A Guide to Your Sprint Consumer Access Plan January 1, 2013

A Guide to Your Sprint
Consumer Access Plan
January 1, 2013
Welcome to Your Blue Cross
and Blue Shield of Illinois (BCBSIL)
Coverage Guide for 2013
Find a doctor or hospital
Sprint members utilize the Provider Finder® at bcbsil.com/sprint to
search for in-network hospitals and providers.
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Use the custom website for all Sprint members at bcbsil.com/sprint
to find out more details about your benefits and to use the online
resources available to you.
Use these phone numbers for the best service
Customer Service - 1-877-284-1571
Sprint Alive!* - 1-866-902-5483 or *545 from your Sprint phone
CVS Caremark Rx* - 1-855-848-9165
Sprint Goes Green
As part of Sprint’s continuous green efforts, beginning January 1, 2013, Sprint will turn off the function that prints and mails
Explanation of Benefits (EOB) statements. You can view, download and/or print your EOBs by logging in to Blue Access for
MembersSM (BAM) at bcbsil.com/sprint. You have the option to turn the “print and mail” function back on by logging in to BAM
and clicking on “Settings” and then “Preferences” in the drop down menu. But why not give the paperless method a try? You can
even set your “Preferences” to send a text or email whenever a claim is processed.
*Not a product of Blue Cross and Blue Shield of Illinois
24609.0912 POD
Sprint Consumer Access Plan
Sprint Consumer Access Plan is a consumerdirected product that lets you decide how, when
and where your health care dollars are spent.
Sprint Consumer Access Plan combines a PPO
plan with a health reimbursement account (HRA)
to help cover the health reimbursement expenses
you pay out of pocket, such as the deductible
and coinsurance.
The Sprint Consumer Access Plan has four
important components:
฀฀Preventive care and wellness visits for adults
and children are covered when you use network
providers. You don’t need to meet the deductible
to enjoy these benefits.
฀฀/LHS[OWSHUILULÄ[Z begin after you meet the
deductible. You have the freedom to choose any
doctor whenever you need care, but choosing
a contracting network doctor will get you the
highest level of benefits.
฀฀Health reimbursement account (HRA) funds
from your employer are used to pay for your first
covered health care expenses. Money spent from
the HRA counts toward your annual deductible.
฀฀Online decision tools can help increase your
awareness and knowledge of health issues as
well as help you manage your health care and
your health care spending.
Network Information
Use the Provider Finder® at bcbsil.com/sprint to see
if your doctor is in the network or to search for
another network provider. You may also call
BCBS customer service at 877-284-1571.
Deductible
You have a deductible to meet each calendar year
before your health plan benefits begin. This is also
called your “self-pay corridor.” The deductible
amount, which is based on your particular benefit
plan, is shared between you and your employer’s
health reimbursement account contribution. Use
HRA funds to pay the first part of the deductible
each year and then you are responsible for the
remainder of the deductible to satisfy the balance.
PPO-eligible benefits—such as physician office
visits, outpatient surgery and diagnostic testing—
are applied toward your deductible.
Prescription Drugs
Prescription drug coverage is administered by
CVS Caremark and is not a product of BCBSIL.
Your prescription drug benefits have a separate
deductible and coinsurance that do not apply to
the BCBS medical plan.
24600.0912
How It Works
Sprint Consumer Access Plan Example
John
has Sprint Consumer Access Plan individual coverage. His plan includes a $300
health reimbursement account funded by Sprint, which covers the first dollars
spent on his heath care. Many of John’s preventive care services will be covered
at 100 percent – with nothing deducted from the health care account – when he
receives care in-network.
Year One
Year Two
– John’s health care account from Sprint = $300
– Sprint funds John’s health reimbursement account
with $300. The annual deductible is $750.
– John’s annual deductible = $750
John had a physical and preventive care lab tests.
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(nothing deducted from the HRA).
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He picked up prescriptions at the pharmacy.
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of $175 out of his pocket and it applied to his
prescription drug benefits, not his medical
benefits. The prescription drug costs are not
deducted from his HRA.
John had appendectomy surgery.
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in the health reimbursement account was applied
to the charges and also toward the deductible.
John paid $450, which satisfied the annual
deductible, leaving a balance of $5,250. John’s
health care plan paid 85 percent ($4,462.50)
of the charges and he was responsible for 15
percent coinsurance ($787.50).
At year-end there is a zero balance in the health
reimbursement account, so nothing rolls over.
John had his annual physical and several lab tests.
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(not from the HRA).
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He picked up his prescriptions at a local pharmacy.
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the pharmacy through CVS Caremark.
The coinsurance is paid out of John’s
pocket and is not covered by the health
reimbursement account.
John had no other medical expenses during
the year.
At year-end, the $300 balance in the health
reimbursement account rolls over.
Jennifer and Bill
have Sprint Consumer Access Plan family coverage through Bill’s employer.
Their son, Daniel, is born during the first year of coverage. The employer funds
Bill’s health reimbursement account with $600 at the beginning of the year. Any
covered family member can use these funds for eligible health care services.
Well child care and certain adult care services are covered in full when Jennifer
and Bill visit network providers.
Year One
Year Two
– Bill’s health care account from Sprint = $600
– Sprint again funds the family health care account
with $600.
– Bill’s annual family deductible = $1,500
Jennifer and Bill had physicals and preventive care lab tests.
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was deducted from the HRA).
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Jennifer had several prenatal office visits.
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the deductible.
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– The annual deductible is $1,500
Bill and Jennifer had physicals and preventive care lab tests
and Jennifer had a mammogram. Daniel received well baby
care and immunizations.
