Open Enrollment

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Open Enrollment
Health Care CoverageFor YouandYour Family AM
Care Plans
Welcome
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Whats new for 9/1/2010 plan Year

• 30 day limit for in-patient Mental Health dropped
• 40 visit limit for out-patient office visit
  dropped
• Mental Health office visit copay decreases to
  30.00
• Complete a Health Risk Assessment and/or Annual
  Physical to receive a 50.00 credit towards your
  deductible
• Primary Care Physicians office visit copay
  increases to 30.00
• Reminder Colon Cancer Preventive Screening and
  Mamogram covered at 100 after office visit copay

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Why Blue Cross and Blue Shield?
Blue Cross and Blue Shield is one of the most
trusted brands, recognized as a symbol of
security and quality 97 million Americans (1 in
3) are covered by Blue Cross and Blue Shield

• Scott White providers and facilities have been
  added to the Blue Choice Network
• Blue Extras - Discount programs
• The Texas AM System dedicated customer service
  unit
• Provider Finder
• Out-of-state providers

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PPO Features AM Care 350 and 1250 Plans

• Administered by Blue Cross and Blue Shield of
  Texas
• No primary care physician (PCP) required no
  referrals required to see a specialist
• Select any provider for care within the PPO
  network or outside the network
• When you receive care inside the network
• Highest level of benefits
• No claims to file
• No balance billing
• When you receive care outside the network
• May have to file own claims
• Can be balance billed
• Worldwide coverage for emergency
  andnon-emergency care

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AM Care Plans
    AM Care 350 Plan AM Care 350 Plan AM Care 1250 Plan AM Care 1250 Plan
    Network Non-Network Network Non-Network
 Deductible 350 Indiv 1,050 Family 700 Indiv 2,100 Family 1,250 Indiv 3,750 Family 2,500 Indiv 7,500 Family
Plan Pays (after deductible) 80 50 70 50
Coinsurance (You Pay) 20 50 30 50
Out-of-Pocket Maximum 3,000 Indiv 9,000 Family 6,000 Indiv 18,000 Family 3,500 Indiv 10,500 Family 7,000 Indiv 21,000 Family
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For Employees
Office Visit Copay Office Visit Copay Office Visit Copay Office Visit Copay
AM Care 350 AM Care 350 AM Care 1250 AM Care 1250
Network Non-Network Network Non-Network
30/45 per visit 50 after deductible 30/45 per visit 50 after deductible
       
Preventive Care Copay Preventive Care Copay Preventive Care Copay Preventive Care Copay
AM Care 350 AM Care 350 AM Care 1250 AM Care 1250
Network Non-Network Network Non-Network
30/45 per visit Not Covered 30/45 per visit Not Covered
       
Prescription Drug Program Prescription Drug Program Prescription Drug Program Prescription Drug Program
Deductible Generic Formulary Non-Formulary
50 10 35 60
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RETIREE INFORMATION

• For Retirees Under Age 65
• Considered Network
• Network providers
• Choose between the 350 plan and the 1250 plan

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Retirees Age 65 and Over

• Choose from three plans
• AM Care 350
• AM Care 1250
• 65 Plus
• Age 65 and enrolled in Medicare Parts AB or
  disabled under 65 and enrolled in Medicare Parts
  AB
• You your covered spouse are both age 65 and
  older (or disabled) and enrolled in Medicare
  Parts AB
• If you are working for the AM system, you are
  working six months or less in the plan year

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Coordination of BenefitsAM Care 350, 1250 and
65 Plus
  1 AM Care Plan Example with 350 Plan deductible met 2 AM Care Plan Example with 350 deductible NOT met
Charge 950 950
Medicare Deductible -135 -135
Balance 815 815
Medicare pay 80 652 652
Patient Share 20 163 163
BCBSTX would have paid 760 760
AM Deductible 350 350
AM Payment 163 balance from Medicare, plus 135 for Medicare deductible Total payment 298 163 applied to AM 350 deductible
Patients Responsibility Zero 163
Plans calculate the normal plan benefits, then pay that amount, or the difference after Medicare has paid, which ever is less Plans calculate the normal plan benefits, then pay that amount, or the difference after Medicare has paid, which ever is less Plans calculate the normal plan benefits, then pay that amount, or the difference after Medicare has paid, which ever is less
Your coinsurance will continue until you meet the out-of-pocket maximum then pay at 100 AM Care 65 Plus 1,400 AM Care 350 2,500 AM Care 1250 3,500 Your coinsurance will continue until you meet the out-of-pocket maximum then pay at 100 AM Care 65 Plus 1,400 AM Care 350 2,500 AM Care 1250 3,500 Your coinsurance will continue until you meet the out-of-pocket maximum then pay at 100 AM Care 65 Plus 1,400 AM Care 350 2,500 AM Care 1250 3,500
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IMPORTANT REMINDERSfor retirees

• Enroll in BOTH Medicare parts A B.
• When you receive your Medicare Card notify BCBSTX
  of your Medicare number which includes an alpha
  character
• If you use a Provider that takes Medicare or a
  BCBSTX provider you cannot be balance billed.

