�

Employer Brochure

�

Table of ContentsThe Value of Good Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �

How BlueCHiP for Healthy Options Works . . . . . . . . . . . . . . . . . . . . . . . . �

Side-by-Side Comparison of Advantage and Basic Benefits . . . . . . . . . . . 3

Access to Quality Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Primary Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Dual Options Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Wellness Participation Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7

Enrolling in BlueCHiP for Healthy Options . . . . . . . . . . . . . . . . . . . . . . . . . 8

The Value of Good HealthThings usually last longer and require fewer repairs if you take good care of them. The same is true of people. There’s no denying it: Those who take good care of themselves increase their chances of living long, healthy lives.

Time and again, studies have proven that people who:

– Exercise regularly, eat a good diet, and maintain a healthy weight can help prevent heart disease, diabetes, and a host of other chronic conditions.

– Don’t smoke, and smokers who quit, can help prevent lung disease, heart disease, cancer, and other serious illnesses.

– Obtain regular routine tests and screenings can help detect diseases in the early stages when they’re easier to treat.

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), we’re pleased to offer BlueCHiP for Healthy Options, a plan designed on the premise that a personal commitment to healthy living can lead to an improved quality of life. With all the benefits of comprehensive coverage, BlueCHiP for Healthy Options includes tools and resources to help members commit to wise lifestyle choices.

�

�

How BlueCHiP for Healthy Options Works

444 Westminster Street • Providence, RI 02903-3279

Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association.

BlueCHiP for Healthy Options Pledge

This plan focuses on primary care, prevention, and wellness. This plan also emphasizes

the importance of proper treatment for the chronically ill. To support these goals, and to

obtain the Advantage level of benefits, members must pledge to commit to the goals of

the BlueCHiP for Healthy Options.I and my dependents ages 12 and over agree to:• Participate in a smoking cessation program if currently a smoker, or remain

smoke-free if a non-smoker.• Participate in a weight loss or weight management program if I have a high body mass

index (BMI), or maintain a healthy weight if my BMI is in the healthy range.

• Participate in disease management or case management if identified by Blue Cross &

Blue Shield of Rhode Island as an individual who would benefit from these programs.

I/we understand that to obtain the Advantage level of benefits , I/we must participate in

the above mentioned programs.

444 Westminster Street • Providence, RI 02903-3279

Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association.

BlueCHiP for Healthy Options Pledge

This plan focuses on primary care, prevention, and wellness. This plan also emphasizes

the importance of proper treatment for the chronically ill. To support these goals, and to

obtain the Advantage level of benefits, members must pledge to commit to the goals of

the BlueCHiP for Healthy Options.I and my dependents ages 12 and over agree to:• Participate in a smoking cessation program if currently a smoker, or remain

smoke-free if a non-smoker.• Participate in a weight loss or weight management program if I have a high body mass

index (BMI), or maintain a healthy weight if my BMI is in the healthy range.

• Participate in disease management or case management if identified by Blue Cross &

Blue Shield of Rhode Island as an individual who would benefit from these programs.

I/we understand that to obtain the Advantage level of benefits , I/we must participate in

the above mentioned programs.

1. Make a pledge.With BlueCHiP for Healthy Options, employees and their families are enrolled in either the Advantage or Basic level of benefits. (See the side-by-side plan comparison on the opposite page.) One of the requirements to enroll in the Advantage level is to acknowledge and agree to the BlueCHiP for Healthy Options Pledge (Pledge), which states that employees and their eligible dependents will commit to a healthy lifestyle. For full details on enrolling in the Advantage level of benefits, please read the enrollment instructions on page 8 of this booklet.

2. Live a healthy lifestyle.As part of the Pledge, employees and their dependents must meet the Wellness Participation Requirements explained on pages 6 and 7. Some of the requirements apply to everyone, while others apply only to members of certain ages. What’s important is that the requirements help members stay on track with improving their health.

3. Pay lower out-of-pocket costs for keeping your Pledge.

Employees and eligible dependents who keep their Pledges stay in the Advantage level of benefits, which has lower out-of-pocket expenses. However, if employees or any of their eligible dependents do not complete all of the requirements, the entire family is switched to the Basic level of benefits at the plan’s anniversary date.

