solutions - blue cross and blue shield of louisiana · preventive and wellness ... tools for 21st...

Solutionsfor Small Groups

Helping You Choose the Plan That’s Right for You and Your Employees

Blue Cross and Blue Shield of Louisiana and

HMO Louisiana, Inc. are Qualified Health Plan Issuers on the Small Business Health Options Program (SHOP) Marketplace

01MK5319 R04/14Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service & Indemnity Company.

If there is any discrepancy between the information in this brochure and the policy, the policy will prevail. Premium will vary with the product and the level of benefits chosen. For complete information, please refer to the policy.

Benefits are based on allowable charges. Allowable charge is defined as the lesser of the billed charge or the amount established or negotiated by Blue Cross and Blue Shield of Louisiana and HMO Louisiana, Inc. as the maximum amount allowed for all provider services covered under the terms of the policy.

Notice: Healthcare services may be provided to you at a network healthcare facility by facility-based physicians who are not in your health plan. You may be responsible for payment of all or part of those fees for those out-of-network services, in addition to applicable amounts due for copayments, coinsurance, deductibles and non-covered services.

Specific information about in-network and out-of-network facility-based physicians can be found at www.bcbsla.com/hbp or by calling the customer service phone number on your ID card.

Why Choose Blue? .......................................................................................................................... 2

GroupCare ............................................................................................................................................... 3

BlueSaver ................................................................................................................................................ 5

PremierBlue ......................................................................................................................................... 7

Blue Point of Service (POS) ...................................................................................................... 9

Essential Health Benefits ....................................................................................................... 11

Preventive and Wellness Services .................................................................................. 13

Wellness ................................................................................................................................................ 14

Prescription Drug Program ................................................................................................. 15

Benefits for Better Living ....................................................................................................... 17

Small Employer Notice ............................................................................................................. 19

Customer Service ........................................................................................................................... 21

W h a t ’ s I n s i d e

This information is presented to help you choose a plan. It is not a contract, nor is it intended to be construed as a contract.

Welcom

e

1

3. You get the Blue Team.. We’ve got 80 years in the business, and together, our employees have about 50,000 years

of experience in administering health plans.

3. Access the world’s largest healthcare network.. The sun never sets on the Blue Cross and Blue Shield network, and “going Blue” means giving

your employees access to a network of doctors, hospitals and other healthcare providers around the globe at a big discount.

3. Customer service is just a phone call or click away. Relieve your HR team; we’ll handle every question your employees have by phone, by email

or online at www.bcbsla.com.

3 Get 21st century tools for 21st century healthcare.. Every group plan comes with a suite of award-winning online tools and wellness benefits that

your employees can use to manage their benefits and stay healthy. They’ll also make it easy for you to manage your group’s health plan.

3. Unlimited flexibility that fits your budget. We’ve got lots of options for you to build a plan that fits your budget. And with ancillary benefits

through our subsidiary, Southern National Life Insurance Company, you can manage all of your employees’ benefits with one bill.

3. Attract and keep the best employees. The best employees consistently rate health insurance as one of the most influential factors in

deciding where to work. Give your employees what they want while raising the profile of your business.

All of our plans comply with the new healthcare reform laws (The Patient Protection and Affordable Care Act–ACA).

If you shop for plans on the government’s SHOP Marketplace, you’ll notice that these plans are divided into levels of coverage: bronze, silver, gold and platinum. We offer plans in each medal level so employers can find their perfect group solution.

Each plan’s level is set by its actuarial value, or how much of the total health costs a plan pays for each year. For 2014, the SHOP Marketplace is open to small employers with 50 or fewer full-time equivalent employees (FTEs).*

*www.healthcare.gov

We’re the solutionyou’re looking for...and here’s why:

Why Choose Blue?

3. We’ve got the oldest, most trusted brand in the industry.. The Blue Cross Blue Shield brand has been around since 1929 and provides

service to over 100 million Americans. You and your employees can be confident in your coverage with Blue Cross.

