2016 INDIVIDUAL PRODUCTS NAVIGATOR MEETING AT TDCI OCTOBER 2015.

2016INDIVIDUAL PRODUCTS

NAVIGATOR MEETING AT TDCI OCTOBER 2015

2016 NAVIGATOR MEETING

• 2016 Product Portfolio• Redetermination and Re-Enrollment

Process• Consumer Tools• Resources

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On-Marketplace Plans

22 base-level plan designs Blue Network ESM is

available in regions 2, 3, 4 and 6 Blue Network SSM is available statewide

Blue Network PSM is availablestatewide on select plans sold on the Marketplace as Multi-State plans

BRONZE

4

$

$$$

$$

$$$$

– 4 Bronze

– 5 Gold

– 3 Platinum

– 10 Silver

GOLD PLATINUM

SILVER


Multi-State PlansMSP is only a name

Plans cannot be purchased across state lines

Do not need a MSP plan to get benefits outside of Tennessee

The words "a Multi-State Plan" will appear in the name of the plan on bcbst.com and HealthCare.gov

6 base-level plan designs (B04, S09, S11, S12, G08

and G11) Available on Blue

Network P5

BRONZE

$

$$$

$$

$$$$

– 1 Bronze

– 2 Gold

– 0 Platinum

– 3 Silver

GOLD PLATINUM

SILVER


Bronze

6

• Number of Base Plans: 4

• Deductible Range: Individual $3,000 - $6,000

• Out-of-Pocket Maximum Range: Individual $6,000 -$6,850

• Coinsurance (2 options): 50% and 100%

• HSA-Compatible:3 HSA-Compatible Plans (B02, B04, and B07)

MSP

(P)

ON

(S,E*)

2016 Plan

Name

Individual

Deductible

Individual

OOP Max

Coinsurance Office

Visits

Rx HSA

Compatible

x Bronze

B01

$3,000 $6,850 50% ded/coins ded/coins No

x Bronze

B02

$4,000 $6,350 50% ded/coins ded/coins Yes

x x Bronze

B04


x Bronze

B07



Silver

7


• Deductible Range: Individual $0 - $5,500


• Coinsurance (4 options): 50%, 80%, 90% and 100%

• 2 Plans with Office Visit Copays :$10 PCP$10 or $40 Specialist

• 3 Plans offering Rx Copays 3 unique copay options featuring either $3 or $8 generics

• HSA-Compatible:2 HSA-Compatible Plans (S16 and S19)

MSP

(P)

ON

(S,E*)

2016 Plan

Name

Individual

Deductible

Individual

OOP Max

Coinsurance Office

Visits

Rx HSA

Compatible

x Silver S01 $0 $6,350 50% ded/coins ded/coins No

x Silver S02 $1,000 $6,250 50% ded/coins $3/50% No

x Silver S04 $2,000 $4,000 50% ded/coins ded/coins No

x Silver S08 $2,000 $5,000 80% ded/coins ded/coins No

x x Silver S09 $2,500 $4,500 80% ded/coins ded/coins No

x x Silver S11 $2,500 $5,500 80% ded/coins $8/$35/$60 No

x x Silver S12 $4,000 $5,500 80% $10 ded/coins No

x Silver S14 $5,500 $6,350 80% $10/$40 $3/$50/$100 No

x Silver S16 $3,500 $3,500 100% ded/coins ded/coins Yes

x Silver S19 $3,000 $4,250 90% ded/coins ded/coins Yes


Gold

8


• Deductible Range: Individual $0 - $3,500


• Coinsurance (3 options): 65%, 80% and 100%

• 2 Plans with Office Visit Copays:$35 PCP$50 Specialist

• 2 Plans offering Rx Copays

• No HSA-Compatible Plans

MSP

(P)

ON

(S,E*)