3

Side-by-Side Comparison of Advantage and Basic BenefitsBEnEfit AdvAntAgE BAsic

calendar Year Medical deductible Individual $750Family $�,500

Individual $5,000Family $�0,000

Annual Out-of-pocket Maximum (Does not include copayments or medical

and pharmacy deductibles.)

Individual $�,000Family $4,000

Individual $5,000Family $�0,000

coinsurance None �0%

Lifetime Benefit Maximum Unlimited $�,000,000 per participant

Physician Office visit

Annual Physical (AMA Guidelines, by age) Copayment waived

Office Visit $�0 copayment $30 copayment

Preventive Immunization �00% coverage �00% coverage

specialist Office visit $50 copayment $60 copayment

Emergency Room $�00 copayment (waived if admitted)

Prescription drug

calendar Year Pharmacy deductible None Individual $�50Family $500

copayments for Retail – 30-day Supply

Tier 1 $�0

Tier 2 $40

Tier 3 $75

Tier 4 $75

copayments for Mail Order drugs – 90-day Supply

Tier 1 $�0

Tier 2 $80

Tier 3 $�50

dental No coverage – Rider available

vision Medically necessary treatment only $50 copayment $60 copayment

Out-of-network care Only emergency and urgent care is covered.

For full benefit information, please refer to the member subscriber agreement.

don’t Risk it

To help your employees enroll in the Advantage level of benefits, please ensure that all enrollment documents are PROPERLY And fULLY cOMPLEtEd and REcEivEd: • No later than the �5th day of the month for new groups OR • No later than the �5th day of the month prior to your group’s anniversary date.

Employees with missing, incomplete, or late enrollment information will be enrolled in the Basic level of benefits, which has significAntLY LOWER cOvERAgE than the Advantage level. For full enrollment instructions, please refer to page 8 of this booklet. You can also call your broker or BCBSRI account representative for questions on the enrollment process.

4

Access to Quality CareAs BlueCHiP for Healthy Options members, your employees and their families can take advantage of an extensive network of local providers. This includes nearly 3,000 specialists, 14 of the area’s hospitals, and 90 percent of Rhode Island’s primary care physicians. Coverage is also provided for out-of-network emergency and urgently needed care. Members who are away from home and need urgent care can easily locate a provider by calling the BlueCard Program at 1-800-810-BLUE. Care will be covered as if it is received at home.

For prescription drugs, members have access to thousands of pharmacies across the United States, including all Rite Aid, CVS/pharmacy®, Osco, Walgreens, and many other large, as well as independent, pharmacies, through WellPoint® Pharmacy Management, our pharmacy benefits manager.

Primary CareAt BCBSRI, we agree with the “family doctor” approach. Doctors who know their patients’ medical history are better equipped to provide them with the best care.

Advantage MembersOne of the wellness participation requirements for Advantage members is to select and maintain a relationship with a primary care physician (PCP). A PCP is a family practitioner, internist, pediatrician, and sometimes an OB/GYN, who provides or coordinates all of his or her patients’ healthcare. As a result, the PCP knows their patient’s health history. By working with their PCPs, members are collaborating with someone who is uniquely qualified to provide and help arrange their medical care. Who better to help determine the best course of treatment? So when they need care, your employees and their dependents just need to contact their PCPs.

Basic MembersWhile Basic members are not required to select PCPs, we encourage them to establish a relationship with a physician who can get to know them and coordinate their care.

5

How Dual Options WorkEach of the plans listed below can be

offered with BluecHiP for Healthy Options.

HealthMate C�C �00/80 $�,000 DED

HealthMate C�C 90/70 $500 DED

HealthMate C�C 80/60 $�,000 DED

HealthMate C�C 80/60 $�,000 DED

HealthMate C�C HDHP $�,500 DED

HealthMate C�C HDHP $3,000 DED

BlueSolutions for HSA $�,500 DED

BlueSolutions for HSA $3,000 DED

Dual Options GuideDual options provide your employees with the opportunity to choose a plan that works best for their healthcare needs and budget, while providing you, the employer, with a cost-saving measure. You can offer your employees a lower premium plan and ask them to contribute toward the difference in cost to purchase a more comprehensive, higher premium option.

The information contained in this chart is provided for illustrative purposes only. It does not constitute a contract. BCBSRI reserves the right to modify or eliminate its product offerings and pairing options at any time without notice. For more information on any of these product offerings, or to receive an employer brochure on our available health plan options, please contact your BCBSRI account representative or broker.