3. We’re a customer-owned, not-for-profit corporation.. Each one of our Blue Cross policyholders owns a piece of us. We answer

to them, and we take our stewardship seriously. We don’t hike up rates just to meet profit goals, and we pass on the discounts we negotiate with healthcare providers and pharmacies to our members.

3. We’re Louisiana strong. We’re invested in our state, and are proud to be industry leaders. We

employ over 2,000 Louisianians and we generate more than $5 billion in economic impact each year.

3. We spend your premiums on your care. Before healthcare reform laws required it, we were already spending

between 80 and 90% of every premium dollar on paying for our members’ health each year.

3. We’re leading the industry in transforming healthcare. We’re actively working with doctors, hospitals and other healthcare providers

to implement a new model of healthcare that makes health providers work hard for patients, and not the other way around.

3. We care about quality of life and keeping our members well.. Healthcare works better when people are conscious of their health and

try to stay healthy. Programs like the Louisiana 2 Step, 2Step4Kids and My Health, My Way will help your employees take big steps in improving their health.

Why Choose Blue?

2

We’ve received 14 consecutive “A” ratings from Standard & Poor’s. Information about our current rating is available at www.standard andpoors.com or by calling Standard & Poors at 212-438-2400.

We’re the solutionyou’re looking for...and here’s why:

Your GroupCare Plan*GroupCare gives you maximum flexibility in designing your group’s coverage. Your group members can rest easy knowing they have solid coverage that won’t break the bank. And you can choose the plan that’s right for your company and your budget.

NetWork tyPe

Preferred Care Provider Network• Group members will get the most benefits in the network.

• Group members get reduced benefits out-of-network, and their insurance may not pay the entire bill.

How your GroupCare plan pays for your healthcare.

Most GroupCare plans have a copayment benefit. This means that you will pay a set dollar amount, or flat fee, for some kinds of care, such as at your doctor’s office or pharmacy. Your copayment will be a lower amount for a primary care doctor and higher for specialists. When you pay a copayment, the deductible does not apply (except when you have a separate drug deductible).

If you choose a plan with a deductible, this is the amount you must pay up front before your insurance pays for your care.

If you have a plan with three or more covered family members, you only have to meet three individual deductibles.

Once you’ve paid your deductible, you’ll pay a set percentage, or coinsurance, for your care. You will pay the lowest coinsurance amount when you stay in-network for care.

What you pay toward your medical and pharmacy deductibles, copayments and coinsurance applies to your out-of-pocket max. Once you’ve paid your out-of-pocket max, your insurance will pay 100% of the cost of covered care for the remainder of the calendar year. A separate out-of-pocket max will apply for services you receive out of your network.

*GroupCare refers to policy #97176EX-036 01/14. For complete information, including limitations and exclusions, please refer to the policy.

GroupCare

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GroupCare

3.Coinsurance

4.Out-of-pocketmax

2.Deductible

1.Copayments

PPO CoverageEach of our GroupCare options provides two levels of coinsurance, with a higher level of benefits when using providers in our PPO network. If a member chooses to use the services of a non-network provider, benefits are still paid, but at the lower coinsurance level. After the out-of-pocket maximum has been reached, Blue Cross pays 100 percent of the allowable charges for covered services for the remainder of the benefit period.

Prescription Drug ProgramGroupCare provides coverage through a prescription drug program managed by Express Scripts* where members pay a copayment at the time of purchase. How much a member pays depends on the plan you choose and the drug a member buys.

Some GroupCare plans may have a separate drug deductible that must be met before the copayment is paid, depending on the group plan you purchase.

GroupCare

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In-network Coinsurance Non-network Coinsurance

Blue Cross pays

Member pays

Blue Cross pays

Member pays

80/60 80% 20% 60% 40%

70/50 70% 30% 50% 50%

60/40 60% 40% 40% 60%

*Express Scripts is an independent company, which serves as the pharmacy benefit manager for Blue Cross and Blue Shield of Louisiana.