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More Hospitals and Doctors
For a current listing of all providers see our
website at
www.bcbstx.com Offers names, addresses, andmap
directions.

• For World Wide Assistance
• Call 1-800-810-BLUE (2583)
• Or Collect 1-804-673-1177
• In-network coverage is available when traveling
  or living worldwide
• 24 Hours a Day, Seven Days a Week

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Blue Access for Members
Experience. Wellness. Online.
Depending on coverage type
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Blue Access for Membersbcbstx.com
Links to My Health features and the Personal
Health Manager
Read the latest news updates
Review benefit coverage
Review secure messages
Use Quick Links to request replacement ID cards,
download forms and more
Update user profile settings
View the most recent medical claims
Download Blue Access icon to your desktop for
quicker access
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Personal Health ManagerHome Page
Take a Health Risk Assessment
Read secure messages
Access MemberCare Profile
Review member alerts
Ask a Question to a certified Nurse, Trainer,
Dietitian or Life Coach
Use the Interactive Symptom Checker
Read the latest health news, search for specific
health topics or explore the prescription drug
index
Explore topics in the Health Information and Care
Center
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Health Risk Assessment Powerful Health and
Wellness Tool
www.bcbstx.com

• Interactive and user-friendly health assessment
  tool
• Personal Health Risk Assessment Designed to Be
  Completed in 10 to 15 minutes
• Choose your assessment topic such as health and
  Wellbeing or fitness and physical activity

Know Your RisksManage Your Health Examines the
members overall health and wellbeing and provides
a Personalized report that highlights areas where
you can improve
Complete the HRA and/or Annual Physical and
receive a 50.00 deductible Credit
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Blue PointsSM Incentives
Stay motivated. Earn Blue PointsSM.
Choose Activities Members and their qualifying dependents can complete a variety of designated health and wellness activities to earn Blue Points
Earn Blue Points Report completed activities in the Personal Health Manager and track your Blue Points balance
Redeem Earned Blue Points A variety of items are available for each point level
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BlueExtrasSM Discounts
Health care dollars go farther just by being
a BCBSTX member
Weight Management Eat right with Jenny Craig and get discounts on membership and foods
Fitness Stay fit by joining a nearby Curves at a discounted joining fee
Hearing Discounts on hearing aids for members, parents and even grandparents
Vision Discounts on eyewear, laser correction surgery and contact lenses at major retailers through Davis Vision
Complementary Alternative Medicine Acupuncture, health clubs and spas, naturopaths, massage therapy, and more
Look for further information about the BlueExtras
Discount Program at WWW.BCBSTX.com
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Treatment Cost Advisor

• Research the cost of health care expenses.
• Provides a summary of estimated costs on a range
  of procedures, surgeries and tests
• Costs are calculated using members demographic
  data, such as ZIP code, city/state, age group or
  gender
• Cost estimates based on Usual and Customary or on
  CMS data

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Hospital Comparison Tool

• View hospital profiles and compare hospitals
  online.
• Compare how local hospitals measure up in
  treating over 150 different diagnoses and
  procedures
• View quality and performance measures
• Read detailed hospital profiles with quality
  indicators

Hospital data is self-reported
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24/7 Nurseline
Around-the-Clock Advice and Information by Phone [phone]
24/7 access to registered nurses for health conditions such as High fevers Earaches Cuts and bruises 1,200 audio health library Referral of members with careneeds to the appropriate program Follow-up calls for emergency care needs Available in English and Spanish
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What if I Have Questions

• Personalized Service 8am 8pm
• Our Philosophy Take the Member Out of the
  Middle
• Call your dedicated customer service team for
• Benefit Information
• Network provider information
• Membership and eligibility
• Inquiries (telephone and e-mail)
• ID card requests
• Claims Inquiries
• Help with online tools!

Toll-free Customer Service
866-295-1212