BCBSRI allows small employers to offer up to two variations of products to their employees. You may offer any two plans together as long as the rate differential between those plans is between 0 and 24 percent. To assist you in making your plan selection, the chart below identifies the eligible dual options that fall within the required 0 to 24 percent rate differential for pairing with the BlueCHiP for Healthy Options product.

Wellness Participation

Requirements …at Enrollment

PLEAsE nOtE: The employee may also be sWitcHEd tO tHE BAsic LEvEL of benefits on the first day of the month following the group’s effective date of coverage if any family member’s PHA is incomplete or missing.

Once enrolled in the Basic level, can members switch to the Advantage level?Employees enrolled in the Basic level of benefits can switch to the Advantage level at the group’s an-niversary date. To do so, they must:• Contact BCBSRI to designate a

PCP for themselves and each of their eligible dependents.

• Submit PHAs for themselves and their eligible dependents aged �8 and older if PHAs weren’t submit-ted during the initial enrollment period.

Personal Health Assessment

Complete each question as best you can by marking the best response. All data collectedand processed will be handled in accordance with our policy and procedure aroundconfidentiality. From time to time, we may offer wellness information or programs. By yourparticipation in this survey, you expressly allow us to contact you (via mail, web or phone)should we decide to offer education that may relate to your lifestyle habits. Theinformation from this health assessment will only be used in conjunction with wellnessprograms, and will not adversely effect your enrollment or benefits.

This Personal Health Assessment ("PHA") asks questions about your health, lifestyle,attitudes and work habits. Based on your responses, you will receive a PHA Reportcreated just for you. This report will provide you with a score that indicates your overalllevel of health & wellness along with markers for several important factors that contributeto your overall score. The report also includes in-depth analysis for each of your health &wellness markers and offers action steps toward improving or maintaining optimalwellness.

To help us accurately read your PHA responses:

1. Use a blue or black ballpoint pen to answer each question.2. USE ALL CAPITAL LETTERS.3. Answer all questions unless instructed to skip.4. Fill in all circles completely.5. Return your completed PHA as directed.6. Do not fold or wrinkle your PHA.7. Do not make any stray marks on the PHA.

Your Responses are Confidential!

All information you provide on your PHA - and all information provided to you in your PHAReport - is kept strictly confidential. Your information will not be seen by your employer.

Published by the Health & Wellness Institute, a division of Blue Cross & Blue Shield of Rhode IslandBlue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association

v2.3

Personal Health AssessmentComplete each question as best you can by marking the best response. All data collected

and processed will be handled in accordance with our policy and procedure around

confidentiality. From time to time, we may offer wellness information or programs. By your

participation in this survey, you expressly allow us to contact you (via mail, web or phone)

should we decide to offer education that may relate to your lifestyle habits. The

information from this health assessment will only be used in conjunction with wellness

programs, and will not adversely effect your enrollment or benefits.This Personal Health Assessment ("PHA") asks questions about your health, lifestyle,

attitudes and work habits. Based on your responses, you will receive a PHA Report

created just for you. This report will provide you with a score that indicates your overall

level of health & wellness along with markers for several important factors that contribute

to your overall score. The report also includes in-depth analysis for each of your health &

wellness markers and offers action steps toward improving or maintaining optimal

wellness.

To help us accurately read your PHA responses:1. Use a blue or black ballpoint pen to answer each question.

2. USE ALL CAPITAL LETTERS.3. Answer all questions unless instructed to skip.

4. Fill in all circles completely.5. Return your completed PHA as directed.6. Do not fold or wrinkle your PHA.7. Do not make any stray marks on the PHA.

Your Responses are Confidential!All information you provide on your PHA - and all information provided to you in your PHA

Report - is kept strictly confidential. Your information will not be seen by your employer.

Published by the Health & Wellness Institute, a division of Blue Cross & Blue Shield of Rhode Island

Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association

v2.3

6

To enroll in the ADVANTAGE level of benefits, employees must:1. Indicate on the enrollment application a primary care physician

(PCP) for themselves and for each of their eligible dependents.

2. Pledge (by signing the enrollment application) that they and their eligible dependents will meet all of the Wellness Participation Requirements.