Tier Description The amount you pay for a 30 day supply:

1Value Drugs: Primarily generic drugs, although some brand-name drugs fall into this category.

$7 or $15

2Preferred Brand Drugs: Selected for this tier based on clinical effectiveness and safety.

$30 or $40

3

Non-Preferred Brand/Generic Drugs: Primarily brand-name drugs that may have therapeutic alternatives as a Tier 1 or Tier 2 drug, although some generic drugs may fall into this category.

$70

4

Specialty Drugs: High-cost brand-name, generic drugs, or biotechnology drugs that are identified as specialty drugs†

10% of cost of drug, up to a $100 max, per fill

*Express Scripts is an independent company that provides pharmacy management service to Blue Cross and Blue Shield of Louisiana and HMO Louisiana, Inc.

BlueSaver

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BlueSaver®

Your BlueSaver Plan*BlueSaver gives your group members greater responsibility for and control over their healthcare costs. But with BlueSaver, members pay just one deductible for all of their care, then enjoy high level coinsurance benefits.

NetWork tyPePreferred Care Provider Network• Group members will get the most benefits in the network.


How your BlueSaver plan pays for your healthcare.

No copayments apply to BlueSaver plans.

You will pay a deductible with your BlueSaver, which is the amount you must pay up front before your health insurance pays for your care.

If you have a family plan (two or more persons), you and your family share one deductible which must be met before your insurance pays.

You will have a separate out-of-network deductible.

Once you’ve paid your deductible, you’ll pay a set percentage for the cost of your care. With BlueSaver, you’ll pay this coinsurance for your care. You will pay the lowest coinsurance when you receive care in your network.

What you pay toward your medical and pharmacy deductibles and coinsurance applies to your out-of-pocket max. Once you’ve paid your out-of-pocket max, your insurance will pay 100% of the cost of covered care for the remainder of the calendar year. A separate out-of-pocket max will apply for services you receive out of your network.

3.Coinsurance

4.Out-of-pocketmax

2.Deductible

1.Copayments

*BlueSaver refers to policy #97176EX-037 01/14. For complete information including limitations and exclusions, please refer to the policy.

*A complete list of qualified medical expenses can be found in Publication 502 on www.irs.gov. †The Bancorp Bank is an independent company providing health savings accounts to Blue Cross members who qualify. Blue Cross and Blue Shield of Louisiana is not engaged in rendering tax, legal or investment advice. Before opening an HSA, you should seek the guidance of a tax professional or financial advisor.

Prescription Drug Program Prescription drug benefits are included in all BlueSaver plans. How much members pay depends on the plan the employer chooses and the drug the member buys.

BlueSaver plans have a two-tier structure for prescription drugs. Once the medical deductible is met, the amount of your coinsurance depends on the plan.

Health Savings Account

When your group members have a high-deductible health plan, they are eligible to open a Health Savings Account (HSA) at a financial institution, where they can contribute part of their paycheck to their HSA without paying federal and state income tax on their contribution amount. Your business can also contribute to each member’s account. Contributions to an HSA also grow tax-free and can be spent on qualified medical expenses tax-free.

To make it easy, we recommend MySmart$aver for your group. MySmart$aver is provided by the Bancorp Bank† and offers preferred rates to Blue Cross members. The website for MySmart$aver is www.mysmartsaver.com and the toll-free 24/7 customer service number is 1-866-546-9510.

BlueSaver

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Tier Description The amount a member pays for a 30-day supply will be either:

– OR – – OR –

1 Generic drugs 0% after deductible 20% after deductible 30% after deductible

2 Brand-name drugs

20% after deductible 40% after deductible 50% after deductible

PremierBlue

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PremierBlue

Your PremierBlue Plan* With PremierBlue, your employees get the broadest coverage offered by the Cross and Shield.

NetWork tyPe

Preferred Care Provider Network• Group members will get the most benefits in the network.


