Healthy Blue LivingSM HMO
Member Guide
Congratulations on beginning another year in our plan that
helps
you stay or get healthy. Healthy Blue Living is one of only a
few
health plans that focuses on your lifestyle choices and how
they
affect your health — and that rewards you with lower
out-of-pocket costs for living a healthy lifestyle.
Thank you for being a Healthy Blue Living member and making a
commitment to improving your health.
1
Within the first
120 DAYS of plan year
See your doctor for a Blue Care Network Qualification Form visit*:
After your appointment, your primary care physician will need to
complete and electronically submit to us a qualification form that
covers six health measures. If your results aren’t within the
Healthy Blue Living wellness targets, work with your doctor to set
goals to improve your health. See Page 2 to learn more about the
six health measures.
Complete a health assessment*: Take an online health assessment by
logging in to your account at bcbsm.com. If you don’t have internet
access, ask for a paper copy by calling 1-855-326-5098. See Page 4
for more details on the health assessment.
Join our tobacco-cessation program: If you use tobacco — confirmed
through your qualification form — participation is required in this
program until a new qualification form shows a negative cotinine
test. See Page 4 for more information.
Join a BCN-sponsored weight-management program: If your
qualification form shows you have a body mass index of 30 or more,
you’re required to enroll and participate at no extra cost in a
BCN-sponsored weight- management program. See Page 5.
Being at the enhanced level is up to you
To stay at the enhanced level, which means everyone on your
contract has lower out-of-pocket costs, you need to complete the
following tasks within the first 90 and 120 days of your plan year.
If you don’t know when your plan year starts, talk to your
employer. Or check your deadline dates by logging in to your member
account at bcbsm.com; click My Coverage, then To-do List.
Healthy Blue Living requirements only apply to the enrollee
(contract holder) of the plan. Dependents and covered spouses don’t
need to meet the requirements.
* If you scored all A’s on your qualification form, you may not
need to complete another qualification form or health assessment
this year. How often you must meet requirements varies by your age.
See Page 3.
Blue Care Network is committed to helping you achieve your best
health status. Rewards for participating in our wellness program,
Healthy Blue Living, are available to all contract holders who meet
all qualification requirements. If you think you might be unable to
meet a standard or requirement for a reward under this wellness
program, you might qualify for an opportunity to earn the same
reward by different means. You can work with your BCN primary care
physician to find an alternative that’s right for you in light of
your health status.
2
The Blue Care Network Qualification Form
The qualification form helps you and your doctor get a snapshot of
your health based on the six high-impact health measures below.
Your primary care physician will electronically submit your
qualification form after your appointment. You don’t need to wait
for the start of your plan year to see your primary care physician.
We’ll accept a qualification form from an office visit occurring up
to 180 days before your plan year begins.
To help you earn or stay at the enhanced level, score A’s and B’s
on your qualification form. This means you’re meeting the targets
below or you’ve committed to treatment to improve a particular
health measure.
6 health measures
* After one negative test, no testing is needed again.
Self-reported tobacco users don’t need the test.
** Consult with your Blue Care Network primary care physician
before starting any regular exercise or weight-management
program.
Even if you use tobacco or have a health condition such as
diabetes, you can qualify for the enhanced level by following your
doctor’s treatment plans and, if needed, participating in required
BCN- sponsored programs.
Doesn’t use (confirmed by primary care physician through blood or
urine cotinine testing*)
Body mass index below 30
Below 140/90 LDL-C below target (based on risk factors: <100,
<130 or <160)
At or below target (fasting blood sugar or A1c)
Any depression is in full remission
Tobacco Weight
Off target: Enroll in our tobacco-cessation program.
Off target: Commit to and follow your doctor’s treatment
plan.
Off target: Commit to and follow your doctor’s treatment
plan.
Off target: Participate in a BCN-sponsored weight- management
program until your BMI falls below 30.**
Off target: Commit to and follow your doctor’s treatment
plan.
Off target: Commit to and follow your doctor’s treatment
plan.
3
The ABCs of your health
All A’s may change two rules for you You don’t need to complete a
qualification form and health assessment every year if you scored
all A’s on your most recent Healthy Blue Living health measures.
We’ll send you a letter when it’s time to submit a new
qualification form and health assessment.
Age Under 40 40 or older
How often Every three years Every two years
Each health measure on the Blue Care Network Qualification Form
tracks your status using a simple A, B, C grading system.
