Blue Care Network

Blue Care Network
Geared perfectly
for your needs
Enroll by calling
Retiree Health Care Connect
(contact information inside)
November 2011
Dear UAW Trust Member:
The UAW Retiree Medical Benefits Trust (the “Trust”) provides health care benefits for UAW
Auto retirees and their dependents. In 2012, the Trust will continue to work with Blue Care
Network of Michigan (BCN) to offer an additional health plan choice to you.
You may remain with your current health plan or choose a new plan — the choice is yours.
This material contains detailed information on the benefits of this plan. Here are a few key
points to keep in mind:
• Your monthly contributions to the Trust remain the same, regardless of the plan you
are enrolled in.
• Your current providers may not be a part of BCN’s network. It is important to check if
your providers are in BCN’s network before changing from your current plan.
• Reduced costs compared to the Blue Cross Blue Shield Traditional Care Network plan:
– No deductibles or coinsurance
– Unlimited office visits are covered with a $25 copay, including specialists
– Additional wellness programs and discounts
• Your prescription drug coverage will be transferred from Medco to BCN
• Your prescription drug cost share will remain the same as the Traditional Care Network
but some prescriptions may be classified differently by BCN, which may result in
different cost share amounts.
You can call Blue Care Network’s customer service center to discuss any questions or
concerns you may have. The contact information is in the enclosed material.
The choice to enroll in a new plan is entirely up to you. If you do not wish to enroll in a new
plan, no action is required. You may call Retiree Health Care Connect (RHCC) to enroll.
GM / Chrysler Trust members: 1-866-637-7555
Ford Trust members: 1-877-829-9444
Plan changes will become effective the first day of the second month following your
change request, no earlier than January 1, 2012.
Sincerely,
1
Always in motion for a healthier Michigan
Blue Cross Blue Shield of Michigan has called this
great state home for more than 70 years. As the
state’s largest health insurer, we feel a unique
responsibility to help improve the health of all
Michigan citizens.
We take that job seriously.
We design and support activities that make a real and
lasting difference in people’s lives. We partner with
physicians, hospitals and our customers to improve
the quality of health care while bringing down costs.
Blue Care Network is Blue Cross Blue Shield
of Michigan’s health maintenance organization
subsidiary. We offer the quality medical benefits
people expect from Michigan’s most trusted name
in health care.
We give members access to a large provider network
and a single point of contact for care — a BCN
primary care physician is a member’s health care
partner and coordinates all care.
To choose Blue Care
Network coverage,
call Retiree Health
Care Connect.
MiBCN.com/URMBT
2
One amazing card for you
• Great medical benefits
• Exceptional health and wellness support
• Worldwide recognition of the blue cross and shield
• Valuable online tools to help you take charge of your health
• Discounts on health and fitness services
• Coverage of preventive services such as immunizations, wellness checks
and important health screenings
• $25 copayment on unlimited office visits (see benefit chart on Pages 6-9)
Our network doctors accept our payments as payment in full.
You pay only your copay.
We can help sharpen your vision
NEW
• A routine eye exam every 12 months
• 20 percent member discount on glasses
For details, call VSP® Vision Care at 1-800-877-7195.
Or, go online to vsp.com.*
*Blue Care Network does not control this website or endorse its general content.
3
We offer easy access
As the state’s largest HMO, our robust provider networks make it
easy to find a doctor or hospital that takes your coverage:
• 4,700 primary care physicians
• 13,500 specialists
• Most of the state’s leading hospitals
To find a BCN doctor, go to MiBCN.com/find or call BCN Customer
Service at 1-800-222-5992 or 1-800-257-9980 (TTY) from 8 a.m. to
5:30 p.m. Monday through Friday.
If illness slows you, we’ll help
If you have asthma, diabetes, congestive heart failure or other chronic
conditions, turn to us for ongoing support. Nurse case managers will
work with you when you’re sick.
We’re just a call away
Health care educators are just a phone call away to answer your
questions about high blood pressure, cholesterol, weight and stress,
plus much more.
We’ve gone mobile
Like to have information
on the go? Members can
register on bcbsm.com and
then click to health plan
details on smart phones or
other smart mobile devices.
