welcomewelcomeTO OPEN ENROLLMENT 2013TO OPEN ENROLLMENT 2013

Today We Will Cover:

• What’s Changing • Your BCBSNM plan features• Customer Service• Online tools and resources

1. Provider availabilityWill you be able to visit the doctors, hospitals and other facilities you want to?

2. Benefit paymentsHow much you will have to pay out of your pocket for your medical expenses?

3. Medical servicesConsider your health status and services you expect to consume during the year. What has your experience been in past years?

Plan Options – What to Think About

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Nationwide coverage when traveling or living outside of home state

BlueCardWorldwide®

coveragewhen traveling in more than 195 countries

more hospitals

nationwide network

More than 96% of hospitals and

91% of doctorsOver 22,000 contracted providers in New Mexico more

providers

More Doctors. More Hospitals.

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Call Customer Service on the back of your BCBSNM ID card

877-994-2583Call BlueCard Access – available 24/7

800-810-BLUE (-2583)

Call Customer Service on the back of your BCBSNM ID card

877-994-2583Call BlueCard Access – available 24/7

800-810-BLUE (-2583)

From your computer OR mobile phone, log on to bcbsnm.comand click on ‘Find Doctor’

From your computer OR mobile phone, log on to bcbsnm.comand click on ‘Find Doctor’

How to Find a PPO Provider

OR Contact your physicians and ask

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Reminder about your PPO

In-network

You receive the highest level of benefits:

• Pay less for care• No balance billing

No claim forms• Providers file claims for you

Out-of-Network

• You pay more of the cost of out-of-network benefits

• Higher deductibles, coinsurance• You may need to

file your own claim• You could be balance billed for

amounts over allowed amount

Your PPO Benefits

Benefit HighlightsState of New Mexico – PPO Plan

In-Network Out-of-Network

Individual Deductible $700 $2,800

Family Deductible $2,100 $8,400

Individual Out-of-Pocket Max $3,500 $7,000

Family Out-of-Pocket Max $10,500 $21,000

Primary Care Physician Office Visit Copay $30 50%*

Specialist Office Visit Copay $50* 50%*

Preventive Care No Charge 50%*

Outpatient Surgery 20%* 50%

Inpatient Admission Copay $1,000* 50%*

Emergency Room Copay $175* per visit

Other Covered Services – Including Lab & Xrays 20%* 50%*

PET Scans, CT Scans and MRI’s 20%* up to $200 Max per Test

50%*

*After deductible

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Benefit example*

Billed Allowable Plan Pays Member Pays(In-Network) Notes

Annual Physical $500 $200 $200 $0 The plan pays 100% of preventive care.Primary Preferred Provider (PPP) visit $190 $90 $60 $30 Copayment

Lab/X-Rays $91,781 $71,870 $69,431 $2,439 $700 applies towards Deductible & $1,739 to Coinsurance

Specialist visits $2,064 $987 $667 $320 Copayments

MRI $2,300 $1,500 $1,200 $200 Total member paid for MRI

Outpatient Surgery $3,443 $2,248 $2,023 $225 Coinsurance

Hospitalization $25,967 $9,259 $8,973 $286 $286 of the $1,000 copayment for hospitalization

The plan picks up the additional allowed amount from the hospitalization because Out-of-pocket maximum has been satisfied

Home Care $110 $90 $90 $0The Out-of-pocket max has been satisfied. The Medical Plan pays at 100% for all In-Network covered benefits

Grand Totals $126,355 $86,244 $82,744 $3,500.00 Note: Out-of-pocket max includes deductible, copayments and coinsurance amounts

*Please note that this is set up as an example and actual payments will vary.

A member obtains a routine physical and associated testing. Later in the year, the member suffers from a serious illness. The member also sees his/her Primary Preferred Provider (PPP), which includes associated lab tests and a high-tech radiology test (MRI). These tests show a need for Outpatient and Inpatient surgeries, as well as follow up lab work and x-rays.

Monthly Health Topics

Benefits and Claims

Member Wellness Portal

Member Care Profile

Health Assessment

Online Tools and Resources

Cost Estimator tool

Provider Finder®

Be Smart. Be Well.®

eCards for HealthSM

Health Care School

Blue Access for MembersSM

ID Card Management

Wellness Points

Member Discounts

Special Beginnings®

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Sample Explanation of Benefits – EOB

• Date claim was finalized

• Amount billed by provider

• Benefits approved and paid

• Amount a member may owe

New Member Wellness Portal in 2013

• Health Assessment• Self-Directed Courses • Wellness Coaching • Fitness Centers• Personalized Wellness

Communication• Life Points Rewards

Life Points

o Instant recognition and rewards with Life Points

o Enhanced member experience

o Offerings that earn points:

• Health Assessment • Self-directed courses

(5 courses)• Fitness Programs• Tracking

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Blue365®

Member Discount Program

Weight Management –Discounts at Jenny Craig®´

on membership and food

Vision Care and Eyewear– Discounts on eyewear, contact lenses and laser vision correction surgery

Nutrition – Discounts on Seattle Sutton’s Healthy Eating®´ meal plans; national home delivery program; pick-up in select IL locations

Complementary Alternative Medicine –Discounts on acupuncture, health clubs, chiropractic, naturopaths, spas, massage therapy, vitamins and supplements, and more

Dental Products – Discounts on Procter & Gamble oral care bundles.

Under the My Health tab

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Advice anytime.Advice isn’t just needed from 9 to 5.

Round-the-clock health and the wellness advice from licensed professionals

More than 1,200 AudioHealthLibrary topics

Available in English andSpanish

800-973-6329

Nurseline24/7

• Claim questions or status• Medical benefit coverage questions• Help with finding network providers• Membership and eligibility • Help with navigating online tools• ID card requests• Health education and transfer

to other health programs• Transition of care

Service that Takes You Out of the Middle

Call your BCBS customer service team for:

877-994-2583877-994-2583

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Why Blue Cross and Blue Shield ?

More doctors and hospitals

BCBSNM has had a presence in New Mexico for over 70 years

Long time partner

Health and wellness programs

Blue Cross and Blue Shield of New Mexico, A Division of Health  Care Service Health Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. © 012 Health Care Service Corporation. All rights reserved.