2016 Plan

Name

Individual

Deductible

Individual

OOP Max

Coinsurance Office

Visits

Rx HSA

Compatible

x Gold G01 $0 $5,250 65% ded/coins ded/coins No

x Gold G06 $1,500 $4,500 80% $35/$50 $8/$35/$60 No

x x Gold G08 $2,100 $2,100 100% ded/coins ded/coins No

x Gold G10 $3,500 $3,500 100% $35/$50 50% No

x x Gold G11 $3,500 $3,500 100% $35/$50 $8/$35/$60 No


Platinum

9


• $0 Deductible on all plans


• Coinsurance (2 options): 50% and 75%

• 2 Plans with Office Visit Copays:$10 or $20 PCP$40 Specialist

• 2 Plans offering Rx Copays:$3/$25/$50

• No HSA-Compatible Plans

MSP

(P)

ON

(S,E*)

2016 Plan

Name

Individual

Deductible

Individual

OOP Max

Coinsurance Office

Visits

Rx HSA

Compatible

x Platinum

P01

$0 $1,800 50% $20/$40 $3/$25/$50 No

x Platinum

P02

$0 $1,500 75% ded/coins ded/coins No

x Platinum

P03

$0 $3,000 75% $10/$40 $3/$25/$50 No


Deciphering BlueCross Plan Names

The plan name includes the metallic level, plan number and provider network

• First letter represents the metal level• The plan number is listed after the metal level• The last letter represents the network

Multi-State Plan• Only a name• Cannot be purchased across state lines• The words "a Multi-State Plan" will appear in the name of the plan

on bcbst.com and HealthCare.gov

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For CSR Plan Designs

Silver-Level CSR Plans• A plans: 73% Actuarial Value (S09E-A)• B plans: 87% Actuarial Value (S09E-B)• C plans: 94% Actuarial Value (S09E-C)

AN/AI CSR Plans• AI1: AN/AI zero cost-share plan (S09E-AI1)• AI2: AN/AI plan with tiered benefits (S09E-

AI2)

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Deciphering BlueCross Plan Names


BlueCross Plans Available Statewide

Regions• Region 1 East• Region 2 Greater Knoxville• Region 3 Greater

Chattanooga• Region 4 Greater Nashville• Region 5 West• Region 6 Greater Memphis• Region 7 East Central

• Region 8 West Central

HAMILTON

12

KNOXDAVIDSON

SHELBY

Marketplace Service Area

Marketplace Service Area Boundaries

Network E is not available

Network E is available

124 7

356 8

Available Networks• On-Marketplace

- Blue Network E available in regions 2, 3, 4 and 6

- Blue Network S available statewide

- Blue Network P available with MSP plans


BlueNetwork Facts

13cover you in all 50 states – and around the world.

Blue Network P– Our PreferredNetwork• Available for plans

purchased on (Multi- State Plans only) the Health Insurance Marketplace

• Statewide network• For consumers

who want:- Access to the most

doctors and providers statewide

No matter what network you choose, all BlueCross plans

Blue Network S –Our Select Network• Available for

plans purchased on the Health Insurance Marketplace

• Statewide network

• For consumers who want:

- Access to a select number of doctors and providers statewide

- Lower premium

Blue Network E– Our EssentialNetwork• Available for plans

purchased on the Health Insurance Marketplace

• Only available in and around Tennessee’s major cities: Chattanooga, Knoxville, Memphis and Nashville

• For consumers who:

- Live in or near one of Tennessee’s four major cities

- Want the lowest premium


2016 Plan Design Changes

Plan design changes to meet actuarial values for 2016

• For 2016, CMS provided a new actuarial value calculator. Based on the new calculator, we made

plan design changes to stay within the actuarial value ranges.

Plan Changes to Meet Actuarial Value Requirements

Reflects 2015 Plan and Benefit information Represents items that will be different for 2016

