Welcome to your Premera health plan

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10/7/2014

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Plug in to the power of your planPower up your plan on premera.com

• Find in-network doctors, urgent care, pharmacies, hospitals.

• Get details of your plan in your benefit booklet.

• Track your claims and spending toward your deductible.

• Pay bills.

• Take a health assessment to find out whether you qualify for support programs.

Get it done on the go with Premera Mobile

• Show proof of coverage. No card required.

• Find doctors and other providers.

• Refill prescriptions and set up medication reminders.

• Check benefits. Find out on the spot whether it’s covered.

• Monitor claims.

Your Premera ID card is the key to your plan. It has your member number and important phone numbers.

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When you log in to premera.com the first time, take the quick welcome survey. Your answers tell us whether you qualify for free personal health support programs.

We’re glad you’re with us! Let’s get startedImportant things to do right away

As soon as your plan starts (see your start date on the enclosed letter):

Get more information

To get complete information about what your plan covers, see your summary of benefits and benefit booklet* on premera.com. Log in, then click My Premera Plan.

1 Create your health savings account.

When you get the welcome kit from UMB Bank®, log in and use the personal funding link to begin using your account. See page 6.

2 Create an account at premera.com.

You’ll need your member number, which is on your ID card. Click Log In and follow instructions to create your account. Then download Premera Mobile to manage your plan on the go. See page 2.

3 Choose a primary care doctor.

To choose your primary care doctor, log in at premera.com and use the Find a Doctor tool. See page 4.

4 Make an appointment for an annual preventive checkup.

It’s free, and you and your primary care doctor can get to know each other. See page 12.

* To request a paper copy of your summary of benefits and complete benefit booklet, call Customer Service at 800.722.1471.

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Your provider network: What’s ‘in’ it for you?Using in-network providers streamlines your care

The Find a Doctor tool on premera.com and Premera Mobile lists the in-network providers covered by your plan.

Your health plan has a specific group of doctors, pharmacies,

hospitals, and other healthcare providers in its network. You pay

for part of the cost of your medical care, and you will pay less if

you use in-network providers.

It’s a good idea to plan where you will get in-network care

before you need it.

Choose an in-network primary care doctor

To get the most from your plan, each family member should have a primary care doctor (also called primary care provider or PCP). This doctor gets to know you and your medical history, and your medical records are all in one place, which means better care and more efficient visits.

Choose from: family doctor; internist; physician assistant; nurse practitioner; women’s health, pediatric, or geriatric specialist; or naturopath.

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For information about virtual care and the 24-Hour NurseLine, see page 10.

In-network pharmacy

Locate a nearby pharmacy with the conveniences you like—say, a drive-through or 24-hour service. When you need to fill a prescription in a hurry, you’ll be glad you know where to go. See page 15.

In-network emergency room

When you experience a medical emergency you should go to the nearest ER. But if you have a choice, stay in-network. By choosing an in-network hospital with in-network ER doctors, you can avoid possible out-of-network costs.

In-network urgent care center

Know where to go for urgent care that can’t wait until your doctor’s office is open, but that is not a life-threatening emergency.

When you’re traveling

You also have access to in-network care all over the United States and internationally through the Blue Cross Blue Shield BlueCard™ and BlueCard Worldwide™ programs. Find the phone number on your member ID card.

Use Find a Doctor to find an in-network provider and then just present your member ID card.

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The unique power of an HSA plan— and how to get itYou chose a unique type of plan that works with a health savings account (HSA). To get the benefit of this plan, you need to open an account.

How to power up your HSA plan

1 First, set up your account with UMB Bank.®*

If you enrolled outside the exchange:

After Premera receives the application and consent forms you completed during enrollment, UMB opens your account. When you get the UMB welcome kit, log in at premera.com and use the personal funding link to begin using your account.

* On behalf of Premera Blue Cross, UMB Bank® is an independent company that provides financial services. You can open an HSA with any qualified financial institution, but Premera tools to manage your account only work with UMB HSAs.

If you enrolled through the exchange (Healthplanfinder):

Complete the HSA enrollment form enclosed in this package and mail it in the enclosed envelope. UMB will open your account. When you get the UMB welcome kit, log in at premera.com and use the personal funding link to begin using your account.

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2 Contribute money to your HSA.

Make tax-deductible contributions using automatic funds transfer. To set it up, on premera.com, click Personal Funding Account, then Manage My Account.

3 Pay healthcare bills, including those that count toward your deductible, from your HSA.

You can use tax-free money from your HSA to pay for qualified medical expenses. Choose a way to pay:

• Use the healthcare payment card on the spot.

