2021 north east isd - benefits review...8 *after deductible **preventive drug list applies your 2021...
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2021 NORTH EAST ISD - BENEFITS REVIEWOpen Enrollment - October 5-26, 2020
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2021 NORTH EAST ISD - BENEFITS REVIEWOpen Enrollment - October 5-26, 2020
GREAT NEWS! No rate changes for 2021
WHAT’S NEW?
- Livongo – Diabetes & Hypertension
- Low and High PPO Plans
- Deductibles and Out-of-Pocket Maximums Increased
- Airrosti – Added Copay - $35
- https://vimeo.com/airrosti/review/382192797/970c8000b8
- Healthy Living Rewards
- Member Rewards
- NEISD will continue the HDHP/HSA District annual contribution
▪ $500 (Employee only medical coverage)
▪ $1,000 (Employee + child/spouse/family)
NO CHANGES TO:
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
2021 Benefits Review
NORTH EAST ISD
Benefit
In-Network Comparisons
PPO – Low PPO – High BlueEdgeSM
/HSA
Preventive Services 100% 100% 100%
Wellness Exams 100% 100% 100%
MD Live/Telemedicine $15 $15 100% After deductible
Retail Health Clinic $25 $25 100% After deductible
PCP Office Visit $25 $25 100% After deductible
Specialist & AirrostiOffice Visit $35 $35 100% After deductible
Urgent Care Clinic $45 $45 100% After deductible
Your 2021 North East ISD Benefits
Comparing Office Visit Copays Only
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*After deductible
**After $100 inpatient Copay and Deductible
2021 North East ISD Benefits Comparison
Benefit
High PPO Plan Low PPO Plan
In-NetworkOut-of-
NetworkIn-Network
Out-of-
Network
Individual Deductible $1,500 $3,000 $2,000 $4,000
Family Deductible $4,500 $9,000 $6,000 $12,000
Employer HCA/HSA Contribution N/A N/A
Individual Out-of-Pocket Max $4,000 $8,000 $6,500 $13,000
Family Out-of-Pocket Max $11,250 $22,500 $15,000 $30,000
Office Visit
PCP/Specialist & Airrosti/Urgent Care$25/$35/$45 70%* $25/$35/$45 60%*
Preventive Care 100% 70%* 100% 60%*
Inpatient Admission 90%** 70%** 80%** 60%**
Emergency Room 90%* 80%*
All Other Covered Services 90%* 70%* 80%* 60%*
MDLive – Medical & Behavioral Health $15 N/A $15 N/A
No RX Benefit Changes.
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*After deductible
**Preventive Drug List applies
Your 2021 North East ISD Benefits
Benefit
BlueEdgeSM
High Deductible Health Plan
In-Network Out-of-Network
Individual Deductible $2,800 $5,200
Family Deductible $8,400 $15,600
Individual Out-of-Pocket Max $2,800 $5,200
Family Out-of-Pocket Max $8,400 $15,600
Office Visit 100%* 60%*
Preventive Care 100% 60%*
Inpatient Admission 100%* 60%*
Emergency Room 100%*
All Other Covered Services 100%* 60%*
Retail Rx – Generic/Preferred/Non-Preferred Ded/Coins** N/A
Mail Order Rx – Generic/Preferred/Non-Preferred Ded/Coins** N/A
HEALTHY LIVING REWARDS
Healthy Activity* Who is Eligible Award Amount
Health Assessment Employee Only $25.00 premium credit
Diabetes Management Program
Employee and/or Spouse/Dependent
$50.00 gift card
Weight Management Program
Employee and/or Spouse/Dependents
$25.00 gift card
Women’s and Family
Health –formerly
Special Beginnings®
Employee and/or Spouse/Dependent
• Enroll in 1st
trimester - $100 gift
card
• Enroll in 2nd
trimester - $75 gift card
- No Changes
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Hospitals may all look the same, but there are often differences
in the quality of care you receive depending on the facility you choose.
The choices you make matter when it comes to your health care.
Blue Distinction® Specialty Care Program
Hospitals and medical facilities with superior expertise in delivering
higher-quality health care in at least one of the following specialties:
Knee and HipReplacement
Spine Surgery
Cardiac Care
Bariatric Surgery
TransplantsMaternity Care
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Blue Distinction® Centers and Blue Distinction® Centers+ have a proven history of delivering exceptional care and results.
With two levels of recognition, you and your doctor can choose the option that best meets your needs.
Two Distinct Recognitions
Blue Distinction CentersDemonstrate quality care, treatment expertise and better overall patient results
Blue Distinction Centers+Demonstrate more affordable care in addition to quality care, treatment expertise and better overall patient results
National access across the top 100 metropolitan areas
Livongo is an independent company that provides chronic condition management for Blue Cross and Blue Shield of Texas. Livongo is solely responsible for the products and services that it provides.
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
LIVONGO®
Expanded Condition Coaching Servicesfor Diabetes and Hypertension
748207.0519
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Not available with HMO networks
Diabetes Management
and Hypertension
Management Solutions
Livongo®
Livongo is an independent company that provides chronic condition management solutions for Blue Cross and Blue Shield of Texas. Livongo is solely responsible for the products and services that it provides.
• Welcome kit with smart glucose meter or connected blood
pressure cuff
• Digital and live coaching through meter, phone and the
Livongo mobile app
• Services covered as preventive with no out-of-pocket costs
If you are eligible, Livongo will contact you
about how to sign up for this program.
14Livongo is an independent company that provides chronic condition management for Blue Cross and Blue Shield of Texas.
Livongo is solely responsible for the products and services that it provides.
