ISABELLA COUNTY 2018 OPEN ENROLLMENT 2018 Plan Year BCN Medical - - PowerPoint PPT Presentation

ISABELLA COUNTY 2018 OPEN ENROLLMENT

2018 Plan Year

Purchased Plan BCBS HRA Option A HRA Option B HRA Option c

Deductible

Single/Family

$5,000/$10,000 $0/$0 $100/$200 $500/$1,000

Coinsurance %

20% 0% 10% - $500/$1,000 20% - $1,500/$3,000

Out of Pocket Max

**Includes deductible, coinsurance and copayments

$6,350/$12,700 N/A N/A N/A

Office/Specialist Visit

$30/$30 $30/$30 $30/$30 $30/$30

Chiro Copay/ Max

$30/24 Visit Max $30/24 Visit Max $30/24 Visit Max $30/24 Visit Max

Urgent Care/ER Copay

$30/$150 $30/$150 $30/$150 $30/$150

Prescription Copays

10/40/80 Mail Order 2x Copay

BCN Medical Coverage

HRA Benefit Options – Effective 1/1/18

Participating Provider

• 1. Present BCBS ID Card & 44North

HRA Card to the provider to explain the HRA process.

• 2. Provider will submit claim to

BCBS.

• 3. After 44North receives your

claim from the carrier, claims specialists will ensure the processing of your medical provider claim within 7 to 10 days.

• 4. You will then receive a 44North

explanation of benefits (EOB), showing the medical provider’s bill has been processed.

Participating Provider

• 5. DON’T FORGET TO PAY

PROVIDER FOR ANY REMAINING CHARGES IF ANY (Copay, etc).

Subscriber

CLAIMS PROCESS

$5,000 Deductible 20% Coinsurance MRA

Surgery Diagnostic Test Hospital Stay Pathology Anesthesia The following are a few examples of medical procedures that are subject to deductible and coinsurance

Claim Example

0% Coinsurance $0 Deductible Option A 10% - $500 Coinsurance $100 Deductible 20% - $1,500 Coinsurance $500 Deductible Option B Option C

Use T his: Sympto ms/ Co nditio ns: Adva nta g e s: Co st: Ave ra g e T ime : Whe re to find:

Doctor’s Office

• Sore throat
• Painful urination
• Low-grade fever
• Earache
• Cold and flu
• Mild allergy symptoms
• Skin rash
• Eye irritation or redness
• Minor burns, cuts or scrapes
• Sprains and strains
• Minor asthma issues
• May have extended

hours

• Ongoing relationship
• Can generally be

reached after hours by phone $ 60 minutes Visit your primary care doctor. If you do not have one you can find a primary care physician at bcbsm.com “find a doctor”

Urgent Care

• Evening and weekend

hours

• Walk-in appointments

available

• Convenient locations

$$ 60-90 minutes Search using http://www.findurgentcare.com

• r http://www.bcbsm.com or

ask your primary care doctor to recommend a near by urgent care.

Emergency Room

• Life threatening conditions
• Chest pain
• Possible broken bones
• Sudden blurred vision
• Poisoning
• Loss of consciousness
• 24/7 availability
• Suitable for

emergency situations $$$ 2-4 hours Call 9-1-1 or visit your local hospital.

Billions of dollars are wasted each year because patients visit the wrong health care centers during non-emergencies. Use the below as a quick reference to be a better consumer.

Where Should I Go For Care?

**Need help finding a participating provider or urgent care center? 44North is available to help! Call 855-306-1099**

Prescription Coverage – Effective 1/1/18

Generic

• $10 copay 30 day
• $20 copay Mail Order

Preferred Brand

• $40 copay 30 day
• $80 copay Mail Order

Non-Preferred

• $80 copay 30 day
• $160 copay Mail Order

Prescription Coverage

• Prior authorization - means that certain clinical criteria must be met

before coverage is provided. You may be required to pay additional

• ut-of-pocket costs or a higher copayment if you do not have prior

authorization. Your pharmacist

• r

physician can request prior authorization on your behalf by calling BCBS pharmacy help desk.

