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2016 Blue Care Network - UAW Retiree Medical Benefits Trust
2016 Blue Care Network Stay on the road toward healthy living care Call/nursing telephone support Hospital and other services Alternatives to hospital care Plan benefits Ready to join Maternity care tal and other services atives to hospital care Benefits: See what comes standard Plan benefits Ready to join Who can join Maternity care When you choose Blue Care Network, you receive all the high-quality medical benefits you expect from Michigan’s largest health maintenance organization, including: Who can join rvices Mental health and substance abuse treatment g the hospital Questions Leaving the hospital Questions DME Substance abuse DME Member Substance abuse Physicians/Providers Low copays for the services you need, such as primary care physicians and specialist visits, and emergency and urgent care Member re Call/nursing telephone support Hospital and other services Alternatives to hospital care Physicians/Providers Plan benefits Ready to join Maternity care Preventive care ption drugs Prescription drugs Deductible, coinsurance and dollar maximums Deductible, coinsurance and dollar maximums Eye care Reasons to join Eye care Maternity care Physician office services Who can join Outpatient diagnostic services Mental health and substance abuse Surgical services hearing Leaving the hospital treatment Surgical services Questions Substance abuse Shot Pneumonia Pneumonia Member Comprehensive preventive care covers flu shots, routine physicals, mammograms, lab works, allergy shots and more Substance abuse essation Facing a complex medical condition Emergency services can join Where amWho i covered Coping with heart failure or COPD Preventive care Questions Prescription drugs Research Facingmonitors a complex medical condi- tion Deductible, coinsurance and dollar maximums Where am i covered Eye care Substance abuse Annual eye exam, plus a 20 percent discount on glasses. For details, call VSP Vision Care at 1-800-877-7195 or go to vsp.com.* Missouri Customer service Member Physicians/Providers ice Magazine care Deductible, coinsurance and dollar maximums Physician office services Outpatient diagnostic services Reasons to join Surgical services hearing Eye care Missouri Shot Customer service Pneumonia Hearing exam and aid covered in full every 36 months rgical services hearing ation Emergency services 2 cing a complex medical condion Shot Pneumonia Coping with heart failure or COPD Facing a complex medical condition Where am i covered Research monitors *Blue Care Network of Michigan doesn’t control this website or endorse its general contents. Where am i covered their family members. Research monitors Reasons to join DME Eye care Research monitors autoworkers, retirees and Physicians/Providers Maternity care with heart failure or COPD more than 1.1 million hearing DME Ready to join 2,300 UAW-represented staff members, we proudly serve Customer service Customer service Shot Plan benefits Missouri A network of more than 5,000 primary care physicians, over 15,000 specialists and most of the state’s leading hospitals Missouri edicare Magazine ces nt diagnostic services Reasons to join With more than All of us at Blue Cross Blue Shield of Michigan and Blue Care Network work together to provide quality, affordable health care. Important terms/definitions Hospital care Call/nursing telephone support Hospital and other services Alternatives to hospital care Plan benefits Ready to join Maternity care Important terms/definitions Hospital care HEALTHY LIVING Important terms/definitions AHEAD Hospital care Beyond original medicare Call/nursing telephone support Hospital and other services Alternatives to hospital care Plan benefits Ready to join Who can join Maternity care Call/nursing telephone support Other services Hospital and other services Alternatives to hospital care Mental health and substance abuse treatment Important terms/definitions Ready to join Plan benefits Leaving the hospital Questions Hospital care Call/nursing telephone support DME Hospital and other services Alternatives to hospital care Plan benefits Ready to join Maternity care Who can join Substance abuse Member Who can join Beyond original medicare Other services Beyond original medicare Other services Mental health and substance abuse treatment SilverSneakers Leaving the hospital DME Substance abuse Preventive care Mental health and substance abuse treatment Questions Who ca Physicians/Providers Leaving the hospital Prescription drugs Deductible, coinsurance and dollar Beyond original medicare maximums DME Questions Reasons to join Other services Mental health and substance abuse treatment Member Physicians/Providers Missouri Leaving the hospital Extras included: Programs, services and discounts Questions DME Eye care Customer service Substance abuse Member Physicians/Provide Physicians/Providers SilverSneakers SilverSneakers Internet/bcbsm.com/online/live coaching Internet/bcbsm.com/online/live coaching Everyday savings Everyday savings Internet/bcbsm.com/online/live coaching Preventive care MyBlue Medicare Magazine Prescription drugsservices Physician office Deductible, coinsurance Reasons to join Outpatient diagnostic servicesand dollarSurgical services maximums