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2016 BCBSGa
Open Enrollment
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Agenda
What’s new in 2016?
BCBSGa Plan Options and Benefits
Personal Health Programs
Online Tools
Questions
3
What’s new in 2016?
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LiveHealth Online
• What is LiveHealth Online?
− LiveHealth Online is BCBSGa’s telemedicine offering. This allows members to have a virtual visit with an in-network doctor, providing an alternative method to access quality care.
− When your own doctor isn’t available or you are short on time, LiveHealth Online can help. LiveHealth Online gives you access to quality medical care 24/7 with no appointments or long wait times
• With LiveHealth Online you get:
− Immediate access to in-network, board-certified doctors 24/7
− Secure and private two-way video chats with doctors
− Prescriptions sent directly to your pharmacy, if needed*
• When to use LiveHealth Online?
− As always, you should call 911 with any emergency
− Use LiveHealth Online for common health concerns such as colds, the flu, fevers, rashes, infections, allergies, and family health questions
HMO Plan: Subject to $35 co-payHRA Plan: In-network co-insurance applies; member does not have to meet the deductible first
*In certain states, prescriptions cannot be issued as a result of an online interaction with a doctor. For state telehealth availability, check the map on livehealthonline.com.
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Roll Over Credits
• In 2015, members were only allowed to roll over their unused well-being incentive credits between the three BCBSGa HRA plans
• Beginning in 2016, members can roll over unused well-being incentive credits if they decide to move from plan to plan, regardless of plan type (HRA or HMO) or insurance carrier
− Example #1: Member moves from the BCBSGa Bronze HRA plan in 2015 to a BCBSGa HMO plan in 2016
− Example #2: Member moves from the UnitedHealthcare HMO in 2015 to a BCBSGa HMO plan in 2016
BCBSGa
Kaiser Permanente
UnitedHealthcare
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BCBSGa Plan Options & Benefits
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BCBSGa HRA Plans
Active and Early Retirees
Gold HRASilver HRABronze HRAProvider Network:SHBP network (Open Access POS) Outside of GA use BlueCard Nat ional PPO networkNo referrals required for specialists
Out-of -net work benef its available
• HRA = Health Reimbursement Arrangement
• No co-pays
• Benefits are subject to deductible/co-insurance
• Our BCBSGa HRA plans offer members true consumerism
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How the HRA plans work
Health Reimbursement Arrangement (HRA) Account• SHBP contributes base HRA well-
being incentive credits to your Health Reimbursement Arrangement (HRA) account.
• These well-being incentive credits are used to help pay for your covered major medical expenses, such as inpatient or outpatient procedures.
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Annual Deductible• Once your HRA well-being
incentive credits are exhausted, you are responsible for meeting an annual deductible before the plan begins to pay a percentage of your covered expenses, called co-insurance.
• You can use the well-being incentive credits in your HRA account to help meet your deductible.
Out-of-Pocket
• After you meet your annual deductible, you pay a percentage of the cost of your covered expenses, called co-insurance.
• If you still have well-being incentive credits in your HRA account after you've met your annual deductible, you can use them to pay your share of co-insurance.
• Once you reach your annual out-of-pocket maximum, the plan pays 100 percent of any of your remaining in-network covered expenses for the rest of the plan year.
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BCBSGa HMO Plan
Active and Early Retirees
• BCBSGa Statewide HMO• Provider Network:
• SHBP network (Open Access POS) • Outside of GA use BlueCard National PPO network• No referrals required for specialists
• No out-of-network benefits available
• HMO = Health Maintenance Organization
• Care is guided by your doctor, but unlike most HMOs, you don’t need referrals to see a specialist.
• Budget friendly
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Benefits at a Glance
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Personal Health Programs
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Online Tools
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Questions?