Arkansas State Employees

Arkansas State Employees 2006 HMO POS www.HealthAdvantage-hmo.com PPO www.ArkansasBlueCross.com We have dedicated Customer Service Representativ...
Author: Sydney Blair
4 downloads 0 Views 569KB Size
Arkansas State Employees 2006

HMO POS

www.HealthAdvantage-hmo.com

PPO

www.ArkansasBlueCross.com

We have dedicated Customer Service Representatives to serve the Arkansas State and Public School Employees and we have three electronic features that you may prefer – e-mail, My Blueprint and My BlueLine, interactive voice response phone line. Also, we have staff in six Regional Offices throughout the state available to assist with your claims and benefits questions during normal business hours.

Call one of our Regional Offices Jonesboro Fayetteville Fort Smith Hot Springs Texarkana Pine Bluff

Health Advantage 1-800-482-8416 USAble Corporate Center 320 W. Capitol, Suite 400 PO Box 8069 Little Rock, AR 72203-8069 www.HealthAdvantage-hmo.com email: [email protected]

1-800-299-4124 1-800-817-7726 1-800-299-4060 1-800-588-5733 1-866-254-3969 1-800-236-0369

Arkansas Blue Cross and Blue Shield 1-800-482-8416 USAble Corporate Center 320 W. Capitol, Suite 400 PO Box 2181 Little Rock, AR 72203-2181 www.ArkansasBlueCross.com email: [email protected]

To determine when and if providers have joined the PPO or HMO network visit the provider directories (updated nightly) found at www.ArkansasBlueCross.com or www.HealthAdvantage-hmo.com. By using the providers listed in the directory, members will receive the highest level of benefits from their health plan.

Arkansas State Employees Arkansas Blue Cross and Blue Shield & Health Advantage Rates 2006

ACTIVE EMPLOYEES

EMPLOYEE ONLY Health Advantage HMO Health Advantage POS BCBS PPO EMPLOYEE AND SPOUSE Health Advantage HMO Health Advantage POS BCBS PPO EMPLOYEE AND CHILD(REN) Health Advantage HMO Health Advantage POS BCBS PPO EMPLOYEE AND FAMILY Health Advantage HMO Health Advantage POS BCBS PPO

COBRA

EMPLOYEE ONLY Health Advantage HMO Health Advantage POS BCBS PPO EMPLOYEE AND SPOUSE Health Advantage HMO Health Advantage POS BCBS PPO EMPLOYEE AND CHILD(REN) Health Advantage HMO Health Advantage POS BCBS PPO EMPLOYEE AND FAMILY Health Advantage HMO Health Advantage POS BCBS PPO

Payroll Deduction Amount (No **HRA Completed)

HRA Completion Employee (or spouse) Tobacco User

HRA Completion Employee (or spouse) Non-Tobacco User

HRA Completion Employee and Spouse Tobacco User

HRA Completion Employee and Spouse One NonTobacco User

HRA Completion Employee and Spouse Two NonTobacco User

$ 45.65 $ 49.44 $ 108.98

$ 40.65 $ 44.44 $ 103.98

$ 36.65 $ 39.44 $ 98.98

$ 159.10 $ 168.20 $ 311.10

$ 154.10 $ 163.20 $ 306.10

$ 149.10 $ 158.20 $ 301.10

$ 149.10 $ 158.20 $ 301.10

$ 144.10 $ 153.20 $ 296.10

$ 139.10 $ 148.20 $ 291.10

$ 84.75 $ 90.45 $ 179.76

$ 79.75 $ 85.45 $ 174.76

$ 74.75 $ 80.45 $ 169.76

$ 180.17 $ 190.22 $ 348.00

$ 175.17 $ 185.22 $ 343.00

$ 170.17 $ 180.22 $ 338.00

$ 170.17 $ 180.22 $ 338.00

$ 165.17 $ 175.22 $ 333.00

$ 160.17 $ 170.22 $ 328.00

Total Monthly Cost (No **HRA Completed)