Eye care Helpful health care resources — Ask a registered nurse any health-related questions by phone 24/7. Find articles, videos, recipes and more at bcbsm.com. Preventive care Everyday savings MyBlue Medicare Magazine MyBlue Medicare Magazine Tobacco cessation Physician office services Physician office services Prescription drugs Emergency services Outpatient diagnostic services Outpatient diagnostic services SilverSneakers Deductible, coinsurance and dollar Reasons to join maximums Coping with heart failure or COPD Facing a complex medical condihearing tion Surgical services Surgical services Internet/bcbsm.com/online/live hearing coaching Everyday savings with your Blue Care Network ID card — See how you can save at bcbsm.com/xtras: Tobacco cessation Emergency services Coping with heart failure or COPD Facing a complex medical condition Emergency services Coping with heart failure or COPD savings Facing a complex medical condi- EverydayWhere am i covered tion • Savings on Michigan products and services, such as gyms, fitness classes, travel services and local activities through Healthy Blue XtrasSM Important terms/definitions Shot Hospital care Pneumonia Coverage when you travel — Emergency and urgent care services are covered around the world with BlueCard®. Preventive care Missouri Customer service Prescription drugs Deductible, coinsurance and dollar maximums Reasons to join Eye care Missouri Research monitors Shot MyBlue Medicare Magazine Shot Missouri Customer service Where am i covered Where am i covered • Discounts for national health and fitness services, sporting goods and more with Blue 365® Tobacco cessation hearing Pneumonia Physician office services Outpatient diagnostic services Surgical services hearing Tobacco cessation program — Our online tobacco cessation program supports your efforts to quit. Pneumonia Research monitors Tobacco cessation Emergency services Coping with heart failure or COPD Research monitors Facing a complex medical condition Where am i covered Other services Research mon Multi-language interpreter services — Translation is available in more than 140 languages. Call/nursing telephone support Hospital and other services Alternatives to hospital care Plan benefits Ready to join • Online coupons for grocery-brand items with our Daily Coupons Beyond original medicare Shot Who can join Mental health and substance abuse treatment Leaving the hospital Questions DME Member Physicians/Providers Questions? Call 1-800-222-5992, 8 a.m. to 5:30 p.m. EST, Monday through Friday. SilverSneakers TTY users call 711. Or visit us online at bcbsm.com/UAWTrust. Preventive care Prescription drugs Deductible, coinsurance and dollar maximums Reasons to join Missouri 3 Customer service nd other services es to hospital care Plan benefits Ready to join 2016 e hospital Questions Maternity care Benefits at a glance Who can join DME Substance abuse You pay Deductible and copayments Member Physicians/Providers Annual deductible per member per year Reasons to join n drugs Deductible, coinsurance and dollar maximums Note: Deductible doesn’t apply to protected class. Protected class members are responsible Missourifor copays only. iagnostic services Surgical services hearing Shot Pneumonia Facing a complex medical condition Out of network $385 per member Costs of services are your responsibility $650 per family contract Customer service Fixed dollar copay: $25 PCP office visits $35 specialist office visits $50 urgent care visits $125 emergency room visits Ford protected – $0 copay for emergency room Copays heart failure or COPD Eye care In network Where am i covered Research monitors Costs of services are your responsibility GM and Chrysler protected – $100 copay for emergency room Percent copay: None Copay dollar maximums 4 Fixed dollar copay: None Percent dollar copay: None Costs of services are your responsibility Understanding important terms Important terms/definitions Hospital care Call/nursing telephone support Hospital and other services Alternatives to hospital care Plan benefits Ready to join Maternity care $$$$ Who can join Insurance pays 100% Beyond original medicare Other services Mental health and substance abuse treatment Leaving the hospital (your copays may apply) Questions DME Substance abuse Member Physicians/Providers $$ Deductible met SilverSneakers Preventive care Prescription drugs Deductible, coinsurance and dollar maximums Reasons to join Deductible Eye care (you pay) Internet/bcbsm.com/online/live coaching MyBlue Medicare Magazine Physician office services Outpatient diagnostic services Surgical services Missouri Tobacco cessation Emergency services Coping with heart failure or COPD Customer service hearing Shot Medical costs Everyday savings In network: $385 per member $650 per family contract Facing a complex medical condition Where am i covered Pneumonia Research monitors Deductible — the amount you pay annually before your plan begins to pay. This doesn’t apply to services that require a copay. Copay — a fixed amount you pay to receive a medical service, usually at the time of service (office visits, emergency room, urgent care). In-network provider — a provider contracted to be part of the BCN network. In order to avoid having to pay for costs of all services, you must see an in-network provider. Out-of-network provider — a provider who doesn’t have a contract to be a part of the BCN network. If you see an out-of-network provider, you’re responsible for the costs of all services. 