JULY 1

Odessa R-VII School District

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Your 2013 Medical Plan Options

• Traditional Health PlansBlue-Care – HMO (Health Maintenance Organization)• Select a Primary Care Physician (PCP)• In-Network Coverage OnlyPreferred-Care Blue -- PPO (Preferred Provider Organization)• No selection of a PCP (Primary Care Physician)• In and Out of Network Coverage

• Consumer Driven Health Plan– Blue Saver – QHDHP (Qualified High Deductible Health Plan)• Similar features to the Traditional PPO Plan

• Preferred-Care Blue PPO Network• In and Out of Network Coverage

• Health Savings Account (HSA)• Employee-Owned Health Savings Account• Tax-Favored way to pay for Medical, Prescription Drug, Vision, Dental Expenses

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Hospital Locator

Hospital Name HMOBlue Care Network

PPO Preferred Care Blue Network

Center Point Medical Center X X

Children’s Mercy Hospitals X X

KU Medical Center X X

Lee’s Summit Hospital X X

Liberty Hospital X NO

Menorah Medical Center X X

North Kansas City Hospital X X

St. Luke’s (All Locations) NO X

Olathe Medical Center X X

Overland Park Regional X X

Providence Medical Center X X

Research Medical Center X X

Shawnee Mission Medical Center X X

St. Joseph Medical Center X NO

St. Mary’s Medical Center X NO

Truman Medical Center (Hospital Hill and Lee’s Summit)

X NO

www.bluekc.com

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www.bluekc.com

View Your Claims, Print a Temporary ID card & Find Rx Info

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Worldwide Network of PPO Healthcare Providers

Welcomed in over 200 countries Worldwide

BlueCard PPO Network

National Network Access through BlueCard®

1,177,194 Physicians 6,776 Hospitals Access in ALL 50 States

Traditional PlansHMO and PPO

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Blue-Care HMOOffice Visits PCP: $25 copay (IM, FP, GP, PED)

Specialists: $50 copay (ENT, Derm, OB/GYN)

Inpatient Hospital Services/Outpatient Surgery

$400 copay per day up to $2,000 per calendar year(applies to inpatient services at a hospital and

outpatient surgeries at a hospital or an outpatient facility)

MRI, MRA, CT and PET Scans Physician’s Office, Imaging Center, Outpatient Setting

$100 copayOnly one copay will apply for each provider on a

specified date of service even if multiple scans are performed

Urgent Care(Minute Clinics, Take-Care Centers)

$50 copay(office visit/lab only)

Emergency Care $100 copay if treated and released(copay waived if admitted to hospital)

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Traditional PPO

In-Network Out-of-NetworkOffice Visit $30* Deductible & 40%

Deductible: Individual $1,000

Deductible: Family $2,000

Coinsurance (your share): 20% 40%

Out-of-Pocket Maximum: Individual

$2,500 $5,000

Out-of-Pocket Maximum: Family

$5,000 $10,000

Hospital: Inpatient or Outpatient

Deductible & 20% Deductible & 40%

Emergency Room $100 copay + Deductible then 20%(Copay waived if admitted)

Urgent Care(includes Minute Clinics and Take Care Centers)

$30* copay Deductible & 40%

*Copay includes Office Charge & Lab services in Physician’s office or Independent Lab

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Prescription Drug CoverageHMO and PPO Plans

Certain drugs may require prior authorization, have quantity limitations or require use of Generics First Program. Refer to the Prescription Drug List in your packet for additional details.

34 day supply

In-Network Pharmacy

Tier 1: $12

Tier 2: $35

Tier 3: $60

102 day supply

Mail-Order

Tier 1: $36

Tier 2: $105

Tier 3: $180

visit www.bluekc.com for a complete list of pharmacies in your area.

BlueSaverHigh Deductible Health Plan + Health Savings Account

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Lower monthly premiums

No copayments at doctor’s office you pay entire discounted cost until deductible is met; then 100%

You pay the entire discounted cost for prescriptions until deductible is met; then 100%

Medical Plan

Owned by you Used for eligible expenses Helps pay for deductible and Rx Tax savings

No “use it or lose it” rule Wells Fargo will administer your HSA

Health Savings Account (HSA)

Consumer Driven Health Plan PPO + HSA (Health Savings Account)

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Full cost of a doctor visit is $140

BCBSKC has negotiated a fee of $65 using Preferred Care Blue Doctors

You pay nothing at the visit

Your doctor sends a bill for $140 to your home, but you don’t pay it

You receive the Explanation of Benefits (EOB) from BCBSKC indicating that you owe $65

You pay your doctor $65 (this amount goes towards your deductible)

QHDHP Claim Flow Example

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Allergy Testing $900

BCBSKC has negotiated a fee of $500 using Preferred Care Blue Doctors

You pay nothing at the visit

Your doctor sends a bill for $900 to your home, but you don’t pay it

You receive the Explanation of Benefits (EOB) from BCBSKC indicating that you owe $500

You pay your doctor $500 (this amount goes towards your deductible)

QHDHP Claim Flow Example

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In-Network Out-of-Network

Cal. Yr. Deductible: Individual

$2,500

Cal. Yr. Deductible: Family $5,000

Coinsurance (your share): 0% 20%

Out of Pocket Maximum: Individual $2,500 $5,000

Out of Pocket Maximum: Family $5,000 $10,000

Office Visit Deductible then 0% Deductible then 20%

Hospital: Inpatient or Outpatient Deductible then 0% Deductible then 20%

Emergency Room Deductible then 20%

Urgent Care (Minute Clinics and Take Care )

