IBC Individual Health Plans 2010

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New Individual Health Plans from Keystone & Personal Choice Effective 7-1-2010

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IBC Individual Health Plans 2010

  1. 1. Health Plans for The benefits you need... at the price you can afford... Individuals and Families from the name you know and trust
  2. 2. Contents Why choose Blue? Because we’re dedicated to improving the health and wellness programs, discounts on health and wellness products, and 24/7 of the communities we serve in Philadelphia, Montgomery, access to a Health Coach. You also get tools and resources to Bucks, Delaware, and Chester counties. In fact, we’re the manage your benefits and make informed decisions about region’s #1 HMO and PPO provider*. With an expansive network your health through our member website, ibxpress.com. of more than 55,000 doctors and 100 hospitals to choose from, Copay plans . . . . . . . . . . . . . . . . . . 2 you can always find the care you need. Need help choosing? It’s all about predictability. Almost all of the in-network services you use are We can help. For more than 70 years, we’ve provided the best in quality, covered by a fixed dollar amount, known as a copay. Visiting your doctor for a reliability, and service to Philadelphians. Choose Independence We offer three different types of plans – copay, deductible, check-up? Pay a copay. Need physical therapy? Pay a copay, and we take care Blue Cross, the name you know and trust. and health savings account (HSA). All of our plans offer of the rest. comprehensive coverage, but what you pay each month Think a Blue plan is too expensive? depends on what you want to spend when you see the doctor Think again. or go to the hospital. With our copay plans, you pay a set Deductible plans . . . . . . . . . . . . . . . 6 dollar amount for most services while our deductible and HSA You have a wide variety of medically underwritten plans** to It’s all about affordability. With these plans, you still have copays or 100% plans help reduce monthly costs by requiring a deductible choose from at various prices. You’re bound to find a plan that coverage for the services you use most often, such as doctor visits, screenings, and coinsurance for certain services. Use the chart below to meets your needs without breaking the bank. That means you and immunizations. The in-network deductible, an amount you pay before figure out what type of plan works best for you. Still not sure? still have money left to catch a Phillies game, visit the zoo, or insurance kicks in, applies only to services such as hospital and emergency Contact your broker for more information. spend the weekend at the shore. care. After you pay your deductible, you’re responsible for coinsurance, a percentage of the provider’s charge. Plus, all of our plans include value-added extras such as reimbursements for gym fees and weight management HSA plans. . . . . . . . . . . . . . . . . . . . 10 Here’s an overview of the types of plans we offer It’s all about savings. With our health saving account (HSA) plans, you have two ways to save. First, you save money by paying lower premiums each $$$ Monthly Rate $ month. Then, you can invest your money in a tax-advantaged HSA to save for deductibles and coinsurance. Plus, if you don’t use all of your HSA dollars, the money is yours and can be rolled over year to year to pay for future expenses. Copay Deductible HSA Office visits Copay Copay Coinsurance after deductible Value-added programs . . . . . . . . . .14 Preventive care Covered 100% Covered 100% Covered 100% There are a lot of advantages to being an Independence Blue Cross member. We HMO options: Copay Emergency care PC options: Coinsurance Coinsurance after deductible Coinsurance after deductible want to make it easier for you to save money and make healthy choices. That’s HMO options: Copay why we offer the programs, tools, and resources members need to get engaged Inpatient hospital PC options: Coinsurance Coinsurance after deductible Coinsurance after deductible in their health and make informed health care decisions. HMO options: Copay HMO: Copay X-ray PC options: Coinsurance PC: Coinsurance after deductible Coinsurance after deductible Laboratory HMO options: Covered 100% HMO: Covered 100% Coinsurance after deductible Glossary . . . . . . . . . . . . . . . . . . . . . 18 PC options: Coinsurance PC: Coinsurance after deductible options Prescription drugs Yes Yes Yes Choosing a health plan doesn’t have to be difficult. Learn more about some of the common terms and definitions, such as coinsurance, deductible, and referral. Pair with a tax-free health N/A N/A Yes savings account (HSA) Important information . . . . . . . . . . 20 Cost-sharing included in the chart above applies to in-network coverage only. For PPO out-of-network cost-sharing, Get a better understanding of our policies and guidelines and the steps refer to the benefits summary charts in this brochure. *According to a leading independent consumer magazine. we take to help you receive appropriate care. **Final rate quote and approval of coverage is dependent on medical underwriting. Approval is not guaranteed, and some applications may not be approved based on medical conditions. 1
