HealthFlex

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HealthFlex
Tools for a Healthier Lifestyle Kansas West
Conference of The United Methodist Church
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HealthFlex Support Tools
Employee Assistance Programs
Optimal Health Disease Management
Pastoral Counseling
Optum NurseLine
Vision VSP
Pharmacy Medco
HealthQuotient WebMD
General Board Health Team
Health Coaching Harris HealthTrends
BlueCross BlueShield
Flexible Spending Account Ceridian
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HealthFlex 2008Kansas West Conference

• BlueCross BlueShield (Illinois)
• Medco for pharmacy benefit
• Ceridian for flexible spending accounts

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BlueCross BlueShieldTerms You Need to Know

• Primary Care Physician (PCP)
• Explanation of Benefits (EOB)
• Pre-notification
• School certification
• Networks
• Preferred Provider Organization (PPO)

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BlueCross BlueShield

• Benefits Summary
• Transition of care
• Participant responsibilities
• Whom do you call?
• Web site

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Kansas West Conference BlueCross BlueShield
HealthFlex Benefits Summary
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Kansas West Conference BlueCross BlueShield
HealthFlex Benefits Summary
Non-Network
Network
Type of Coverage
65
15 co-payment
Physician Office Services (PCP)
65
40 co-payment
Specialist Office Visits
65
15
Therapies (PT, OT ST)
100 100 annual benefit
100

• Preventive Care
• Well Child

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Kansas West Conference BlueCross BlueShield
HealthFlex Benefits Summary
Non-Network
Network
Type of Coverage
15 or 40 co-payment 100 co-payment 15
co-payment
100 up 100 calendar year benefit
Preventive Care Well Adult One Well Person
Examannually Colonoscopy (over age 45,once
every three years) Licensed Dietician Office
Visit
65 15 co-payment
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Kansas West Conference BlueCross BlueShield
HealthFlex Benefits Summary
Non-Network
Network
Type of Coverage
65
85
Outpatient Services
200 per hospital co-payment then 65 after
deductible
85
Inpatient Hospital Stay
Not covered
85 at BCQTCs
Transplant Services
15 or 40 co-payment 50 co-payment
85 after deductible

• Emergency Care
• Physician Office
• Hospital ER (or Urgent Care)
• Ambulance

15 or 40 co-payment 50 co-payment
85 after deductible
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Kansas West Conference BlueCross BlueShield
HealthFlex Benefits Summary
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Kansas West Conference BlueCross BlueShield
HealthFlex Benefits Summary
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Transition of Care

• Allows the patient time to find a new
  in-network provider
• Conditions
• Serious medical condition
• In third trimester of pregnancy
• Being treated for a terminal illness
• Receiving cancer treatment and therapies
• In cardiac rehabilitation
• Other

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Participant Responsibilities

• Present new card to doctor orpharmacy beginning
  January 1, 2008
• Utilize network providers to ensure highest
  level of benefits
• Contact BCBS, Medical Services Advisory to
  pre-notify inpatient admissions
• Contact BCBS customer service to have outpatient
  services predetermined

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BlueCross BlueShieldWho Do You Call?
Call customer service (1-866-804-0976) to
discuss

• Benefits
• Eligibility
• Claim processing
• Coordination of benefits

• Transition of ongoing care
• Locate providers
• Additional I.D. cards

Customer service is available from 800 a.m. to
600 p.m., Central time, Monday through Friday
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BlueCross BlueShieldAccess the Web Site

• Search for a PPO doctor or hospital using the
  Provider Search
• Create a personalized directory
• Order additional I.D. cards
• Download claim forms
• Check claim status
• View an Explanation of Benefits (EOB)
• Confirm who is covered under your plan
• Health and wellness information via the Mayo
  Clinic

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BlueCross BlueShield ID Card
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Medco Pharmacy

• Administers the HealthFlex prescription drug
  benefit
• Wide network of retail pharmacies
• Medco by mail

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Medco Pharmacy

• Benefit Summary
• Generics First
• My Rx Choices
• Retail refill allowance
• Transition

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Kansas West Conference Medco Pharmacy HealthFlex
Benefits Summary
Non-Participating Rx Benefit
Participating Rx Benefit
Type of Coverage
Limited to amount the plan would have paid for
the drug at a retail pharmacy
50 100 10 20 35

• Retail Pharmacy Deductible
• Individual
• Family
• Retail Co-payment
• Generic
• Preferred name brand
• Non-preferred name brand

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Kansas West Conference Medco PharmacyHealthFlex
Benefits Summary
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Medco PharmacyGeneric First
Generic First (effective January 1, 2008)

• If the prescription is written by a provider and
  has a generic equivalent, the prescription will
  be filled with the generic drug, the participant
  is responsible for the co-payment
• The patient is required to pay the generic
  co-payment plus the difference in cost between
  the generic and brand name drug, when the brand
  name is chosen and the generic is available

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Medco PharmacyGeneric Drugs

• Most affordable way to obtain quality
  medications
• The U.S. Food and Drug Administration (FDA)
  requires that generic drugs have the same active
  chemical composition, same potency and be
  offered in the same form as their brand-name
  equivalents
• Generic drugs must meet the same FDAstandards as
  brand-name drugs and are tested and certified by
  the FDA to be as effective as their brand-name
  counterparts

