resource guide first Open this to get the most out of your 2015 BCN Advantage benefits to the Michigan Blues

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1 WELCOME to the Michigan Blues Open this resource guide first to get the most out of your 2015 BCN Advantage SM benefits 2015 BCN Advantage HMO-POS Medicare and more Blue Care Network of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. BCN Advantage is HMO-POS plan with a Medicare contract. Enrollment in BCN Advantage depends on contract renewal. UAW Trust Group H5883_O_GrpURMBTRsrcGd FVNR 1014

2 Thank you for choosing BCN Advantage! Welcome to the Blues. We're celebrating our anniversary. We're 75 years new! Your Blues plan includes more than just reliable medical coverage. We know you want all your health care benefits to be at your fingertips, ready to support you and easy to understand, so we ve pulled together the basics in this easy to use Resource Guide. Hang on to it and use it throughout the year. Table of Contents What you can expect... 2 Your BCN Advantage group plan replaces and enhances Original Medicare. Learn what that means as your membership starts. Learn the basics... 4 Find out what it means to be a member of a health maintenance organization, or HMO, and the helpful basics of your BCN Advantage group plan. Get the most from your benefits... 6 Whether you re in good health or coping with an illness, you ll find we have programs and services you ll want to use. Save on products and services... 9 As a Blues member, you have access to loads of savings and special discounts close to home and around the country. Consider these helpful pointers Discover a few state and federal programs that you should be aware of and consider. The guide on Page 13 helps you use your Group Evidence of Coverage. Resources... Back cover We've pulled together plan resources and contact information for you in one handy list. Benefits, provider network, premium and/or copayments/coinsurance may change on January 1 of each year. 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. The BCN Advantage website is While website addresses for other organizations are provided throughout this booklet, Blue Care Network of Michigan does not control these sites and is not responsible for their content.

3 Five quick steps You'll find these steps will help you get the most out of your Blues coverage. STEP 1 Start STEP 2 Register STEP 3 Choose STEP 4 Fill STEP 5 Get using your ID Card! Use your Blues ID card the day your coverage starts. We send new members their ID cards in a separate mailing. Show your doctor and other providers your new ID card the next time you need care. in our members-only site online. Here s why. Track your health care spending, sign up to receive certain documents online, and take advantage of member discounts by registering in the secured member section of You'll need your Blues ID card when you first sign up. your doctor. Pick a primary care physician, if you haven t already. See page 5 for how to select a doctor in our network. out your annual health survey. Complete your Medicare Advantage Health Assessment as soon as you get it in the mail (we send it out a few weeks after the start of your plan year). We ll send you the results to discuss with your doctor. your annual checkup. Make an appointment for your annual checkup with your doctor so you can begin taking advantage of your benefits, including free preventive care. Tools you can use Looking for more information about your plan benefits and extras? Want to find helpful tools and health information online? It s all at your fingertips! 1 Keep your Group Evidence of Coverage and plan riders handy. See Page 13 in this booklet for a guide to some of the most frequently requested information. : Bookmark our website on your computer. The secured member section opens up all kinds of helpful information and online tools to help you live well, get better and stay healthy. UAW Trust n BCN Advantage Group Resource Guide n Five quick steps n 1

4 What you can expect from your Blues plan Look for these helpful icons throughout this guide to get more information on the topics covered. ( phone numbers : online information mail 1 paper documents How to use this guide Your BCN Advantage group plan replaces and enhances Original Medicare. We cover everything Medicare does, plus more, all in one plan. There are a few things your should know and a few steps to take. We explain them here, starting with what you can expect to receive from us and what you need to do as a BCN Advantage group member. Expect to hear from us Your membership confirmation and ID card After you elected to join BCN Advantage, we sent you a letter confirming your enrollment. If you re new to the Blues or recently changed from one Blues plan to another, we also sent your new Blues ID card. Put your red, white and blue Medicare card away in a safe place. Use your Blues ID card. KIT Member kit This resource guide is part of your Blues welcome kit, which includes several documents that the federal government requires us to send you. In this kit you ll find: 1 A Group Evidence of Coverage and any plan riders issued to you (together, they make up your legal contract with us) 1 A Provider Directory If you're a renewing member, we sent you some of these documents with your Annual Notice of Changes. Read through them and keep them handy. Medicare Advantage Health Assessment In the next month or so, we ll mail a Medicare Advantage Health Assessment for you to fill out and return. The federal government requires us to send this survey to all members each year. Rest assured, the information does not affect your enrollment or your premium amount, and it's kept confidential. You ll receive a report back that you can share with your doctor. 2 n What you can expect n BCN Advantage Group Resource Guide n UAW Trust