  3. 3. Copay plans It’s all about predictability. Whether paying for utilities, your phone bill, or groceries, it can be hard to predict how much you’ll need to pay each month. But our copay plans offer the predictability you need to control your budget so that you aren’t surprised when your bill arrives. Almost all of the services you use are covered by a fixed copay if you use in-network providers. Visiting your doctor? Pay a copay. Need physical therapy? Pay a copay. We’ll take care of the rest. Here’s a look at what our copay plans include: • office visits • preventive care • prescription drugs • hospital stays • emergency/urgent care • X-rays • laboratory services • routine eye care (HMO plans only) • maternity (HMO plans only) Need help choosing between our Keystone HMO and Personal Choice® PPO plans? There are several key differences between our HMO and Personal Choice plans. With our HMO plans from Keystone Health Plan East, you select a primary care physician to coordinate all of your health care needs and provide you with referrals to network specialists. In comparison, our Personal Choice plans give you the flexibility to receive care from doctors both in and out of network. There’s no need to pick a primary care physician and you never need a referral. Our Personal Choice plans also provide in-network coverage coast- to-coast when you use BlueCard® PPO providers. While our Personal Choice plans offer you freedom to access care directly, they do not provide coverage for maternity and routine eye care, which are included in our HMO options. City skyline from steps of the Philadelphia Museum of Art, Philadelphia County. Our copay plans have predictable, set costs for most services. This 2 makes it easier for you to budget so that you can add in trips to the 3 movies, art museum, or any of the attractions that Philly has to offer.
  4. 4. Copay plans HMO 20 Copay HMO 15 Copay HMO 10 Copay Personal Choice PPO 30 Copay Benefits per calendar year You pay You pay You pay You pay in-network You pay out-of-network** Deductible, individual/family None $5,000/$10,000 Coinsurance, after deductible 20% 50% None None None $5,000/$10,000 $10,000/$20,000 Out-of-pocket maximum, individual/family Includes coinsurance only Includes coinsurance only Preventive services Mammogram (no referral required) $0 50%, no deductible Pediatric immunizations (subject to office visit copay) $0 $0 $0 $0 Nutrition counseling (6 visits per year‡) $0 50%, after deductible Physician services Primary care office visit $20 $15 $10 $30 50%, after deductible Specialist office visit $50 Routine gynecological exam/Pap test (no referral required, 1 per year) $30 $25 $20 $30 50%, no deductible Routine eye exam (once every two years) Not covered Not covered Eyeglasses or contact lenses (once every two years) $35 benefit* $35 benefit* $35 benefit* Not covered Not covered Spinal manipulations (20 visits per year‡) $50 $30 $25 $20 50%, after deductible Physical/occupational therapy (30 visits per year‡) $50 Hospital/other medical services Inpatient hospital services 20%/unlimited days 50%, after deductible/70 days $400† $200† $100† Maternity hospitalization Not covered Not covered Emergency room (not waived if admitted) $100 $100 20% 20%, after in-network deductible $100 Outpatient surgery $400 $200 Ambulance $0 $0 $0 Outpatient lab/pathology Routine radiology/diagnostic $30 $25 $20 20% 50%, after deductible MRI/MRA, CT/CTA scan, PET scan $60 $50 $40 Biotech/specialty injectables $100 $75 $50 Durable medical equipment (HMO: up to $1,000 per year; PC: up to $2,000 per year, 50% 50% 50% which includes up to $1,000 for diabetic equiptment and supplies) Mental health/substance abuse/serious mental illness treatment Not covered Not covered Not covered Not covered Not covered Prescription drug Prescription deductible, individual/family $250/$750 $100/$300 $100/$300 None None Generic formulary copay $15, after prescription deductible $15, after prescription deductible $15, after prescription deductible $10 Brand formulary copay $25, after prescription deductible $25, after prescription deductible $25, after prescription deductible $30 50%, no deductible Non-formulary copay $35, after prescription deductible $35, after prescription deductible $35, after prescription deductible $50 Prescription mail order Available Available Available Available Available Maximum prescription drug benefit, individual/family Up to $2,500/$5,000 per year Up to $2,500/$5,000 per year Up to $2,500/$5,000 per year Up to $2,500 per person per year ‡ *Paid-in-full benefit available with select group of frames at Davis Vision participating providers. ** It is important to note that all percentages are percentages of the plan allowance, not the provider’s actual charge. Out-of-network, non-participating providers may bill you for differences between the plan allowance, which is the amount paid by Personal