5 Who can join 2016 Benefits at a glance Mental health and substance abuse treatment Leaving the hospital Mental health and substance abuse treatment Questions Leaving the hospital DME Substance abuse Questions Member DME Physicians/Providers Substa Preventive services Vision exam — VSP 1-800-877-7195 Preventive care Prescription drugs Immunization — pediatric and adult elephone support Hospital and other services Alternatives to hospital care Mammogram You pay Deductible, coinsurance and dollar maximums Plan benefits Preventive care Pap smears $25 copay covered once every 12 months Reasons to join Covered in full; office visit copay may apply Ready to join Prescription drugs Deductible, coinsurance and dollar maximums Physician office services Outpatient diagnostic services Surgical services Maternity care Covered in full; office visit copay may apply Reasons to join Covered in full; office visit copay may apply hearing Who can join Missouri Shot Physician office services and substance abuse Physician Leavingoffice the hospital azine services Routine office visits Emergency services Questions Outpatient diagnostic services $25 copay per visit Substance abuse Coping with heart failure or COPD Facing a complex medical condition Where am i covered Shot Member Research monitors Pneumonia $25 copay per visit/protected class $25 copay per visit Routine pediatric care $25 copay per visit Annual gynecological exam Prescription drugs Deductible, coinsurance and dollar Coping with heart failure or COPD maximums Reasons to join Facing a complex medical condition Surgical services You pay Covered in full; office visit copay may apply hearing Diagnostic X-rays Covered in full after deductible; office visit copay may apply Shot Radiation therapy Coping with heart failure or COPD Research monitors Eye care Customer service Diagnostic and therapeutic procedures Laboratory Outpatient diagnostic tests services $25 copay per visit Where am i covered Missouri 6 $35 copay per visit Periodic physical exam Emergency services ices Pneumonia hearing Physicians/Providers services Customer service You pay DME Surgical services Consulting specialist care (when referred) e Eye care Customer Covered in service full Missouri Prostate-specific antigen screening — laboratory services only Magazine Member Physicians/Providers Facing a complex medical condition Where am i covered Pneumonia Covered in full after deductible; office visit copay may apply Research monitors Ey ons zine Call/nursing telephone support Hospital and other services Alternatives to hospital care Plan benefits Ready to join Maternity care Maternity services provided by a physician e/live You pay Maternity care Prenatal and postnatal care $25 copay per visit Mental health and substance abuse Leaving the hospital Delivery in hospital and well-baby Questions care in hospital treatment Covered in full for professional services after deductible DME Substance abuse Member Physicians/Providers Hospital care (inpatient/outpatient) You pay Substance abuse Preventive care Hospital care Prescription drugs Call/nursing telephone support Number of days of care Deductible, coinsurance and dollar Hospital and other services maximums Alternatives to hospital care Reasons to join Plan benefits Unlimited Eye care Ready to join Maternity care In-hospital physician care, general nursing care, surgery Missouri (including all related surgical services, anesthesia, lab, X-rays and drugs) Covered in full after deductible Customer service Outpatient facility services Physician office services Eye care Covered in full after deductible Who can join Outpatient diagnostic services Surgical services Mental health and substance abuse treatment Leaving the hospital hearing stomer service e Who can join Shot Other services Questions Emergency medical care* You pay Urgent care facility Ambulance services Preventive care Physicians/Providers Research monitors tion Prescription drugs Deductible, coinsurance and dollar maximums *Chrysler and GM protected class members: $100 copay for emergency room Reasons to join Physician office services Outpatient diagnostic services Surgical services $50 copay per visit Covered in full after deductible — ground and air service Missouri Customer service hearing Shot Tobacco cessation Emergency services Coping with heart failure or COPD Facing a complex medical condition $125 copay per visit Eye care Ford protected class members: $0 copay for emergency room and urgent care MyBlue Medicare Magazine Substance abuse Member Hospital emergency room waived if condiadmitted) Coping with heart failure (copay or COPD Facing a complex medical Where am i covered Emergency services Pneumonia DME Where am i covered Pneumonia Research monitors 7 2016 Benefits at a glance Call/nursing telephone support Hospital and other services Alternatives to hospital care Plan benefits Ready to join Maternity care Who can join Mental health care You pay Maternity care Outpatient visits Mental health and substance abuse treatment Leaving the hospital Questions Contact plan for specific copays DME Covered in full up to 45 days, per calendar