NMSU PPO & Medicare Carve-out. Blue Cross and Blue Shield of New Mexico (BCBSNM). NMSU Retirees. Two Plans are available:. NMSU Preferred Provider Option PPO Plan Non-Medicare Eligible Retirees NMSU Carveout Plan Medicare Eligible Retirees. - PowerPoint PPT Presentation
NMSU PPO & Medicare Carve-outBlue Cross and Blue Shield of New Mexico (BCBSNM)
NMSU RetireesNMSU Preferred Provider Option PPO PlanNon-Medicare Eligible Retirees
NMSU Carveout PlanMedicare Eligible Retirees
Two Plans are available:
Nationwide coverage when traveling or living outside of home stateWorldwide coveragewhen traveling in more than 195 countries more than 5,300 hospitals nationwide networkNationwide, more than 95% of hospitals and 85% of doctorsOver 20,000 contracted providers in New Mexico
more than 896,000providers Preferred Providers - PPO3You receive the highest level of benefits when you see a provider in the BCBSNM network of contracted providers BCBS ID card accepted in lieu of payment in fullNo balance billingProvider files claim for youYou receive a lower level of benefits when you see an out-of-network providerYou are responsible for paying the provider up frontYou will be billed for the remaining balance over the allowed amountYou are responsible for getting prior authorization
When You Choose a Network Provider PPO4
4In-Network out-of-pocket maximum $3,500 Individual/$8,750 Family
Out-of-Network out-of-pocket maximum $5,500 Individual/$13,750 Family
Out-of-Network Deductible $1,000 Individual/$3,000 FamilyWhats New for January 1, 2014 - PPO55Benefits - PPOMember SharePreferred ProviderNon-Preferred ProviderDeductibleIndividual$ 500$1,000Family$1,500$3,000Out-of-Pocket MaximumIndividual$3,500$5,500Family$8,750$13,750Primary Provider Office Visit$25 (deductible waived)40%*Specialist Visit$3540%*Preventive Care / Well VisitsNo ChargeNot CoveredInpatient Admission25%*40%*Emergency Room25%*Urgent Care25%*40%*Pet Scans, CT Scans, MRIs, Lab Tests, X-rays, including EKGs25%40%**After deductible6Retail Pharmacy Program - PPO
7Mail-order copay is 2 times the monthly cost88Self Service: Blue Access for MembersMembers can:Check status of claimsView Explanations of BenefitsCommunicate with Customer Advocates through e-mailView provider selectionsOrder new ID cards or print temporary copyLink to Wellness site (Well onTarget)
Claims and Customer Service
88Blue Access for Members is a secure portion of our Web site that allows members to access their personal membership and claims information. Members may: check the status of a claim view Explanations of Benefits; prevent EOB mailingsreceive e-mail notification when claims are filedview provider selectionsconfirm covered dependentsorder replacement ID cards and print a temporary ID cardsend an e-mail inquiry to Customer Service (Currently, members can send emails to Customer Service, and a Customer Advocate can respond either by phone or U.S. mail. Later in 2006, two-way secure e-mail messaging capabilities will be rolled out enterprise-wide. Our Customer Advocates can actually correspond back and forth with members through their secure BAM mailbox. Currently in pilot phase.)Blue Access is also the doorway to other health benefits tools, such as:the Treatment Cost Advisorhospital comparison toolPersonal health manager (only available with Blue Care Connection Program)And health risk assessment (only available with Blue Care Connection Program)Details on those tools are coming up.FOR SPEAKERS INFORMATION ONLY: [Blue Access is available 7 days a week, from 6 a.m. to 3 a.m.] Also, the Personal Health Manager and Health Risk Assessment are only available for members who are enrolled in Blue Care Connection.
The NEW Integrated Provider Finder9Quick and Easy Ways to find Providers and Treatment CostsLog-in to bcbsnm.com/BlueAccess for MembersNational quality designations for facilities and physicians nationwideUsers can view patient reviews on physiciansor submit one of their ownEnhanced provider demographics addedEstimate the cost of providers procedures, treatments and tests.Cost estimates are based on real claims data of all BCBS plans and National.
Cost Estimator Features - PPO13Cost for over 300 specific procedures Quality measurement informationLearn More about this Treatment (alternatives to surgery)Alternative options:Lower costCloser locationsAlternative to hospitalsCOMING in November 2013Member Liability Estimator - displays expected member out-of-pocket costs based on specific benefit plan, episodic contracted cost information, and real-time deductible and coinsurance
17Blue Access for MembersSM
My Coverage includes benefit highlights.Review secure messagesMy Claim Activity displays recent claims, or go to the Claims Center for all your claim detailsQuick Links to request replacement cards, download forms and moreForm Finder easier to view and find specific forms for membersBAM is password protected and gives you immediate, secure access to your account information.