If you score a C on any measure, everyone on your contract will be
at the standard level.
You’re meeting the wellness target.
You have a health condition that might not be controlled, but
you’re participating in treatment to improve the condition.
You’re not meeting the wellness target and you haven’t committed to
treatment to improve your condition.
A
B
C
Confirm that we’ve received your qualification form on time
by:
• Logging in to your account at bcbsm.com. Click My Coverage, then
To-do List.
• Calling the Customer Service number on the back of your BCN
member ID card.
4
Achieving a healthy lifestyle can be challenging. That’s why we
provide valuable resources to help you reach your wellness goals.
If you choose not to complete a requirement or participate in a
required program, everyone on your contract will be placed at the
standard level.
Health assessment The health assessment provides a picture of your
health and helps you understand what steps you can take to improve
or maintain it. Here’s how to take the health assessment:
1. Log in to your member account at bcbsm.com.
2. Click on the Health & Wellness tab, which will take you to
Blue Cross® Health & Wellness, powered by WebMD® Health
Services.*
3. Click the Healthy Living tab.
4. Click Health Assessment.
The results of your health assessment will include:
• A health score based on an analysis of your modifiable health
risks
• A list of your highest-risk areas
• A Modifiable Risk Report and a Condition Risk Report
• A list of the next steps you can take to improve your
health
The assessment takes about 10 minutes to complete. You can take it
before or after you see your primary care physician. To help you
earn the enhanced level, complete the health assessment within the
first 90 days of your plan year.
Note: If you don’t have internet access, call 1-855-326-5098 to ask
for a paper copy. Also, you must completely fill out the health
assessment. Incomplete paper health assessments can’t be
processed.
* WebMD Health Services is an independent company supporting Blue
Care Network by providing health and wellness services.
Working toward wellness
Tobacco use Tobacco use is determined by a blood or urine test
ordered by your primary care physician. Cotinine testing is
required in the first year of enrollment. Once a negative test is
received, we don’t require it again.
To be at the enhanced level If your qualification form shows you
use tobacco, you must enroll at no extra cost in Tobacco Cessation
Coaching, powered by WebMD. It’s a telephone-based program that
includes five calls from a health coach over a 12-week period. If
you aren’t ready to set a quit date within 30 days, you’ll be
required to enroll in Lifestyle Coaching and participate until the
end of your plan year or until you quit using tobacco. If this
requirement applies to you, we’ll send you a letter with more
details and enrollment instructions.
5
Weight management To be at the enhanced level If your qualification
form shows your body mass index is 30 or more, you’re required to
enroll at no extra cost in one BCN-sponsored weight-management
program within the first 120 days of your plan year. After we
receive your qualification form showing your BMI is 30 or more,
we’ll mail you details about the programs and how to sign up for
one. Or download the Healthy Blue Living weight-management guide at
bcbsm.com/hblweight.
If your BMI is lower than 30, you can still participate in a
weight-management program. We encourage members to be healthy, and
you can participate at the member discount rate. See Page 7.
Auto renewal for a BCN-sponsored weight- management program If you
were required to participate in a weight program in your previous
plan year, and your qualification form still shows you have a BMI
of 30 or more, you can continue in your program without
re-selecting it. If you want to switch programs, you can call the
Customer Service number on the back of your BCN ID card or log in
to your account at bcbsm.com. Auto renewal applies only if you: 1)
were compliant in the previous plan year; 2) are actively
participating in a program; and 3) had your doctor submit an
updated qualification form showing your BMI is still 30 or
more.
Depression Depression is one of the top causes of disability
worldwide. People with depression are more likely to develop
cardiovascular disease and diabetes.
A measurement tool is used to screen Healthy Blue Living members
for depression. You can access mental health/substance abuse
treatment services 24/7 by calling the number on the back of your
BCN member ID card.
About your spouse or dependent
• The enrollee (contract holder) of the plan is the only member on
a contract who needs to complete the Healthy Blue Living
requirements.
• Even though covered spouses don’t need to meet the requirements,
they should still see their doctor regularly and take the health
assessment to help them get or stay healthy. Make sure they select
or have a primary care physician who participates with Blue Care
Network.
• BCN won’t cover the cost of a weight-management program for
covered spouses. However, they can still participate at the member
discount rate through Blue365®. See Page 7.
