Regence BlueShields New Preferred Plan FourFront - PowerPoint PPT Presentation
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Title: Regence BlueShields New Preferred Plan FourFront
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Regence BlueShields NewPreferred Plan FourFront
- Product Overview
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FourFront Overview
- FourFront is an innovative new product that is
designed to - Lower costs
- Preserve popular up front benefits
- Encourage customer engagement - a customer driven
product
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FourFront Product FeaturesgtBenefits
- FourFront has a simple three tiered benefit
structure
Tier 1 Up front benefits
Tier 2 Employee cost-sharing
Tier 3 Catastrophic coverage
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FourFront Product FeaturesgtBenefits - Tier 1
- 1. Up front benefits - 100 coverage, not
subject to deductible - The first 4 office calls after a 15 copay
- 500 outpatient diagnostic labs and x-ray
- Preventive care option (required)
- 100 for Preferred providers, 50 for
Participating providers
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FourFront Product FeaturesgtTier 1- Statistics
- Office Calls
- The average member only visits the doctor 3 times
per year. - Preventive Care
- Only 1 of RBS members use more then 300 in
preventive services. - Diagnostic Lab X-ray
- 90 of RBS members do not reach 500 in DXL
claims. - Note Based on RBS claims history
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FourFront Product FeaturesgtBenefits - Tier 2
- 2. Employee cost-sharing - Other services subject
to the deductible - paid at 80 - 5 office calls, after a 15 copay
- All outpatient diagnostic labs and x-rays
exceeding the first 500 - Emergency room, after 75 copay
- Inpatient hospital
- 80 for Preferred providers, 50 for
Participating providers
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FourFront Product FeaturesgtBenefits - Tier 3
- 3. Catastrophic Coverage
- Most services are paid at 100 after 2500
stoploss is reached (copays still apply)
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FourFront Product FeaturesgtBenefits - Options
- Deductible
- 200, 500, 1000
- Preventive Care
- Option 1 - 300 annual max paid at 100 after a
15 - copay.
- Option 2 - No annual max, paid at 100 after a
15 - copay
- 100 for Preferred providers, 50 for
Participating providers
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FourFront Product FeaturesgtBenefits - Options
- FourFront is not Customizable
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FourFront Product FeaturesgtBenefit - Care
Management
- Special Beginnings - Pregnancy care program
- A pregnancy reference book (five to chose from)
- Tailored pregnancy information
- 24-hour access to nurse phone line
- Guidance through healthcare system
- Ongoing contact with program nurse
- A gift upon completion of the program
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FourFront Product FeaturesgtNetwork
- FourFront is built on RBSs broad PPO network
- Network has no PCP or referral requirements
- Members can choose from the 18,000 area
physicians, providers, and facilities in the PPO
network
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FourFront Product Features gtPrice
- FourFront rates are approximately 10-15 lower
than RBSs most popular PPO plan - PPO
100/90/60/15
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FourFront Product Features gtPrior Service
- Applies to all members who rollover from other
RBS products. (except RegenceCare) - If we pay it we count it.
- Some office calls that fall under specific
benefits are paid according the appropriate
benefit - not necessarily an office call. (ex.
smoking cessation and rehabilitation)
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FourFront OverviewgtEducational Material
- Members
- Member packet
- Website
- Newsletters
- Providers
- Townhall meetings
- Roadshows
- Newsletters
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Preferred Plan FourFront Name-brand health
coverage at a generic price
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Scenario 1
- A member goes to their PPO physician for
treatment of allergies. The physician bills an
office call and an allergy injection. - 1. Office Call 1-4 Paid at 100 of the allowed
amount (not subject to deductible) after a 15
copay. - The Allergy Injection Is subject to the
deductible, paid at 80 of the allowed amount. - Or
- 2. Office Call 5 Is subject to the deductible,
paid at 80 of allowed amount after a 15 copay.
- The Allergy Injection Is subject to the
deductible, paid at 80 of the allowed amount.
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Scenario 2
- A member goes to their PPO chiropractor for the
first time. The chiropractor bills an office
call and a spinal manipulation. - 1. Office Call 1-4 Paid at 100 of the allowed
amount (not subject to deductible) after a 15
copay. - The Spinal Manipulation Is subject to the
deductible, paid at 80 of the allowed amount. - Or
- 2. Office Call 5 Is subject to the deductible,
paid at 80 of allowed amount after a 15 copay.
- The Spinal Manipulation Is subject to the
deductible, paid at 80 of the allowed amount.
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Scenario 3
- A pregnant member goes to her PPO OB/GYN for
prenatal visits. - Maternity is generally billed as one charge for
all professional services for that pregnancy.
The total amount is subject to deductible and
paid at 80 of the allowed amount.
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Scenario 4
- A member goes to their PPO physician for
treatment of pneumonia. The physician bills an
office call, a chest x-ray and some blood work. - 1. Office Call 1-4 Paid at 100 of the allowed
amount (not subject to deductible) after a 15
copay. - And
- Diagnostic Labs and X-ray Less than 500 Paid
at 100 of allowed amount (not subject to the
deductible). - Or
- Diagnostic Labs and X-ray Over 500 Is
subject to the deductible, paid at 80 of the
allowed amount. - OR...
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Scenario 4 (cont.)
- 2. Office Call 5 Is subject to the deductible,
paid at 80 of allowed amount after a 15 copay.
- And
- Diagnostic Labs and X-ray Less than 500 Paid
at 100 of allowed amount (not subject to the
deductible). - Or
- Diagnostic Labs and X-ray Over 500 Is
subject to the deductible, paid at 80 of the
allowed amount.
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