LIVONGO®
Diabetes Management Features
• Real-time personalized
messaging on the Livongo
connected blood glucose meter
• Certified diabetes educators
available 24/7/365
• Instant interventions when
blood glucose readings are out
of range
• Optional notifications for high
and low readings to give loved
ones and providers insight
• Test strips and lancets at
no extra cost, delivered right
to the member’s door
• Member-initiated reports (with
blood glucose readings and
trends) enable more focused
conversations with a clinician
• Business reports on enrollment,
activation and clinical outcomes
15Livongo is an independent company that provides chronic condition management for Blue Cross and Blue Shield of Texas.
Livongo is solely responsible for the products and services that it provides.
LIVONGO®
Hypertension Management Features
• Easy remote monitoring via
wireless-connected blood
pressure cuff
• Licensed professionals provide
live coaching and 24/7 digital
alerts
• Notifications for high blood
pressure readings and
reminders to check blood
pressure
• Intuitive mobile experience to
track progress and receive
personalized, clinically-
grounded coaching and
educational content
• Member-initiated reports (with
blood pressure readings and
trends) enable more focused
conversations with a clinician
• Business reports on enrollment,
activation and clinical outcomes
Brought to you by North East ISD Benefit Plan
VALUABLE MEMBER RESOURCES
17Screen images are for illustrative purposes only.
Blue365 is a discount program only for BCBSTX members. This is NOT insurance. Some of the services offered through this program may be
covered under your health plan. Employees should check their benefit booklet or call the Customer Service number on the back of their ID card for
specific benefit facts. Use of Blue365 does not change monthly payments, nor do costs of the services or products count toward any maximums
and/or plan deductibles. Discounts are only given through vendors that take part in this program and are subject to change. BCBSTX does not
guarantee or make any claims or recommendations about the program’s services or products. Members should consult their doctor before using
these services and products. BCBSTX reserves the right to stop or change this program at any time without notice.
Member discounts
simply for being a
BCBSTX member
• Exclusive health and wellness deals
from national and local retailers
• Save money on fitness gear, family
activities, gym memberships, healthy
eating, dental, vision, hearing aids
and more from top national and local
retailers
• Log in to Blue Access for MembersSM
and click “Member Discount Program”
in Quick Links to view your available
discounts and to register for weekly
emails
Blue365®
Member Discount Program
18*Blue Points program rules are subject to change without prior notice. Member agrees to comply with all applicable federal,
state and local laws, including making all disclosures and paying all taxes with respect to their receipt of any reward.
The Fitness Program is provided by Tivity Health™ Services, LLC, an independent contractor which administers the Prime® Network of fitness centers.
The Prime Network is made up of independently-owned and managed fitness centers. Prime is a registered trademark of Tivity Health, Inc. Tivity Health
is a trademark of Tivity Health, Inc.
Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association,
an association of independent Blue Cross and Blue Shield Plans.
The portal includes
recommended activities that
make up your Personal
Member Journey.
Well onTarget®
Highlights• Health Assessment
• Member dashboard
• Digital self-management programs
• Trackers and tools
• Interactive symptom checker
• Health and wellness content
• Secured messaging
• Blue PointsSM
rewards*
• Fitness Program
• Tracking for fitness and nutrition
and also device integration
• Personal wellness challenges
• Mobile app (AlwaysOn)
Member Wellness Portal
Screen images are for illustrative purposes only.
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Answer! Your health advisor’s
goal is to help you get the
care you need to get better.
IF A HEALTH ADVISOR REACHES OUT …
A HEALTH ADVISOR:
• Can help to coordinate your and your family’s serious health concerns
• Gives you one person you can
count on when you need help
the most
• Works with a team of specialists to help make sure you have the right care for your unique circumstances
20Screen images are for illustrative purposes only.
*Message and data rates may apply.
To download
the app, go to
Google Play,
the App Store
or text*
BCBSTXAPP
to 33633
• Find an in-network doctor,
hospital or urgent care facility
or search for Spanish-speaking
doctors
• Access your claims, coverage
and deductible information
• Access temporary digital
member ID card
• Secure login with Face ID
(iOS only) and Fingerprint ID
• Let us know your
communication preferences
BCBSTX App for Mobile Devices
• Find medicines – see cost and coverage information
– Search for medicines to find: cost estimates, formulary status, therapeutic alternatives, utilization management (UM) requirements and medicine interactions.
– Find and compare pricing for a generic version of the brand name medicine searched, or a 90-day supply at a retail pharmacy.
– Find ways to save money with low-cost generic drugs.
– Learn about drug interactions, possible side effects, and therapeutic alternatives.
• Find a pharmacy
– Search for in-network pharmacies by location and pharmacy name.
– Compare medicine prices across in-network pharmacies.
• Prescription history
– Providing a summary of paid pharmacy claims including member cost, plan paid amount, HSA/FSA paid amount and total cost of medicines.
MyPrime.com – Prime Therapeutics’ member tool for managing medicinesKeeping track of prescriptions, covered drugs, and preferred pharmacies
can be time consuming and complicated. MyPrime.com is Prime’s safe,
convenient website offering members quick access to their pharmacy
benefit information.
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Stay Engaged
in Your Health Care
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• Use in-network providers
• Research costs in Provider Finder®
• Review EOBs and bills sent
by your providers
• Use wellness benefits
• See your physician regularly
for preventive care or illness
• Ask your health care provider questions
about prescribed medications and treatment
• Ask your doctor if lower-cost
drug options are right for you
• Log into BlueAccess for Members
bcbstx.com for more health
and wellness information
• Text NEISD to 33633 – provide email & phone
number
How You Can Be a Smarter Consumer
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