5 What happens next? ( You ll hear from us throughout the year as we keep you informed about your plan, your health and opportunities to take advantage of as a member of BCN Advantage. We want to help you First and foremost, we want to help you make the best possible use of your plan. Second, the federal Centers for Medicare & Medicaid Services requires us to send several documents to every plan member at certain times of year. This includes your: Group Evidence of Coverage and any plan riders Annual Notice of Changes Explanation of benefits statements We want to save you money To help keep the cost of health care down, we do our best to combine helpful information in a few general documents like our member magazine Your Health Advantage. You may need special information There may be times when you ll need help with a chronic illness like heart disease or diabetes, so we'll send you materials or call you about a specific program. There also may be events during the year that we want you to be aware of, so we'll send you notices of those. It s all part of your benefits as an appreciated Blues member. So check your mailbox throughout the year. And don't be surprised if you get a phone call from us. Find it online Did you know? We post many of our plan documents on our website, For example, you can: Look up discounts and special savings programs. Search for certain words or phrases in the Group Evidence of Coverage. Sign up for electronic benefit statements in our secured member website. And much more! Everything is right at your fingertips. How are we doing? You may receive surveys asking for your opinion of our plan, our network doctors and the care you receive. If you do, please complete and return each survey as directed. Our goal is to make sure your needs are met and the care you receive meets the highest standards of quality. We re always looking for ways to provide better coverage and service. Please note: Your answers don't affect your coverage; you won't lose your coverage even if you become ill. We simply appreciate your honest feedback. UAW Trust n BCN Advantage Group Resource Guide n What you can expect n 3

6 Learn the basics of your health plan Look through this section (and those that follow) for information and tips to help you all year long. You re a member of an HMO What does that mean? Health Maintenance Organizations, like Blue Care Network, provide member centered care that is coordinated by a primary care physician, or PCP, who you select from a network of contracted doctors. You should get all your care from this doctor. If you need care from a specialist, your PCP will refer you. Care and services you get on your own may not be covered. Personal concierge service is yours The BCN Advantage Concierge Program provides personalized service to help you make the most of your coverage. Your specially assigned concierge coordinator can: Explain your plan details Answer benefit questions Help you find a doctor Now a word about referrals: easy. When your primary care doctor determines that you need care from a specialist, he or she will refer you to one who is in our network. With BCN Advantage, the referral itself is easy. It may be written and given to you to take with you or faxed directly to the specialist s office. A referral may also be a simple phone call from your doctor to the specialist. Your doctor simply documents the referral in your patient file. Best of all, one referral can cover up to one year of specialty care. There is no need to get a new referral for every follow up visit. We ve made preventive care the foundation of our coverage because it s easier to stay healthy than it is to get healthy. We also help manage sudden and ongoing medical conditions to help you feel your best. Discuss preventive services Provide timely reminders Connect you to community resources Your concierge coordinator works closely with our customer service staff and care management nurses. He or she can also reach out to your doctor s office to set up appointments or clear up questions. Health care can be complicated. And Medicare can be confusing. It s nice to know you have one-on-one help that gives you peace of mind; you have someone to turn to whenever you have questions about your health care coverage. You ll hear from your personal concierge coordinator on a regular basis, usually once a month or so. He or she plans each phone call based on your questions and personal concerns. If you haven t received a welcome call to get started yet, you will soon. 4 n Your health plan basics n BCN Advantage Group Resource Guide n UAW Trust