Choice, and the provider’s actual charge. This amount may be significant. Claims payments for out-of-network professional providers (physicians) are based on Independence Blue Cross’s (IBC’s) own fee schedule. For services rendered by hospitals and other facility providers, the allowance may not refer to the actual amount paid by Personal Choice to the provider. Under IBC contracts with providers, hospitals, and other facility providers, IBC pays using bulk purchasing arrangements that save money at the end of the year but do not produce a uniform discount for each individual claim. Therefore, the amount paid by IBC at the time of any given claim may be more or it may be less than the amount used to calculate your liability. † Amount shown reflects the copayment per day. There is a maximum of five copayments per admission. ‡ For PPO plans, maximums shown are combined for in- and out-of-network care. 4 Certain plan benefits may be enhanced in order to comply with health care reform legislation. 5
  5. 5. Deductible plans It’s all about affordability. Our deductible plans are a great way to lower your monthly costs. Better yet, the in-network deductible applies only to services such as hospital and emergency care. You still have copays or 100% coverage for services such as doctor visits, screenings, and immunizations. Here’s a look at what our deductible plans include: • office visits • preventive care • prescription drugs • hospital stays • emergency/urgent care • X-rays • laboratory services • routine eye care (HMO plans only) • maternity (HMO plans only) Why have insurance if I have to pay a deductible? A deductible may seem like a lot of money to pay, but keep in mind, it doesn’t apply to all services. Think of the cost if you don’t have insurance. An unexpected accident or illness could result in medical bills up to $50,000 or more. A deductible is much less, and probably much easier to pay off. Plus, when you show your card to a participating provider, your deductible is based on our discounted rates. It’s typically a fraction of what people without insurance pay. Once you reach the deductible, you’re responsible for a percentage of the cost and we’ll take care of the rest. Need help choosing between HMO and Personal Choice? Turn to page 3. Linvilla Orchards, Delaware County. With a deductible plan, you get lower monthly rates and you don’t have to pay for benefits you don’t use. That makes it easier to enjoy hayrides through the fields, fishing in Orchard 6 7 Lake, and picking fresh fruit at Linvilla Orchards.
  6. 6. Deductible plans HMO 5000 HMO 2500 HMO 1500 Personal Choice PPO 5000 Personal Choice PPO 2500 You pay You pay Benefits per calendar year You pay You pay You pay You pay in-network out-of-network* You pay in-network out-of-network* Deductible, individual/family $5,000/$10,000 $2,500/$5,000 $1,500/$3,000 $5,000/$10,000 $10,000/$20,000 $2,500/$5,000 $5,000/$10,000 Coinsurance, after deductible 30%, unless otherwise noted 30%, unless otherwise noted 30%, unless otherwise noted 20% 50% 20% 50% $5,000/$10,000 $10,000/$20,000 Out-of-pocket maximum, individual/family $7,500/$15,000 $5,000/$10,000 $5,000/$10,000 $10,000/$20,000 $20,000/$40,000 Includes coinsurance only Includes coinsurance only Preventive services Mammogram (no referral required) $0, no deductible 50%, no deductible $0, no deductible 50%, no deductible Pediatric immunizations (subject to office visit copay) $0, no deductible $0, no deductible $0, no deductible Nutrition counseling (6 visits per year†) $0, no deductible 50%, after deductible $0, no deductible 50%, after deductible Physician services Primary care office visit $30, no deductible $30, no deductible $30, no deductible $30, no deductible $30, no deductible 50%, after deductible 50%, after deductible Specialist office visit $50, no deductible $50, no deductible $50, no deductible $50, no deductible $50, no deductible Routine gynecological exam/Pap test (no referral required, 1 per year) $30, no deductible $30, no deductible $30, no deductible $30, no deductible 50%, no deductible $30, no deductible 50%, no deductible Routine eye exam (once every two years) $50, no deductible $50, no deductible $50, no deductible Not covered Not covered Not covered Not covered Eyeglasses or contact lenses (once every two years) $35 benefit* $35 benefit* $35 benefit* Not covered Not covered Not covered Not covered Spinal manipulations (20 visits per year ) † $50, no deductible $50, no deductible $50, no deductible $50, no deductible 50%, after deductible $50, no deductible 50%, after deductible Physical/occupational therapy (30 visits per year†) Hospital/other medical services Inpatient hospital services/days 20%, after deductible/unlimited 50%, after deductible/70 20%, after deductible/unlimited 50%, after deductible/70 Maternity hospitalization Not covered Not covered Not covered Not covered Emergency room (not waived if admitted) 20%, after in-network 20%, after in-network 30%, after deductible/unlimited 30%, after deductible/unlimited 30%, after deductible/unlimited 20%, after deductible 20%, after