How your PremierBlue plan pays for your healthcare.

Most PremierBlue plans have a copayment benefit. This means that you will pay a set dollar amount, or flat fee, for some kinds of care, such as at your doctor’s office or pharmacy. Your copayment will be a lower amount for a primary care doctor and higher for specialists. When you pay a copayment, the deductible does not apply (except when you have a separate drug deductible).

Most plans have a deductible. This is the amount you must pay up front before your health insurance pays for your care.

If you have a family plan, each person has their own deductible to meet (up to three deductibles per plan). A separate out-of-network deductible will apply.

Once you’ve paid your deductible, you’ll pay a set percentage, or coinsurance, for your care. You will pay the lowest coinsurance when you receive care in your network.

What you pay toward your medical and pharmacy copayments and coinsurance applies to your out-of-pocket max. Once you’ve paid your out-of-pocket max, your insurance will pay 100% of the cost of covered care for the remainder of the calendar year. A separate out-of-pocket max will apply for services you receive out of your network.

*PremierBlue refers to policy #97176EX-038 01/14. For complete information including limitations and exclusions, please refer to the policy.

3.Coinsurance

4.Out-of-pocketmax

1.Copayments

2.Deductible

Advantages of PremierBlue• Broad provider network across Louisiana

• Copayments for doctor visits and services

• Preventive and wellness benefits

• Prescription drug coverage

• Deductible options available for lower premium

Prescription Drug Program

PremierBlue provides coverage through a four-tier prescription drug program where members pay a copayment at the time of purchase. How much members pay depends on the plan employers choose and the drug that the member buys.

Some PremierBlue plans may have a separate drug deductible that must be met before the copayments are paid, depending on the group plan you purchase.

PremierBlue

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Tier Description The amount you pay for a 30-day supply:

1Value Drugs: Primarily generic drugs (and certain brand-name drugs)

$7 or $15

2Preferred Brand Drug: Selected for this tier based on clinical effectiveness and safety.

$30 or $40

3

Non-Preferred Brand/Generic Drugs: Primarily generic brand-name drugs that may have therapeutic alternatives as a Tier 1 or Tier 2 drug, although some generic drugs may fall into this category. Covered compounded drugs are included in this tier.

$70

4

Specialty Drugs: High-cost brand-name or generic drugs and biotechnology drugs that are identified as specialty drugs.

10% of cost of drug, up to $100 max, per fill

Blue Point-of-Service


9

Your Blue Point-of-Service Plan* A wholly owned subsidiary of Blue Cross and Blue Shield of Louisiana, HMO Louisiana, Inc., is part of the largest and most experienced health insurer in the state.

Blue Point-of-Service gives you the same excellent care and reliable costs as an HMO plan, but with the added benefit of out-of-network coverage.

NetWork tyPeHMO Louisiana Network• Your employees get the most benefits when they get care in the HMO Louisiana Network.• Members who go out-of-network will receive cost-sharing, or coinsurance, benefits.• Blue Point-of-Service is currently available in three service areas of the state: Baton Rouge,

New Orleans and Shreveport.

How your Blue Point-of-Service plan pays for your healthcare.

Most Blue POS plans have a copayment benefit. This means that you will pay a set dollar amount, or flat fee, for some kinds of care, such as at your doctor’s office or pharmacy. Your copayment will be a lower amount for a primary care doctor and higher for specialists. When you pay a copayment, the deductible does not apply (except when you have a separate drug deductible).

Most plans have a deductible. This is the amount you must pay up front before your health insurance pays for your care.

If you have a family plan, each person has their own deductible to meet (up to three deductibles per plan). A separate out-of-network deductible will apply.

Once you’ve paid your deductible, you’ll pay a set percentage, or coinsurance, for your care. You will pay the lowest coinsurance when you receive care in your network.

What you pay toward your medical and pharmacy copayments and coinsurance applies to your out-of-pocket max. Once you’ve paid your out-of-pocket max, your insurance will pay 100% of the cost of covered care for the remainder of the calendar year. A separate out-of-pocket max will apply for services you receive out of your network.