7 Thousands of doctors are in our network Use doctors in our network to get your medical care Our plan gives you access to a network of thousands of primary care doctors and specialists in our service area.* These doctors accept our payment and the share of the costs that you pay as payment in full. If you haven t done so already, make an appointment with your doctor for your annual wellness visit. The price is right for the wellness visit it s free! Your doctor can also use this time to make sure you re on track with your preventive care and confirm that your medical status hasn t changed. See your dentist and eye doctor Dental and eye exams can detect disease and contribute to your overall health. If your BCN Advantage group plan includes dental and vision coverage, make appointments soon with your network dentist and eye doctor so you can take full advantage of your benefits. 1 Look in your Group Evidence of Coverage for benefit and cost details. Get SmartER How do you know if you really need emergency care? An emergency means that if you don t get immediate medical help: Your health or life may be in danger Your body functions may be seriously damaged An organ or part of your body may not work properly again When you have a true emergency, go to the emergency room or call 911 right away. Otherwise, call your primary care doctor s office for an appointment. If it s after hours or on a weekend, an urgent care center is a good option. Receive prompt attention and get the treatment you need. You'll save time and money. Three ways to find a BCN Advantage primary care physician: : Click on Find a Doctor. Select the type of search you want to do. You can also log in to our member website to do a more personalized search. 1 Look in your copy of our Provider Directory. ( Call Customer Service at the number on the back of your ID card. * Source: BCN Statewide Provider Counts report, July 2014 UAW Trust n BCN Advantage Group Resource Guide n Your health plan basics n 5

8 Get the most from your benefits Your benefits aren t just for when you re feeling sick or coping with a chronic condition. They can help protect and enhance your health. When you re healthy Free preventive care helps you stay healthy Your Medicare Advantage coverage includes free preventive screenings and services. Make an appointment with your doctor to get your appropriate preventive care, including: Welcome to Medicare exam when you re new to Medicare. Annual wellness visit when you ve been enrolled in Medicare for more than a year. This exam includes a personalized prevention plan with advice, screening schedules, referrals and education based on your specific health situation. Bone mass measurement to detect osteoporosis and other bone issues. Colorectal cancer screening. Glaucoma screening. Hepatitis C screening. Immunizations including flu, pneumonia and hepatitis B vaccinations. Mammogram and Pap smear. Prostate screening. In-home checkups keep you on track If you haven t been to your doctor in a while, we have a program that brings a health care professional to you. We partner with Mobile Medical Examination Services, Inc. (or, MedXM) to provide this service. The results are shared with you and your primary care doctor. Eligible members receive a letter in the mail asking them to participate. Fitness membership built right in Your BCN Advantage group plan includes the SilverSneakers Fitness Program an exercise and wellness program that helps you live a healthy, active lifestyle through fun, energizing activities and social opportunities. There are more than 11,000 participating facilities nationwide. Healthways is our SilverSneakers partner. Find your nearest SilverSneakers facility at: : ( TTY users call a.m. to 8 p.m. Monday through Friday Collect rewards for a job well done Good health has its own rewards; we want to take it a step further. Our Blue Advantage Rewards SM program is our way of recognizing your efforts to stay healthy. Watch your mailbox for our Blue Advantage Rewards packet. Then complete the services, fill out and return the corresponding forms, and enjoy your rewards! For more information: ( Call Customer Service at the number on the back of your ID card. : Enter "Rewards" in the search box in the upper right-hand corner to find links to more information and the rewards forms. 6 n Get the most of your benefits n BCN Advantage Group Resource Guide n UAW Trust