deductible deductible deductible Outpatient surgery Ambulance Outpatient lab/pathology $0, no deductible $0, no deductible $0, no deductible Routine radiology/diagnostic $50, no deductible $50, no deductible $50, no deductible 20%, after deductible 50%, after deductible 20%, after deductible 50%, after deductible MRI/MRA, CT/CTA scan, PET scan $100, no deductible $100, no deductible $100, no deductible Biotech/specialty injectables Durable medical equipment (HMO: up to $1,000 per year; PC: up to $2,000 per 50%, after deductible 50%, after deductible 50%, after deductible year, which includes up to $1,000 for diabetic equiptment and supplies) Mental health/substance abuse/serious mental illness treatment Not covered Not covered Not covered Not covered Not covered Not covered Not covered Prescription drug Prescription deductible, individual/family None None None None None None None Generic formulary copay $10 $10 $10 $10 $10 Brand formulary copay $30 $30 $30 $30 50%, no deductible $30 50%, no deductible Non-formulary copay $50 $50 $50 $50 $50 Prescription mail order Available Available Available Available Available Available Available Maximum prescription drug benefit, individual/family Each year you have coverage up Each year you have coverage up Each year you have coverage Up to $2,500 per person, per year† Up to $2,500 per person, per year† to $2,500/$5,000 to $2,500/$5,000 up to $2,500/$5,000 *Paid-in-full benefit available with select group of frames at Davis Vision participating providers. ** It is important to note that all percentages are percentages of the plan allowance, not the provider’s actual charge. Out-of-network, non-participating providers may bill you for differences between the plan allowance, which is the amount paid by Personal Choice, and the provider’s actual charge. This amount may be significant. Claims payments for out-of-network professional providers (physicians) are based on Independence Blue Cross’s (IBC’s) own fee schedule. For services rendered by hospitals and other facility providers, the allowance may not refer to the actual amount paid by Personal Choice to the provider. Under IBC contracts with providers, hospitals, and other facility providers, IBC pays using bulk purchasing arrangements that save money at the end of the year but do not produce a uniform discount for each individual claim. Therefore, the amount paid by IBC at the time of any given claim may be more or it may be less than the amount used to calculate your liability. 8 † For PPO plans, maximums shown are combined for in- and out-of-network care. 9 Certain plan benefits may be enhanced in order to comply with health care reform legislation.
  7. 7. HSA plans It’s all about savings. Finally, there’s a way to make the most of your health care dollars. When you have one of our Personal Choice® HSA-qualified medical plans, the savings are twofold. First, you save money by paying lower premiums each month. Then, you can invest your money in a tax- advantaged health savings account (HSA) to save for deductibles and coinsurance. Plus, if you don’t use all of your HSA dollars, the money is yours and can be rolled over year to year to pay for future expenses. Here’s a look at what our HSA-qualified medical plans cover, both in and out of network: • office visits • preventive care • prescription drugs • hospital stays • emergency/urgent care • X-rays • laboratory services Want to open a health savings account? You can use our preferred vendor, The Bancorp Bank, an independent company, to set up an HSA or you can pick any bank you like. To set up a Bancorp HSA, simply check the box in Section A of the application that reads: “Yes, I’d like an HSA account set up with Bancorp.” Bancorp HSA features include: • no application or account set up fees; • no monthly maintenance fees1; • ability to earn interest with first deposit2; • free no-annual-fee Visa® Check Card; • toll-free 24/7 customer service and online access; • ability to invest HSA funds through National Financial Services once balance reaches $2,500. To learn more, visit the Bancorp website at www.mybancorphsa.com. 1 Standard banking fees apply, e.g. insufficient funds 2 Interest paid on balances over $1 Downtown West Chester, Chester County. Our HSA plans help you save money, so you can spend it on what you love most: grabbing a bite to eat with friends or browsing local stores for that next great find. 10 11