• If your spouse’s primary coverage is Medicare, he or she can’t be
on your Healthy Blue Living contract. Individuals eligible for
Medicare may be able to enroll in a Medicare product. Check with
Medicare or your spouse’s employer for options.
6
To keep or earn the enhanced level, check off these steps as you
complete them. For more information, log in to your account at
bcbsm.com or call the Customer Service number on the back of your
BCN member ID card. Remember, some requirements are relaxed if you
scored all A’s on your most recent qualification form. Refer to
Page 3.
*If you have a tobacco-cessation or weight-management requirement,
we’ll send you a letter with enrollment steps.
Your Healthy Blue Living checklist
Within the first
Within the first
120 DAYS of plan year
Visit your BCN primary care physician, and have him or her complete
and electronically submit your Blue Care Network Qualification Form
before the 91st day of your plan year.
Meet the six health measures or commit to your PCP’s treatment plan
to improve your health.
Complete your health assessment by logging in to your account at
bcbsm.com. Or request a paper copy by calling 1-855-326-5098.
If you use tobacco, enroll and participate in our tobacco-cessation
program.*
If your body mass index is 30 or more, participate in a
BCN-sponsored weight- management program.*
Being on time can save you money
Many members drop to the standard level because they don’t complete
requirements on time. They have the same great plan, but with
higher out-of-pocket costs.
7
24-Hour Nurse Advice Line For no extra cost, reach a registered
nurse 24/7 toll-free at 1-855-624-5214 or 711 (TTY). A registered
nurse can answer your health care questions, assess symptoms and
provide self-care tips.
Digital Health AssistantSM programs After you complete your health
assessment on the Blue Cross Health & Wellness site, you’ll
receive recommendations for the Digital Health Assistant online
coaching programs that are best for you. These include:
• Conquer Stress
• Eat Better
• Enjoy Exercise
• Lose Weight
• Quit Tobacco
• Feel Happier
The Digital Health Assistant programs help you set small,
achievable goals that you commit to for one week. You can choose
activities, create a plan and track your progress right on the Blue
Cross Health & Wellness site.
Member discounts You have access to national and Michigan-based
discounts on a variety of health products and services from
groceries and fitness gear to travel and gym memberships. Take
advantage of these offers and more. To get started:
• Log in to your member account at bcbsm.com.
• Click Member Discounts with Blue365® on the right side of the
page.
First-time visitors will need to verify information.
Informative publications Watch your mail in the spring and fall for
our award-winning Good Health magazine. It’s filled with health and
wellness articles, recipes and health care coverage
information.
For additional health and wellness information online, follow us at
facebook.com/MiBCN and AHealthierMichigan.org.
Outstanding customer service Our dedicated Customer Service
representatives are trained to answer your health plan questions
and are just a toll-free phone call away. Call the number on the
back of your BCN member ID card.
Wellness resources to help you succeed
8
How do I find out the 90th and 120th day of my plan year for the
requirements? If you don’t know when your plan year begins, talk to
your employer. Your to-do list in your online member account also
shows your deadline dates for the Healthy Blue Living plan
requirements; log in as a member at bcbsm.com, click My Coverage,
then click To-do List.
For example: If your plan year begins on January 1, then your
90-day requirements would be due by March 31, and your 120-day
requirements would be due by April 30.
I misplaced the Blue Care Network Member Handbook I got in the mail
when I enrolled. How can I get another one? Request a copy by
calling the Customer Service number on the back of your Blue Care
Network ID card.
My plan year is about to start. How soon can I go to my doctor for
my qualification form visit? You don’t need to wait for the start
of your plan year. We’ll accept a qualification form from an office
visit occurring up to 180 days before your plan year begins.
How long will it take to fill out the health assessment online? It
usually takes about 10 minutes to complete. If you don’t have
internet access, ask for a paper copy by calling
1-855-326-5098.
Why should I take a paper copy to my appointment if my doctor must
submit the qualification form electronically? We provide a paper
qualification form only as a sample of the information your doctor
submits electronically. It may be helpful for you to take this with
you to remind your doctor that you’re a Healthy Blue Living member.
We don’t accept paper qualification forms from members or doctors.
You can download and print the sample qualification form by logging
in to your account at bcbsm.com; click My Coverage, then To-do
List.
It’s been less than 12 months since my last physical. Can I have
another one so soon? We don’t limit the number of times you can
visit your doctor to have a qualification form completed. There’s
no copay for your qualification form visit, even if you’re
returning to your primary care physician after a recent
physical.