9 When you re sick Support your good health through BlueHealthConnection 24 hours a day, seven days a week Sometimes health decisions aren t easy. Our BlueHealthConnection programs can assist you whether you re researching a rash, coping with a life changing illness, unsure about your medications or need help as you leave the hospital. Our knowledgeable and compassionate nurses can offer guidance, provide tips and educational material, suggest community resources and answer your questions. ( TTY users call hours a day, seven days a week : Review all our BlueHealthConnection programs online at Click on the LOGIN tab and log in to your member website. Click on BlueHealthConnection in the right hand column Health education message line Request a self help guide or information on a health topic. ( TTY users call hours a day, seven days a week Get help to give up tobacco Our phone based program provides support and resources to increase your chances for success. You ll speak with a nurse who can help you create a plan to quit, set a date to start a new life without tobacco and coach you through the process. Look online for reliable health information and tools Sign in to our secured member website to access a wealth of credible, timely health information and tools. Access the site by going to: : Click on the LOGIN tab and log in to your member website. Click on BlueHealthConnection in the right hand column Coping with a chronic medical condition or dealing with a sudden illness can be a challenge. Your plan includes programs to help you whatever life brings your way. ( TTY users call a.m. to 9 p.m. Monday through Saturday : This site provides resources to help you make better decisions about diet and exercise, as well as find supportive organizations in your community. UAW Trust n BCN Advantage Group Resource Guide n Get the most of your benefits n 7

10 Receive extra help when you re seriously ill or injured When something serious happens, you can count on our dedicated nurse case managers to help find the right care for you. They'll also give you the information and resources you need. We offer care management services based upon your medical claims or when your doctor refers you for assistance. In some cases, we partner with independent, non Blue companies to provide services on our behalf. Behavioral health services: Care is available for conditions that cause emotional or mental distress, including struggles with alcohol. When you call, we ll evaluate your needs and arrange for services, including urgently needed care. ( TTY users call Routine issues: 8 a.m. to 5 p.m. Monday through Friday Emergencies: 24 hours a day, seven days a week Chronic conditions: We offer educational materials, reminders and other support for members with depression, diabetes, chronic obstructive pulmonary disease, heart disease, heart failure and kidney disease. You ll automatically be signed up for these special programs after we receive a diagnosis from your doctor. Complex and serious conditions: Our care management programs help members with certain complex conditions. We may assign a nurse to work with you, your family, your doctor and other health professionals. Your nurse will counsel you and teach you about your condition. He or she will follow your treatment and make sure your care is well coordinated. Among others, we have programs available to assist with: Asthma Bone marrow transplants Cancer Chronic obstructive pulmonary disease Congestive heart failure Diabetes Heart disease Kidney health Solid organ transplants Follow up care when you leave a hospital: A nurse may contact you while you re in the hospital and after you ve left the hospital to answer questions and help with the transition home. They may: Help you to understand how to take your medications and what you need to do to stay healthy when you return home Assist in arranging prescribed services or equipment after discharge Help arrange transportation for follow up appointments; if needed Provide information about available community resources that may be helpful Home heart monitoring: Should you need them, we partner with Alere Medical Inc. to provide tools to help manage conditions such as heart failure and chronic obstructive pulmonary disease, or COPD. Alere also provides educational support and can help you work with your doctor to manage your condition. 8 n Get the most of your benefits n BCN Advantage Group Resource Guide n UAW Trust

11 Save on products and services Basic discounts In Michigan Healthy Blue Xtras SM offers savings for health products and services from companies across Michigan. This includes safety items, fitness gear and more. Around the U.S. You also automatically have access to the tools and discounted offers available through Blue365, a national program that helps you find health and wellness information, support and services you need 365 days a year. As a Blues member, you can get special discounts that can save you a bundle. To access our Healthy Blue Xtras and Blue365 discount programs, go to the secured member section of our website. Create your personal account and log in to see all the savings right at your fingertips. : Click on the blue For Members tab then Medicare Advantage Extras on the drop-down menu. Scroll down and click on Discounts. On dental care products To help keep your smile healthy and bright, we ve partnered with Crest and Oral B to offer significant discounts on oral care products. These products, normally offered only through your dentist, are designed to help promote a clean, healthy mouth. To access these discounts, log in to the secured member section at: : Click on the LOGIN tab and log in to our member website. Click on the Health & Wellness tab Scroll down to find Exclusive discounts on Crest and Oral B dental care products in the right hand column UAW Trust n BCN Advantage Group Resource Guide n Save on products and services n 9

