Board of Regents University System of Georgia

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Board of RegentsUniversity System of Georgia
How Your 2010 HSA PPO (HDHP) Health Plan Works!
January 2010
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Agenda

• What is an HSA PPO?
• 2010 Plan Year Benefits
• Provider Networks
• 360 Health
• Consumer Web Tools
• Questions

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HSA PPO Overview
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What is a HSA PPO?

• Healthcare Savings Account HSA
• High Deductible Healthcare Plan HDHP
• Preferred Provider Organization PPO
• You have the freedom to use any licensed
  physician, specialist or health care facility in
  our PPO network for your covered services
• One of the benefits of choosing an HSA PPO is
  having the freedom to visit any doctor or
  specialist you desire without a referral. Just
  remember, if you choose a non-preferred
  specialist, your out-of-pocket costs will be
  higher than if you visit a preferred specialist.
• You dont need to worry about filing a claim when
  you use a network provider because our PPO
  network providers bill us Directly.

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What is an HSA PPO? Cont.

• You have emergency coverage when youre traveling
• across the United States and throughout the
  world, 24/7
• There are two types of health care professionals
  you can see
• as an HSA PPO member preferred and non-Preferred
• (a.k.a. non-network)
• Preferred Providers are health care
  professionals and
• facilities that have negotiated special contracts
  with us and
• are a part of our PPO network. In addition,
  preferred
• providers file claims for you. But keep in mind,
  you may
• need to pay any applicable deductibles when you
  receive care.

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What is an HSA PPO? Cont.

• Non-Preferred Providers or Non-Network
  Providers are health care professionals and
  facilities that arent in our PPO network.
  Therefore, they dont offer services at a
  discounted rate like our preferred providers. So
  remember, even though you can visit a
  non-preferred provider, youre responsible for a
  higher, out-of-network percentage of the costs
  and any charges that exceed the covered services.
  In addition, keep these things in mind
• You may have to pay more out-of-pocket
• You may have to pay for services up front
• You may have to file your own claims
• You may be balanced-billed if your charges
  exceed the amount allowed by your particular HSA
  PPO plan. If this happens, youll need to pay for
  the charges that go over the amount well
  reimburse you.

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What is an HSA PPO? Cont.

• An HSA is a tax-advantaged account established to
  pay for qualified medical expenses for those who
  are covered under a high deductible health plan.
  With money from this account, you pay for health
  care expenses until your deductible is met. Then,
  BCBSGa pays for covered expenses in excess of
  your deductible.
• Any unused funds are yours to retain in your HSA
  and accumulate toward your future health care
  expenses or your retirement.
• If you chose to go through US Bank, you can
  establish regular funding of your HSA through
  payroll deduction or automatic transfers from
  another bank account. Contributions can also be
  easily made by mailing a check and deposit coupon
  to U.S. Bank.
• A HSA provides you with greater flexibility and
  convenience for payment of qualified medical
  expenses. The U.S. Bank HSA functions similar to
  a checking account allowing you to pay for
  qualified medical expenses with your Health
  Savings Solution debit card or checks. Debit
  card(s) and checks are provided as standard
  product features to all accountholders.

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HSA PPO HDHP PLAN- At a Glance
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Using Your HSA PPO HDHP Plan to Get Care

• When you visit an in-network doctor
• Show your ID card
• Take advantage of discounts provided
• In most instances, a claim is filed for you
• Payments from your Traditional Health Coverage
  made directly to your doctor (you will receive
  and EOB or you can review claim payments online)
• May use your HSA checkbook or debit card to pay
  your doctor for any amounts you owe (provided you
  have the funds available)- Depending on the Bank
  you chose to set-up your account with
• When you visit a doctor that is not in the
  network
• Show your ID card
• Use your HSA checkbook or debit card to pay your
  provider for services (provided you have the
  funds available)
• File a claim

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Using Your HSA PPO HDHP Plan to Get Care

• When you visit a pharmacy
• Show your ID card
• Take advantage of our discounts at over 95 of
  pharmacies nationwide
• Payments from your account are made directly to
  the pharmacy
• If you dont have available funds in your
  account, you pay the discounted rate
• To get the lowest cost, visit our online health
  site to learn about generics or other low-cost
  alternatives

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2010 Plan Year Benefits
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Annual Deductibles

• Definition The amount you (the insured person)
  must pay before your health plan pays for covered
  services.
• BCBSGa Georgia In-Network Out of Network
• Individual 1,500
• Family 3,000
• All Eligible Charges are subject to the
  Deductible except all preventive care services
• No benefits are payable until the Calendar Year
  Deductible is satisfied, unless otherwise
  indicated. For family coverage, all eligible
  family Members share one combined Deductible.