• Pay out of pocket then reimburse yourself from the HSA.

• Pay out of pocket and let the HSA fund grow tax free.

Learn more and manage your HSA plan

For more information and to manage your account, log in at premera.com and select Personal Funding Account under Manage My Account. To monitor and manage your account on the go, log in to Premera Mobile, tap Health Account, and then download the ConnectYourCare® mobile app.*

* On behalf of Premera Blue Cross, ConnectYourCare® is an independent company that provides health savings account services.

How your Premera plan works To get the most out of your health plan, it’s important to understand the lingo

Preventive care & preventive prescriptions

Non-preventive care & prescriptions

Type of Service Financial Coverage

Plan Year Start

Plan Year End

Deductible Met Out-of-pocket Maximum Met

Deductible Coinsurance You pay $0

Here’s an example.* Let’s say your plan has a $2,500 deductible, 20 percent in-network coinsurance, and a $4,100 out-of-pocket maximum. These are your cost shares.

Starting on day 1 of your plan year: You pay for most care and medical services (office visits, diagnostic tests, emergency care, prescriptions) until you pay a total of $2,500, your deductible.

Some care, including most preventive care, is fully covered before you meet your deductible. See page 12.

After you’ve paid $2,500, your plan’s coverage kicks in. You pay 20 percent of the cost of your covered care, your coinsurance. Your plan pays the other 80 percent. For example, if the total

cost of an office visit was $200, you’d pay $40 coinsurance. Your plan would pay the rest—$160.

After you’ve paid $4,100 in deductible, and coinsurance, you’ve met your annual out-of-pocket maximum. Your plan pays 100 percent of your covered care for the rest of the year.

* This is an example only. For details about your plan’s actual deductible, coinsurance, and out-of-pocket maximum amounts, see your summary of benefits and your benefit booklet on premera.com.

Pay your bills your wayPaying your premium and your bills

To pay for medical services

When you get medical services, you pay your share of the cost to your doctor or other provider:

1 After your visit, you get an explanation of benefits (EOB) online or in the mail. This informs you how much the services cost, what your plan paid, and how much you will owe. The EOB is not a bill.

2 Then, you get a bill from your doctor that tells how much you owe and how to pay. This is your share of the cost. You can pay from your health savings account, tax free.

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To pay your monthly premium

If you enrolled directly with Premera or through a producer, you send your payment to Premera. You can pay by automatic funds transfer from your bank or by monthly billing.

If you enrolled through Washington Healthplanfinder (the exchange), you will receive your bill from the exchange. When you get your monthly bill, you can send your payment either to the exchange or to Premera directly.

To pay your bill, log in at premera.com and select Pay My Bill under Member Services.

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Get anytime anywhere access Your plan covers virtual care and free 24-Hour NurseLine

24-Hour NurseLine

Call the free 24-Hour NurseLine at 800.841.8343 to consult with a nurse anytime. The nurse can help you decide whether you should be on your way to the ER or urgent care, call your doctor in the morning, or how to treat the problem yourself.

Virtual care

Ask if your doctor offers same-day and after-hours care via phone, video, or other online media.

You can also use Teladoc® to talk to a certified physician anytime anywhere in the United States.* When your plan starts, register at teladoc.com/premera and fill in your medical history. Then, if you need care when your regular doctor is not available, call 855.332.4059.

You usually pay $40 or less for a consultation with a Teladoc physician. Whether you get care from your doctor or a Teladoc doctor, standard deductible and coinsurance apply.

* On behalf of Premera Blue Cross, Teladoc® is an independent company that provides virtual medical care services. Teladoc operates subject to state regulation and may not be available in certain states.

It’s best to see your regular

doctors. When you can’t,

you can call the free 24-Hour

NurseLine to help you decide

what to do. Or get virtual care

(by phone, video, or other online

media) from your regular doc or

Teladoc® anytime, anywhere.*

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Preventive care: Strengthen your defensesWhen you catch issues early, your lifestyle changes and medical treatment can be more effective

That’s why your plan covers

most preventive care and tests

at 100 percent—no deductible

or coinsurance. Preventive care

includes regular checkups,

immunizations such as flu and

tetanus shots, and screenings

such as blood pressure and

cholesterol tests.

To ace your preventive care benefits

1 Call your primary care doctor now and make an appointment for a checkup.

2 Print your preventive benefits list and take it with you to the appointment. To get the complete list of covered preventive care services, log in at premera.com.

3 Know that tests to monitor a previously diagnosed condition are considered diagnostic, not preventive, and are not covered at 100 percent. Your doctor may order tests that are not covered as preventive.

