2015-3093-01 brochure v03 - neshaminy.org€¦ · langhorne, pa 19047 215-702-7090 825 town centre...

Member Handbook

Dear Bucks and Montgomery County Schools Health Care Consortium Member: Over the past several years we have continually examined the cost of health insurance, all while

striving to improve the health of our population. As the health care landscape continues to evolve,

health care costs continue to escalate. In this changing environment - with increasing cost pressures

- we are asking all Consortium members to play an active role in their health and health care

choices, to ensure we maintain quality healthcare at the lowest possible cost.

With your continued cooperation, we can ensure you have the most innovative, extensive, and

efficient solutions for your health needs.

To help you maximize your coverage and resources available, this handbook has been created to

outline the easily accessible benefits for our consortium. From accessing tools online, to preferred

providers, to financial incentives – there are multiple options available to support your health goals,

and help keep your costs and the Consortium costs as low as possible.

Please know that we, Independence Blue Cross, and Health Advocate are always there to answer

your questions - and support you through the Health Care process. Let’s keep working together for a

better, healthier future!

Sincerely,

Anne Rohricht Vice Chair

Bucks and Montgomery County Schools Health Care Consortium

Linda Weaver

Chair

Bucks and Montgomery County Schools Health Care Consortium

Table of Contents Plan Benefits………………………………………..5

•  Plan Comparison

•  Care Facilities

•  Preferred Imaging Providers

Member Tools: Online & Mobile……………………17

•  ibxpress.com

•  IBX Mobile

•  Mobile Health Alerts with IBX Wire TM

Wellness Solutions………………………………….25

•  Healthy Lifestyles Solutions SM

•  Personal Health Record

•  Nutrition Counseling

•  Baby BluePrints ®

•  Fitness Program

•  Tobacco Cessation Program

•  Weight Management Program

Health Advocate…………………………………….37

•  Health Care Help and Wellness Coaching

•  Medical Visit Checklist

Plan Benefits Details on your plan design:

•  Personal Choice 10/20/70

•  Personal Choice 20/30/70

•  Keystone Point of Service 15S

Benefit Design Overview The Bucks and Montgomery County Schools Consortium offers three Preferred Medical plans that

will meet the healthcare needs for you and your family members.

Keystone Point-of-ServicePlan (KPOS 15S)

Keystone Point-of-Service lets you maintain freedom of choice by allowing you to select your own

doctors and hospitals. You can maximize your coverage by having care provided or referred by your

primary care physician (PCP), as well as lowering your out of pocket expenses when using an in

network physician. Of course, with Keystone Point-of-Service, you have the freedom to self-refer

your care either to a Keystone participating provider or to providers who do not participate in the

network; however, higher out-of-pocket costs apply.

Personal Choice (PC 10/20/70 & PC 20/30/70)

Personal Choice®, the Preferred Provider Organization (PPO), gives you freedom of choice by

allowing you to choose your own doctors and hospitals. You can maximize your coverage by

accessing your care through Personal Choice's network of hospitals, doctors, and specialists, or by

accessing care through preferred providers that participate in the BlueCard® PPO program

nationally. Additionally, your out of pocket expenses will be lower when using an in network

physician. Of course, with Personal Choice, you have the freedom to select providers who do not

participate in the Personal Choice network or BlueCard PPO program. However, if you receive

services from out-of-network providers, you will have higher out-of-pocket costs and may have to

submit your claim for reimbursement.

With Personal Choice...

•  You do not need to enroll with a primary care physician

•  You never need referrals

What’s changing for 2015/2016?

The Bucks and Montgomery County Schools Health Care Consortium (BMCSHCC) will be

introducing several changes to the Preferred Plans effective July 1, 2015 to promote the use of cost

effective providers and to comply with Health Care Reform. Please refer to the following benefit

comparison for further details.

For additional information about your medical plan, exclusions and benefits limitations, please

refer to your Member Handbook, available on ibxpress.com

2015 Preferred Plan Comparison

8


9


If your plan is not illustrated above and you have questions, please contact your benefits

department for more information.

*This document is for comparison purposes only. For further detail on benefit exclusions and precertification requirements, please refer

to the Benefits at A Glance Summaries for each plan design.

10

As an Independence Blue Cross member, you have alternatives to the

emergency room when your own doctor is unavailable. You may visit an urgent

care center if you have an illness or injury that is not life-threatening but

requires immediate medical attention. And if you have an illness or injury that

is less serious, you may visit a retail health clinic.

What Is an Urgent Care Center?