  8. 8. HSA plans Want to make the most of Personal Choice PPO 5000 HSA Personal Choice PPO 3000 HSA your HSA plan? You pay in- You pay You pay Benefits per calendar year network out-of-network* You pay in-network out-of-network* Take the savings you get with your monthly Deductible, individual/family $5,000/$10,000 $10,000/$20,000 $3,000/$6,000 $6,000/$12,000 premiums and open a health savings account (HSA). Coinsurance, after deductible N/A 50% 20% 50% You can use the money in your HSA to pay for Out-of-pocket maximum, individual/family deductibles and coinsurance. If you have money left (includes deductibles, copays, and coinsurance) $5,000/$10,000 $20,000/$40,000 $5,000/$10,000 $10,000/$20,000 over at the end of the year, it carries over into your Preventive services account for next year. Mammogram 50%, no deductible 50% , no deductible Pediatric immunizations (subject to office visit copay) $0, no deductible $0, no deductible Monthly premium Nutrition counseling (6 visits per year†) 50%, after deductible 50%, after deductible Premium savings put into HSA Physician services Primary care office visit $0, after deductible 50%, after deductible 20%, after deductible 50%, after deductible Specialist office visit Routine gynecological exam/Pap test (1 per year) $0, no deductible 50%, no deductible $20, no deductible 50% , no deductible Routine eye care Not covered Not covered Not covered Not covered Spinal manipulations (20 visits per year ) † Want to see just how much you can save with an HSA? $0, after deductible 50%, after deductible 20%, after deductible 50%, after deductible Physical/occupational therapy (20 visits per year†) Let’s say each year you contribute $1,500 to your HSA and withdraw, on average, $500 for health care expenses. Hospital/other medical services With an interest rate of 3.5%, your savings will grow each year! Depending on how you invest your money in the $0, after deductible/ 50%, after deductible/ 20%, after deductible/ 50%, after deductible/ account, your savings can be even greater. Inpatient hospital services/days unlimited days 70 days unlimited days 70 days Maternity hospitalization Not covered Not covered Not covered Not covered $0, after in-network 20%, after in-network Balance at end of year 10 Tax savings Emergency room (not waived if admitted) $0, after deductible deductible 20%, after deductible deductible $11,731.39 $5,314.02 Outpatient surgery $14,000 Ambulance Outpatient lab/pathology $12,000 Routine radiology/diagnostic $0, after deductible 50%, after deductible 20%, after deductible 50%, after deductible MRI/MRA, CT/CTA scan, PET scan $10,000 Biotech/specialty injectables $8,000 Durable medical equipment (up to $1,000 per year) Mental health/substance abuse/serious mental illness treatment Not covered Not covered Not covered Not covered $6,000 Prescription drug $4,000 Prescription deductible, individual/family Integrated with medical Integrated with medical Integrated with medical Integrated with medical Generic formulary copay $10, after deductible $2,000 Brand formulary copay $0, after deductible 50%, after deductible $30, after deductible 50%, after deductible $0 Non-formulary copay $50, after deductible 1 2 3 4 5 6 7 8 9 10 Prescription mail order Available Available Available Available Maximum prescription drug benefit†, individual/family None None None None The above chart is for illustrative purposes only. With an annual deposit of $1,500 on the first day of each year, an annual percentage yield of 3.5% with all * It is important to note that all percentages are percentages of the plan allowance, not the provider’s actual charge. Out-of-network, non-participating providers may bill you for earnings reinvested in the account, and $500 withdrawn for eligible medical expenses on the first day of each year. differences between the plan allowance, which is the amount paid by Personal Choice, and the provider’s actual charge. This amount may be significant. Claims payments for out-of- network professional providers (physicians) are based on Independence Blue Cross’s (IBC’s) own fee schedule. For services rendered by hospitals and other facility providers, the allowance The chart is not intended to be used as legal and/or tax advice. Please consult with your tax advisor and/or attorney for your particular situation. may not refer to the actual amount paid by Personal Choice to the provider. Under IBC contracts with providers, hospitals, and other facility providers, IBC pays using bulk purchasing arrangements that save money at the end of the year but do not produce a uniform discount for each individual claim. Therefore, the amount paid by IBC at the time of any given claim may be more or it may be less than the amount used to calculate your liability. † Maximums shown are combined for in- and out-of-network care. Certain plan benefits may be enhanced in order to comply with health care reform legislation. 12 13
  9. 9. Value-added programs A plan for better health We care about you and your health. We want to make it easier for you to save money and make healthy choices. That’s why we offer the programs, tools, and resources members need to get engaged in their health and make informed health care decisions. Enjoy big rewards with Healthy LifestylesSM Our unique Healthy Lifestyles programs offer cash rewards, discounts, and reminders designed to help you and your family lead healthier lives. Cash rewards – We believe you should be rewarded for taking action to maintain and improve your health. Exercise regularly? We’ll give you up to $150 back on your fitness center fees. Quit smoking or lost weight? We’ll reimburse you up to $200 on your program fees. We’ll even give you money back when you buy a bike helmet, complete a CPR class, or go to a parenting class. Valuable discounts – How about a discount on a massage or fitness gear? Just show your card and you’ll earn a discount at participating providers. From alternative health services like acupuncture to yoga books and DVDs, you’ll enjoy the discounts that come with an Independence Blue Cross membership. Our members also get exclusive discounts on CorCell®, a program that preserves your child’s umbilical cord blood - a resource that may help combat a variety of life-threatening diseases.