*Blue POS refers to policy #19636EX-025 01/14. For complete information including limitaions and exclusions, please refer to the policy.

3.Coinsurance

4.Out-of-pocketmax

1.Copayments

2.Deductible


HMO Louisiana provides coverage through a prescription drug program in which members pay a fixed copayment at the time of purchase.

All Blue Point-of-Service plans include a four-tier copayment structure for prescription drugs. Different copayments apply to each tier. Tier placement is based on our evaluation of a particular medication’s clinical efficiency, outputs, cost and pharmacoeconomic factors.

Some Blue POS plans may have a separate drug deductible that must be met before the following copayments are paid, depending on the group plan you purchase.


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Tier Description The amount you pay for a 30-day supply:

1Value Drugs: Primarily generic drugs (and certain brand-name drugs)

$7 or $15

2Preferred Brand Drug: Selected for this tier based on clinical effectiveness and safety.

$30 or $40

3

Non-Preferred Brand/Generic Drugs: Primarily generic brand-name drugs that may have therapeutic alternatives as a Tier 1 or Tier 2 drug, although some generic drugs may fall into this category. Covered compounded drugs are included in this tier.

$70

4

Specialty Drugs: High-cost brand-name or generic drugs and biotechnology drugs that are identified as specialty drugs.

10% of cost of drug up to $100 max, per fill

Essential Health Benefits

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Benefits Frequency Copay

Eye Exam 12 months $0

Spectacle Lenses 12 months $0

Frame 12 months $0

Contact Lens (in lieu of eyeglasses) 12 months $0

Contact Lens Evaluation, Fitting & Follow Up 12 months $0

*Pediatric Vision benefits and network are administered by Davis Vision, which is an independent company providing vision benefits to Blue Cross Blue Shield of Louisiana and HMO Louisiana, Inc. For a full list of benefits, please refer to your medical policy. To find a pediatric vision provider, go to www.bcbsla.com/findadoctor.

The Affordable Care Act ensures that individual health plans offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following categories (certain limitations and exclusions apply):

• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use disorder services, including behavioral health treatment• Prescription drugs• Rehabilitative and habilitative services and devices• Laboratory services• Preventive and wellness services and chronic disease management• Pediatric services, including oral and vision care• Contraceptive coverage• Coverage for clinical trials

Vision and Dental Health is Essential

Our new Pediatric Vision and Dental benefits satisfy the minimum essential benefits required under PPACA and provide value-added coverage to your medical plan for members under age 19.

Essential Benefit: Pediatric Vision*


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Essential Benefit: Pediatric Dental*

Contract year deductible you pay (in-network)

Per insured person (not applied to diagnostic & preventive services) $25

Benefits you pay (in-network)

Routine oral exams, oral cleanings, flouride treatments, sealants 0%

Oral x-rays 0%

Space maintainers, simple extractions, basic restorative, crown repairs,

prefabricated stainless steel crowns, emergency palliative treatment20%

Endodontic, endodontic therapy, root canal, surgical periodontics, non-surgical periodontics, periodontal maintenance, surgical extractions, oral surgery, general anesthesia/sedation

20%

Prosthetics, dentures, inlays, onlays and crowns, prosthodontic services, adjustments and repairs of prosthetics, other prosthetic services, dental implants

50%

Medically necessary orthodontic services (No benefits for cosmetic orthodontia)

50%

*Pediatric Dental Benefits are administered by United Concordia through the Advantage Plus Network. United Concordia is an independent company providing dental benefits to Blue Cross Blue Shield of Louisiana and HMO Louisiana, Inc. For a full list of benefits, please refer to your medical policy. To find a pediatric dental provider, go to www.bcbsla.com/findadoctor.

Preventive and Wellness Services

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· Subject to age requirement limits for certain preventive services.· All services are as required or directed by your physician.

