access the broad BlueChoice HealthPlan Medicaid Network. Members are required to also carry their State-issued Healthy Connections ID cards (also pictured here). The alpha prefix is ZCD. These ID cards are distinguished by the Healthy Connections logo. January

9 BlueChoice HealthPlan BlueChoice Network Commercial Network Open Access (PPO) Group product lines access the broad commercial BlueChoice Network. Referrals are not required for members to see specialists within the network. The alpha prefix is ZCL. These ID cards also distinguish the plans by having the Carolina Advantage and Advantage Plus logos. January

10 BlueChoice HealthPlan BlueChoice Network Commercial Network High Deductible Open Access (PPO) Group product lines access the broad commercial BlueChoice Network. Referrals are not required for members to see specialists within the network. The alpha prefix is ZCL. These ID cards also distinguish the plans by having the Carolina Advantage High Deductible Health Plan (HDHP), Advantage Plus HDHP, and Consumer-Driven Health Plan logos. Members have a cost sharing account to help in meeting deductibles and other approved health care expenses: o Health savings account (HSA) o Health reimbursement account (HRA) BlueCross BlueShield of South Carolina employees only January

11 BlueChoice HealthPlan BlueChoice Network Commercial MyChoice Individual (PPO) Individual product lines access the broad commercial BlueChoice Network. Referrals are not required for members to see specialists within the network. The alpha prefix is ZCL. These ID cards also distinguish the plans by having the MyChoice Individual Coverage, MyChoice Individual Coverage HDHP or MyChoice Open Access logos. January

12 BlueChoice HealthPlan BlueChoice Network Commercial MyChoice Individual (PPO) Individual product lines access the broad commercial BlueChoice Network. Referrals are not required for members to see specialists within the network. The alpha prefix is ZCL. These ID cards also distinguish the plans by having the MyChoice Individual Coverage, MyChoice Open Access HDHP or MyChoice Open Access Value Plan logos. January

13 BlueChoice HealthPlan BlueChoice Network MyChoice (Primary Choice Plans HMO) Individual product lines access the broad commercial BlueChoice Network. Referrals are not required for members to see specialists within the network. The alpha prefix is ZCC. These ID cards are identifiable by the MyChoice Individual Coverage logo. January

14 NEW Individual Product Exchange Network ID Cards Only new individual product lines access the new Blue Essentials SM network (BlueCross) and the new MyChoice Advantage network (BlueChoice). Alpha prefixes are: BlueCross (ZCU, ZCF, ZCQ) and BlueChoice (ZCX, ZCJ). These ID cards also distinguish the new networks by having Blue Essentials Network and Exclusive Provider Organization on the cards for BlueCross and the My Choice Advantage logo and Exclusive Provider Organization (EPO) on the cards for BlueChoice. Benefits are only available in network! See the back of the ID card. The suitcase on the front of the card, lower right, indicates the network that members access when out of state. Note: all group products continue to access the broad commercial networks. This includes those purchased through the federal or private exchange. January

15 BlueCross BlueShield of South Carolina Blue Essentials Network Blue Essentials Individual (EPO) ID Cards Only NEW individual product lines access the new Blue Essentials network. Alpha prefixes are ZCU, ZCF and ZCQ. These ID cards also distinguish the new networks by having Blue Essentials Network and Exclusive Provider Organization on the cards. Benefits are only available in network! See the back of the ID card. The suitcase on the front of the card, lower right, indicates the network members access when out of state. Note: all group products continue to access the broad commercial networks. This includes those purchased through the federal or private exchange. January

16 BlueCross BlueShield of South Carolina New Product ID Cards BlueCross PPO Network Small Group PPO Group product lines access the broad commercial BlueCross Network (Preferred Blue ). New alpha prefixes are ZCV and ZCR. These ID cards also distinguish the network by having Preferred Blue Network on the cards. The suitcase on the front of the card, lower right, indicates the network members access when out of state. January

17 BlueChoice HealthPlan New Group Product ID Cards MyChoice Advantage Network MyChoice Advantage Individual (EPO) Only NEW individual product lines access the new MyChoice Advantage network. Alpha prefixes are ZCX and ZCJ. These ID cards also distinguish the new networks by having the My Choice Advantage logo along with Exclusive Provider Organization (EPO) on the cards. Benefits are only available in network! See the back of the ID card. The suitcase on the front of the card, lower right, indicates the network members access when out of state. Note: all group products continue to access the broad commercial networks. This includes those purchased through the federal or private exchange. January

18 BlueChoice HealthPlan New Group Product ID Cards BlueChoice Network Business Advantage (Small Group PPO) Group product lines access the broad commercial BlueChoice Network. New alpha prefixes are ZCL and ZCG. These ID cards also distinguish the network by having the Business Advantage logo on the cards. The suitcase on the front of the card, lower right, indicates the network members access when out of state. January