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Is it preventive or diagnostic?

After you have been diagnosed with a medical condition, tests to monitor that condition are no longer considered preventive benefits. You may be responsible for paying deductible and coinsurance for diagnostic tests.

For example, your first cholesterol test is considered preventive and is covered in full. But if that test detects an unhealthy cholesterol level that needs to be monitored over time, follow-up testing is considered diagnostic and is subject to deductible and coinsurance.

Is it urgent or is it an emergency?

• Urgent care clinics provide care for health needs that can’t wait until the next day, but are not life-threatening. They are usually available evenings and weekends.

• Emergency rooms should be used only for severe pain or life-threatening emergencies. Examples include severe stomach or chest pain, difficulty breathing, or broken bones.

• Always call 911 if health or life is in danger. If you’re not sure, call the 24-Hour NurseLine, 800.841.8343.

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Are you covered? Know before you goKnowledge is power; decisions you make can keep your costs down

You can find a list of services that require prior authorization on premera.com. Make sure to ask your doctor about prior authorization when you discuss tests and treatments.

Q Is there some care I have to get approved beforehand?

A Yes. Your provider needs to get prior authorization, an OK from Premera, before you get certain kinds of care and procedures. Otherwise, you may need to pay part or all of the cost, above your usual cost shares.

For example, you need prior authorization for:

• Planned hospital admissions

• Some medicines

• Non-emergency ambulance

• Advanced imaging such as MRIs and CT scans

Q Can I see any doctor I want to?

A You can, but you’ll pay a larger share of the cost if you get covered care from out-of-network doctors, hospitals, pharmacies, and other providers.

Q Do I need to get a referral from my primary care doctor to get specialist care covered?

A No. As long as the specialist is in network (use Find a Doctor to check) and the care you get is covered (log in at premera.com to check), you’re set.

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How to save money on prescriptionsHow much you pay for a covered prescription drug depends on its tier and, sometimes, how you order it

Check your tier

For detailed information about how tiers are covered on your plan, see your ID card or log in at premera.com.

Ask about generics

Generics are often cheaper than brand name drugs. Generics might be the same chemically as the brand name, or different chemically but with similar effects. Ask your doctor about generics when you get a prescription.

Manage your medications online or on the go

To track and pay for your prescriptions, log in at premera.com. You can also download the Express Scripts® app to manage or order prescriptions on the go.*

At premera.com or through the Express Scripts app, you can:

• Check which prescriptions are covered and which require prior authorization

• Compare costs

• Find in-network pharmacies

• Order or refill your prescriptions

Mail order prescriptions through Express Scripts may cost you less. It can pay to order and refill prescriptions online.

$ TIER 1Most generics

$$ TIER 2Most brand name drugs

$$$ TIER 3Most specialty drugs for complex medical conditions

Some preventive medications are covered in full.

* On behalf of Premera Blue Cross, Express Scripts® is an independent company that provides pharmacy benefit services.

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Need help? Get help

Create an account Create an account on premera.com and download the Premera Mobile app. See page 2.

Customer Service800.722.1471 toll free, Monday – Friday, 8 a.m. – 5 p.m. Pacific

Translation servicesJust let Customer Service know what language you prefer to speak.

24-Hour NurseLine800.841.8343. See page 10.

Virtual care Call 855.332.4059 or visit teladoc.com/premera. See page 10.

Personal health supportIf you’re managing a chronic condition such as asthma, diabetes, heart disease, or COPD, support is included in your plan. Call 888.742.1479 (888.517.3508 TTY/TDD) or email healthhelp@premera.com.

0297060215

An independent licensee of the Blue Cross Blue Shield Association 037397 (11-06-2019)

Discrimination is Against the Law

Premera Blue Cross (Premera) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Premera does not exclude people or treat them differently because of race, color, national origin, age, disability, sex, gender identity, or sexual orientation. Premera provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). Premera provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services, contact the Civil Rights Coordinator. If you believe that Premera has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator ─ Complaints and Appeals, PO Box 91102, Seattle, WA 98111, Toll free: 855-332-4535, Fax: 425-918-5592, TTY: 711, Email AppealsDepartmentInquiries@Premera.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Ave SW, Room 509F, HHH Building, Washington, D.C. 20201, 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

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ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ

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800-722-1471 (TTY: 711). .ديریبگ تماس TTY: 711)-722-800) 1471 با. باشد یم فراهم شما یبرا گانيرا بصورت یزبان التیتسه د،یکن یم گفتگو فارسی زبان به اگر: توجه