HRA Completion Employee (or spouse) Tobacco User

HRA Completion Employee (or spouse) Non-Tobacco User

HRA Completion Employee and Spouse Tobacco User

HRA Completion Employee and Spouse One NonTobacco User

HRA Completion Employee and Spouse Two NonTobacco User

$ 340.75 $ 348.48 $ 469.94

$ 330.75 $ 338.48 $ 459.94

$ 320.75 $ 328.48 $ 449.94

$ 811.33 $ 829.89 $1,121.41

$ 801.33 $ 819.89 $ 1,111.41

$ 791.33 $ 809.89 $ 1,101.41

$ 791.33 $ 809.89 $ 1,101.41

$ 781.33 $ 799.89 $ 1,091.41

$ 771.33 $ 789.89 $ 1,081.41

$ 506.72 $ 518.35 $ 700.54

$ 496.72 $ 508.35 $ 690.54

$ 486.72 $ 498.35 $ 680.54

$ 900.44 $ 920.95 $ 1,242.82

$ 890.44 $ 910.95 $ 1,232.82

$ 880.44 $ 900.95 $ 1,222.82

$ 1,222.82 $ 900.95 $1,006.47

$ 1,212.82 $ 890.95 $1,006.47

$ 1,202.82 $ 880.95 $1,006.47

NOTE: The Employee Rates stated above are set by the Arkansas State & Public School Life and Health Insurance Board. RETIREES: Rates are posted on the Employee Benefits Division web site. In September Health Advantage will mail brochures with new rates and ARHealth Benefits to the home address of current retirees.

SELF-SERVICE FEATURES If your busy lifestyle demands all your time during the normal 8 to 5 customer service hours, we have two selfservice features that are available 24 hours a day, seven days a week.

My Blueprint is an online, self-service center for members of Health Advantage and Arkansas Blue Cross. We strive to meet customer expectations by providing members with this convenient self-help access to their health plan information 24 hours a day, seven days a week. For Health Advantage members, the self-service center is available on www.HealthAdvantage-hmo.com. Arkansas Blue Cross members should go to www.ArkanasasBlueCross.com. Register today to access My Blueprint. Click on the First-Time User link and follow the instructions to create your own log-on and password, giving you immediate secure access to your information.

What can I do by using My Blueprint? o o o o

Check member eligibility Check status of claims and claim history Update My Blueprint information Medical Cost & Quality Calculator (New)

o o o o

Order replacement ID card View Explanation of Benefits Access HealthConnect Blue Generic Drug Calculator (New)

My BlueLine, the interactive voice response system, recognizes speech patterns to answer questions when you call the customer service telephone number 1-800-482-8416. If you are calling during business hours, at any time you can press “1” to use My BlueLine or press “2” to immediately be routed to the next available customer service representative. If you choose to use My BlueLine, you simply respond to the questions asked by the system – with no buttons to push – getting your questions answered quickly and easily. What information is available by using My BlueLine? o o

Get answers to benefit questions Check status of claims

o o

Order a new ID card Order a claim form

With HealthConnect Blue, you have access to a Health Coach day or night by calling 1-800-318-2384 or through the HealthConnect Blue link from My Blueprint at www.ArkansasBlueCross.com or www.HealthAdvantage-hmo.com. When should you call? • When you’re looking for general health information • When you’re admitted to or discharged from the hospital • When you want more information about your disease or illness A Health Coach can offer information, support and help you work with your doctor to make confident health decisions that are right for you. Being well informed is the first step in taking charge of your health. There’s no better place to start than with a HealthConnect Blue Health Coach.

Call 1-800-318-2384 today!

Arkansas State Employees Preventive Dental Rider The Arkansas State Employees with medical insurance administered by Health Advantage have a preventive dental rider with their medical coverage: No referral is required for this benefit, which is a $25 copayment, limited to two (2) preventive visits per year per covered member. The dental network available to State Employees for preventive services includes all dentists who are participating with Arkansas Blue Cross and Blue Shield’s Preferred Payment Plan (PPP). No reimbursement will be made for services provided by non-participating dentists or for services other than the codes listed below. CODE

DESCRIPTION

0120 0140

Periodic oral evaluation Limited oral evaluation – problem focused

0150

Comprehensive oral evaluation Intraoral X-rays – Periapical – first film Intraoral X-rays – Periapical – each additional film

0210 0220

BENEFIT GUIDELINE Two periodic exams per member per year Limited oral exam when done in conjunction with a procedure at the same visit is considered part of the definitive procedure and a separate fee may not be charged. Includes a thorough examination and recording of the extraoral and intraoral hard and soft tissues. A full mouth series is covered once every 3-5 years

Routine working and final treatment x-rays are part of a complete procedure and are not a separate benefit. A maximum of 8-10 films are allowed on the same date of service.