An urgent care center is a medical facility that employs board-certified

doctors for the treatment of cuts, sprains, sinus infections, nausea, and other

types of less serious medical conditions. You don’t need an appointment to

visit an urgent care center and they often have night and weekend hours.

What Is a Retail Health Clinic? In addition to urgent care centers, you also have the option of visiting a

retail health clinic. A retail health clinic employs certified nurse

practitioners who can treat minor, uncomplicated illnesses and injuries,

such as fevers and colds, rashes, bumps, and scrapes.

Suggestions when deciding where to go for care

When should I use the emergency room? Seek treatment at a hospital emergency room for

life- threatening medical situations including:

•  Severe shortness of breath or chest pain

•  Sudden or unexplained loss of consciousness

•  Sudden, severe abdominal pain

•  Cut or wound that won’t stop bleeding

Questions about your health care choices or locating providers? If you are unsure about where to

go for care, please contact your

physician, Health Advocate at

1-866-695-8622, or IBX at

1-800-275-2583.

Preferred Plans - Did you know?

Urgent Care Centers and Retail Health Clinics

Abington Orthopedic Specialists 1200 Old York Rd

Abington, PA

(215) 481-2000

Aria Health Various locations

215-831-5800

Chestnut Hill Hospital 8835 Germantown Ave

Philadelphia, PA 19118

(215) 248-8200

Doylestown Hospital 595 W State

St Doylestown, PA

18901

(215) 345-2200

Einstein Medical Center- Montgomery County 559 W Germantown Pike East

Norriton, PA 19403 (484)

622-1000

Grandview Hospital 270 Main

St Harleysville, PA

(215) 453-4100

Holy Redeemer Hospital & Medical Center 1648 Huntingdon Pike

Jenkintown, PA 19046

(215) 947-3000

Jeanes Radiology Assoc 1619 Grant Ave #5

Philadelphia, PA

(215) 676-3300

Jefferson Univ. Radiology Associates Various locations

800-JEFF-NOW

Lansdale Hospital 100 Medical Campus Dr

Lansdale, PA 19446

(215) 368-2100

Lower Bucks Hospital 501 Bath Rd

Bristol, PA 19007

(215) 785-9200

Phoenixville Hospital 140 Nutt Rd

Phoenixville, PA 19460

(610) 983-1000

St. Lukes Quakertown Hospital 1021 Park Ave

Quakertown, PA 18951

800-801-7745

Upper Bucks Ortho Associates 711 Lawn Ave # 3

Sellersville, PA 18960

(215) 257-3700

Bustleton Gastroenterology ASC 2000 Grant Avenue

Suite 102


215-464-7222

Colon and Rectal Surgeons, Ltd. 9892 Bustleton Avenue

Suite 206


215-673-0343

KPOS Members: This service is not applicable for KPOS members because ofcapitation. Capitation is a form of payment for health care services whereby a physician, hospital or other provider is paid a contracted rate for each patient who is a member of a group or plan, for which they have agreed to provide service. Because of this agreement, members in a capitated system are limited to the providers who have agreed to the terms of the plan. The above list includes limited High Value providers - but for a full and current list of in network imaging providers, please refer to ibxpress.com/providerfinder or call Health Advocate.

BMCSHCC has identified this list of providers as being a High Value Provider - for Personal Choice Providers only.

Preferred Imaging Providers: Routine/Complex Radiology

Ambulatory Endoscopic Surgical Center of Bucks County 301 Oxford Valley Road, Suite 804

