slide 41 board of regents of the university system of georgia plan year 2011
TRANSCRIPT
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Board of Regentsof The University System of
Georgia Plan Year 2011
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Agenda
2011 Plan Grid
BOR Miscellaneous Changes
Healthcare Reform
Plan Type Overview
Questions
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2011 Plans
2011 Plan Grid
Products Provider Participating Networks
ID Card Pre-fix
Comments
BlueChoice HMO In Georgia – HMO Network
Out of state – Emergency coverage only
USU No benefit changes other than HCR, MHP– pharmacy thru BCBS
PPO In Georgia – PPO Network
Out of state – BlueCard National Network
GSR No benefit changes other than HCR and MHP – pharmacy thru Medco
OA POS (Alternative Network) – new
In Georgia - Open Access POS
Out of state – BlueCard National Network
XKQ Model PPO benefits – pharmacy thru Medco
HSA PPO (HDHP) In Georgia – PPO Network
Out of state – BlueCard National Network
XKC No benefit changes other than HCR, MHP -pharmacy thru BCBS
HSA OA POS (HDHP) (Alternative Network) – new
In Georgia - Open Access POS
Out of state – BlueCard National Network
XKQ Model HSA PPO (HDHP) benefits – pharmacy thru BCBS
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BOR Miscellaneous Changes 2011
• Open Enrollment begins 10/25 – All members will receive new ID cards with new
group number effective 1/1/2011• Medco – co-pay changes • MetLife – no changes to dental benefits• There will be a $100 Medicare Part B premium
surcharge for a retiree who is Medicare eligible and does not elected Part B.
• There will be a $50 tobacco surcharge added to BOR premiums for smokers – BOR is adding OTC and Prescription-only smoking
cessation products to all plans pharmacy benefits.
Healthcare Reform
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Plan Year 2011 HealthCare Reform Changes
• Dependent children will be covered up to age 26 with no requirements
• Preventive Services:– PPO: Removal of $20 co-pay – PPO: Removal of $750 yearly wellness maximum– HMO: Removal of $15 co-pay – All Plans- Some new required Preventive Screening Tests will
be added to preventive service categories • Behavioral Healthcare:
– PPO Plans: Remove $20 co-pay on outpatient mental health professional fees – will be subject to deductible and co-insurance
– HMO Plan: Remove $15 co-pay on outpatient mental health professional fees and $200 co-pay from inpatient mental health – will pay at 100%
• Miscellaneous HCR changes:– Prescriptions required for over-the-counter drugs. This new
standard applies to FSA’s and HSA’s
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Plan Limit Category PPO & Open Access
POS
HMO HSA PPO (HDHP) & HSA Open Access POS
Action
Lifetime Maximum 2 million 2 million 2million Remove Limits
Wellness Maximum $750 Unlimited Unlimited Remove Limits
TMJ $1,100 $0 $5,000 Remove Limits
Hospice $0 $10,000 $10,000 Remove Limits
Transplant Medical $500,000 $0 $0 Remove Limits
Donor Search $10,000 $0 $0 Retain Limits
Home Hyperalimination $500,000 $0 $0 Remove Limits
Private Duty Nursing $7,500 $0 $0 Retain Limits
Wigs $0 $0 $500 Retain Limits
Plan Year 2011 HealthCare Reform Changes continued…
Overview of Plan Options
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Preferred Provider Organization (PPO) & Open Access POS (Alternative Network)
Plans
Plan Structure:– No Primary Care Physician assignment needed– No Referrals– Deductibles
• $300 individual/$900 family– Co-Insurance
• 90/10– Maximum out of pocket
• $1000 individual/$2000 family– Office Visit Co-payments for non-preventive services =
$20– Out of network coverage available (higher deductible
$400, co-insurance 60/40 and balance billing)
• Pharmacy:– MedCo
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HSA PPO (High Deductible Health Plan) & HSA Open Access
POS (HDHP Alternative Network) Plans
• Plan Structure:– No PCP selection required– No Referrals– Deductibles
• $1,500 Individual• $3,000 Family
– Co-Insurance• 90% In-Network
– Maximum out of pocket• $3,000 Individual In-Network• $6,000 Family In-Network
– Healthcare Savings Account (HSA)• Offered through US Bank
– The monthly maintenance fee has been reduced to $2.75, the one - time set up fee has been reduced to $10.00.