* Important reminders – We’ll help you remember to schedule those routine tests and screenings that always seem to slip your mind. We’ll send you educational reminders for mammograms, Pap tests, and colorectal screenings. You’ll also get special reminders and resource mailings to keep the whole family up to date on immunizations and vaccinations. Healthy Lifestyles programs are value-added programs and services – they are not benefits under the health care plan that you purchased and are therefore subject to change without notice. *CorCell is an independent company offering a discount on cord blood preservation services to Independence Blue Cross members. CorCell does not offer Blue Cross and/or Blue Shield products or services. CorCell is solely responsible for its products and services. Valley Forge National Historical Park, Montgomery County. Our wellness programs offer cash rewards and valuable discounts. 14 It’s just the motivation you need to go for a run, ride your bike, or 15 take a walking tour on the expansive grounds of this historical site.
  10. 10. Value-added programs Make informed decisions Take control of your health Receive personalized support ibxpress.com also provides the tools you need to make lifestyle You don’t have to be alone when making Our member website, ibxpess.com, provides tools and changes – like losing weight or quitting smoking – by helping important decisions regarding your resources to help you make informed health care decisions. you get started, set reachable goals, and track your progress. health. Our ConnectionsSM Health We’ve partnered with WebMD® to provide you with Management Programs give you the personalized tools and reliable information to help you make • Personal Health Profile (PHP) – This powerful one-on-one support you need when health decisions that are right for you. health assessment tool will give you a clear picture facing significant treatment decisions or • Provider Finder and Hospital Finder help you find of what you are doing right and suggest ways to stay everyday health concerns. Your personal the participating doctors and hospitals that are best healthy. After you complete the PHP, you’ll receive an Health Coach is available 24/7 to answer equipped to handle your needs. You can learn about accurate, confidential, and personalized action plan. your questions and to help you make where your doctors went to medical school, their board knowledgeable, confident decisions • Lifestyle Improvement Programs – These certification, languages spoken, and more. You can regarding your health care. Your Health personalized, self-paced, step-by-step programs also compare hospitals based on their experience, Coach can provide: will help you improve your health. You’ll find cost, patient satisfaction, and other factors you several different programs, such as exercise, weight • information on everyday health find important. management, nutrition and smoking cessation, designed concerns, such as headaches and • Symptom Checker provides a head-to-toe tool to to inspire and support your positive health changes. joint pain; help you evaluate how serious your symptoms are – and These online programs combine proven tactics with the what you should do about them. ultimate in privacy, security, and convenience. • help if you are facing a significant medical decision, such as treatment • Health Encyclopedia provides information on more • Health Trackers – Chart your progress over time options for back pain, breast or than 160 health topics and the latest news on to help you stay motivated. Track blood pressure, prostate cancer, or surgery: common conditions. cholesterol, body fat, and other health factors. Or, customize the tool by adding a new health tracker for • personalized calls about your • Treatment Cost Estimator helps you estimate your additional data you want to track – like test results, chronic condition or health costs for hundreds of common conditions – including number of push-ups, etc. concerns; tests, procedures, and health care visits – so you can plan and budget for your expenses. • Personal Health Record – Use your Personal Health • information about what types of Record to store, maintain, track, and manage your questions to ask your doctor. health information in one centralized, private, and Take a tour of our secure location. We’ll even update your Personal Health Record for you each time we process one of your claims. 1 WebMD is an independent company offering online health information and wellness education to Independence Blue member website on Cross members. www.ibxpress.com. Health information at your fingertips No matter where you take your laptop, ibxpress.com makes it easy for you to stay on top of your health. 16 17 1 1