Yardley, PA 19067

215-321-9599

Regional Gastrointestinal Consultants 301 Oxford Valley Road

Suite 804 A and B

Yardley, PA 19067

215-321-4700

Bryn Mawr Medical Specialist Association 933 Haverford Road

Bryn Mawr, PA 19010

610-527-3800

Bryn Mawr Medical Specialist Association 825 Old Lancaster Road

Suite 320

Bryn Mawr, PA 19010

610-525-9570

Bux-Mont Endoscopy Center 1107 Bethlehem Pike


215-257-3011

Bux-Mont Gastroenterology 301 Oxford Valley Road

Suite 701

Yardley, PA 19067

215-321-7221

College Heights Endoscopy Center 3147 College Heights Boulevard

Allentown, PA 18104

610-841-2432

Colon-Rectal Surgery Associates 1255 South Cedar Crest Boulevard

Suite 3900

Allentown, PA 18103

610-402-1095

3131 College Heights Boulevard

Suite 1200

Allentown, PA 18104

610-439-8551

Eastern Pennsylvania Endoscopy Center 1501 North Cedar Crest Boulevard

Suite 103

Allentown, PA 18104

610-289-2172

Eastern Pennsylvania Gastroenterology Cedarpointe Corp Center

1501 North Cedar Crest Boulevard

Suite 110

Allentown, PA 18104

610-821-2828

2597 Schoenersville Road

Suite 207

Bethlehem, PA 18017

610-821-2828

GI-ASC, LLC 3998 Red Lion Road

Suite 240


215-632-3500

Gastrointestinal Specialists 280 Middleton Boulevard

Langhorne, PA 19047

215-702-7090

825 Town Centre Drive

Suite 148

Langhorne, PA 19047

215-702-7090

4900 Frankford Avenue


215-632-3500

3998 Red Lion Road

Suite 240 Medical Office Building


215-632-3500

10 Presidential Boulevard

Suite 124

Bala Cynwyd, PA 19004

610-664-9700

Grant Surgicenter, LLC 2000 Grant Avenue

Suite 101


215-992-6000

Bustleton Gastroenterology ASC 2000 Grant Avenue

Suite 102


215-464-7222

Colon and Rectal Surgeons, Ltd. 9892 Bustleton Avenue

Suite 206


215-673-0343

Greater Northeast Gastroenterology Associates 7439 Frankford Avenue


215-333-1377

Northeast Gastroenterology Associates, Inc. 2000 Grant Avenue

Suite 103


215-333-1776

205 Newtown Road

Suite 213

Warminster, PA 18974

215-333-1776

Huntingdon Valley Surgery Center 1800 Byberry Road

Building 10

Huntingdon Valley, PA 19006

215-914-4602

Colon and Rectal Associates 1650 Huntingdon Pike

Suite 309

Meadowbrook, PA 19046

215-938-1644

Colon and Rectal Associates 1235 Old York Road

Suite G20

Abington, PA 19001

215-517-1250

Vaze Inc. PC 727 Welsh Road

Suite 101

Huntingdon Valley, PA 19006

215-914-0600


Preferred Imaging Providers: Colonoscopy

Main Line Endoscopy Center-West 325 West Central Avenue

Lower Level

Malvern, PA 19355

610-644-7274

Main Line Gastroenterology 1088 West Baltimore Pike HCCII

Suite 2407

Media, PA 19063

610-565-1808

Main Line Endoscopy Center-East 333 East City Line Avenue

Two Bala Plaza, Suite IL30


610-660-8470

Main Line Gastroenterology 252 Lankenau Medical

Office Building

East 100 Lancaster Avenue

Wynnewood, PA 19096

610-896-7360

Main Line Endoscopy Center-South 1088 West Baltimore Pike

Suite 2407

Media, PA 19063

610-565-1808

Main Line Gastroenterology 495 Thomas Jones Way

Suite 200

Exton, PA 19341

610-594-2641

2050 West Chester Pike

3rd Floor

Havertown, PA 19083

610-449-1525

325 Central Avenue

Suite 200

Malvern, PA 19355

610-644-6755

One Medical Center Boulevard

Suite 220

Chester, PA 19013

610-644-6755

Main Line Surgery Center 10 Presidential Boulevard

Suite 200


610-949-9066

Gastrointestinal Specialists 280 Middleton Boulevard

Langhorne, PA 19047

215-702-7090

825 Town Centre Drive

Suite 148

Langhorne, PA 19047

215-702-7090

4900 Frankford Avenue


215-632-3500

3998 Red Lion Road

Suite 240 Medical Office Building


215-632-3500

Gastrointestinal Specialists 10 Presidential Boulevard

Suite 124


610-664-9700

Manoa Diagnostic Center, LP 1010 West Chester Pike

Suite 101

Haverford, PA 19083

610-789-3510

Suburban Gastroenterology 1010 West Chester Pike Suite 202

Havertown, PA 19083

610-789-3510

PGC Endoscopy Center, Inc. 700 Cottman Avenue

Suite 201


215-742-9900

Philadelphia Gastroenterology Consultants 515 West Chelten Avenue


215-742-9900

Philadelphia Gastroenterology Consultants 7524 Frankford Avenue


215-742-9900

700 Cottman Avenue

Suite 201


215-742-9900

Rhawn Street Endoscopy 1403 Rhawn Street


215-332-8100

Fox Chase Gastroenterology 1403 Rhawn Street


215-728-6688

The Endoscopy Center at St. Mary 1205 Langhorne-Newtown Road

Suite 103

Langhorne, PA 19047-1219

215-750-7490

Gastroenterology Group PA 1203 Langhorne Newtown Road

Suite 234

Langhorne, PA 19047

215-750-2911

Center for Colon and Rectal Health Inc 599 West State Street Suite 301B

Doylestown, PA 18901

215-348-7600

1203 Langhorne Newtown Road

Suite 130

Langhorne, PA 19047

215-741-4910

Endoscopy Center of Bucks County 790 Newtown-Yardley Road

Suite 415

Newtown, PA 18940

215-579-2004

Bucks County Gastro Assoc 1107 Bethlehem Pike