12 Remember to tell these businesses that you re a member of BCN Advantage to receive your discounts. Extra discounts As a Blues Medicare Advantage member, you have access to savings arranged just for you! Here are just a few of the special values that you can enjoy as a plan member. : Visit every now and then to see more! Click on the blue For Members tab then Medicare Advantage Extras on the drop-down menu. Scroll down and click on Discounts. Sign up for home delivered meals Save 12 percent on delicious dinners, delivered to your home by Magic Kitchen. These frozen, chef prepared entrées include low fat, low carb, low sodium, dairy free and gluten free options for fast, healthy and convenient meals. ( TTY users call 711. : Make your home safer Save up to 30 percent with Guardian Medical Monitoring on medical and home alarms, medication dispensers, video monitors, smoke detectors, pressure sensitive floor mats, door and window contacts, motion detectors and residential security systems. ( TTY users call : Get in home help Comfort Keepers helps you maintain your highest level of independent living with in home services, including hands on care giving, meal preparation, medication reminders, light housekeeping, transportation, bathing and more. Save 5 percent off the hourly rate. For more information, call or visit: ( TTY users call hours a day, seven days a week : Receive without a computer The Presto Mail service converts regular and photo attachments into beautiful, easy-to-read color printouts that are delivered to a Printing Mailbox on a daily schedule, just like letters. No computer necessary! Sign up for the service and get the Presto Printing Mailbox free (valued at $99.99). Learn more at: ( TTY users call 711. : 10 n Save on products and services n BCN Advantage Group Resource Guide n UAW Trust

13 Consider these helpful pointers Help yourself and others Pack your card when you travel Traveling is fun. You don t want to worry about medical care should something unexpected happen. As a Blues member, you don t have to worry. You can get follow-up, urgent and emergency care when traveling anywhere in the U.S. outside of Michigan. With our BlueCard travel program, you can receive care from doctors who participate with Blues plans across the country. The BlueCard Worldwide program covers you when you travel outside of the United States and its territories. You can receive urgent and emergency medical care through doctors and hospitals in more than 200 countries. Talk with your primary care doctor before you travel. He or she can make sure you have: All the necessary instructions you may need A supply of your medications The right vaccines Then make sure you pack your Blues ID card along with your other necessities. ( To locate a BlueCard provider, call TTY users call hours a day, seven days a week This number is also on the back of your ID card. Make a plan for your personal care Sometimes you can't make health care decisions for yourself due to an accident or serious illness. You have the right to say what kind of care you want and don t want if you re in this situation. Advance directives are the legal documents that you use to spell out your directions before something happens. They include a Durable Power of Attorney for Health Care so you can assign someone to speak for you and carry out your wishes. Each state requires its own legal forms and arrangements. Forms that are suitable for use in Michigan are available at no cost. Protect your privacy All health plans are required to have written permission to share your personal information or discuss your health care with others. Make sure you fill out and return a PHI Authorization form while you're in good health. ( Call Customer Service at the number on the back of your ID card. : Click on the blue Help tab then Frequently Asked Questions in the drop-down menu. Click on the Other Topics link on the left-hand side. Click on What's an advance directive? Take advantage of these programs. UAW Trust n BCN Advantage Group Resource Guide n Helpful pointers n 11