• Step Therapy - Drugs that require step therapy may require previous

treatment with one or more formulary agents prior to coverage.

• Quantity Limits - BCBS has established Quantity Limits for certain

medications based either on package size or to promote appropriate prescribing of drugs intended for one-a-day doses. Some medications, including specialty drugs, are limited to a 30 day supply and cannot be filled for a 90 day supply

1 1 2 2 2 3 3 4 4 3 5 5 6 7 7 8 9

10 10

6

Blue Cross Blue Shield Purchased Plan EOB 44North Reimbursed Plan EOB

How to Read Your EOBs

1. Employer Info 2. Member Info 3. Provider Info 4. Date of Service 5. BCBS Approved Amount 6. Purchased Plan Deductible 7. BCBS Paid 8. HRA Deductible 9. HRA Coinsurance

• 10. Reimbursed Amount Paid to Provider
• 11. Amount Employee Must Pay Provider

11

Register as a first time User at www.BCBSM.com BCBS will send you a PIN by mail in order to activate.

• View EOBs (exception - OV)
• Deductible Balances Inquiry
• Monitor Claim Status
• Update COB Information

MRA/FSA Online Portal

Usernames and Passwords are CASE SENSITIVE

Trouble logging in? Please call 855-306-1099

Access your claim information 24/7 with our online claims portal.

• 1. Go to www.44n.com
• 2. Click on “Client/Member Portal”
• 3. Click on “HRA and FSA Claims Portal”
• 4. Sign in using your last name & last four digits of your social security number as

your Username. Your password is your last name along with your birth date.

DENTAL & VISION – NO CHANGE!

BCBS DENTAL COVERAGE

• 100%/75%/50%
• $1,200 Annual Maximum Benefit

BCBS VISON COVERAGE

• $10 Exam Copay - 12 month
• $150 Frame Allowance – 12 month
• $25 Glasses Copay
• $150 Contact Lens Allowance
• Contacts and Lenses - 12 month

Bi-Weekly Employee Cost Share

Coverage Level:

Opt ption n A

Opt ption B n B Opt ption C n C

Single

$10. $10.95 $7. $7.41 $0. $0.00

Two-person

$26. $26.28 $17. $17.79 $0. $0.00

Family

$32. $32.85 $22. $22.24 $0. $0.00

Voluntary Term Life

• Gives you the opportunity to choose a life insurance benefit that fits you

at a price you can afford.

• Accessible for Employee, Spouse and Dependents
• Benefits are Portable and Convertible
• Rates are based on the Employee’s current age for both Employee and

Spouse

Guarantee Issue Amount – Newly Eligible

• Full Time Employee: $200,000
• Spouse: $30,000
• May not exceed 50% of Employee elected amount
• Dependent Children: $10,000
• Age 14 days – 25 years (if a full-time student)
• 70 years or older, maximum benefit is $50,000

Eligible Increments of Increase

• Employee: $10,000
• Spouse: $5,000
• You and your spouse may increase your coverage 1 increment during
• pen enrollment up to the Maximum Benefit Level
• Employee: $300,000 Maximum
• Spouse: $150,000

SECTION 125

FSA

• Pre-tax medical reimbursement
• Can elect up to $2650 annually
• $500 Rollover to Next Plan Year
• Eligible Expenses Include:
• Deductible/Coinsurance
• Copays (Rx, ER, etc)
• Dental/Vision

DEPENDENT CARE

• Pre-Tax Dependent Care
• Can elect up to $5000 annually

Benny “Smart” Card

The Smart Card works for:

• Prescriptions: In store, mail order, or online
• Patient balances due on medical statements.
• Please make sure BCBS has processed the claim before you make a payment.
• Office Visit Copays
• Out of pocket expenses for vision, dental, and orthodontic claims
• For more uses, contact 44North at 855.306.1099

**Plea ease se onl nly u use S e Smart C Card t d to p pay for e eligible e e expen penses w ses within t the he cur urrent pl plan y year. Any claims in the 90-day run out period will need to be submitted manually. Additional documentation may be requested by 44North for transactions that the IRS does not allow auto-substantiation (Ex: deductible/coinsurance items, dental, vision, or when card is used at non-IIAS merchant.)