I quit smoking and lost weight. How can I stop participating in the
tobacco-cessation and weight- management programs? Return to your
primary care physician for another qualification form visit. Once
we receive a qualification form showing a negative cotinine test,
you’ll no longer need to participate in our tobacco-cessation
program. Once we receive a qualification form showing your BMI is
below 30, you’ll no longer need to participate in our
weight-management program.
Healthy Blue Living FAQs
We speak your language If you, or someone you’re helping, needs
assistance, you have the right to get help and information in your
language at no cost. To talk to an interpreter, call the Customer
Service number on the back of your card.
Si usted, o alguien a quien usted está ayudando, necesita
asistencia, tiene derecho a obtener ayuda e información en su
idioma sin costo alguno. Para hablar con un intérprete, llame al
número telefónico de Servicio al cliente, que aparece en la parte
trasera de su tarjeta.
.
.
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Nu quý v, hay ngi mà quý v ang giúp , cn tr giúp, quý v s có quyn c
giúp và có thêm thông tin bng ngôn ng ca mình min phí. nói chuyn vi
mt thông dch viên, xin gi s Dch v Khách hàng mt sau th ca quý
v.
Nëse ju, ose dikush që po ndihmoni, ka nevojë për asistencë, keni
të drejtë të merrni ndihmë dhe informacion falas në gjuhën tuaj.
Për të folur me një përkthyes, telefononi numrin e Shërbimit të
Klientit në anën e pasme të kartës tuaj.
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Jeli Ty lub osoba, której pomagasz, potrzebujecie pomocy, masz
prawo do uzyskania bezpatnej informacji i pomocy we wasnym jzyku.
Aby porozmawia z tumaczem, zadzwo pod numer dziau obsugi klienta,
wskazanym na odwrocie Twojej karty.
Falls Sie oder jemand, dem Sie helfen, Unterstützung benötigt,
haben Sie das Recht, kostenlose Hilfe und Informationen in Ihrer
Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen
Sie bitte die Nummer des Kundendienstes auf der Rückseite Ihrer
Karte an.
Se tu o qualcuno che stai aiutando avete bisogno di assistenza, hai
il diritto di ottenere aiuto e informazioni nella tua lingua
gratuitamente. Per parlare con un interprete, rivolgiti al Servizio
Assistenza al numero indicato sul retro della tua scheda.
, , , . , .
Ukoliko Vama ili nekome kome Vi pomaete treba pomo, imate pravo da
besplatno dobijete pomo i informacije na Vašem jeziku. Da biste
razgovarali sa prevodiocem, pozovite broj korisnike slube sa zadnje
strane kartice.
Kung ikaw, o ang iyong tinutulungan, ay nangangailangan ng tulong,
may karapatan ka na makakuha ng tulong at impormasyon sa iyong wika
ng walang gastos. Upang makausap ang isang tagasalin, tumawag sa
numero ng Customer Service sa likod ng iyong tarheta.
Important disclosure Blue Cross Blue Shield of Michigan and Blue
Care Network comply with Federal civil rights laws and do not
discriminate on the basis of race, color, national origin, age,
disability, or sex. Blue Cross Blue Shield of Michigan and Blue
Care Network provide free auxiliary aids and services to people
with disabilities to communicate effectively with us, such as
qualified sign language interpreters and information in other
formats. If you need these services, call the Customer Service
number on the back of your card. If you believe that Blue Cross
Blue Shield of Michigan or Blue Care Network has failed to provide
services or discriminated in another way on the basis of race,
color, national origin, age, disability, or sex, you can file a
grievance in person, by mail, fax, or email with: Office of Civil
Rights Coordinator, 600 E. Lafayette Blvd., MC 1302, Detroit, MI
48226, phone: 888-605-6461, TTY: 711, fax: 866-559-0578, email:
[email protected]. If you need help filing a grievance, the
Office of Civil Rights Coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department
of Health & Human Services Office for Civil Rights
electronically through the Office for Civil Rights Complaint Portal
available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by
mail, phone, or email at: U.S. Department of Health & Human
Services, 200 Independence Ave, S.W., Washington, D.C. 20201,
phone: 800-368-1019, TTD: 800-537-7697, email:
[email protected]. Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.html.
Find us online: bcbsm.com | news.bcbsm.com |
facebook.com/MiBCN
ahealthiermichigan.org | twitter.com/bcbsm |
youtube.com/bcbsmnews
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