This outline is presented for general information only. It is not a contract, nor intended to be a contract. If there is any discrepancy between this document and the policy, the provisions of the policy will govern. Please refer to the benefit policy for more details.

Our plans offer several preventive and wellness services to keep your employees and their covered family members healthy. Listed below is a sample of the preventive services available at no cost when obtained from a network provider.

Service Frequency Limit Age Limit

Routine physical exam One per year No limit

Pap smear One per year No limit

Prostate-specific antigen (PSA) test One per year Age 50 and older

Routine mammogram, if recommended by a physician One per year No limit

Immunizations recommended by a physician No limit No limit

Well-baby care for dependent children No limit Up to age 24 months

Colonoscopy for adult men and women One every 10 years Age 50 and older

Asymptomatic bacteriuria for pregnant women No limit No limit

Congenital hypothyroidism screening No limit Newborns less than age 1

Chlamydial and gonorrhea screenings for women One per year No limit

Hearing screening One per year Ages 0 - 21

Hepatitis B virus infection screening for pregnant women No limit No limit

HIV screening No limit No limit

Cholesterol screening No limit No limit

Osteoporosis screening in postmenopausal women One per year Age 60 and older

Sickle cell disease screening No limit Newborns less than age 1

Syphilis infection screening One per year No limit

Type 2 diabetes mellitus screening in adults No limit No limit

Visual impairment screening One per year Ages 0 - 21

Lead screening One per year Ages 0 - 6

Developmental screenings No limit Ages 0 - 3

Autism screenings No limit Ages 1 - 2

Tuberculosis screening One per year Ages 0 - 21

Skin cancer screening for young adults One per year Ages 10 - 24

Obesity screening for adults One per year Age 18 and older

Screening for intimate partner violence and abuse One per year Women of childbearing age

Vitamin D supplementation to prevent falls No limit Age 65 and older



Wellness

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Return on InvestmentAt Blue Cross and Blue Shield of Louisiana, we’re workplace wellness evangelists. Why? Because we’ve seen the results.

Since we started our own workplace wellness program in 2006, we’ve seen:

• Staff turnover go down by 5%

• Our workers’ compensation costs go down by 13.6%

• A 20% drop in disability costs

• A total employee weight loss of 4,661 pounds in 2010 alone.

Wellness

Workplace Wellness powered by My Health, My Way

Having healthy employees means more productivity, less absenteeism and a better attitude in the workplace. With My Health, My Way, we give you the tools you need to engage your employees in their health, including:• Free Personal Health Assessments (PHA) for your employees• Healthy lifestyle resources• Wellness trackers• Access to healthy and fun events in your area• Local health resources• Exclusive discount programs• And more!

Care Management Programs

Blue Cross and Blue Shield of Louisiana offers care management programs to help our members with chronic conditions or serious injuries. These programs help our members navigate the medical system and get appropriate and timely care. Our disease management programs are designed to prevent and manage specific diseases such as asthma, diabetes and heart disease.

Online Tools and Discounts

By logging into their online accounts at www.bcbsla.com, your employees will find free tools that help them track weight loss, eating habits, exercise and more. They’ll also find ways to get and stay in shape that are local, fun and social.

Your employees will also get great discounts that are exclusive to our Blue365 network (see next page for more information.)

Security and Confidentiality: If your Personal Health Assessment identifies you as someone who may benefit from Care Management services, your information may be shared with medical personnel, and you may be contacted by a Care Management nurse.

The information you provide in the PHA will be used as described above and as permitted by law. Your responses will not affect your enrollment in a health plan or your premiums.



15

Prescription Drug Program – Convenience, Simplicity

Prescription drugs are a regular medical expense for many people, and are the most-used part of any health insurance plan. Our comprehensive plans give you the coverage you need to keep your employees healthy and happy. Our prescription benefits are managed by Express Scripts.