215-257-3011


Preferred Imaging Providers: Colonoscopy

Philadelphia Gastroenterology 207 North Broad Street 6th Floor


215-463-1483

1811 South Broad Street


215-463-1483

AASOP, Inc. 9501 Roosevelt Boulevard

Suite 103


215-671-9900


Preferred Imaging Providers: Colonoscopy Clinical Gastro Assoc 1 Cornerstone Drive

Suite 300

Langhorne, PA 19047

215-891-9400

The Endoscopy Center, LLC 817 Lawn Avenue


215-453-3050

GI Health Professionals PC 817 Lawn Avenue


215-257-5071

Wills Eye Surgery Center in North East Philadelphia 8400 Roosevelt Boulevard

Suite A


215-332-7500

Philadelphia Gastroenterology 525 Jamestown Avenue

Suite 101


215-483-1083

Wills Eye Surgery Center of Plymouth Meeting 625 Ridge Pike

Building B

Plymouth Meeting, PA 19428

610-834-9700

KPOS Members: This service is not applicable for KPOS members because of capitation. Capitation is a form of payment for health care services whereby a physician, hospital or other provider is paid a contracted rate for each patient who is a member of a group or plan, for which they have agreed to provide service. Because of this agreement, members in a capitated system are limited to the providers who have agreed to the terms of the plan.The above list includes limited High Value providers - but for a full and current list of in network imaging providers, please refer to ibxpress.com/providerfinder or call Health Advocate.

Member Tools Online and Mobile:

As part of Independence’s ongoing commitment to finding new, innovative ways to

improve the lives and health of our members, we are pleased to provide you with

information, tools, and support you need to make smarter health care decisions.

Independence members can access benefits information and use these online and mobile

resources to help get the most from their coverage through the secure member website,

ibxpress.com, and with the free Independence app for your smartphone, IBX Mobile.

Find a doctor or hospital, view claims and benefits, and help manage your health with personalized tools With ibxpress.com, you have quick and secure access to the information

you need to make smarter health care decisions — anytime and anywhere.

Easily find the tools that help you manage your benefits and take control

of your health, so you get the most from your health plan.

Get the information you need quickly Log in or register at ibxpress.com • Current users – Log in with your

current username and password.

• New users – Click Register Now

and use the information on

your member ID card to

complete your registration.

Find a Provider

Search for doctors, hospitals, specialists, and other health care professionals, view physician quality metrics, and

compare provider profiles. Users will also have the ability to save searches and add favorites, create directories,

and read and write patient reviews of doctors and facilities.

View Claims

See claims in real time and quickly search up to two years of claims history. View or download an Explanation

of Benefits (EOB) to figure out what you owe and how much your health plan paid for covered services.

My Benefits

Review your coverage details, update your personal information, choose or change your primary care

physician, and get money-saving tips to help you maximize your benefits.

Health & Wellness

Get reliable information and support to reach your health goals with personalized tools, including a Personal

Health Record, Wellness Profile, My Health Assistant, Symptom Checker, discounts, reimbursements, and more.

Your Member Website – ibxpress.com

Estimate your costs before you get care Help keep your health care expenses under control by planning ahead! The

Care Cost Estimator on ibxpress.com helps PPO members compare costs

and shop for the best quality and value, just like you would for other

important purchases.

Due to various factors, the cost of procedures such as common surgeries,

X- rays, and MRIs can vary. For example, a simple X-ray can cost twice as

much at a hospital than at a local imaging center. Our Care Cost Estimator

makes it easy to compare the estimated costs on over 1,300 common

surgeries, laboratory tests, and procedures, at different doctors, hospitals,

and medical facilities, helping you make the right choice for your health

and budget.

How the Care Cost Estimator works

1.  Visit ibxpress.com and log in to your member

account. Click the Care Cost Estimator option

under More Features.

2.  Using the drop-down menus provided,

answer a few simple questions about the

type of visit and care needed. Next, click

Show Estimate, and you’ll get a list of

results that fit your search criteria.

Make smart choices about your

health and finances! Log in to

ibxpress.com and try the Care

Cost Estimator today.

