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NMSU PPO & Medicare Carve-out. bcbsnm.com. NMSU Retirees. Two Plans are available:. NMSU Preferred Provider Option PPO Plan Non-Medicare Eligible Retirees NMSU Carveout Plan Medicare Eligible Retirees. nationwide network. more than 896,000 providers. more than 5,300 hospitals. - PowerPoint PPT PresentationTRANSCRIPT
bcbsnm.com
NMSU PPO & Medicare Carve-out
NMSU Retirees
– NMSU Preferred Provider Option PPO Plan
• Non-Medicare Eligible Retirees
– NMSU Carveout Plan• Medicare Eligible Retirees
Two Plans are available:
Nationwide coverage when traveling or living outside of home state
Worldwide® coveragewhen traveling in more than 195 countries
more than 5,300
hospitals
nationwide network
Nationwide, more than 95% of hospitals and 85% of doctorsOver 20,000 contracted providers in New Mexico
more than 896,000providers
Preferred Providers
PPO Network Providers….
In-network
You receive the highest level of benefits:
– Pay less for services received– No balance billing
No claim forms– Providers file claims for you
Out of Network:• You pay more of the cost
Higher deductibles, coinsurance
• You may need to file your own claim
• You could be balance billed for amounts over allowed amount
Always verify provider network status
Call BlueCard Access 24/7800-810-BLUE (2583)
Call Customer Service1-866-369-NMSU (6678)
Log on: bcbsnm.comClick on ‘Find A Doctor”
How to Find a PPO Provider
OR Contact your physician and ask if they belong to the BCBS PPO Network
BenefitsMember Share
Preferred Provider Non-Preferred Provider
Deductible– Individual $ 500 $ 700–Family $1,500 $ 2,100
Out-of-Pocket Maximum– Individual $2,000 $ 4,000–Family $5,000 $ 10,000
Primary Provider Office Visit $25 (deductible waived) 40%*Specialist Visit $35 40%*Preventive Care / Well Visits No Charge Not CoveredInpatient Admission 25%* 40%*Emergency Room 25%*Urgent Care 25%* 40%*Pet Scans, CT Scans, MRIs, Lab Tests, X-rays, including EKGs 25% 40%*
*After deductible
Retail Pharmacy Program
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Self Service: Blue Access® for Members
Log on to bcbsnm.comand click the “Log In” tab to get started
A claim has been paid. Please log in to Blue Access for Members for details.
A claim has been paid. Please log in to Blue Access for Members for details.
A claim has been paid. Please log in to Blue Access for Members for details.
BlueExtrasSM Discounts
Weight Management – Discounts at Jenny Craig®´ on membership and food
Vision Care and Eyewear – Discounts on eyewear, contact lenses and laser vision correction surgery
Nutrition – Discounts on Seattle Sutton’s Healthy Eating®´ meal plans; national home delivery program
Hearing Aids – Discounts on hearing aids for members, parents, and grandparents
Just for being BCBSNM Members!
Complementary Alternative Medicine – Discounts on acupuncture, health clubs, chiropractic, naturopaths, spas, massage therapy, vitamins and supplements, and more
24/7 Nurseline
• Our 24/7 Nurseline is here to help
• Nurses provide health advice and information
• AudioHealth Library® includes topics such as kicking the smoking habit
• Available in English and Spanish
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Advice anytime – • Round-the-clock health and
wellness advice from licensed professionals
• 1-800-973-6329
Well OnTarget – A New Way to Experience Wellness!Personalized tools and resources to help all members on the path to health and wellness. These will be replacing the current wellness tools.
•LiveOn Member Wellness PortalOnMyTime Self-directed CoursesHealth & Wellness ContentTools & Trackers
•OnMyTeam Wellness Coaching•Improved and user friendly Health Assessment•Life Points Program will be replacing the Blue Points program•Fitness program that offers membership to a national network of leading national, regional and local fitness centers for one low monthly price of $25 and no contract.
Premiering January 2013!
The New and Improved National Provider Finder on bcbsnm.com:
• National• View provider profiles • Ability to compare 3 providers/facilities side by side• Rate a Provider• Google map feature
Premiering 2nd Quarter 2013!