0230

Intraoral X-rays – Periapical each additional film

0240

Intraoral X-rays – Occlusal film Extraoral – first film Extraoral – each additional film Bitewing – a film Bitewing – 2 films Bitewing – 4 films

Two occlusal films per 12 month period.

Panoramic film Prophylaxis – Adult Prophylaxis – Child Topical application of fluoride – child (prophylaxis not included) Sealant – to age 10 on 1st molars, age 15 on 2nd molars

1 of either D0210 or D0330 in a 5 year period

0250 0260 0270 0272 0274 0330 1110 1120 1203

1351

One series of bitewing x-rays (2 or 4) allowed per calendar year.

Two topical applications of fluoride allowed per calendar year for covered dependents up to their 19th birthday. 1 per tooth in a 3 year period.

State Employees and their dependents do not have a separate dental identification card for this benefit. To receive reimbursement, claims should be filed using your Health Advantage identification number. Note: If you have a DentalBlue policy through ASEA/SEBCO, this rider is not related to that dental policy. If you have services other than those listed above, please ensure your dentist has both identification numbers.

Health Advantage HMO and POS Questions and Answers Have you ever wondered if you have coverage outside Arkansas? What if your children live or go to school in another state? Do you have a European vacation on the horizon? BlueCard® can help. Q: What is BlueCard? A: BlueCard links participating health-care providers and the independent Blue Cross and Blue Shield Plans across the country through a single electronic network for professional, outpatient, and inpatient claims processing reimbursement. The program allows participating Blue Cross and Blue Shield providers in every state to submit claims for patients who are enrolled through another Blue Plan to their local Blue Cross and Blue Shield Plan. The three-character alpha prefix (XCH) at the beginning of the member’s identification number is the key element used to identify and correctly route out-ofarea claims. The alpha prefix identifies the Plan or national account to which the member belongs. Q: How does BlueCard work? A: When you need urgent or emergency care out of the service area, you can call 1-800-810-2583 (BLUE) located on the back of the Identification Card to locate a Blue Cross and Blue Shield provider. You should ask for the traditional network. The call center is open 24 hours a day, seven days a week. You may also access BlueCard providers online at www.bcbs.com. The claim is filed with the local Blue Plan and the alpha prefix lets the local Plan know where to route the claim. Members using the BlueCard Access have innetwork benefits for care outside the service area. Q: My child will be attending college out of state. How will he/she be covered? A: Contact Customer Service at 1-800-482-8416 and request an Out of Area application or go to www.HealthAdvantage-hmo.com to print a form. Your child will be listed as an Out of Area college student and your normal benefits will apply to Blue Cross providers in that state. Q: I am required to carry insurance on my children who reside with their other parent out of state. Are they eligible for coverage?

A: Yes. You should contact Customer Service at 1800-482-8416 and request an Out of Area application or go to www.HealthAdvantagehmo.com to print a form.. Your dependents will be listed as Out of Area dependents and your normal benefits will apply if they see Blue Cross participating providers in that state. Q: If we’re on vacation out of state and one of us becomes ill, how can we get urgent or emergency care? A: If it’s a true emergency, seek medical assistance at the nearest facility. Emergency care is covered as in-network no matter where you receive it. If it’s not an emergency, but is an illness that requires medical attention, you should call the BlueCard number (located on the back of your identification card) at 1-800-810-2583 (BLUE). This is a provider locator service which will give you names of Blue Cross Blue Shield providers in your travel area. Q: What do I need to do if I need urgent or emergency care and I’m outside the United States? A: Members traveling abroad should contact the BlueCard helpline at 1-800-810-2583 (BLUE) and ask for BlueCard Worldwide. This is a provider locator service open 24 hours a day, 365 days a year. We also recommend that you visit the Web site at www.bcbs.com to locate providers in advance and take advantage of the valuable health and travel information listed there. Q: I am going on COBRA and will be moving out of state. Am I eligible to continue coverage? A: Yes. Contact Customer Service at 1-800-4828416 and request an Out of Area application or go to www.HealthAdvantage-hmo.com to print a form. You will be listed as an Out of Area member and your normal benefits will apply if you see Blue Cross providers in that state.