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My Rx Choices

• Online tool
• www.medco.com
• Drug comparison
• Cost savings
• Therapeutic equivalents
• Printed report for doctor

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Medco Pharmacy Retail Refill Allowance (RRA)

• Medco by mail
• Maintenance drugs
• One mail order co-payment for each 90 day refill
• Retail Refill Allowance (RRA)
• Three maintenance drug fills allowed at retail
• Subsequent fills at retail, members will be
  responsible for paying 100 of the discounted
  price

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Medco PharmacyTransition

• Effective January 1, 2008, provide your
  pharmacist with your new identification card
• Effective January 1, 2008, request home delivery
  of refill maintenance medications

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MedcoWhom Do You Call?
Call the number on your BCBS ID card
(1-866-804-0976) and select the prescription
drugs option from the voice prompt

• Benefits
• Eligibility
• Claim questions
• Find an in-network pharmacy
• Transition of mail order medications
• Order status for mail order prescriptions
• Find lower cost medications and generic
  alternatives
• Price a medication
• Drug information

Customer service is available 24 hours per day,
7 days a week.
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MedcoAccess the Web Site

• Eligibility
• Claim questions
• Price a medication
• Drug information
• View benefit summary
• Find an in-network pharmacy
• Download mail order claim forms
• Order status for mail order prescriptions
• Find lower cost medications and generic
  alternatives

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Optum NurseLine

• Support for physical, emotional and personal
  health concerns
• Available 24 hours a day
• Access through the 800 on your card

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Vision Service Provider (VSP)
Vision benefits exam core

• One eye exam every 12 months
• 10.00 co-payment
• Value added discounts
• Prescription glasses Discounted 20
• VSP doctors evaluation and fitting for contact
  lenses Discounted 15
• Laser VisionCare

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United Behavioral Health

• Benefit Summary
• Pastoral consultation line
• Life Solutions Program
• www.liveandworkwell.com

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Kansas West Conference UBH HealthFlex Benefits
Summary
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Kansas West Conference UBH HealthFlex Benefits
Summary
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Kansas West Conference UBH HealthFlex Benefits
Summary
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Pastoral Consultation Line

• Provides guidance, support and resources for
  pastors faced with challenging counseling issues
• Access 1-800-842-2869

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United Behavioral Health

• Life Solutions Program
• Child/Parenting support services
• Adult/Elder support services
• Chronic condition support resources
• Life learning resources

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Ceridian Flexible Spending Accounts (FSA)

• Health Care Account
• You can pay for eligible out-of-pocket health
  care expenses with pre-tax dollars
• 5,000 maximum annual contribution
• Dependent Care Account (DCA)
• You can be reimbursed for eligible child and
  dependent care with pre-tax dollars
• 5,000 maximum annual contribution

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Ceridian Flexible Spending Accounts (FSA)

• Automatic claims processing(participants
  choice)
• As you incur expenses that are eligible for the
  FSA the monies are automatically sent to you
• Direct deposit (participants choice)
• Money can be deposited directly into your
  checking or savings account

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Ceridian Flexible Spending Accounts (FSA)
Grace Period extension (IRS Ruling)

• January 1, 2009 through March 15, 2009
• Expenses incurred during this grace period may
  be reimbursed from the previous years FSA
  balance

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FSA Eligible Expense Examples
Savings examples

• Prescriptions and over-the-counter medications
• Health care co-payments and deductibles
• Dental and orthodontia expenses
• Vision expenses, glasses, contact lenses, contact
  lens solutions
• Before-and-after school care
• Child and elder care services

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FSA Participation Facts

• Estimate the amountof yearly expenses
• Amount is deducted from your paycheck
• Expenses incurred through Grace Period extension
  are eligible

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FSA Participation Facts

• Health and dependent care accounts are separate
• Tax implications
• Unused dollars are forfeitedUse it or lose it

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WebMD

• One stop location for participants to access
  multiple health and benefits informationand
  resources

• Access to vendors
• HealthQuotient
• Decision support tools

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HealthQuotient
Evaluate your healthaccess www.gbophb.org

• 25-27 questions
• 15-20 minutes to complete
• Screens for 21 risk factors
• Based on lifestyle, medical history, family
  history
• You can take the quotient as often as you like

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HealthQuotient
What happens after I take it?

• Report is generated
• May be contacted by Harris HealthTrends

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HealthFlex Healthy Lifestyles Condition
Management Programs

• Harris HealthTrends
• If you are at risk for developing a chronic
  disease
• Optimal Health
• You are striving to manage
• diabetes, coronary artery disease or congestive
  heart failure

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General Board of Pension and Health Benefits
Health Team

• Member advocate
• Voice to vendors
• Ombudsman
• Additional layer ofcustomer service
• Access 1-800-851-2201, Health team prompt

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Election Process

• Election packets will be mailed in early
  November
• Elections must be made online
• Access (www.gbophb.com)
• WebMD registration required
• Contents of election packet
• Web guide
• Election form

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Participant ConnectionTelephone Access
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Participant ConnectionWeb Access
Pharmacy
Vision Service Provider
To access www.gbophb.org
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