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care benefit with nothing deducted from the HRA and no
cost to the family,
She gave birth during the summer.
Bill saw his dermatologist for a follow-up visit.
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$280 was deducted from the HRA and applied to the
deductible. Jennifer paid $900 out of pocket to satisfy
the family deductible. From the remaining balance of
$8420, 85 percent ($7,157) was paid by the health care
plan and 15 percent coinsurance ($1,263) was paid by
Bill and Jennifer.
Bill visited the local pharmacy and picked up prescriptions.
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medical plan deductible, but applied to the separate
pharmacy benefits. The amount was not deducted from
his HRA.
Daniel had a well baby check up and immunizations.
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He was also treated for an ear infection. Total charges
were $280.
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At the end of year one, there was a zero balance in the HRA,
so there was no amount to roll over to next year.
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and applied to the deductible.
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Daniel saw his pediatrician for a cold and ear infection.
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to the deductible.
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At the end of year two, the HRA balance is $100. This amount
rolls over and is added to Sprint’s annual contribution. The
family’s health reimbursement account at the beginning of
year three is $700.
Frequently Asked Questions
About HRA Plans
What is a health reimbursement account?
A health reimbursement account is a fund established for
you by your employer to help you meet the Sprint Consumer
Access Plan’s annual deductible. You can use the HRA funds
to pay for your first health care expenses and to help you meet
the deductible. You are responsible for paying the remaining
deductible balance.
What happens to the health reimbursement
account balance if I leave the plan?
If you change medical plans or jobs, or if you retire, any
unspent balance returns to your employer.
Are there any coverage differences between
this HRA Plan and the other plans offered
by Sprint?
Bariatric Surgery, Infertility Treatment and Gender Identity
Services are not covered.
How are my prescriptions handled?
Prescription drug coverage is administered by CVS Caremark
and is not a product of BCBSIL. Your prescription drug benefits
have a separate deductible and coinsurance that does not apply
to the BCBS medical plan.
How are claims paid from the health
reimbursement account?
When you use a contracting network provider, your claims
will be filed automatically with Blue Cross and Blue Shield of
Illinois. Any amount deducted from your HRA will be shown on
your explanation of benefits along with the remaining balance.
Health reimbursement arrangements (HRAs) and health savings accounts (HSAs), including products under our BlueEdge product portfolio, have tax and legal
ramifications. Blue Cross and Blue Shield of Illinois does not provide legal or tax advice, and nothing herein should be construed as legal or tax advice. These
materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on, for the purpose of avoiding tax penalties.
Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials.
You may seek advice based on your particular circumstances from an independent tax advisor regarding the tax consequences of specific health insurance plans
or products.
Quick and Easy Ways to
Find a Doctor or Hospital
Use online tools from Blue Cross and Blue Shield of Illinois (BCBSIL) to find a
network provider, or determine the cost of a health care service for yourself or
a family member. Provider Finder® and Cost Estimator are fast, simple tools that
work side by side.
Use Provider Finder to:
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specialty, network type, ZIP code,
language and gender. Get directions
from Google Maps™, too.
Find it online or on the phone:
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฀ ฀ ฀bcbsil.com/sprint and click
on Find a Doctor.
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phone’s Web browser, too. Go to
bcbsil.com/sprint and click on Find a
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Provider Finder App for your iPhone®
or Android® phone. If you use your
GPS location or input a ZIP code,
the App can pinpoint the closest
provider locations for you.
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Advocate at the toll-free telephone
number on the back of your BCBSIL
member ID card for help in locating
a provider.
23650.0812
Cost Estimator
Get answers before you make big health care decisions
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make health care decisions about hospital procedures for yourself or your family.
It’s easy to get results:
SM
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(BAM)
at bcbsil.com/sprint. Click on link to Find a Doctor
or Hospital.
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diagnosis. Cost Estimator generates a range of
treatment estimates by provider.
With Cost Estimator, you can determine:
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®
is an option for treatment
Blue Distinction
®
For hospitals with expertise in specialty care
Blue Distinction is a designation awarded by the Blue Cross and Blue Shield
companies to hospitals that have demonstrated expertise in delivering
clinically proven specialty health care. Its goal is to help consumers find
specialty care on a consistent basis, while enabling and encouraging health
care professionals to improve the overall quality and delivery of care nationwide.
®
Blue Distinction Centers for Cardiac Care
Provides a full range of cardiac care services, including inpatient cardiac care,
cardiac rehabilitation, cardiac catheterization and cardiac surgery.
®
Blue Distinction Centers for Transplants
Transplant program that provides services, such as global pricing, financial
savings analysis, and global claims administration and support services.
Sprint requires the use of an approved Blue Distinction Center for this service.
®
Blue Distinction Centers for Complex and Rare Cancers
Inpatient cancer care programs for adults, including those treating complex
and rare subtypes of cancer, delivered by multidisciplinary teams with
subspecialty training and distinguished clinical expertise, focus on
treatment planning and complex, major surgical treatments.
Blue Distinction Centers for Knee and Hip Replacement
Provides inpatient knee and hip replacement services,
including total knee and total hip replacement surgeries.
Use the Blue Distinction
Center Finder.
• Go to bcbsil.com/sprint
• Select the Provider Finder®
tool and search for hospitals
• To find a Blue Distinction
center near you, search
by designated area of
specialty and state
• Once you become a member,
you can also call the toll-free
customer service number at
(877) 284-1571.
SM
®
Blue Distinction Centers for Spine Surgery
Inpatient spine surgery services, including discectomy,
fusion and decompression procedures.
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
22851.0910
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