General Questions and Answers Q: Do I need a referral for my annual gynecologist visit and mammogram? A: No. Both are covered without a referral. No referral is ever required to an in-network gynecologist. Q: What is covered under the Enhanced Wellness Benefit? A: For a complete list of preventive services that are now covered 100%, visit www.arbenefits.org and look under the “Benefits Library” for the Summary Plan Description or you may call Customer Service at 1-800-482-8416. Q: Do I need referrals if I’m under the POS plan? A: POS members, you have a choice. You can choose to seek care in-network and follow the same guidelines as the HMO members or you have the option to go out-of-network or seek specialty care without a referral and pay an additional cost. When medical care is obtained out-of-network, you are responsible for the out-of-network deductible, copayment, coinsurance, and may also be responsible for the difference between billed charges and the Health Advantage allowed amount. Q: Does Health Advantage require preauthorization for services? A: Health Advantage only requires preauthorization for the following services: • Breast reduction (not related to cancer) • Enteral feeding • IDET • Out-of-network services • Swing bed care (pre-authorization from Case Management) • Transplant (excluding kidney and cornea) Q: Are pre-existing conditions excluded? A: No. The State of Arkansas does not exclude preexisting conditions. Q: My Emergency Room (ER) claim was denied for not being an emergency. What is an emergency? A: An emergency is defined as traumatic bodily injury or sudden, unexpected onset of an illness which requires immediate care and attention from a

qualified physician, or when the condition, if not treated immediately, could reasonably be expected by a prudent layperson to result in serious physical impairment. When emergency services are needed, the member is to proceed as follows: 1. Seek emergency care immediately at the nearest emergency facility. 2. As soon as possible, notify your PCP of your emergency care, so that follow-up care may be arranged. 3. All follow-up care must be authorized by the PCP and rendered by an in-network provider in order for in-network benefits to apply. Q: How will the Any Willing Provider (AWP) law affect my coverage? A: AWP is an Arkansas law, so providers outside Arkansas will not be affected. In Arkansas, if a provider applies to be a participating provider, and completes our credentialing process, then that provider will be part of the Health Advantage network, and normal in-network benefits will apply. Providers will still have the choice whether or not to participate, so there may still be some providers who will not be in-network. For the most accurate and up-to-date provider directory, please visit www.HealthAdvantage-hmo.com. Q: May I remain with Health Advantage after my retirement? How will my coverage change? A: Yes, as a retiree under age 65 and not Medicare primary, you may remain on this Health Advantage plan. Your copays, out-of-pocket maximums and benefits (including a prescription drug card) will remain the same. Non-Medicare primary retirees also have the option to move to the ARHealth benefit plan. While the benefits will remain the same, the premium amount, copays and out-ofpocket maximums will change. Retirees over age 65 or Medicare primary retirees will be automatically changed to the ARHealth benefit plan administered by Health Advantage. More information is currently available on the Health advantage Web site:

www.HealthAdvantage-hmo.com

Arkansas State Employees 200 IN-NETWORK HMO & POS DEDUCTIBLE ANNUAL COINSURANCE LIMIT Copays do not apply to coinsurance limit LIFETIME MAXIMUM PHYSICIAN SERVICES Primary Care Physician Office Visits Specialist Office Visits Inpatient and Outpatient Physician Services PREVENTIVE CARE SERVICES - *Please refer to SPD for a complete list of covered preventive services HOSPITAL SERVICES Inpatient Services (semi-private room) Maximum 3 Copays per person per contract year Outpatient Surgery Outpatient diagnostic testing (lab, x-ray, tests performed outside the doctor’s office) Emergency Room Visit or Urgent Care Center- Copay waived if admitted to the same hospital as in-patient ALLERGY SERVICES Office Visit

Allergy Injections Allergy Serum AMBULANCE SERVICES$1,000 Maximum Per Member Per Contract Year REHABILITATIVE SERVICES Inpatient Rehabilitation Services- Limited to 60 days per Member per Contract Year Outpatient Rehabilitation Services: Physical, Occupational, and Speech Therapy Chiropractic Services and Cardiac Rehab Limit of 60 aggregate visits per Member per contract year MATERNITY SERVICES Initial Specialist Visit OB Services Hospital Services (facility fee) Inpatient Physician Services Outpatient Diagnostic Testing (lab and X-ray)