Documentation For Reimbursement

Documentation in regards to HRA/FSA fund distribution is important! The IRS requires the following for claims to be reimbursed:

• Date of Service
• Name of person receiving service
• Name of provider
• Type of service provided
• Amount charged for each service and/or the amount reimbursed by the insurance
• Approved charge vs. not approved (cosmetic for example)
• Amount applied towards the deductible/coinsurance/co-pay

Your EOBs contain all of this information! Example Receipts:

PRICING TRANSPARENCY

WHY DO WE KNOW THE COST OF APPLIANCES, FURNITURE, AND

GROCERIES, BUT NOT MEDICATIONS, MEDICAL TESTS, AND PROCEDURES? O UR 44NORT

H SHOPPE RS WI L L HE L P YOU:

SAVE ON ME

DI CALPROCE DURE S

SAVE ON PRE

SCRI PT I ONS

F

I ND F E DE RALG RANT S AND C O-PAY ASSI ST ANCE PROGRAMS

Common non-emergent procedures eligible for comparisons:

• MRIs
• Ultrasounds
• CT Scans
• Mammograms
• Colonoscopies

Contact a 44North Shopper to see if yours can be quoted!

PRICING TRANSPARENCY

PRICING TRANSPARENCY

$20 GIFT CARD FOR CALLING 25% OF THE SAVINGS

SO HOW DOES IT WORK?

Referred Facility

MRI Without Contrast FACILITY LOCATION COST A McLaren $2,319 B Open MRI $1,057 C Mid-Michigan-Midland $1,762 D Mid-Michigan-Clare $1,966

See how it works:

44North Shopper Facility

$2,319 at the referred facility

• $1,057 at the 44North Shopper facility

$1,262 potential savings

25% of the potential savings = $315.50!

Contact a 44North representative today to price your next procedure. 855-306-1099 x 1075 | SHOPPER@44N.COM

Receive quality care via phone or online video Talk to a licensed physician anytime, anywhere with the leading telemedicine network, Teladoc.

GET THE CARE YOU NEED

Teladoc doctors can treat many medical conditions, including:

• Cold & flu symptoms
• Allergies
• Bronchitis
• Skin problems
• Respiratory infection
• Sinus problems
• And more!

TALK TO A DOCTOR ANYTIME FOR F REE REGIS

ISTER TODAY AY AT AT WWW WWW.TELA LADO DOC.CO COM OR OR 1-800

00-TELADO

ADOC

Call to speak with a Patient Advocate to:

• Navigate your healthcare bills
• Understand your EOBs
• Assist with pharmacy charges

N EED HELP WITH CLAIMS ISSUES? 855-306-1099 OPTION 1 We’ve saved members $6 million dollars from misbilled claims.

We find the errors, contact the provider and insurance carriers to resolve any misbillings that can cost you money.

REMINDERS

Don’t Forget:

• You will receive a 44North benefit summary card
• Show your providers both BCBS and 44North Cards
• For those electing FSA, indicate if you would like HRA claims to be

automatically processed through FSA

• Indicate if you would like Paperless 44North EOB’s
• Turn in your Enrollment/Beneficiary Forms to Cindie by Friday,

November 10, 2017

• Call 44North when you have elective procedures recommended to

receive a Pricing Transparency report

• Activate your Teladoc account so it’s ready when you need it
• You or your provider can contact 44North at any time by calling

855-306-1099

ISABELLA COUNTY 2018 OPEN ENROLLMENT

THANK YOU

Question or Comments? Call us at 855-306-1099