MiBCN.com/URMBT
4
Save money, stay healthy, get fit
Use your ID card to unlock big savings with our revolutionary
Healthy Blue XtrasSM savings program. Get discounts on
products and services that can help you live a healthier
lifestyle. We’ve got savings on everything from diet plans
to fitness centers, grocery stores to relaxing getaways and
fitness equipment to medical emergency jewelry.
Members can go online to view the special discounts
just for them.
Offers are available from more than 50 Michigan-based
companies, encouraging members to buy local and
contribute to the Michigan economy. In addition, almost
30 offers are from national companies through our national
savings program, Blue365®.
Our card travels with you — that’s peace of mind
Whether you’re vacationing “up north” or down south,
Blue Care Network coverage travels with you. And with
your dependents, too.
No other card is as recognized and
accepted as the one that carries
the blue cross and shield.
Our card gives you access to thousands of hospitals and doctors across
the U.S. who participate with Blue plans. Around the world in 200
countries and territories, get emergency care at BlueCard® hospitals.
BlueCard is a Blue Cross and Blue Shield Association program that
gives Michigan Blues members access to out-of-state Blue plans.
5
We mesh perfectly with pharmacies
Blue Care Network ID cards are accepted at thousands of
pharmacies nationwide, including most major chains. For
maintenance drugs, you have the choice of mail order or
retail pharmacies.
Moving for the winter?
We have you covered. Coordinate care away from home
with your Blue Care Network primary care physician before
you go.
Our network’s always growing
We’re signing up more and more doctors for you to see.
Check your choices at MiBCN.com/find.
MiBCN.com/URMBT
6
2012 Blue Care Network benefits at a glance
Physician office services
Routine office visits
$25 copay per visit
Consulting specialist care (when referred)
$25 copay per visit
Periodic physical exam
$25 copay per visit
Routine pediatric care
$25 copay per visit
Annual gynecological exam
$25 copay per visit
Preventive services
Vision exam — VSP® Vision Care:
1-800-877-7195, vsp.com
$25 copay covered once every 12 months
Immunization — pediatric and adult
Covered in full; office visit copay may apply
Mammography screening
Covered in full
Pap smears
Covered in full; office visit copay may apply
Prostate Specific Antigen (PSA) screening —
laboratory services only
Covered in full; office visit copay may apply
Diagnostic and therapeutic procedures
Laboratory tests
Covered in full; office visit copay may apply
Diagnostic X-rays
Covered in full; office visit copay may apply
Radiation therapy
Covered in full; office visit copay may apply
7
Maternity services provided by physician
Prenatal and postnatal care
$25 copay per visit
Delivery in hospital and well-baby care
in hospital
Covered in full
Hospital care (inpatient/outpatient)
Number of days of care
Unlimited
In-hospital physician care, general nursing
care, surgery (including all related surgical
services, anesthesia, lab, X-rays and drugs)
Covered in full
Outpatient facility services
Covered in full
Emergency medical care*
Hospital emergency room
(copay waived if admitted as an inpatient)
$100 copay per visit
Urgent care facility
$ 50 copay per visit
Ambulance services
Covered in full — ground and air service
*Ford Protected: $0 copay for emergency room and urgent care
Mental health care
Outpatient visits
Contact plan for specific copayments
Inpatient psychiatric hospital services
Covered in full up to 45 days, per calendar year,
renewable after 60 days of nonconfinement.
BCN 65SM**: Covered in full, 45 additional
days of inpatient mental health, renewable
after 60 days of discharge once the 190 days
covered under Medicare are exhausted or the
intermediate substance abuse covered under
the certificate is exhausted.
**BCN 65 is a Blue Care Network plan for individuals who are at least age 65, enrolled in Medicare
Parts A and B and live in an eligible Michigan area. For details, go to MiBCN.com/URMBT or call
BCN Customer Service at 1-800-222-5992 or 1-800-257-9980 (TTY).
continued on Page 8
MiBCN.com/URMBT
8
2012 Blue Care Network benefits at a glance
continued from Page 7
Alcoholism and substance abuse services
Outpatient visits for crisis intervention and
short-term therapy
Up to 35 visits per year, covered in full
Intermediate care (intermediate days
combined with inpatient mental health)
Covered in full up to 45 days per calendar year,
renewable after 60 days of nonconfinement.