NOT APPLICABLE $1,000 Individual $1,500 Family Unlimited $20 Copayment $25 Copayment 10% Coinsurance $0 Copayment 0% Coinsurance $250 Copayment + 10% Coinsurance $100 Copayment 10% Coinsurance $100 Copayment

$20 PCP Copayment or $25 Specialist Copayment 0% Coinsurance 0% Coinsurance

OUT-OFNETWORK POS ONLY $500 Individual $1,000 Family $4,000 Individual $8,000 Family $1,000,000 30% after Deductible 30% after Deductible 30% after Deductible 30% after Deductible

30% after Deductible 30% after Deductible 30% after Deductible $100 Copayment

30% after Deductible 30% after Deductible 30% after Deductible

0% Coinsurance

10% Coinsurance

$250 per admission + 10% Coinsurance

30% after Deductible

20% Coinsurance

30% after Deductible

$25 Copayment $0 Copayment + 10% Coinsurance $250 Copayment + 10% Coinsurance $0 Copayment + 10% Coinsurance 0% Copayment + 10% Coinsurance

30% after Deductible 30% after Deductible 30% after Deductible 30% after Deductible 30% after Deductible

06 HMO/POS Benefit Summary DURABLE MEDICAL EQUIPMENT$10,000 MAX PER MEMBER PER CONTRACT PROSTHETICS- $15,000 ANNUAL MAXIMUM DIABETIC EQUIPMENT AND INSULIN PUMP SUPPLIES (Diabetic supplies not for insulin pump are covered by the prescription drug card) OSTOMY SUPPLIES HOME HEALTH SERVICES-120 VISITS PER MEMBER PER CONTRACT YEAR HOME IV DRUGS/SOLUTIONS INJECTABLE MEDICATIONS-Medications when covered by Health Advantage-Subject to exclusions and limitations INFERTILITY SERVICES** Infertility Counseling Infertility Testing (outpatient Surgery Copay may apply) SKILLED NURSING FACILITYLimited to 60 days Per Member Per Contract Year Hospice Care (must be approved by Health Advantage) TMJ- Covered when diagnosed as medical condition Limited to $500 Lifetime Maximum per Member Organ Transplant Services- must be approved by Health Advantage (2 transplants per Member per Lifetime) – kidney and cornea transplants are not subject to prior approval. Routine Vision Exam 1 every 24 months Preventive Dental (cleanings and exam) 2 per person per year (see page 5 for complete list of services)

IN-NETWORK HMO & POS

OUT-OFNETWORK POS ONLY

20% Coinsurance

30% after Deductible

20% Coinsurance

30% after Deductible

20% Coinsurance

30% after Deductible

10% Coinsurance

30% after Deductible

0% Coinsurance

30% after Deductible

10% Coinsurance Office Visit Copay May Apply

30% after Deductible

$25 Copay 10% Coinsurance $250 Copay + 10% Coinsurance 20% Applicable Copay 10% Coinsurance $250 per admission

30% after Deductible 30% after Deductible 30% after Deductible 30% after Deductible 30% after Deductible 30% after Deductible NOT COVERED

$25 Copay

NOT COVERED

$25 Copay

NOT COVERED

*The Summary Plan Description (SPD) can be viewed online at www.arbenefits.org under the Benefits Library section, or you may contact Employee Benefits Division for a paper copy. **Treatment for infertility is not a covered benefit – benefits cover testing and counseling only. NOTE: Out-of-Network Deductible, Copayment and Coinsurance amounts do not apply to the In-Network Annual Coinsurance Limit. Annual Coinsurance Limits are calculated on a fulfillment basis, not aggregate. Expenses incurred for services that exceed benefit limits are not applied to the Annual Coinsurance Limit. For In-Network benefits, services must be performed, arranged or authorized by the Primary Care Physician, except for Emergency Care. The Member may be responsible for the difference between Billed Charges and Allowable Charges for services covered at the Out-of-Network benefit level if the provider does not participate with any Blue Cross plan nationwide. To determine when and if providers have joined the HMO network visit the provider directories (updated nightly) found at www.HealthAdvantage-hmo.com. By using the providers listed in the directory, members will receive the highest level of benefits from their health plan.