The Care Cost Estimator

3. Even though your cost may not change based on the provider or facility, you can compare estimates of

the total procedure costs for the procedure or service at different providers or facilities. You can also

check out the average high and low costs for the service in your area, as well as the related services,

such as anesthesia, recovery room, doctors’ fees, medications, and supplies. Click on any results for a

detailed explanation of how your cost estimate was calculated.

4. Quality counts, too! In addition to the cost estimate, check on the hospital’s ratings on various procedures,

as well as comments and patient reviews.

Use this free app for 24/7 access to time-saving tools and health coverage information With the IBX app, the power to make informed health care decisions is right in

the palm of your hand. Time-saving tools make it quick and easy to:

•  Find a network doctor, hospital, pharmacy, or urgent

care center with a Google Maps search

•  Choose or change your primary care physician

•  Request new member ID cards

•  Check coverage information under your health plan

•  View claims and track deductibles and spending account balances

Doctor’s Visit Assistant The app has a Doctor’s Visit Assistant that securely stores personal health

information for you and anyone covered under your health plan in a single

place. Use it to make the most of your doctor appointments:

•  View and share a digital copy of your member ID card

•  Check the status of referrals

•  Review your Personal Health Record

•  Keep track of prescribed medications and dosage instructions

•  Record notes and upload photos of symptoms to discuss with your doctor

How to locate Urgent Care

Download the IBX app Visit ibx.com/mobile to

download the free IBX app to

your iPhone or Android device

from the Apple App Store or the

Google Play store. Are you

registered at ibxpress.com?

Simply download the app and

log in with your ibxpress

username and password.

Finding Urgent Care or Retail Clinics on the go is quick and easy with the IBX app - just

open the app, specify your search, and get results! See the below for more detail.

IBX Mobile: Manage your health plan on the go

Access your ID card with our online and mobile tools

Get health reminders right at your fingertips With IBX Wire, a new communication service exclusively for

Independence members, you can get health reminders sent right to

your phone.

Make checking your phone a little healthier with IBX Wire

When you sign up for IBX Wire, you have a direct connection with your

health care plan through your mobile phone. As important news becomes

available — your benefits change, a new feature is available, or you are

past due for a screening — IBX Wire reaches out and lets you know.

Messages are sent about every other week and you control the frequency,

including the ability to stop messages at any time.

Sign up today

Simply grab your ID card and call the number on the back to sign up now.

*Standard message and data rates may apply. Text STOP to stop and

HELP for help. Terms and Conditions available at myhelpsite.net/ibx.

Notification messages within IBX Wire are sent via automated SMS.

Enrollment in IBX Wire is not a requirement to purchase goods and

services from Independence Blue Cross.

What’s the difference between IBX Mobile and IBX Wire? •  IBX Mobile allows you

to access health plan

information from your

mobile device.

•  IBX Wire will send health

alerts and plan updates directly

to your phone.

IBX Wire™: Get the message about your health

Wellness Solutions You deserve a health plan that supports you on the road to better health. Independence

can help you as you take steps to improve or maintain your health — whether you want

to be more active or eat better, you’re fit and want to stay that way, or fall somewhere

in between.

The key to health care isn’t about just providing coverage when you’re sick or injured

— it’s about helping you be your best, fittest self to reduce the risk of sickness or injury

in the first place. Independence believes that if you have the right information and

support, you can take better control of your health.

These wellness programs are available to you free of charge just for being a member.

Get started on your plan for better health today!

More than anything else, the ordinary decisions we make every day are

the things that most influence our health and well-being — what we eat,

how much we move our bodies, and how we deal with stress.

With this in mind, Independence offers members the Healthy

Lifestyles Solutions programs. These reimbursement and discount

programs encourage members to make the small lifestyle changes

that can lead the way to better long-term health and well-being.

Healthy Lifestyles Solutions Program Overview Reimbursements — Receive a reimbursement of up to $150 for the cost

of a fitness center membership or approved tobacco cessation and weight

management programs. For more information, visit ibx.com/

reimbursements.

Stress Management — Receive a free stress-relief guide.

Wellness Guidelines — Learn about nationally recommended steps you

can take to help keep yourself healthy and feeling your best.

Blue365® — Save on health-related products and services with exclusive value-added discounts and

offers from leading national companies.

Blue InsiderSM — Get discounts to a wide range of national, regional, and local businesses, attractions,

and events.

Baby BluePrints® — Our maternity program is designed to help you be healthy, confident, and

comfortable throughout your pregnancy.