Deductible then 0% Deductible then 20%

Retail Prescriptions (34 day supply) Deductible then 0% Deductible & 50% after $12/$35/$60

Mail Order Prescriptions (102 day supply)

Deductible then 0% N/A

BlueSaverQHDHP + HSA (Health Savings Account)

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Prescription Drugs on the QHDHP Important Points/Reminders…

Member pays Entire Rx Cost (less BCBSKC discount) of the prescription

1. Discounted cost of the prescription applies to deductible.

2. After the deductible is met – Prescription Drugs are covered at 100%

Always show your BCBSKC I.D. card at the pharmacy

Prescription Drugs are credited to your Deductible at the time of your purchase

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What is an HSA?

A Health Savings Account (HSA) that can help you manage your expenses today and in the future.

It’s yours to: Own . The HSA is always yours, even if you change jobs, become unemployed

or retire. Grow. Your unused balance rolls over from year to year. Save. HSA’s provide tax-free earnings and tax-free withdrawals. Choose. Use for current expenses, save for the future or explore investment

options.

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Eligibility to Open an HSA• You must elect the BlueSaver QHDHP $2,500 High Deductible plan

AND• You may NOT be covered by any of the following:

– A Traditional health plan

– Medicare, Medicaid, or Tricare Coverage

– Health Flexible Spending Account (FSA) (except a limited account for Dental and Vision)

– Spouse’s general purpose health FSA

– Veteran’s Administration (VA) benefits within the last 3 months

• You cannot be claimed as a dependent on someone else’s tax return.

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Saving and Spending – Contributions to your HSA

o Money may be contributed to your HSA by you, or anyone else, as long as the

total doesn’t exceed the IRS annual maximum:

2013

o Catch up of an additional $1,000 if 55 years of age

o Withdrawals can be made only after the money is deposited to your account.

o No expenses may be reimbursed for services incurred before the HSA is set up, regardless

of when the QHDHP was effective.

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How to use your HSA Funds

Use the HSA funds to pay for IRS “qualified medical expenses” permitted under Federal Tax law including:

Medical out-of-pocket expenses (i.e. deductibles and coinsurance) Dental treatment (i.e. fillings, braces, extractions) Prescription drugs and over-the-counter drugs Eye exams, eyeglasses, and contact lens

Pay for expenses for yourself and your spouse or other tax-code dependents, even if they are not covered by your health plan.

Domestic partners are not tax code dependents. See IRS Publication 502 website for a full listing of IRS eligible expenses.

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HSA Eligible Expenses

Acupuncture Alcoholism Treatment Ambulance Services Artificial Limb or Prosthesis Artificial Teeth Birth Control Pills Chiropractors Crutches Dental Care Diagnostic Devices (such as a blood sugar test

kit) Doctor’s Fees Drug Addiction Treatment Fertility Enhancement (including in-vitro

fertilization) Hearing Aids and Hearing Aid Batteries Hospital Services (including meals and lodging) Laboratory Fees

Medicines or Drugs Nursing Home Nursing Services Operations or Surgery Psychiatric Care Psychologist Telephone Equipment (for vision/hearing

impaired) Television Equipment (for hearing-impaired) Therapy or Counseling Transplants Transportation for medical care Vasectomy Vision (exams, eyeglasses, contacts, corrective

surgery) Wheelchair X-Rays

Complete list: IRS Publication 502

Eligible Expenses also include: Medicare premiums (Part A through D), COBRA premium, certain Long Term Care insurance premium and health insurance premium if receiving unemployment.

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What If…

I use my funds for a non-qualified expenses, such as a new TV?• 20% penalty for non-qualified expenses plus taxes• Keep your receipts in case of an audit!

I turn age 65?• Spend on non-qualified expenses with no penalty • Pay normal income tax

I change to one of the Traditional plans next year? What happens to the funds in the account?

• Continue to spend on qualified medical expenses, you just can’t contribute

I don’t have enough funds in my HSA to cover my service or prescription?• Pay out of pocket, you can reimburse yourself once your funds are available• Use on-line Services to transfer funds

General Information

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Preventive Care: What to Know!All of your BCBSKC plans will cover Preventive Care Services at 100%, according to established government guidelines:

• Annual Physicals• Childhood Immunizations• Well Women Exams• PSA Tests

Services MUST be Preventive and received by In-network providers

Effective July 1, 2013:• Generic Oral Contraceptive drugs at 100%• Certain Contraceptive implants, injectables & devices at

100%• Breastfeeding support, supplies (pumps) and counseling at

100%

Refer to the Routine Preventive Services flier for a complete list of covered services.

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24-Hour Nurse Line

Access to Care Advisors to help you with symptoms or answer health-related questions

How Can They Help?◦ Gain convenient access to quality care◦ Become better informed about healthcare◦ Gain confidence when speaking to providers◦ Become educated on self-care for non-urgent situations◦ Improve knowledge of drugs and medications

24 hours a day…365 days a year!

877-852-5422

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▪ Blue365 online resources include: Tools to help employees make the best choices about their health Select discounts and savings on products and services they can use to

improve and maintain health▪ Select companies include:

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Questions?