BCN 65: Covered in full; 45 additional days of
intermediate substance abuse care, renewable
after 60 days of discharge once the 190 days
covered under Medicare are exhausted or the
intermediate substance abuse covered under
the certificate is exhausted.
Detoxification
Covered in full
Skilled nursing care
Skilled nursing facility care
100 days renewable after 60 days of
nonconfinement
Nursing services in the home
(when medically necessary)
Covered in full
Home health care
(when medically necessary)
Covered in full
Hospice care
Covered in full
9
Other services
Prosthetics, orthotics and corrective
appliance (when medically necessary)
Covered in full
Vasectomies, tubal ligations
Covered in full; office visit copay may apply
Infertility treatment
Not covered — exclusion includes in-vitro
fertilization, artificial insemination and infertility drugs
Durable medical equipment
(when medically necessary)
Covered in full
Allergy testing, evaluation and serum
Covered in full; office visit copay may apply
Allergy injections
Covered in full; office visit copay may apply
Physical therapy: 60 treatments per
condition per year
Covered in full — limited to 60 visits per
medical episode, per plan year.
BCN 65: Limit is based on Medicare guidelines.
Hearing aid – hearing examination and aid
covered once each 36 months
Covered in full — binaural hearing aids every
36 months, if younger than 19
Pharmacy
Retail and mail order prescription drug
copay including contraceptives; 1-30 day
supply
Retail prescription drug copay including
contraceptives; 84-90 day supply
Generic – $10 copay
Preferred brand – $30 copay
Nonpreferred brand – $80 copay
Generic – $20 copay
Preferred brand – $60 copay
Nonpreferred brand – $160 copay
Mail-order prescription drug copay including Generic – $20 copay
contraceptives; 31-90 day supply
Preferred brand – $60 copay
Nonpreferred brand – $160 copay
Exclusions
Coverage for erectile dysfunction medications
(e.g., Viagra®, Cialis®, Levitra®, Staxyn®),
except in prior authorized cases of pulmonary
arterial hypertension.
Coverage for proton pump inhibitor drug
class (e.g., omeprazole, Prilosec®, Zegerid®,
Nexium®, Aciphex®, Prevacid®, Protonix®),
except in prior authorized cases of Barrett’s
esophagitis and Zollinger-Ellison syndrome.
MiBCN.com/URMBT
10
Just a call gets the wheels turning
Enroll or ask questions about coverage by calling Retiree Health
Care Connect. To make BCN your plan starting January 1, you’ll
need to enroll by November 30.
We’re working hard to be your partner in health care
If you’ve been a Blue Cross Blue Shield of Michigan member, we
want you to stay with the brand you know and trust.
Exceptional customer service is available to you face-to-face, by
phone and at MiBCN.com. We’ll help you make the most of your
health when you’re well and when you’re ill.
11
Retiree Health Care Connect
GM / Chrysler Trust members: 1-866-637-7555
Ford Trust members: 1-877-829-9444
Blue Care Network Customer Service
1-800-222-5992 or 1-800-257-9980 (TTY)
8 a.m. to 8 p.m., Monday through Friday
MiBCN.com/URMBT
Presorted
FIRST CLASS MAIL
US Postage Paid
Blue Cross
Blue Shield
of Michigan
600 E. Lafayette Blvd.
Detroit, MI 48226-2998
MiBCN.com/URMBT
UAWStrong
As a Michigan-based plan, we’ve been involved with the auto industry
for many years. We’ve worked with the UAW Retiree Medical Benefits
Trust since its creation to provide high quality, member-friendly coverage.
With more than 2,000 UAW-represented staff members, we proudly serve
more than 1.1 million autoworkers, retirees and their family members.
All of us at Blue Cross Blue Shield of Michigan and Blue Care Network
work together to provide quality, affordable care.
For BCN coverage, call Retiree Health Care Connect. See numbers inside.
CB 12196 OCT 11
114017STCM