Arkansas State Employees Indemnity PPO Benefit Summary 2006 In-Network Deductible (Annual) Individual Family Coinsurance (what you pay) Annual Out-of-Pocket Limits Individual

$500 At least two family members must meet the $500 deductible. 20%

Out-of-Network $1,000 At least two family members must meet the $1,500 deductible. 30%

$2,000 $2,500 At least two family members must At least two family members must meet the Family meet the individual out-of pocket limit. individual out-of-pocket limit Lifetime Maximum None $1,000,000 Preventive Care Services – for a complete list of services covered at 100%, please refer to your Summary Plan Description which can be accessed at www.arbenefits.org. Immunizations, Mammograms, Physical Exams-Adults, Gynecological Visits No deductible, 0% coinsurance 30% coinsurance after deductible Well Baby Care Well Child Care Physician Services 20% coinsurance after deductible 30% coinsurance after deductible Outpatient Services 20% coinsurance after deductible 30% coinsurance after deductible Inpatient Hospital 20% coinsurance after deductible 30% coinsurance after deductible Emergency Room Services 20% coinsurance after deductible 30% coinsurance after deductible Maternity Services 20% coinsurance after deductible 30% coinsurance after deductible Physician and Hospital Services Transplants 20% coinsurance after deductible 30% coinsurance after deductible Most transplants require prior approval Durable Medical Equipment 20% coinsurance after deductible 30% coinsurance after deductible $10,000 maximum per year Prosthetics 20% coinsurance after deductible 30% coinsurance after deductible $15,000 maximum per year 20% coinsurance after deductible 30% coinsurance after deductible TMJ $500 lifetime maximum Physical, Occupational, Speech Therapy, Cardiac Rehab, and Chiropractic Services 60 visits per member per year 20% coinsurance after deductible 30% coinsurance after deductible combined Ambulance (Land or Air) 20% coinsurance after deductible 30% coinsurance after deductible $1,000 maximum per year for transport services Home Nurse Visits 120 visits per 20% coinsurance after deductible 30% coinsurance after deductible year Home Infusion IV Drugs & 20% coinsurance after deductible 30% coinsurance after deductible Solutions Important Notice: If you use a hospital/physician who is a preferred provider, such hospital/physician has agreed to accept Arkansas Blue Cross and Blue Shield's payment for covered services as payment in full - except for your deductible and coinsurance, if applicable. If you use a hospital/physician who is a non-preferred provider, such hospital/physician is free to bill you charges for covered services in excess of Arkansas Blue Cross and Blue Shield's payment. Before receiving services from any hospital/physician, please check your directory of participating providers. Member may be responsible for charges in excess of any dollar maximum. This benefit summary provides a brief description of your state employee benefits for the Arkansas Blue Cross and Blue Shield Indemnity PPO Plan. Arkansas Blue Cross and Blue Shield is a Claims Administrator under the direction of the Employee Benefits Division. For a complete description of your benefits please refer to the Summary Plan Description (SPD) published by Employee Benefits, your Group Administrator.

PPO QUESTIONS AND ANSWERS Q: What is a PPO plan? A: A PPO (Preferred Provider Organization) is an Indemnity Plan. The Arkansas Blue Cross and Blue Shield PPO Plan offers the largest network of hospitals, physicians and other health-care providers, which can be accessed without having to obtain a referral from a Primary Care Physician. Q: What if I receive care outside of the Blue Cross network? A: If you choose a hospital or physician who is a participating provider with any Blue Cross and Blue Shield nationwide, that provider has agreed to accept Blue Cross’ payment in full except for your deductible and appropriate coinsurance. If you use a hospital or physician who is not a participating provider with Blue Cross, that provider is free to bill you charges for covered services in excess of the company’s payment. Q: What is BlueCard® and how does it work? A: BlueCard links participating health-care providers and the independent Blue Cross and Blue Shield Plans across the country through a single electronic network for professional, outpatient, and inpatient claims processing reimbursement. The program allows participating Blue Cross and Blue Shield providers in every state to submit claims for patients any Blue Cross Blue Shield member. When you need medical assistance out of the service area, you can call 1-800-810-2583 (BLUE) located on the back of the Identification Card to locate a Blue Cross and Blue Shield provider. You should ask for the PPO Network. The call center is open 24 hours a day, seven days a week. You may also access BlueCard providers online at www.bcbs.com. The claim is filed with the local Blue Plan and the alpha prefix lets the local Plan know where to route the claim. Members using the BlueCard Access have in-network benefits for care outside the service area. Q: What do I need to do if I have a need for medical assistance and I’m outside the United States? A: Members traveling abroad should contact the BlueCard helpline at 1-800-810-2583 (BLUE) and ask for BlueCard Worldwide. This is a provider locator service open 24 hours a day, 365 days a

