BCBSAZ Renewal for Individual ‘PLUS’ Plans

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10/28/14-

 

Blue Cross Blue Shield of Arizona (BCBSAZ) announces details of this year’s renewal for Non-Grandfathered (Suite C) individual plans.  These are plans that were purchased between April 2010 & December 2013, and are easily identified by the name, which will include the word ‘PLUS’.

Renewal mailings for these individual members are scheduled to begin the week of October 20th. The letter you will receive will include your plan information, current and renewal premiums, along with your broker’s contact information.

For members who wish to keep the plan they have, there is no further action you need to take…it will renew automatically.

For those who wish to review alternate health plan choices, we will be able to help you compare all 2015 plan options starting in November.  2015 plan enrollment begins November 15th and ends February 15th.

Overview-  Here’s What’s Happening!

For most, staying in your existing Suite C individual plan will provide coverage at a lower premium than the new, 2015 individual plans.  Exceptions may include those who are subsidy eligible, need maternity coverage, are 65 or older, or were rated up in the Suite C individual due to medical underwriting.

Many of our clients will experience a percentage rate increase this year in the double-digits.  Not everyone will be affected, but these are the factors that will lead to the greatest increases:

  1. Rate Pass in 2014 – Suite C individual customers did not receive a rate increase in 2014
  2. Age – members may face up to two years’ worth of age-related rate increases
  3. New ACA fees – The Affordable Care Act (ACA) mandates certain fees be added to rates

Discontinued Plans– Two existing Suite C individual plans will be discontinued on January 1, 2015.  All discontinued Suite C individual plan members will be mapped to comparable 2015 individual plans. You will also have the right to purchase any individual plan currently sold by BCBSAZ.

Discontinued Plan Mapped To
BlueSecure HMO Plus  —-> CopayComplete 40 PPO
Comp One Plus           —-> EverydayHealth 1000 PPO

Changes in Benefits– The following changes apply to: BlueOptimum Plus, BlueValue Plus, BlueBasic Plus, BlueEssential Plus, and BluePortfolio Plus:

Behavioral and Mental Health Services

  • Plans will now cover behavioral and mental health partial hospitalization services. (Precertification is required.)
  • Coverage for inpatient admissions to behavioral health subacute facilities will be expanded.
  • Care coordination will no longer be required for services provided through the behavioral services administrator (BSA).

Emergency Services

  • Reimbursement for emergency services provided by non-contracted providers will be based on billed charges.

Preventive Services

  • Additional preventive care services will be covered. (A list of covered services will be included in the Preventive Services section of the member’s benefit plan booklet, and available from BCBSAZ.)

Telemedicine

  • Plans will cover telemedicine services delivered by an in-network provider through interactive audio-video electronic media to treat burns, cardiologic conditions, dermatologic conditions, infectious diseases, mental health disorders, neurologic diseases, and trauma.
  • Benefits are also available for emergency or urgent telemedicine services provided by out-of-network providers to treat these conditions.

Precertification

  • Currently, services are denied or members pay a $300 charge if the member’s in-network or out-of-network provider fails to obtain precertification for covered services that require precertification. Except for medications that require precertification, services will no longer be denied and members will no longer pay a $300 charge if an in-network provider fails to obtain precertification for a service that requires it.

Depending on the type of service, services will continue to be denied or members will continue to pay a $300 charge if the member’s out-of-network provider fails to obtain precertification

Pre-Existing Conditions

  • Plans will no longer exclude pre-existing conditions for members of any age (currently 19 and older).

The following changes apply only to BlueOptimum Plus, BlueValue Plus, BlueBasic Plus, and BlueEssential Plus:

Office-Visit Copays

  • The in-network copay for a primary care physician visit will increase to $35, the in-network copay for a specialist office visit will increase to $60*, and the in-network copay for an urgent care visit will increase to $75.

* Specialist office visit cost-sharing for BlueBasic Plus will remain at 20% member coinsurance after deductible is met.

Out-of-Pocket Coinsurance Maximums

  • The in-network per-member out-of-pocket coinsurance maximum will increase by $500. The out-of-network per-member out-of-pocket coinsurance maximum will increase by $1,000.
Plan 2014 Out-of-pocket Coinsurance Maximum  (per member)  2015 Out-of-pocket Coinsurance Maximum (per member)
In-network Out-of-network In-network Out-of-network
BlueOptimum Plus $2,500 $5,000 $3,000 $6,000
BlueValue Plus $3,000 $6,000 $3,500 $7,000
BlueBasic Plus $4,000 $8,000 $4,500 $9,000
BlueEssential Plus $5,000 $10,000 $5,500 $11,000

The following changes apply only to BluePortfolio Plus:

Deductible

  • The in-network deductible on the BluePortfolio Plus $2000 deductible plan option will increase to a $2,600 deductible for individuals and a $5,200 deductible for families.

All plan changes effective December 31, 2014. All benefits covered by benefit plans, including the benefits discussed in this notice, are subject to applicable law, BCBSAZ medical coverage guidelines and benefit plan limitations and exclusions.

Remember, if you are happy with your plan and the new rate, you don’t need to do anything. The Suite C individual plans will automatically renew. (This option will be noted in the renewal letter, along with notice of any benefit changes to the current plan.)

For more information, please contact your Broker Service Representative, L&A Services, Inc.

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