What You Need to Know about Member Identification Cards January 2014 1
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, www.southcarolinablues.com or www.bluechoicesc.com. January 2014 2
State Health Plan State Health Plan (SHP) Network The State Health Plan product uses the State Health Plan Network. Providers that do not participate in the State Health Plan Network are considered out of network. These plans are easily identifiable by the Public Employee Benefit Authority (PEBA) logo and the ZCK or ZCS alpha prefix. January 2014 3
BlueCross BlueShield of South Carolina Preferred Blue Network Federal Employee Program (FEP) The Federal Employee Program (FEP) uses the Preferred Blue Network. Providers that do not participate in the Preferred Blue Network are considered out of network. Basic plan members do not have out-ofnetwork benefits while the standard plan operates as a PPO. These plans are easily identifiable by the Federal Employee Program product name and identification numbers beginning with the letter R. January 2014 4
BlueCross BlueShield of South Carolina Preferred Blue Network BlueCross BlueShield Large Group PPO The Preferred Provider Organization (PPO) products use the Preferred Blue Network. Providers that do not participate in the Preferred Blue PPO are considered out of network. These plans have many prefixes and benefits vary. January 2014 5
BlueCross BlueShield of South Carolina Preferred Blue Network (PPO) BlueCross BlueShield Small Group PPO The PPO products use the PPO Network. Providers that do not participate in the PPO are considered out of network. Verify the network by looking for the Preferred Blue Network name and the PPO suitcase on the card. The current PPO Small Group contract is identified by the ZCY alpha prefix. It does not have the Preferred Blue Network name. The ZCY prefix may also represent an individual PPO policy. The private local marketplace (exchange) product is identified by the ZCV alpha prefix. The federally facilitated marketplace (exchange) product is identified by the ZCR alpha prefix. The PPOB symbol indicates the member got the coverage through the federal exchange. ZCY123456789999 January 2014 6
Medicare Advantage Plans Medicare Advantage Network The Medicare Advantage product uses Medicare Advantage Networks. Providers that do not participate in any of these available networks are considered out of network. Networks include health maintenance organization (HMO), medical savings account (MSA), private fee-for-service (PFFS), point of service (POS) and network sharing preferred organization (MA PPO). You can identify the applicable network by looking at the indicator on the bottom of the card. These plans are easily identifiable by the Medicare Blue SM and Medicare Blue SM Saver product names as well as the ZCT alpha prefix. January 2014 7
BlueCross BlueShield of South Carolina BlueCross Exchange Network Blue Essentials SM Individual (EPO) The Blue Essentials product covers individuals and uses the BlueCross Exchange Network (Blue Essentials Network). Providers that do not participate in the BlueCross Exchange Network (Blue Essentials Network) are considered out of network. This is a separate network from traditional PPO. Verify the network by looking for the Blue Essentials Network name on the card. The private local exchange product is identified by the ZCU alpha prefix. The federally facilitated exchange product is identified by the ZCF alpha prefix. The multi-state plans are identified by the ZCQ alpha prefix. The PPOB symbol indicates the member got coverage through the federal exchange. January 2014 8
BlueChoice HealthPlan BlueChoice Network Open Access (PPO) Carolina Advantage, Advantage Plus BlueChoice HealthPlan Open Access plans use the BlueChoice Network. Providers that do not participate in the BlueChoice Network are considered out of network. Referrals are not required for members to see specialists within the network. These plans are identifiable by the ZCL alpha prefix paired with the Carolina Advantage and Advantage Plus logos. January 2014 9
BlueChoice HealthPlan BlueChoice Network Commercial Network High Deductible Open Access (PPO) BlueChoice HealthPlan High Deductible Open Access plans use the BlueChoice Network. Providers that do not participate in the BlueChoice Network are considered out of network. Referrals are not required for members to see specialists within the network. These plans are identifiable by the ZCL alpha prefix paired with the Carolina Advantage HDHP, Advantage Plus HDHP, and Consumer Driven Health Plan logos. Members have a health savings account (HSA), health reimbursement account (HRA) or similar account to help in meeting deductibles and other approved health care expenses. January 2014 10
BlueChoice HealthPlan BlueChoice Network Commercial MyChoice Individual (PPO) BlueChoice MyChoice Individual plans use the BlueChoice Network. Providers that do not participate in the BlueChoice Network are considered out of network. Referrals are not required for members to see specialists within the network. These plans are identifiable by the ZCL alpha prefix paired with the MyChoice Individual Coverage, MyChoice Individual Coverage CDHP or MyChoice Open Access logos. January 2014 11
BlueChoice HealthPlan BlueChoice Network MyChoice Individual (PPO) BlueChoice MyChoice Individual plans use the BlueChoice Network. Providers that do not participate in the BlueChoice Network are considered out of network. Referrals are not required for members to see specialists within the network. These plans are identifiable by the ZCL alpha prefix paired with the MyChoice Open Access HDHP or MyChoice Open Access Value Plan logos. January 2014 12
BlueChoice HealthPlan BlueChoice Network MyChoice (Primary Choice Plans HMO) The BlueChoice HealthPlan MyChoice product uses the BlueChoice Network. Providers that do not participate in the BlueChoice Network are considered out of network. These products are identifiable by the MyChoice Individual Coverage logo. Members are required to select a primary care physician (PCP) and get referrals from their PCPs before seeking the services of a specialist. Primary Choice members do not have out-of-network benefits. January 2014 13
BlueChoice HealthPlan BlueChoice Network Business Advantage (Small Group PPO) The Business Advantage Plans use the BlueChoice Network. Local providers that do not participate in the BlueChoice Network are considered out of network. The private local exchange product is identified by the ZCL alpha prefix paired with the Business Advantage logo. The federally facilitated exchange product is identified by the ZCG alpha prefix. The PPOB symbol indicates the member got coverage through the federal exchange. January 2014 14
BlueChoice HealthPlan Medicaid BlueChoice HealthPlan Medicaid Network The BlueChoice HealthPlan Medicaid product uses the BlueChoice HealthPlan Medicaid Network. Providers that do not participate in the BlueChoice HealthPlan Medicaid Network are considered out of network. Members are required to also carry their State-issued Healthy Connections ID card (also pictured here). January 2014 15
BlueChoice HealthPlan BlueChoice Exchange Network MyChoice Advantage Individual (EPO) The MyChoice Advantage product uses the BlueChoice Exchange Network. Local providers that do not participate in the BlueChoice Exchange Network are considered out of network. This is a separate network from traditional BlueChoice. Verify the network by looking for the MyChoice Advantage product name on the card. The private local exchange product is identified by the ZCJ alpha prefix. The federally facilitated exchange product is identified by the ZCX alpha prefix. The PPOB symbol indicates the member got coverage through the federal exchange. January 2014 16