hmo blue new england options v.4 deductible plan
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HMO Blue New England Options v.4 Deductible Plan. - PowerPoint PPT PresentationTRANSCRIPT
HMO Blue New England Options v.4 Deductible Plan
This health plan includes a tiered provider network called HMO Blue New England Options v.4. Members in this plan pay different levels of cost share (copayments, coinsurance, and/or deductibles) depending on the benefits tier of the provider furnishing the services. A provider’s benefits tier may change. Overall changes to the benefits tiers of providers will happen no more than once each calendar year. For help in finding the benefits tier of a provider, visit the online provider search tool at www.bluecrossma.com and search for HMO Blue New England Options v.4.
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HMO Blue NE Options v.4 Deductible Plan
• Use HMO Blue New England Network Providers
• Choose PCP - Change Effective 1st of Month
• Referrals to Network Specialists
• No Referrals For: OB/GYN, Chiropractic or Outpatient Behavioral Health Visits, Routine Vision Exam, Emergency or Out-of-Area Urgent Care
HMO Blue NE Options v.4 Deductible Plan
• Supports Our Promise to Put Our Members’ Health First
• Provides Cost Share Incentives to Encourage Use of High-Quality, Lower-Cost Providers
• Plan Design Encourages You to Become More Engaged in Making Health Care Decisions
• You Can Control What You Pay For PCP Visits & Hospital Services
HMO Blue NE Options v.4 Deductible PlanPCPs & General Hospitals in Massachusetts Network*
Ranked in 3 Benefit Tiers: • Enhanced
- Hospitals and PCPs that meet the standards for quality and low cost.
- You Pay Lowest Cost Share
• Standard
- Hospitals and PCPs that meet the standards for quality and moderate cost. Hospitals that do not meet the standards for quality but meet the standards for low or moderate cost.
- You Pay Standard Cost Share
• Basic
- Scored Below Benchmarks For Quality and/or Moderate Cost
- You Pay Highest Cost Share
*Providers in NH, ME, VT, RI & CT Covered as Enhanced
Find Your Providers’ Tiers
• Go to Blue Options Resource Center at www.bluecrossma.com/blueoptions/ or Call Member Service
- Find Provider’s Tier
- Find How Provider Scored on Each
Benchmark
- Find PCP’s Hospital Affiliations
Preventive Visits
Preventive Visits, Related Tests & Immunizations Covered in Full – No Copayment!
• Well-Child Care Visits
• Routine Adult Physical Exams
• Routine GYN Exams
• Routine Vision Exams
• Routine Hearing Exams
• Family Planning Services - Office Visits
Tiered Benefits
• PCP Office Visits
- $15/$25/$50
• Plan-Year Deductible (General Hospital Services Only)
- Enhanced Hospitals: No Deductible
- Standard Hospitals: $500/$1,000
- Basic Hospitals: $2,000/$4,000
General Hospital Benefits
• General Hospital Inpatient & Surgical Day Care Admissions
- $150/$150*/$1,000*• Emergency Room Visits/Admissions: $150
(Any Hospital)• General Hospital Outpatient MRIs, Nuclear
Cardiac Imaging Tests, PET & CT Scans
- $50/$50*/$450*
* After Deductible
General Hospital Benefits
• General Hospital Outpatient Chemotherapy, Radiation Therapy & Dialysis
- Nothing/Nothing/Nothing (No Deductible)• General Hospital Outpatient Physical,
Occupational, Speech Therapy & Cardiac Rehabilitation
- $50/$50/$50 (No Deductible)• Other General Hospital Tests & Medical Visits
- Nothing/Nothing*/Nothing*
* After Deductible
Other Services Not Tiered
• Outpatient Behavioral Health Visits: $15
• All Other Outpatient Professional Providers’ & Specialists’ Visits: $50
• Outpatient MRIs, Nuclear Cardiac Imaging Tests, PET & CT Scans (At Other Than a General Hospital): $50
• Day Surgery at an Ambulatory Surgical Facility (At Other Than a General Hospital): $150
Other Services Not Tiered
• Inpatient Admissions to Chronic Disease, Mental Health & Substance Abuse Treatment Hospitals: $150
• Retail Rx: $15/$30/$50
• Mail Service Rx: $30/$60/$150
• All Other Services Covered in Full
Out-of-Pocket Maximum
$5,000/$10,000 Plan-Year Out-of-Pocket Maximum
Includes:
• Deductible
• Copayments Over $100 (Except Rx)
Considerations
• PCP’s Tier
• Covering PCP’s Tier
• PCP’s Hospital Affiliations
• Hospitals Used by Specialists to Whom PCP Refers
• Go to www.bluecrossma.com/blueoptions/
or Call Member Service to find a new PCP
Healthier Living
• $150 Fitness Benefit
• $150 Weight Loss Benefit
• Living Healthy Babies!
• Childbirth Class Benefit
• Blue Care Line: 1-888-247-BLUE (2583)
• Blue365 – Health & Wellness Resources/Discounts
• Living Healthy Vision Discounts
• Living Healthy Naturally Discounts
• Safe Beginnings Discounts
Member Central Account
www.bluecrossma.com
Create an Online Account, Then You Can:
• Change Your PCP
• Request an ID Card
• Review Your Benefits
• Review Your Claims
• Enroll in My Blue Health
Questions?
For Provider Information or Questions About Membership, Benefits, Referrals or Claims Call Member Service Number on ID Card
Monday - Friday, 8 a.m.- 6 p.m.
or Visit www.bluecrossma.com