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2015

Policy Form

Deductible Individual

In Network

Coins In Network

OOP Max Individual

In Network

Office Visit

Rx Benefit

B01 2,500 50% 6,350 Ded/ Coins

Ded/ Coins

B04 5,300 100% 5,300 Ded/ Coins

Ded/ Coins

S01-A 0 50% 5,200 Ded/ Coins

Ded/ Coins

S11-A 2,500 80% 4,150 Ded/ Coins

8/35/60

S12-C 0 80% 1,100 10 Ded/ Coins

S14-A 4,500 80% 5,200 $10/ $40 3/50/100

S16-A 2,950 100% 2,950 Ded/ Coins

Ded/ Coins

S19-A 2,200 90% 4,250 Ded/ Coins

Ded/ Coins

S19-B 500 90% 2,250 Ded/ Coins

Ded/ Coins

2016

Policy Form

Deductible Individual In Network

Coins In

Network

OOP Max Individual

In Network

Office Visit

Rx Benefit

B01 3,000 50% 6,850 Ded/ Coins

Ded/ Coins

B04 6,000 100% 6,000 Ded/ Coins

Ded/ Coins

S01-A 0 50% 5,250 Ded/ Coins

Ded/ Coins

S11-A 2,500 80% 4,100 Ded/ Coins

8/35/60

S12-C 0 80% 1,000 $10 Ded/ Coins

S14-A 4,500 80% 5,250 $10/ $40 3/50/100

S16-A 3,000 100% 3,000 Ded/ Coins

Ded/ Coins

S19-A 2,250 90% 4,250 Ded/ Coins

Ded/ Coins

S19-B 500 90% 2,300 Ded/ Coins

Ded/ Coins


Discontinued 2015 Plans and Mapping Process

Discontinued Seven Base-Level Plans • Low enrollment in these plans, less than 2 percent of total population Variations • Auto Re-enrollment into comparable plans for 2016 • Renewal Letter will list benefit changes different plan during Open Enrollment

• Includes CSR• Option to choose

a

Proposed Discontinuation of Plans

Reflects 2015 Plan and Benefit information Represents items that will be different for 2016

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2015 - Plans to be discontinued

Policy Form


Coins In Network

OOP Max Individual

In Network

Office Visit

Rx Benefit

B03 4,000 80% 6,350 Ded/ Coins

Ded/ Coins

S07 1,500 70% 6,350 Ded/ Coins

Ded/ Coins

S07-A 1,500 70% 3,950 Ded/ Coins

Ded/ Coins

S07-B 0 70% 2,000 Ded/ Coins

Ded/ Coins

S07-C 0 70% 650 Ded/ Coins

Ded/ Coins

S07-AI1 0 100% 0 $0 100%

S07-AI2 1,500 70% 6,350 Ded/ Coins

Ded/ Coins

G02 0 75% 6,350 Ded/coins Ded/ Coins

G04 1,000 80% 4,000 $35 / $50 8/35/60

2016 - Plans for members to be mapped to

Policy Form


Coins In

Network

OOP Max Individual

In Network

Office Visit

Rx Benefit

B02 4,000 50% 6,350 Ded/ Coins

Ded/ Coins

S04 2,000 50% 4,000 Ded/ Coins

Ded/ Coins

S04-A 1,000 50% 3,650 Ded/ Coins

Ded/ Coins

S04-B 0 50% 1,450 Ded/ Coins

Ded/ Coins

S04-C 0 50% 550 Ded/ Coins

Ded/ Coins

S04-AI1 0 100% 0 $0 100%

S04-AI2 2,000 50% 4,000 Ded/ Coins

Ded/ Coins

G01 0 65% 5,250 Ded/coins Ded/ Coins

G06 1,500 80% 4,500 $35 / $50 8/35/60


Marketplace Notices

17

CMS Notices• Delivered prior to

Open Enrollment to all active enrollees- Outlines

Redetermination Process- Customized messaging

for the following groups:o Special Notice Group -

household income that is in excess of 500% FPL

o Income-Based Outreach Group - household income that is in excess of 350% FPL

o Opt-Out Group - did not authorize the FFM to request updated tax return information

o Did Not Reconcile - enrollees who received APTC in 2014 but did not file an income tax return or failed to file form 8962 for 2014

- IRS Commissioner issued preliminary results on July 17th (irs.gov/pub/irs-tl/ missionerLetterlwithcharts.pdf)

· If Tennessee follows national averages, nearly 57% of enrollees could fall into this group

- IRS conducted outreach to these households earlier in the summer (irs.gov/pub/notices/ltr5591_english. pdf)

• Eligibility Redetermination Notices- Will be sent to members who have not

yet taken action around December 15th (via email or mail)

- Contains updated 2016 subsidy eligibility


BlueCross Discontinuation and Renewal Notices• Will be sent prior to Open Enrollment• Includes information on crosswalked plans• Includes changes to premium and notes the 2015 APTC as “estimated”

Note: 2015 Subsidies will not carry over to 2016. For enrollees who contact the FFM during OE to update eligibility information, the FFM will redetermine the 2016 subsidy based on the information provided. For passively re-enrolled members who are still subsidy eligible, the FFM will use the projected annual household income and family size from the most recent 2015 application or use income and family size data from the IRS to redetermine subsidies for 2016.