Substance abuse year, renewable after 60 days of nonconfinement Inpatient psychiatric hospital services Member Physicians/Providers Preventive care Alcoholism and substance abuse services Prescription drugs Substance abuse Deductible, coinsurance and dollar maximums You pay Reasons to join Up to 35 visits per year, coveredEyeincarefull Outpatient visits for crisis intervention and short-term therapy Missouri Intermediate care (intermediate days combined with inpatient mental health) service Covered in full up toCustomer 45 days per calendar year, renewable after 60 days of nonconfinement Detoxification gazine Physician office services Covered in full Outpatient diagnostic services Surgical services hearing Shot Eye care g telephone support Pneumonia Skilled nursing care Hospital and other services Alternatives to hospital care Plan benefits Skilled nursing facility care Coping with heart failure or COPD Emergency services You pay Ready to join Facing a complex medical condition Covered in full after deductible;100 days Maternity care renewable after 60 days of nonconfinement Where am i covered Nursing services in the home (when medically necessary) Research monitors Covered in full after deductible Who can join Home health care (when medically necessary) th and substance abuse Leaving the hospital Hospice care Questions Covered in full after deductible Covered in full after deductible DME Substance abuse Member Physicians/Providers are Prescription drugs Deductible, coinsurance and dollar maximums Reasons to join Eye care Missouri 8 e services Outpatient diagnostic services Surgical services hearing Customer service ons port /live e abuse Hospital care Call/nursing telephone support Hospital and other services Alternatives to hospital care Plan benefits Ready to join Maternity care Who can join Other services You pay Prosthetics, orthotics and correctiveLeaving appliance (when medically Mental health and substance abuse the hospital Questions treatment necessary) Other services Covered in full DME Substance abuse Vasectomies, tubal ligations Covered in full after deductible; Member office visit copay may apply Infertility treatment Not covered — exclusions include in-vitro fertilization, artificial insemination and infertility drugs Physicians/Providers Durable medical equipment (when medically necessary) Preventive care Prescription drugs Allergy testing, evaluation and serum Hospital and other services Alternatives to hospital care Plan benefits Ready to join Deductible, coinsurance and dollar maximums Covered in full Reasons to join Covered in full after deductible Covered in full;Maternity officecare visit copay may apply Missouri Customer service per member per visit Allergy injections Physical therapy: 60 treatments per condition per year MyBlue Medicare Magazine Physician office services Outpatient diagnostic services Covered in full after deductible — Limited to 60 visits per medical episode, per plan year Who can join Surgical services hearing Covered in full every 36 months (two hearing aids are covered Shot Pneumonia in full if member is 19 or younger) Hearing exam and aid Leaving the hospital Questions Tobacco cessation Eye care Emergency services DME Coping with heart failure or COPD Prescription drugs Facing a complex medical condition Substance abuse Where am i covered Research monitors Member Physicians/Providers Your UAW Trust prescription drug benefit is provided separately through Express Scripts®. Blue Care Network provides coverage for medical services only. For more information on your drug coverage, contact Express Scripts at 1-866-662-0274. Prescription drugs Deductible, coinsurance and dollar maximums Reasons to join Express Scripts® Inc. is an independent company. It is solely responsible for providing prescription Eye care drug coverage to UAW Retiree Medical Benefits Trust members.Missouri It does not provide BlueCustomer Care Network products or services to service Trust members. Outpatient diagnostic services Surgical services hearing Shot Pneumonia Questions? Call 1-800-222-5992, 8 a.m. to 5:30 p.m. EST, Monday through Friday. TTY users call 711. Or visit us online at bcbsm.com/UAWTrust. Coping with heart failure or COPD Facing a complex medical condition Where am i covered Research monitors 9 Blue Care Network service area Blue Care Network is open to Trust members residing in 26 counties. You must receive routine care from network providers. Arenac Clare Gladwin Huron Isabella Midland Bay Tuscola Gratiot Shiawassee Clinton BCN is not available to URMBT retirees in these counties Ingham Jackson Hillsdale 10 Lapeer Genesee BCN is available in these counties Eaton Sanilac Saginaw Oakland Livingston Washtenaw Monroe Wayne St. Clair Macomb Notes Contact information Want to enroll? Call Retiree Health Care Connect 1-866-637-7555 8:30 a.m. to 4:30 p.m. EST, Monday through Friday TTY users call 711 Questions? 1-800-222-5992 8 a.m. to 5:30 p.m. EST, Monday through Friday TTY users call 711 bcbsm.com/UAWTrust Prescription drug questions (Express Scripts) 1-866-662-0274 Open 24 hours a day, seven days a week (except Thanksgiving and Christmas) TTY users call 711 Blue Cross Blue Shield of Michigan is proudly represented by the UAW CB 12196 AUG 15 R040531
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