Blue365Member Discount Program 18Weight Management Discounts at Jenny Craig on membership and foodVision Care and Eyewear Discounts on eyewear, contact lenses and laser vision correction surgeryDental Products Discounts on Procter & Gamble oral care bundles.
Hearing Aids Discounts on hearing aids for members, parents and grandparents
Under the My Health tab
24/7 NurselineAdvice anytime Round-the-clock health and wellness advice from licensed professionals1-800-973-6329
Our 24/7 Nurseline is here to helpNurses provide health advice and information AudioHealth Library includes topics such as kicking the smoking habitAvailable in English and Spanish
What if I Have Questions?Claim questions/statusNetwork provider informationMembership and eligibility Medical coverage questionsInquiries (telephone and e-mail)Transition of Care information ID card requestsHelp with online tools1-866-369-NMSU (6678)Toll-freeCustomer Service
Personalized ServiceCall your customer service team for:20NMSU Medicare Carveout Plan No changes
Low or no out-of-pocket costsFreedom to choose your providersNo referrals requiredNo claims to fileWorldwide Coverage for EmergencyMany non-Medicare covered services provided21NMSU Medicare Carveout Plan
No DeductibleNo CoinsuranceNo Co-paymentsNo referrals required22When a Provider Accepts Medicare Assignment: Medicare Carveout PlanWhen provider does NOT accept Medicare assignment
When services are NOT covered by Medicare, but ARE plan benefits23ORExample: Acupuncture is not covered by Medicare.$140 Calendar year deductible20% Coinsurance$1500 Annual out-of-pocket maximum Prior Authorization from BCBS applies
What if I Have Questions? Medicare Carveout medical Claim questions/statusNetwork provider informationMembership and eligibility Medical coverage questionsInquiries (telephone and e-mail)Transition of Care information ID card requestsHelp with online tools1-866-369-NMSU (6678)Toll-freeCustomer Service
Personalized ServiceCall your customer service team for:24
Medicare Blue RX(Medicare Part D Prescription Drug Plan) Eligibility MedicareNMSU eligible retiree/spouse /dependentEnrollment in the Medicare Carve Out (MCO) plan is required upon reaching Medicare eligibility to continue coverage through NMSUUpon reaching Medicare eligibility, usually age 65.Not enrolled in any other Medicare Prescription Drug Plan (PDP).If the retiree/spouse/dependent is eligible for Medicare prior to reaching age 65, the retiree/spouse must contact NMSU Benefit Services and provide a copy of the Medicare A&B card
261. Membership/Enrollment Timeliness Measures the timeliness and efficiency of the plans completion of subscribers application and, subscribers required enrollment materials.2. Membership/Enrollment Accuracy Measures the member and group enrollment quality and process.3. Claims Timeliness Measures the percent of non-investigated claims finalized within 14 days.4. Claims Financial Accuracy Determines the percent of claim dollars paid accurately.5. Customer Service ASA Measures the average answer time for member calls.6. Customer Abandonment Rate Measures the number of calls lost due to customer hanging up.Non-Medicare Retirees Aging inMCO plan include Medicare Part D prescription planNMSU will mail you a packet containing the Medicare Part D information at least forty-five days prior to your birthday month.NMSU will automatically enroll you in Blue Medicare Rx and Medicare Carveout program once they have received confirmation of Medicare Part A and Medicare Part B enrollment from you.NMSU must have proof of Medicare Part A & B enrollment prior to the effective date of MedicareNew Enhanced Plus BlueMedicareRX- MedicareEffective 1/1/2014 Preferred and nonPreferred pharmacy copays.Preferred Pharmacies CVS, Albertsons and WalMart.All other pharmacies are considered nonPreferred.
281. Membership/Enrollment Timeliness Measures the timeliness and efficiency of the plans completion of subscribers application and, subscribers required enrollment materials.2. Membership/Enrollment Accuracy Measures the member and group enrollment quality and process.3. Claims Timeliness Measures the percent of non-investigated claims finalized within 14 days.4. Claims Financial Accuracy Determines the percent of claim dollars paid accurately.5. Customer Service ASA Measures the average answer time for member calls.6. Customer Abandonment Rate Measures the number of calls lost due to customer hanging up.NEW Enhanced Plus Blue MedicareRX Preferred Pharmacies 5-tierBenefitEnhanced Plus PlanIndividual Deductible $0Preferred PharmacyNonPreferred PharmacyTier 1 - Preferred Generic$0 copay$5 copay no changeTier 2 - Non-Preferred Generic$2 copay$7 copay Tier 3 Preferred Brand$25 copay$30 copay- no changeTier 4 Non-Preferred Brand$55 copay$60 copay no changeTier 5 Specialty33%33% - no changeAfter your total out-of-pocket costs