3. Submit completed Personal Health Assessments (PHA) for themselves and their eligible dependents who are aged 18 and older. (PHAs must be submitted with enrollment applications.)

The entire family will be enrolled in the BASIC level of benefits if: – The employee or his or her dependents do not comply with the

above requirements, and/or – Enrollment documents are not PROPERLY AND FULLY

COMPLETED and RECEIVED: • No later than the 25th day of the month for new groups OR • No later than the 15th day of the month prior to your group’s

anniversary date.

…for Ongoing Participation

PLEAsE nOtE: If the employee or any of his or her eligible dependents do not meet all of these require-ments, the entire family will be sWitcHEd tO tHE BAsic LEvEL at their plan’s anniversary date.

Employees and dependents who are aged 18 and older must each meet the following requirements:1. Maintain a relationship with his or her PCP.

2. Maintain a healthy weight or participate in weight management classes if overweight or have an unacceptable body mass index (BMI) in the opinion of his or her PCP.

3. Remain smoke-free, or attend smoking cessation classes if a smoker.

Within six months after the employee’s effective date:

4. Have an annual checkup with his or her PCP.

Within eight months after the employee’s effective date:5. Submit an annual PCP Checklist.

6. Submit an annual Self-Reporting Form.

7. Participate in our wellness, disease management, and/or case management programs if identified by BCBSRI as someone who could benefit by such programs.

Dependents under age 18 must each meet the following requirements:1. Maintain a relationship with his or her PCP.

Within six months after the employee’s effective date:2. Have an annual checkup with his or her PCP.

Within eight months after the employee’s effective date:3. Submit an annual PCP Checklist. (Does not apply to members who are

under age 12.)

4. Participate in our wellness, disease management, and/or case management programs if identified by BCBSRI as someone who could benefit by such programs.

dOn’t fORgEt

dOn’t fORgEt

dOn’t fORgEt

dOn’t fORgEt

You’ll find step-by-step enrollment instructions

on the next page.

7

8

Enrolling in BlueCHiP for Healthy Options

Step 1 Contact your broker or BCBSRI account representative to request an Employer Tool Kit.

Step 2Offer BlueCHiP for Healthy Options to employees. Make sure they understand that to enroll in the Advantage level of benefits, they’ll need to: • Complete a Personal Health Assessment (PHA) for themselves and each eligible

dependent who is aged 18 or older. • Read the BlueCHiP for Healthy Options Pledge, and then complete

and sign their applications. – A primary care physician (PCP) must be indicated on the application for the

employee and for each of his or her eligible dependents.Without this information, employees will be EnROLLEd in tHE BAsic LEvEL Of BEnEfits.

Step 3Complete all applicable employer enrollment forms and applications fully and correctly.

Step 4Obtain all employee enrollment applications and PHAs.

Step 5Review each application to ensure that: • It’s been signed by the employee. • A PCP is indicated for the employee and each of his or her eligible dependents. • PHAs are included in a sealed envelope.

Step 6Mail all enrollment applications and employer forms along with PHAs in the self-addressed envelope (which is included in the Employer Tool Kit) to the address below nO LAtER tHAn: • The �5th day of the month for new groups OR • The �5th day of the month prior to your group’s anniversary date. Sales and Marketing Services/Operations – 00�98

Blue Cross & Blue Shield of Rhode Island 444 Westminster Street Providence, RI 0�903-996�

Enrollment documents for BlueCHiP for Healthy Options must be PROPERLY And fULLY cOMPLEtEd, and REcEivEd: • No later than the �5th day of the month for new groups OR • No later than the �5th day of the month prior to your group’s anniversary date.Employees with missing, incomplete, or late enrollment information will be enrolled in the Basic level of benefits, which has significAntLY LOWER cOvERAgE than the Advantage level.

9

Questions?

To learn more about these enrollment instructions or the BlueCHiP for Healthy Options product, please contact your broker or BCBSRI account representative.

�0

444 Westminster Street • Providence, RI 02903-3279

Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association.

BlueCHiP for Healthy Options complies with the Rhode Island Office of the Health Insurance Commissioner’s (OHIC) requirements for a HEALTHpact plan. HEALTHpact plans are designed to assist

small employers in offering health coverage that encourages members to make healthy lifestyle choices by meeting certain wellness participation requirements.

6/08 HO-4985 • 5751BR