Depending on the group plan you choose, members pay either a fixed copayment or deductible and coinsurance at the time of purchase. Some plans have a separate prescription drug deductible that members must pay before the copayments apply.

your Pharmacy Network

We have a broad nationwide pharmacy network. However, if members choose to go out-of-network they must pay for the drug at the point of sale and may be required to file a claim to get benefits. We will reimburse our in-network amount and members will owe the difference.

Prior Authorization

We may ask your group members to get authorization from us or our pharmacy benefit manager before they fill certain prescriptions.

You can find a complete list of drugs that need prior authorization online at www.bcbsla.com/pharmacy.

Mail ServiceYour group members may use the Express Scripts mail-order system, which features:• Rapid at-home prescription delivery

• Toll-free 24-hour access to registered pharmacists

• A toll-free drug information line

Refills can be ordered by mail, phone or online at www.express-scripts.com.

Lead With Generics and Step therapy

In some cases, we may ask your group members to try a generic or generic equivalent to the drug their doctor prescribed.

If this drug doesn’t work in treating a member’s condition, we’ll then cover the drug prescribed by the doctor.

Quantity Per Dispensing Limitations and Allowances

Your group members may get a 30-day supply of their drug (or a 90-day supply of maintenance medications). These are available at retail pharmacies or by mail.

We base these limits on the manufacturer’s recommended dosage and duration of therapy; common usage for episodic or intermittent treatment; FDA-approved recommendations and/or clinical studies; and/or as determined by our Pharmacy and Therapeutics Committee.

Specialty Pharmacy Network

We maintain a specialty pharmacy network to administer drugs that require special ordering, handling, customer service or patient education. Specialty drugs require an authorization.

If members fill prescriptions for these drugs outside of the specialty pharmacy network, they may be required to pay for the drug at the point of sale and file a claim to get benefits. Your producer, agent or our customer service department can provide you with a list of specialty drugs.


16

Limitations and exclusions We exclude certain prescription drugs from coverage, including, but not limited to:• Drugs used for cosmetic purposes

• Fertility drugs

• Weight reduction drugs

• Impotence drugs

• Brand-name contraceptive drugs

Benefits for Better Living

17


As Blue Cross members, your employees will have access to a network of discounts on just about everything they’ll need to get and stay healthy.

Fitness

• Gym memberships – $25 a month for unlimited access to a network of local gyms in your area through Healthways.

• Gym gear – Including heart rate monitors and 15-20% off Reebok products.

Personal Care

• Senior Care – Discounts of elder care support services.• Davis Vision – Up to 40% off exams and frames.• LASIK – Discount on LASIK surgery from QualSight.

Healthy eating

• eDiets.com and NutriSystem.

Living

• Financial Services – Including tax preparation services from H&R Block.

Discounts from Blue365

TM


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Dental DiscountsYour employees will get special discounts on dental services, even if your plan doesn’t include dental coverage.

Benefits That Travel

With a global network of doctors, hospitals and other healthcare providers, your employees can be sure they’ll have access to care wherever they are.

And with the Blue Cross and Blue Shield Doctor and Hospital Finder app, it’s easier than ever before to find care.

When it comes to vacation, go hard, but go prepped for everything.

remember to Pack

• Your Blue Cross member ID card – Get medical care just about anywhere.

• Our mobile phone provider directory – Search for doctors and hospitals in your network with your smartphone. Use the bar code to the right or search for “Blue Cross provider directory” in the app store.

When you Need Care

1. If it’s a true emergency, go to the nearest emergency room.

2. If it’s not an emergency, find a doctor in your network. Use the mobile phone app, search online at provider.bcbs.com, or call 1-800-810-BLUE (2583).

3. Either way, give us a call. When you can, call Customer Service at the number on your ID card. A five-minute phone call can save you a big, unexpected bill from an out-of-network doctor or hospital.

Find a Dental Discount Provider• Visit www.bcbsla.com/

findcare.

• Under “Network,” choose “Discount Dental.”

• Click Search.