CorCell® — Independence members are eligible for discounts on the storage of cord blood, which can be

used to help a member’s baby fight a future illness.

*Disclaimer: May not be available to all health plans. Participants must have active and eligible coverage at the

time of submission. Healthy Lifestyles Solutions programs are value-added programs and services; they are not

benefits under the health care plan purchased and are therefore, subject to change.

Visit ibxpress.com to learn more!

Healthy Lifestyles� Solutions

Accessing your Personal Health Record is easy through ibxpress.com.

Just click the Personal Health Record link in the Health and Wellness area of your personal web-page.

You will then see a dashboard of all your most important medical and health records in one place!

Personal Health Record

Eat your way to better health with free nutrition counseling

Members can take advantage of six free visits Eating healthier would be a lot easier with your own private chef to

cook nutritious meals. We can’t hire a chef for you, but we can give you

one- on-one time with nutrition experts to help you set goals for better

eating habits.

As part of your benefits, Independence lets you schedule up to six visits a

year for nutrition counseling* at no additional cost to you when you visit

an in network doctor or registered dietitian. No referrals needed!

Eat your way to a healthier you Eating healthier doesn’t have to mean eating less. It means learning

how to add nutritious foods into your diet. It means understanding how

what you eat affects your overall health and happiness. A healthy diet

and weight can give you more energy and may even lower your blood

pressure and cholesterol.

Many people develop chronic conditions, such as diabetes, heart disease,

and high blood pressure, as a result of being overweight. Nutrition

counseling can help you better manage your diet and your weight, and

may reduce your risk for developing these health conditions.

*Please contact Customer Service or your benefits administrator to

determine if an office visit copay may apply. Deductible and

coinsurance may apply to services obtained out of network.

Find a registered dietitian 1. Go to ibx.com/findadoctor.

2. Find a registered

dietitian or doctor by

selecting Diet &

Nutrition Providers.

3. Call your dietitian to

schedule your nutrition

counseling appointment.

No referrals necessary!

Questions? Call 1-800-ASK-BLUE

(1-800-275-2583).

Nutrition Counseling

Give your baby a healthy start

Enroll in our free maternity program and get resources and support for a healthy pregnancy Whether you’re a mom-to-be or a practiced parent, our maternity

program can help you plan for the healthiest pregnancy and

delivery possible.

Enroll in the free Baby BluePrints maternity program for:

• Prenatal resources and information that guide you

through each stage of pregnancy

• Support from an experienced, registered nurse Health Coach, which

may include periodic health assessments over the phone

• Direct communication between your Health Coach and your

doctor if your pregnancy requires special care, to ensure that

you get the care you need

Sign up for Baby BluePrints today: 1-800-598-BABY

(1-800-598-2229)

Baby BluePrints®

Get up to $150 back with Independence‘s Fitness Program

You don’t have to enroll in the Healthy Lifestyles Solutions Fitness Program to become eligible for

reimbursement. When you meet the eligibility requirements, just submit your documentation to ibx.com/

reimbursements to request reimbursement.

Get reimbursed in four easy steps

1. Join an approved fitness center.

2. Exercise at your chosen fitness center regularly.

3. Record your workouts.

4. Submit your documentation and request your reimbursement.

Fitness Program guidelines Eligible members

In order to be eligible for reimbursement, participants must be age 18 or older.

Selecting an approved fitness center

The Fitness Program rewards you for incorporating a well-rounded exercise program into your routine.

To be eligible for the fitness center reimbursement, you must choose a full-service fitness center that offers

a variety of cardiovascular, flexibility, and resistance training in a supervised setting.

Eligible fitness centers

Eligible full-service fitness centers generally feature most of the following amenities:

•  Group exercise classes (e.g. aerobics, spinning, body sculpting, kickboxing)

•  Resistance training equipment (e.g. weight machines)

•  Free weights

•  Cardiovascular training equipment (e.g. treadmills, stationary bicycles, elliptical trainers)

•  Pool for swimming laps

•  Track for running/walking

Ineligible fitness centers

Membership at athletic clubs that focus primarily on a single competitive or recreational sports activity are not

eligible for reimbursement, even if the activity includes elements of a comprehensive exercise program. While we

recognize that activities such as martial arts, rowing, tennis, and basketball are excellent ways to stay fit, they

often do not require consistent, year-round attendance, or proper supervision. Nor do these activities incorporate

all the elements of a comprehensive exercise program. Therefore, participation in these programs does not qualify

for reimbursement. Examples of ineligible programs and facilities include:

•  Tennis/squash/racquetball

•  Basketball

•  Golf

•  Pilates/yoga

•  Martial arts/karate

•  Sports leagues

•  Recreational swim clubs

•  Dance instruction

•  Outdoor “boot camp” style programs

•  Sculling/style program rowing

•  Chiropractic services

Healthy Lifestyles� Solutions Fitness Program

Reimbursement rules and requirements

•  You must complete 120 workouts during a 365-day Fitness Program

period. However, the 365-day time period does not need to be within the

same calendar year as the reimbursement. For example, you could get a

reimbursement paid out in January 2016 for 120 workouts

documented in 2015.