14 Fraud costs you money: report it We re serious about fighting health care fraud. We work with local, state and federal law enforcement agencies to investigate reports of Medicare fraud, waste and abuse. By reducing fraud, we help keep down the cost of health care. You can help, too! Some examples of Medicare fraud, waste and abuse include: An individual or organization pretends to represent Medicare or Social Security and asks you for your Medicare or Social Security number, bank account number or credit card number. Someone asks you to sell your Medicare health insurance or prescription drug card. Someone asks you to get drugs for them using your Medicare prescription drug card. You were billed for services or drugs you didn t receive. You feel a Medicare plan has discriminated against you. We need your help Do any of the above situations sound familiar? If you suspect any kind of fraud, please let us know immediately. Toll free Medicare anti fraud hotline ( TTY users call :30 a.m. to 4:30 p.m. Monday through Friday : Click on the blue Help tab then Frequently Asked Questions in the drop-down menu. Scroll down to Complaints and Grievances. Click on What if I suspect Medicare fraud? These two laws protect women of all ages. Women s health protection acts Breast reconstruction following a mastectomy The Women s Health and Cancer Rights Act of 1998 includes important protection for breast cancer patients who choose breast reconstruction in connection with a mastectomy. BCN Advantage coverage complies with this legislation, which includes the following: Reconstruction of the breast after a mastectomy for treatment of cancer Surgery and reconstruction of the other breast to produce an even appearance Prostheses and other care to lessen physical complications of all stages of a mastectomy Obstetrical stays The Newborns and Mothers Health Protection Act of 1996 prohibits health plans from limiting hospital lengths of stay for childbirth to less than 48 hours following a vaginal delivery or 96 hours following a cesarean section. A doctor or other health provider doesn t need to get authorization for these lengths of stays for childbirth. However, the attending physician or certified nurse midwife, in consultation with the mother, may discharge the mother or newborn earlier than 48 hours following a vaginal delivery or 96 hours following a cesarean section. 12 n Helpful pointers n BCN Advantage Group Resource Guide n UAW Trust

15 A guide to your Evidence of Coverage Your Group Evidence of Coverage and plan riders are important legal documents that explain your medical coverage through BCN Advantage. Copies are included in your welcome kit. How much do I pay for My monthly premium?... Chapter 1, section 4.1 My annual deductible?... Chapter 4, section 1.1 My doctor office copayments?... Chapter 4, section 2 Tell me about my BCN Advantage plan. What are my rights and responsibilities as a BCN Advantage member?... Chapter 6 How do I use network doctors, hospitals and vendors?... Chapter 3, section 1 When do I need a referral?... Chapter 3, section 1.2 What does my primary care doctor do for me?... Chapter 3, section 2.1 How do I get care from a specialist or from an out of network doctor?... Chapter 3, sections 2.3, 2.4 Am I covered for emergency and urgently needed care?... Chapter 3, section 3 How do I coordinate my BCN Advantage coverage with other insurance?... Chapter 1, section 7.1 What am I covered for? Your benefits are described in the medical benefits chart... Chapter 4, section 2 There are some services that we don t cover... Chapter 4, section 3 You may ask for reimbursement for a bill for covered services... Chapter 5, sections 1 2 What if I have a problem with my coverage? Look up step by step directions if you want to appeal a medical coverage decision... Chapter 7, sections 3 9 Blue GPS Navigate your way to good health Check out these helpful chapters Chapter 1 tells you what to do with your red, white and blue Medicare card and explains other Medicare basics. Chapter 2 tells you how to contact BCN Advantage, Original Medicare and the Social Security Administration. Chapter 10 gives definitions of key terms. UAW Trust n BCN Advantage Group Resource Guide n Helpful pointers n 13

16 Resources Do you have questions or want more information? Keep this handy list at your fingertips. Report fraud ( TTY users call :30 a.m. to 4:30 p.m. Monday through Friday After business hours, leave a voic message, and your call will be returned the next business day. BCN Advantage Customer Service ( TTY users call a.m. to 8 p.m. Monday through Friday Weekend hours October 1 through February 14 This number is also on the back of your ID card. Certain services are available 24/7 through our automated telephone response system. UAW Retiree Medical Benefits Trust Retiree Health Care Connect ( Your prescription drug coverage is provided by Express Scripts, not BCN ( Diabetes supplies provider: J & B Medical Supply Co. ( TTY user call a.m. to 5 p.m. seven days a week Durable medical equipment, prosthetics and orthotics provider: Northwood ( TTY users call a.m. to 5 p.m. Monday through Friday Lab providers ( Customer Service, above. Behavioral health and substance abuse care ( TTY users call 711. Routine issues: 8 a.m. to 5 p.m. Monday through Friday Emergencies: 24 hours a day, seven days a week P.O. Box Southfield, MI Blue Care Network of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. DB OCT 14 R027875