Small Em

ployer Notice

19

Small Employer Notice

. Premiums for this Benefit Plan may increase after the Group’s first twelve (12) months of coverage except when premiums may increase more frequently as described in the following paragraph. Except as provided in the following paragraph, We will give Group forty-five (45) days written notice of any change in premium rates (ninety (90) days written notice for employer groups with more than one-hundred (100) enrolled employees). We will send notice to the Group’s latest address shown in Our records. Any increase in premium is effective on the date specified in the rate change notice. Continued payment of premium will constitute acceptance of the change.

We reserve the right to increase the premiums more often than stated above due to a change in the extent or nature of the risk that was not previously considered in the rate determination process at any time during the life of the Benefit Plan. This risk includes, but is not limited to, the right to increase the premium amount because of: (1) the addition of a newly covered person; (2) the addition of a newly covered entity; (3) a change in age or geographic location of any individual insured or policyholder; (4) or a change in the policy Benefit level from that which was in force at the time of the last rate determination. An increase in premium will become effective on the next billing date following the effective date of the change to the risk. Continued payment of premium will constitute acceptance of the change.

Change in Premium Amount

Small Em

ployer Notice

20

. Company may terminate this Benefit Plan if any one of the following occurs:

• Group commits fraud or makes an intentional misrepresentation.

• Group fails to comply with a material plan provision, including, but not limited to provisions relating to eligibility, employer contributions or Group participation rules. If the sole reason for termination is that Group’s participation falls to less than two (2) employees (there is only one (1) employee covered (or owner, if covered), termination of Group coverage will be effective on the Group’s next anniversary date. Otherwise, termination for a reason addressed in this paragraph will be effective after Group receives sixty (60) days written notice as described below.

• In the case of Network plans, there is no longer any enrollee under the Group benefit plan that lives, resides or works in the service area of the Company or in the area for which the Company is authorized to do business.

• Group’s coverage is provided through a bona fide association and the employer’s membership in the association ends.

• Company ceases to offer this product or coverage in the market.

Renewability of Coverage

Customer Service

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Customer Service

By phone

8 a.m. – 5 p.m., Monday through Friday

1-800-599-BLUE (2583)

on the web

www.bcbsla.com

online Solutions through AccessBlue

AccessBlue, our secure online portal, lets you manage your group plan with the click of a mouse. Simply visit www.bcbsla.com and click on AccessBlue to get started.

This self-service tool includes eEnrollment, which allows you to enter new hire applications, track their status, make changes to employee contracts, enter terminations, request member materials and more. Within this tool you can also choose the eBilling option, where you can preview invoices, make electronic payments and view your payment history.

other AccessBlue features include:

• Training and support via an eLearning module• Health management tools• Access to a wealth of knowledge and resources from the

convenience of your desktop!

Notes:

Solutionsfor Small Groups

Helping You Choose the Plan That’s Right for You and Your Employees

Blue Cross and Blue Shield of Louisiana and

HMO Louisiana, Inc. are Qualified Health Plan Issuers on the Small Business Health Options Program (SHOP) Marketplace

SaleS OfficeS

lake charles 337-562-0595 219 West Prien Lake Road Lake Charles, LA 70601-8450

Monroe 318-323-1479 2360 Tower Dr., Suite 102 Monroe, LA 71201

New Orleans 504-832-5800 3501 North Causeway Blvd., Suite 600Metairie, LA 70002

Shreveport 318-795-0573 411 Ashley Ridge Blvd. Shreveport, LA 71106

alexandria 318-448-1660

4508 Coliseum Blvd., Suite A Alexandria, LA 71303

Baton Rouge 225-295-2556

5525 Reitz Ave. Baton Rouge, LA 70809-3802

Houma 985-853-5964

1437 St. Charles St., Suite 135Houma, LA 70360

lafayette 337-232-7527

5501 Johnston St. Lafayette, LA 70503

Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service & Indemnity Company.

solutions - blue cross and blue shield of louisiana · preventive and wellness ... tools for 21st...

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