•  You must have coverage with Independence Blue Cross at the time

of your request for reimbursement.

•  You are only eligible for one reimbursement per program, per

calendar year.

•  Dependents must be at least 18 years old to be eligible for reimbursement.

•  Logging in for another member at a fitness center is prohibited.

•  Falsification of information in order to receive

your reimbursement is strictly prohibited.

How to record your workouts

Choose a primary method of recording your workouts that works best for you:

•

•

Logbook

Computer printout from your fitness center that shows all workout dates

Record workouts using the logbook

To record workouts using the logbook, ask a fitness center representative to sign and date the logbook each

time you work out.

You may also use the logbook to record your workouts when you visit a fitness center other than your primary

fitness center (e.g. when you work out while traveling or vacationing out of town).

Record workouts using a fitness center’s computer printouts

You may choose to use your fitness center’s computer printout as your primary method of logging workouts. However,

keep in mind that Independence Blue Cross cannot assume any responsibility for the reliability of fitness center

computer systems. For this reason, if you select a fitness center computer printout as your primary method of logging

workouts, you also accept the risk that all your workouts may not be credited toward your reimbursement should your

fitness center have technical issues. Other important information

• Independence Blue Cross does not guarantee the solvency of any fitness center and, therefore, has

no liability should a fitness center close.

For members other than those enrolled in a Medicare Advantage plan, Healthy Lifestyles Solutions

programs are value-added. They are not part of the health care benefits you have purchased and, therefore,

are subject to change without notice.

At Independence Blue Cross, we encourage all of our members to adopt and maintain a regular fitness

program. However, if you are 40 or older, overweight, have a history of high blood pressure or heart

disease, or have any other health concerns related to exercise, you are encouraged to consult your doctor

before beginning any exercise program.

•

•

Questions? Call Healthy Lifestyles

Solutions at 1-800-590-8880.

Get up to $150 back when you complete an approved program to help you quit using tobacco You probably know many of the reasons why you should quit smoking — it can help you breathe easier,

live longer, and protect the health of those around you. Quitting isn’t easy, and many people try more

than once before they succeed, but it’s worth it. To help you quit for good, our Healthy Lifestyles Solutions Tobacco Cessation Program will reimburse you up

to $150 for completing an approved tobacco cessation program. If you’re 18 or older and your program costs

less than $150, you can apply the difference toward reimbursement of nicotine replacement products or

medications prescribed to you to help you quit.

How it works You don’t have to enroll in the Healthy Lifestyles Solutions Tobacco Cessation Program to be eligible

for reimbursement. When you meet the eligibility requirements, just submit your documentation to

ibx.com/ reimbursements to request reimbursement.

1. Sign up for an approved tobacco cessation program

See “Selecting a tobacco cessation program” on the following page for information about choosing

an approved program that will work for you.

2. Complete the approved program

Complete an eligible program that focuses on behavior modification and provides frequent and

regular support, such as weekly meetings or telephone-based sessions.

3. Submit documentation and request your reimbursement Log on to ibx.com/reimbursements and submit the following documentation:

•

•

Proof of your participation in an approved tobacco cessation program or a certificate of completion

All program receipts and receipts for nicotine replacement products or medications prescribed to you to help you quit

Once all of your documentation is submitted, you can request your reimbursement to be paid by direct deposit

or American Express rewards card.*

*Please note that American Express charges a fee of $4.00 plus three percent of the reimbursement amount.

Healthy Lifestyles� Solutions Tobacco Cessation Program

Tobacco Cessation Program guidelines

Selecting a tobacco cessation program

No matter who you are, you canfind a program that will give you the

type of support and encouragement you need to kick the habit. Eligible

programs include those that focus on behavior modification and provide

frequent and regular support, such as weekly meetings or telephone-

based sessions.

Work with your health care provider to determine which method is best

for you. You can opt for an individual approach, or choose a program

that offers group support. Some programs can even help you manage

stress, avoid weight gain, and overcome barriers to quitting. You can

also choose a program offered by a network hospital in your area.