• BOR is contributing to your HSA in 2011:– Single $375 (half in January and half in July)– Family $750 (half in January and half in July)
• HSA IRS contribution limits for 2011 are as follows:– Single - $3,050.00– Family - $6,150.00– Catch-up- $1,000.00
– Out of network coverage available with co-insurance of 70/30 – Unlimited preventive services, based on national guidelines for age and gender
appropriate services.
• Pharmacy:– BCBSGa (ESI)
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Health Maintenance OrganizationBlueChoice HMO
• Plan Structure:– PCP selection required– Referrals to Specialist Required (Except: OBGYN, Chiro,
Dermatologist, Ophthalmologist for medical eye care and Oral Surgeon for impacted teeth)
– Co-payment Structure• $15 Office Visit except for preventive care• $200 Inpatient co-pay except for mental health• $75 Emergency Room
– No Deductibles – No Co-Insurance– No Maximum out of pocket
• Pharmacy:– BCBSGa (ESI)
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Searching For ProvidersPlease note that some providers may opt-out of being on the web directory. You should always
check with the provider or customer service if you don’t show your provider on the web.
How to locate an HMO provider1. Go to bcbsga.com/bor.2. Click on “Find a Doctor.”3. Click on “Locate Georgia Providers.”4. Select “BlueChoice Healthcare Plan (HMO) & BlueChoice Option (POS).”5. You will then be linked to the ProviderFinder. Follow prompts to locate a provider. Under “Plan Information,” select “BlueChoice Healthcare Plan (HMO)”
How to locate Georgia Providers for PPO and HSA PPO (HDHP)1. Go to bcbsga.com/bor.2. Click on “Find a Doctor.”3. Click on “Locate Georgia Providers.”4. Select “BlueChoice Preferred Provider Organization (PPO).”5. You will then be linked to the ProviderFinder.Follow prompts to locate a provider. Under “Plan Information,” select “BlueChoice Preferred Provider Organization (PPO)” again.
How to locate Georgia Providers for Open Access POS and HSA Open Access POS (HDHP) – BOR 2011 Alternative Network Plans1. Go to bcbsga.com/bor.2. Click on “Find a Doctor.”3. Click on “Locate Georgia Providers.”4. Select “Blue Open Access HMO & Blue Open Access POS”5. You will then be linked to the ProviderFinder.Follow prompts to locate a provider. Under “Plan Information” select “Blue Open Access POS.”
How to locate national providers1. Go to bcbsga.com/bor2. Click on “Find a Doctor.”3. Click on “Locate National Medical Providers.”4. Enter the first three letters of the ID number on your IDcard. You will then be linked to the National Doctor and Hospital Finder. Follow prompts to locate a provider.
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2011 360º Health Programs for all BOR Products
– Asthma (Adult & Pediatric)– Heart Failure – Diabetes (Adult & Pediatric)– Coronary Artery Disease (CAD) – Chronic Obstructive Pulmonary Disease
(COPD)– 24/7 NurseLine– MyHealth Coach
• Hypertension• Hyperlipidemia• Oncology (prostate, skin, breast, colon
and lung cancer)• Musculoskeletal (arthritis and
osteoporosis)• Low Back Pain
Consumer Web Tools @ www.bcbsga\bor
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Phone Numbers all BOR Products
All BCBSGa Products:
BOR Dedicated Customer Service Unit.............................................................. 800-424-8950/TDD 404-842-8073
Behavioral Health Services ................................................................................ 800-292-2879/TDD 404-842-8073
Consumer Choice Option Nomination ............................................................... 800-424-8950
Online Tools and Provider Search ......................................................................bcbsga.com/bor
24/7 NurseLine.....................................................................................................800-785-0006/TDD 800-368-4424
Precertification......................................................................................................800-233-5765/TDD 800-368-4424
MyHealth Coach ..................................................................................................800-785-0006/TDD 800-368-4424
ConditionCare.......................................................................................................800-785-0006/TDD 800-368-4424
Pharmacy Benefits ...............................................................................................800-424-8950/TDD 404-842-8073
Pharmacy Benefits Manager for PPO & Open Access POS
Medco Health Solutions, Inc. ................................................................................ 877-300-5139/TDD 800-759-1089
Call for information regarding your pharmacy benefit plan and covered benefits 24 hours a day, seven days a week.
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Questions
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