year. We also recommend that you visit the Web site at www.bcbs.com to locate providers in advance and take advantage of the valuable health and travel information listed there. Q: Are preventive care services covered by this PPO plan? A: Yes. For a complete list of preventive care services, please refer to your Summary Plan Description (SPD). You may access the SPD online at www.arbenefits.org and look in the Benefits Library, or you may call Employee Benefits Division at 1-877-815-1017 and request a copy. Q: Are pre-existing conditions covered? A: Yes. All of the health plans offered cover preexisting conditions. Q: How will the Any Willing Provider (AWP) law affect my coverage? A: AWP is an Arkansas law, so providers outside Arkansas will not be affected. In Arkansas, if a provider applies to be a participating provider, and completes our credentialing process, then that provider will be part of the Blue Cross PPO network, and normal in-network benefits will apply. Providers will still have the choice whether or not to participate, so there may still be some providers who will not be in-network. For the most accurate and up-to-date provider directory, please visit www.ArkansasBlueCross.com. Q: I am about to retire. What do I need to do to continue my insurance, and what are my coverage options? A: If you are a non-Medicare primary retiree, you have the option to remain on the Blue Cross PPO Plan or change to the new ARHealth Benefit Plan administered by Health Advantage. If you are age 65 or older, or Medicare is your primary insurer, you will be automatically changed to the ARHealth benefit plan administered by Health Advantage. For specifics of this plan please access the Health Advantage Web site at: www.HealthAdvantage-hmo.com.

W

HO C Cont act yo AN H ur Ag ELP e n c Cont y Ins a ct E uranc BD ( e Rep 877)8 r e se n 15-10 ARB tative enefi 17 ts We b site Call C www ustom .arbe nefits (800) er S e rvice .org 482-8 416 Healt h Blue Advantag e Shiel d We or Arkan sa s B b site Emai lue C * l Cus ross a tome custo nd r S mers ervic e ervic epse@ Hosp arkb ital A luecr dmis oss.c s i o n Pre om Call N notifi MH C c ation Rx ( ** 800)8 Call C 80-11 orphe 8 8 alth (866) 378-1 645

Where do you go for help when you have questions? Use this chart to find the answers!

COMMON QUESTIONS Need a Health Insurance Card How do I Add/Drop members from my contract?

X

X

What do I do with Student Verification Forms?

X

X

Need to change my address/telephone number

X

My Social Security Number, name, or birthdate is wrong on my identification card

X

X

X

X

X

X

X

Need to know if a provider is in your network

X

X

X

How do I appeal a claim denial?

X

Need to check claim status or have other claims related issue

X

X X

Need to change my Primary Care Physician (PCP)

X

Who do I call if I'm admitted to a hospital that's not in the network?

X X

X X

Need a new prescription card Need to know why a prescription took a higher copay or was not covered

X X

X

How do I get Prior-Approval for a prescription? What Mental Health providers are covered?

X X

How do I precertify a mental health service? * www.HealthAdvantage-hmo.com or www.ArkansasBlueCross.com

** Arkansas Blue Cross members call 1-800-451-7302 for hospital admissions outside of Arkansas **Health Advantage members call 1-800-299-4120 for hospital admissions out of the Health Advantage Network

X GoodNews! We offer a Discount Wellness Program. For health and fitness discounts statewide, including Curves, Jenny Craig, and Weight Watchers, Please check out our websites:

www.HealthAdvantage-hmo.com www.Arkansasbluecross.com

A recent court decision reinstates an Any Willing Provider (AWP) law in Arkansas. Applications are being accepted from providers who wish to join the netwroks. Doctors and hospitals do not immediately and automatically become in-network providers, but must meet criteria outlined by Health Advantage or Arkansas Blue Cross and Blue Shield. Due to the passage of this law and the provider interest in joining our networks, we are unable to print up-to-date provider directories. The best way to determine if a doctor or hospital has been included in the network is to check the online provider directories or call Customer Service at 1-800-482-8416.

Suggest Documents