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Annual Out of Pocket Maximums

• Definition This is the maximum amount you pay
  for expenses covered under your plan.
• BCBSGa In-Network
• Individual 3,000
• Family 6,000
• BCBSGa Out-of-Network
• Individual 6,000
• Family 12,000
• Amounts satisfied toward the Out-of-Network
  Out-of-Pocket Limit will not be applied toward
  the In-Network Out-of-Pocket Limit. Amounts
  satisfied toward the In-Network Out-of-Pocket
  will not be applied toward the Out-of-Network
  Out-of-Pocket Limit.
• Member costs incurred for balance billing will
  not apply toward the maximum out of pocket limit.

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Co-Insurance

• Definition The Portion of covered services which
  is the members responsibility to pay.
• BCBSGa In-Network 10 of Network Rate
• Out of Network 30 of eligible charges
• Subject to Balance Billing
• All payments are based on Eligible Charges and
  negotiated fees/discounted rates.

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Benefit Dollar Maximums

• Definition The maximum dollar amount the Health
  Plan will cover for certain services.
• Lifetime Maximum 2,000,000 (combined Medical
  and Pharmacy)
• TMJ Treatment 5,000 (Lifetime)
• Wellness/Preventive Care Unlimited
• Hospice Care 10,000
• All are In and Out of Network Combined

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Pharmacy

• A limited number of Prescription Drugs require
  pre-authorization for Medical Necessity. If
  preauthorization is not approved, then the
  designated drug will not be eligible for
  coverage. To determine if a Prescription Drug
  requires pre-authorization, please call Customer
  Service.
• If a non-participating pharmacy is used, the
  Member must file a claim for reimbursement the
  Member may be responsible for the difference
  between the BCBSGA negotiated rate and the
  pharmacys actual charge.
• 30-day supply (retail Participating pharmacy)
  90/10 Coinsurance

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Provider Networks
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Provider Network- Georgia

• Georgia Network
• BCBSGa PPO Network
• 6,215 Primary Care Physicians
• 17,170 Specialty Physicians
• 152 Hospitals
• 80 Of available Physicians in the state of
  Georgia
• How to Locate a Georgia Provider
• Go to www.bcbsga.com
• Click on Find a Doctor
• Click on Locate Georgia Providers
• Select BlueChoice Preferred Provider
  Organization (PPO)
• You will then be linked to the Provider Finder.
  Follow
• prompts to locate provider by Name and/or
  Location,
• Specialty, etc.
• Claims
• Claims should be filed to BCBSGa (Columbus)

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Provider Network- National

• Out of State Providers
• BlueCard National Network
• Over 261,200 Primary Care Physicians
• Over 466,600 Specialty Physicians
• Over 6,360 Hospitals
• 90 of all available providers in the United
  States
• How to Locate a National Provider
• Go to www.bcbsga.com
• Click on Find a Doctor
• Click on Locate National Medical Providers
• Enter the first three (3) letters of the
  Identification Number on your ID card.
• You will then be linked to the National Doctor
  and Hospital
• Finder. Follow prompts to locate provider.
• Claims
• Claims should be filed to the home plan of the
  state in which you receive services.

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Provider Network- International

• International Providers
• BlueCard Worldwide
• Provides members with access to a network of
  traditional inpatient, outpatient and
  professional healthcare providers around the
  world
• The program includes a range of medical
  assistance and claim support services for members
  traveling or living in countries outside their
  Home Plan service area.
• How to Locate a International Provider
• Go to www.bcbsga.com
• Click on Find a Doctor
• Click on Locate National Medical Providers
• Click on For Providers outside the U.S.
• Click on BlueCard Doctor and Hospital Finder
• You will then be linked to the BlueCard Worldwide
  website.
• Follow prompts to locate provider.

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Provider Network- International Cont.

• Claims
• For inpatient care at a BlueCard Worldwide
  hospital that was arranged through the BlueCard
  Worldwide Service Center, 1.800.810.BLUE (2583),
  you only pay the provider the usual out-of-pocket
  expenses (non-covered services, deductible, and
  co-insurance). The provider files the claim for
  you.
• For all outpatient and professional medical care,
  you pay the provider and submit a claim. You may
  also have to pay the hospital (and submit a
  claim) for inpatient care obtained from a
  non-BlueCard Worldwide hospital or when
  inpatient care was not arranged through the
  BlueCard Worldwide Service Center.
• BlueCard Worldwide? Service Center
• P O Box 72017
• Richmond, VA 23255-2017 USA
• To submit a claim, you complete an International
  Claim Form and send it to the BlueCard Worldwide
  Service Center. The claim form must be completed
  fully otherwise it will be returned to you and
  payment will be delayed. 
• For questions, you may contact your local BCBSGa
  Customer Service Unit or the BlueCard Worldwide
  Service Center Outside the U.S. (call collect)
  1.804.673.1177