NMSU Medicare Carveout Plan – No changes
Low or no out-of-pocket costs
Freedom to choose your providers
No referrals required
No claims to file
Worldwide Coverage for
Emergency
Many non-Medicare covered
services provided
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NMSU Medicare Carveout Plan
No Deductible
No Coinsurance
No Co-payments
No referrals required
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When a Provider Accepts Medicare Assignment:
Medicare Carveout Plan
When provider does NOT accept Medicare
assignment
When services are NOT covered by
Medicare, but ARE plan benefits
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OR
Example: Acupuncture is not covered by Medicare. $100 Calendar year deductible
20% Coinsurance
$1500 Annual out-of-pocket maximum
Prior Authorization from BCBS applies
What if I Have Questions?
• Claim questions/status• Network provider information• Membership and eligibility • Medical coverage questions• Inquiries (telephone and e-mail)• Transition of Care information • ID card requests• Help with online tools
1-866-369-NMSU (6678)
Toll-freeCustomer Service
Personalized Service
Call your customer service team for:
Medicare Blue RX(Medicare Part D Prescription Drug Plan)
Eligibility – Medicare
• NMSU eligible retiree • Entitled to Part A and Enrolled in Part B. Under your
NMSU employer sponsored program you must be enrolled in Medicare Part A and Part B in order to be eligible for the Medicare Carveout plan.
• Not enrolled in any other Medicare Prescription Drug Plan (PDP).
• If you elect to not be enrolled in NMSU’s Blue MedicareRX Plan, you will not be eligible for NMSU’s Medicare Carveout plan.
Enhanced Plus Blue MedicareRXBenefit Enhanced Plus PlanIndividual Deductible $0Annual Drug Cost up to $2,510 $5 Generic
$30 Preferred Brand$60 Brand33% Specialty
Annual Drug Costs exceeding $2,930 (up to a total of $4,750 out of pocket costs)
$5 Generic$30 Preferred Brand$60 Brand33% Specialty
After your total out-of-pocket costs exceed $4,750
You pay the greater of: $2.65 copay for Generic/NonPreferred Generic and $6.60 copay for all other drugs, or 5% coinsurance, whichever is greater.
** Copayments shown are per 30-day supply at an in-network pharmacy. For more detailed information on this benefit plan, please refer to your Summary of Benefit.
Non-Medicare Retirees – Aging in
• NMSU will mail you a packet containing the Medicare Part D information at least forty-five days prior to your birthday month.
• NMSU will automatically enroll you in Blue Medicare Rx and Medicare Carveout program once they have received confirmation of Medicare Part A and Medicare Part B enrollment from you.
• NMSU sends a letter 2 months prior to the 65th birthday to obtain this information.
NMSU
• If your dependent child loses Medicaid eligibility as secondary coverage (Dependent has Medicare as the primary coverage) you may add them to the NMSU medical and Blue MedicareRX within 31 days of the loss of coverage.
• You must provide proof of loss to NMSU’s Benefits Office
Mentally or Physically impaired Dependents
Termination
• NMSU allows you to terminate your Blue MedicareRX group plan at any time during the year with proof of enrollment in another plan.
• Remember if you disenroll from NMSU’s Blue MedicareRX or enroll in another Medicare Part D plan you will not be eligible for the NMSU medical plan.
Pharmacy (continued)
• For a complete list of our retail, network and preferred network pharmacies
• Mail order option
What pharmacy can I use?
- Call 1-877-838-3877, 7 days a week, 7 a.m. – 7 p.m., Local time. For the hearing or speech impaired, please call
1-888-285-2252- Or visit www.bcbsnm.com
- You can also save on copayments with our convenient mail-order program administered by Prime Therapeutics^.
Resources
• Medicare Blue RX
• Medicare
- Call 1-877-838-3877, 7 days a week, 7 a.m. – 7 p.m., CST- For the hearing or speech impaired, please call 1-888-285-2252
days a week, 7 a.m. – 7 p.m., CST- Visit www.bcbsnm.com
- Call 1-800-MEDICARE (1-800-633-4227) 24 hours a day - TTY/TDD Users: 1-877-486-2048, 24 hours a day- Visit www.medicare.gov
Resources (continued)
• Social Security - Call 1-877-772-1213, 7 a.m. – 7 p.m. Monday- Friday- TTY/TDD Users: 1-800-325-0778, 7 a.m. – 7 p.m.
Monday-Friday - Visit www.socialsecurity.gov
Nearly 100 million Americans choose the Blues… including over 400,000 New Mexicans.
Administered by: Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association