Search for a network hospital in your area at ibxpress.com or contact

our Health Resource Center at 1-800-ASK-BLUE for more information.

The following are not reimbursable: •  Co-pays, coinsurance, deductibles

• Hypnosis

•  Acupuncture

•  Dietary supplements, injections

•  Electronic cigarettes

Support for quitting other forms of tobacco

There are 28 known cancer-causing substances in chewing tobacco, spit tobacco, and other smokeless

tobacco products. All smokeless tobacco contains nicotine, so it’s just as addictive as cigarettes. And if you

use any form of smokeless tobacco, you put yourself at an increased risk for serious health conditions,

including tooth decay, gum disease, and oral cancers of the lip, tongue, cheeks, gums, throat, and floor and

roof of your mouth. If you’re using smokeless tobacco, make a commitment to quit today. Many of the

tobacco cessation programs that are eligible for our reimbursement also support individuals who want to quit

using smokeless tobacco.

Nicotine replacement and medication prescribed to assist with tobacco cessation

You may be eligible to obtain nicotine replacement medications under your pharmacy plan with a prescription from

your doctor.

For more information, please contact Healthy Lifestyles Solutions at 1-800-590-8880.

Get up to $150 back when you participate in an approved weight management program No one ever said that weight loss is easy, but support from others can make the challenge feel

more manageable.

Enroll in Weight Watchers®, Weight Watchers® Online, or an approved weight management program at

any network hospital to get encouragement to manage your weight for the long haul. Plus, the Healthy

Lifestyles Solutions Weight Management Program will reimburse you up to $150 for the cost of an

approved weight management program.

How it works

You don’t have to enroll in the Healthy Lifestyles Solutions Weight Management Program to be

eligible to receive reimbursement. When you meet the eligibility requirements, just submit your

documentation to ibx.com/reimbursements to request reimbursement.

1. Sign up for an approved weight management program

See “Selecting an approved weight management program” for information about choosing

an approved program that’s eligible for reimbursement.

2. Attend the approved program

Follow the requirements of your program and stick with it throughout the duration of your program

year. Remember that a healthy weight reduces your risk for heart disease, high blood pressure, diabetes,

and stroke.

3. Submit documentation and request your reimbursement. Log onto ibx.com/reimbursements and request your reimbursement by submitting proof of

participation and payment. For example:

•  If attending Weight Watchers in person, you will need to submit receipts and copies of your booklets.

•  If participating in Weight Watchers Online, you should submit screen prints to show proof of payment and

progress in the program.

•  If attending a hospital-based or youth program, proof of payment and participation is required.

Once all of your documentation is submitted, you can request your reimbursement to be paid by direct deposit

or American Express rewards card.*

*Please note that American Express charges a fee of $4.00 plus three percent of the reimbursement amount.

Healthy Lifestyles� Solutions Weight Management Program

Weight Management Program guidelines

Selecting an approved weight management program

Choose Weight Watchers and attend weekly meetings, or opt for an

approved weight management program based at a network hospital. Some

weight management programs for members under age 18 may also be

eligible for reimbursement. If you like, you may join more than one

program per year; however, the maximum reimbursement you can receive is

$150 per year issued once per calendar year.

Weight management with Weight Watchers

The Weight Watchers program combines in-person group sessions,

education, and tools to help you make the nutrition and exercise

decisions that are right for you. With Weight Watchers Online, you can

create a customized weight loss plan and use online and mobile tools to

help you track your progress anywhere you go.

Weight management at network hospitals

Many of our network hospitals offer weight management classes to the community. Programs and schedules

vary from hospital to hospital. For more information about available programs, contact the community

health education department of your local hospital.

Weight management programs designed for youth and adolescents

Reimbursement is available to help with the cost of programs designed for minors. The program must focus on

behavior modification, nutrition education, and have a goal of losing weight. Youth programs are commonly

available through YMCAs, community centers, and hospitals.

Use the Find a Provider tool on ibx.com to locate a network hospital in your area, or call our Health

Resource Center at 1-800-ASK-BLUE.

Not reimbursable:

•

•

•

•

Dietary supplements

Plans that require the purchase of food products designed for use with the

Plan Injections

Meal plans; liquid meals

Weight loss programs that are not reimbursable:

•  Any online program other than Weight Watchers Online

•  Any programs offered at a medical practice other than a hospital

®Weight Watchers is a registered trademark of Weight Watchers International, Inc., an independent company.

For more information, please contact Healthy Lifestyles Solutions at 1-800 -590 -8880.

HealthAdvocate

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