18


Online Wellness Portal

20


Strive for Better Health- Sign up via BlueAccess- Health assessment- Self-directed coaching- Complete ONMYTIME

courses- Tailored Health

Management- Text messaging reminders- Device Dashboard

Self-Assessment- Track food intake- Track exercise activities- Track progress- Sync mobile app- Sync fitness device- View personal reports- Manage trackers

21

Online Wellness Portal App


Healthcare Cost Estimator

Our tools make it simple for members to locate quality, in-network care while understanding estimated costs.

Now members can locate providers and facilities plus find cost estimates – all from a single tool.

22


myBlue TNSM Updates

BlueCross’ myBlue TNSM app brings greater convenience and ease-of-use to members through simplified provider search and improved usability.• Consolidated “Find Care” menu

• Search for Doctors, Pharmacies, Urgent Care and Hospitals

• Improvements to Search functionality

• Access to Non-Emergency Care

• Easy Log In

• Register for BlueAccess

•

SM

Download the app on your mobile device. Available in the iTunes AppStore® or Google Play

TM

23


First Mailing (~48 hours after enrollment):

• Approval Letter (includes monthly premium, name and date of birth of all covered members, etc.)

• Schedule of Benefits

• Bank draft authorization form (set up recurring payments)

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Second Mailing (~48 hours after enrollment):

• Member Guide (Includes info on BlueAccessSM, Nurseline, etc.)

• Network ID Mailer (Details on Find a Doctor, etc.)

Third Mailing (~48 hours after initial payment):

• Member ID Card

Member Resources Mailed


Member Resources Online

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BlueAccessSM – personalized, secure member area at bcbst.com

Make a Payment – View billing statements and pay monthly premium

My Benefits and Coverage– Get full details on what’s

covered, who’s covered and what you pay for medical services, including Evidence of Coverage (EOC)

My Claims and Balances– Check claims status and

details. Print benefit and claims information. View

remaining deductibles, out-of- pocket maximums and more

Cost and Quality Tools – Find network doctors or hospitals, including quality and safety certifications. Get answers about health care expenses – even compare costs

Pharmacy – View drug lists and mail order forms

My Account – Set up account profile, including contact preferences, communication channels, messaging alerts and BlueVoice participation


Marketplace Advocates Map

West TN, Advocate

Adrian Winfrey

Office: (901) 544-2009

Moblie (901) 258-0769

[email protected]

Middle TN, Advocate

Laura “Shea” Phillips

Office: (423) 535-6977

Moblie (423) 290-3578

[email protected]

Southeast TN, Advocate

Shena Allen

Office: (423) 535-4856

Moblie (423) 298-4343

[email protected]

East TN, Advocate

Pati McGraw

Office: (865) 588-4681

Moblie (865) 214-0342

[email protected]

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Statewide

Tiffany Gray, Principal Consultant

Office: (901) 544-2595

Moblie (901) 573-0536

[email protected]

mailto:[email protected]









BlueCross BlueShield of Tennessee | 1 Cameron Hill Circle | Chattanooga, TN 37402 | bcbst.com

For TDD/TTY help call 1-800-848-0299.Spanish: Para obtener asistencia en Español, llame al 1-800-565-9140 | Tagalog: Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 1-800-565-9140

| Chinese: 如果需要中文的帮助 , 请拨打这个号码 1-800-565-9140 | Navajo: Dinek’ehgo shika at’ohwol ninisingo, kwiijigo holne’ 1-800-565-9140

BlueCross does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association

15IND2912 (10/15)Navigation Meeting at TDCI

Presentation

2016 INDIVIDUAL PRODUCTS NAVIGATOR MEETING AT TDCI OCTOBER 2015.

Documents

Transcript of 2016 INDIVIDUAL PRODUCTS NAVIGATOR MEETING AT TDCI OCTOBER 2015.