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360 Health
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360º Health Programs

• Programs Available
• Asthma (Adult Pediatric)
• Coronary Artery Disease (CAD)
• Chronic Obstructive Pulmonary Disease (COPD)
• Heart Failure
• Diabetes (Adult Pediatric)
• 24/7 NurseLine (BlueChoice On-Call)
• Future Moms
• Kidney Disease
• ComplexCare
• NICU

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ConditionCare
Programs Include

• ConditionCare
• Our programs provide personalized support
  tailored to the needs of each member to improve
  their health while reducing medical costs.
• Multi-specialty team approach that includes
  registered dieticians, CSWs, pharmacists, and
  exercise physiologists
• Dedicated care managers provide a wide variety of
  educational tools to help members manage their
  health.

Asthma, adult and pediatric Diabetes, adult and
pediatric Chronic Obstructive Pulmonary
Disease Heart Failure Coronary Artery Disease
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360º 24/7 NurseLine

• 24/7 NurseLine
• Our information hotline provides access to a
  registered nurse over the phone 24/7, anytime,
  anywhere for assistance or just to hear a
  reassuring voice.
• Helps members assess symptoms
• Increases understanding of medical condition or
  prescribed course of treatment
• Ensures members have the right care in the right
  setting

Members are directed to appropriate care
settings, resulting in fewer emergency room
visits and reduced costs.
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360º Future Moms

• Future Moms
• Helps expectant women establish a healthy
  lifestyle for a healthy pregnancy.
• Follows progress from the first trimester through
  delivery
• Offers early risk assessment and high risk
  management
• Obstetrical nursing support for both high-risk
  and non-high-risk expectant mothers
• Post-delivery follow-up, including postpartum
  depression assessment, education and referral

Future Moms is a HERA Award Winner for
improvements in Womens and Childrens Health
Outcomes
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NICU Program

• Neonatal Intensive Care Unit (NICU)
• This program will be offered to members with
  newborns in the NICU. Staffed by a team of
  experienced NICU nurse case managers and a
  neonatologist to provide
• Intense family involvement
• Collaborative relationships with providers
• Coordination of timely discharge of infants to a
  qualified and competent homecare environment
• Ongoing follow-up after discharge

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360º Health Kidney Disease

• Chronic Kidney Disease
• Members are assigned a registered nurse, who also
  specializes in renal care to
• Coordinate care with the nephrologist and other
  providers
• Assist with the demands associated with dialysis
  treatment
• Assure that they are getting the appropriate
  testing (e.g. anemia, Hemoglobin A1c LDL, bone
  density)

Support for patient and family
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Consumer Web Tools
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Overview Page
The Overview tab is designed to give quick access
to the most commonly used tools and resources at
a glance

• Secure Message Center
• Request ID card
• View benefits
• Manage Profile
• Recently processed claims
• Contact Us

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MyClaims Page
The MyClaims page displays a searchable database
for the 2 previous years of claim data. Claim
details and an online EOB are available for
processed claims
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Provider Finder Page
Search the online Provider Directory to find
network physicians, hospitals, specialists, and
many other healthcare professionals, refine the
search by gender and/or office availability,
print a map and driving directions.
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Prescriptions Page
Find a local pharmacy, search the drug formulary,
estimate drug costs, and research possible drug
interactions.
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360Health - Overview
360Health The gateway into leading a better,
healthier life and becoming a more informed
healthcare consumer

• Compare Hospitals
• Health Risk Assessment
• Explore the Condition Center
• Animated Surgery Guide
• 3D Symptom Checker
• MyHealth Record
• Online Communities

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360Health MyHealth Assessment
Health Risk Assessment Receive an overall
wellness snapshot, compare your score against
peers, reduce health risks to improve overall
health status

• Calculate health status
• Identify health risks
• Data feed into MyHealth Record
• Medical
• PBM
• Lab (Summer 2008)
• Personalized summary
• Guidance to improve health
• Track progress of health goals
• After assessment completion
• Instant health report
• Program engagement
• Risk factor modeling

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360Health - MyHealth Record

• Secure, centralized medical information
• Vaccinations
• Medications
• Test Results
• Conditions
• Allergies
• Surgeries
• Import claims into MyHealth Record
• Create a family health file
• Create emergency health card

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SpecialOffers

• Unique assembly of discounted programs and
  services that complement our benefits
• Developed specifically to improve the health and
  wellness of our members
• Free to members
• Discounts on a wide variety of health and
  wellness merchandise
• Some discounts exclusively available through us

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Questions
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