  11. 11. Glossary Choosing a health plan doesn’t have to be difficult. Learn more PPO - This stands for preferred provider organization. With a Precertification – This may also be called about some of the common terms and definitions before you PPO plan, there’s no need to select a primary care physician. preapproval or prior authorization. Basically, make a decision. You can visit any doctor or specialist in the network, without a you may need additional approval from referral. You also have the freedom to choose doctors outside your health plan before you receive certain Copay - It’s a set dollar amount you pay for a covered health the network if you’re willing to pay more for their services. tests, procedures, or medications. It’s a way service. If you have a $10 copay for a doctor’s visit, you simply to make sure the services you’re getting pay $10 and we cover the rest. Preexisting condition - It’s a health condition you received are effective. medical care or advice for before applying for insurance. Coinsurance - Some plans require you to pay a percentage All of our medically underwritten plans have exclusions for Rate guarantee - All of the plans in of your medical costs. If you use a participating provider, your preexisting conditions for the first 12 months of coverage, this brochure come with a six-month rate costs are based on our discounted rate. meaning that some conditions may not be covered for the first guarantee. This means that your final rate Deductible – This is a fixed dollar amount that you must year. Under our HMO plans, we will look at any conditions that will remain the same for the first six months pay before your insurance kicks in. If you use a participating you received services or advice for in the 90 days preceding of coverage. You will be notified in advance provider, your costs are based on our discounted rate. your enrollment. For our PPO plans, the look back period is 12 of any rate increases approved by the months. There are two ways that you can waive or reduce the Pennsylvania Insurance Department. HMO - This stands for health maintenance organization. If preexisting condition exclusion period. you pick an HMO plan, you’ll need to select a family doctor who Referral – If you have an HMO plan, your can help you with general health concerns, or refer you to a • Blue-to-Blue transfer – If you’ve had active health family doctor (or PCP) will need to write network specialist for care. coverage with a Blue Cross® or Blue Shield® plan for up you a referral before you see other network to 12 months without a break in coverage prior to your providers, such as a dermatologist. No need Health savings account (HSA) - A tax-advantaged savings requested effective date, you can receive credit for each to pick up a piece of paper, our referrals are account that can be used to save for health care expenses. You month of prior coverage up to the entire exclusion period done electronically. must be enrolled in an HSA-qualified high-deductible health of 12 months. plan to be eligible to open an HSA. There is a maximum amount that you can contribute to an HSA each year but if you don’t • Creditable Coverage – If you had active coverage with use all of the money within your benefit period, it rolls over to another insurance carrier for at least 18 months without the next year. a break in coverage of more than 63 days prior to your current application, you can receive credit for the entire Medically underwritten plan - All of the plans in this exclusion period of 12 months. brochure are medically underwritten. Your health history and If you qualify for a preexisting condition waiver, be sure to current health will be reviewed to determine whether you complete Section G of the application and provide any qualify for enrollment. If approved, some health conditions may required documentation. require you to pay a higher premium. Premium - This is the amount you pay for your health Out-of-pocket maximum – This is the maximum amount insurance coverage. This is separate from costs you pay when that you will have to pay under your plan. Once you hit your you use your benefits to get care, such as copays, deductibles, out-of-pocket maximum, we’ll cover services requiring a and coinsurance. deductible or coinsurance 100% for the remainder of the Primary care physician (PCP) – This is just another term benefit period. Check plan details to see what’s included in the for your family doctor. HMO plans require you to pick a PCP to out-of-pocket maximum calculation. Please note that none of coordinate your health care and refer you to a specialist if needed. the plans include balance billing by out-of-network providers in the out-of-pocket maximum calculation. Frankenfield Covered Bridge, Bucks County. Riding your bike is a great way to get your health in gear – 18 and admire the foliage and covered bridges of Bucks County. 19 16 1

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