Download Product Portfolio 2: Consumer

Product Portfolio 2:
Consumer – Driven Health Plans and
Ancillary Products
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Product Portfolio 2 Overview
This presentation provides a general overview of CDHPs and Ancillary Products.
Besides covering the basics, the presentation also discusses some of the specific
products available under the four HCSC Divisions.
Objectives
After completing this course, you should be able to:
• Describe the basic features of CDHP and Ancillary health care products.
• Differentiate between an HSA and an HCA.
Disclaimer: All individually identifiable health information contained within this presentation is fictitious and should
be kept highly confidential. Any association to any person, living or dead, is purely coincidental. The information
contained within this presentation is not for use/disclosure outside of Health Care Service Corporation and its
affiliated companies.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Introduction to the
Product Portfolio Lessons
Over the past few decades, health care insurance has evolved, moving from traditional coverage options to more
cost-effective managed care plans. Twenty years ago most people had indemnity plans, also known as
traditional or fee-for-service insurance. A person with an indemnity plan could see any provider, and both the
insurance company and the individual shared the cost of service. These days most people are opting for managed
care plans such as HMOs, PPOs and Consumer-Driven Health Plans. These plans provide a more organized
system of delivering and paying for health care. In light of this shift in health insurance, HCSC has continued to
evolve in its sophisticated product offerings.
At HCSC our mission is to promote accessible, cost-effective and quality health care. To do this, we must offer a
wide variety of product options. And that’s exactly what we do. Our product portfolio is diverse to meet the diverse
needs of our employer groups and individual members. It’s no surprise that 1 in 3 Americans are Blues members,
and 97% of Americans recognize our brand!
To complement our comprehensive portfolio, we approach health care insurance with a unique customer service
strategy. Let’s take a closer look…
1 in 3 Americans
are with the
Blues!
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Introduction to the
Product Portfolio Lessons
Simply put, our goal is to provide our members with an unmatched health care experience. We achieve
this by:
• empowering them to become better, more proactive health care consumers.
• engaging them at every stage of their health care continuum.
• creating a seamless, hassle-free product experience with easy-to-access benefit and claims
information, nationwide coverage and excellent customer service.
• We empower members to be • We engage members at
more accountable and
proactive about their health
care.
every stage of their health
care experience.
• We create a seamless,
hassle-free health care
experience.
Keep this strategy in mind as we discuss our product portfolio. You’ll see how these three goals play an
essential part in defining the products we offer. In the next section you’ll learn about Consumer-Driven
Health Plans. It provides a general overview of CDHPs, followed by information about our specific
BlueEdge products.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Consumer-Driven Health Plans
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
CDHP Glossary of Terms
BlueEdgeSM – A comprehensive, innovative portfolio of consumerdriven health plans developed by HCSC, including HCA and HSA
products.
Hospital Comparison Tool – Available on BAM, this tool generates a
side-by-side view of hospitals meeting specified criteria, such as
patient volume, location, mortality rates and unfavorable outcomes.
Consumerism – A strategic shift in the health care industry to move
some of the responsibility for health care to the consumer. This is
achieved by increasing consumers’ awareness and financial
responsibility, while enabling them to make informed decisions that
improve health outcomes.
HRA (Health Reimbursement Account; referred to as an HCA at
HCSC) – Introduced in 2004, the Health Reimbursement Account
(HRA) is a tax-exempt account used to pay for medical expenses. An
HRA must be funded solely by the employer.
prospective members and members considering a change to
consider the financial and tax impact of their plan choices, and how
medical services may impact their BlueEdge budget.
Treatment Cost Advisor – Available on BAM; an estimating tool that
helps members compare costs and treatment options for numerous
procedures, surgeries, tests and health topics.
HSA ─ Health Savings Account The HSA is a tax-exempt trust or
Employer-sponsored ─ Refers to when an employer offers a
custodial account that is set up to pay for medical expenses used in
benefit or a program to its employees. Employers may or may not
conjunction with a qualified high-deductible health plan (HDHP). An
cover all or part of the costs involved, and they may not contribute to HSA can be funded by the employer and/or the employee.
the sponsored program.
Mellon Bank – HCSC’s banking partner and vendor for HSA business.
HCA (Health Care Account) – The acronym and terminology used
Portability ─ A feature that allows the account to move with the
at HCSC that equates to the Health Reimbursement Account.
employee when they leave the company.
HDHP (High-Deductible Health Plan) – An HDHP is defined by
Rollover ─ An account feature that allows the balance left in an
IRS code as the following:
account to be added to the next year, which is then added to the
• A higher annual deductible than typical health plans.
employer’s annual contribution. Accumulated funds are applied to
• A maximum limit on the sum of the annual deductible and out-of- eligible claims.
pocket medical expenses that are paid for covered expenses. Out- Self-Pay Corridor ─ The difference between the plan's deductible and
of-pocket expenses include copayments and other amounts, but do the employer sponsored HCA (deductible minus HCA funds = member
not include premiums.
share).
• May provide preventive care benefits without a deductible or with a Tax-exempt ─ An account that does not create a tax liability. None of
deductible below the minimum annual deductible.
the funds going into health care accounts is taxable, nor are the
outgoing funds that are used to pay for qualified expenses.
Health Plan Cost Estimator – Available on BAM, this tool helps
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Consumerism
Traditionally, most of an insured’s medical costs have
been covered by third parties such as an employer or
an insurance company. As a result, consumers were
less aware of their health care costs, which means
they may use unnecessary medical services or fail to
take advantage of preventative care options to stay
healthy. In response to the rising costs of medical
services and a much stronger emphasis on wellness
and prevention, the health care industry has shifted
its focus to what we call Consumerism.
Consumerism refers to a strategic shift in the health
care industry to move some of the responsibility for
health care to the consumer. It’s about putting
consumers in the driver’s seat by increasing their
awareness and financial responsibility, while enabling
them to make smart decisions that improve health
outcomes.
A consumerism approach to health care is mutually
beneficial to both employees and employers.
Employees can make well-informed decisions about
their health care, while employers pay lower health
care costs and shift their focus to workforce wellness.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
CDHP Overview
HCSC’s answer to consumerism is BlueEdgeSM – a
comprehensive portfolio of innovative ConsumerDriven Health Plans (also known as ConsumerDirected Health Plans or CDHPs). Before
introducing you to BlueEdge, let’s first look at
CDHPs in general.
Created as part of the Medicare Act of 2003, CDHPs
were designed to engage members to play a more
proactive role in making cost-effective decisions
about their health care. They work similar to a
traditional PPO with a few key differences:
CDHPs work in conjunction with tax-advantaged
spending (HRA) or savings accounts (HSA) that the
member uses to pay for eligible medical expenses.
Educational tools and resources are another key
feature of CDHPs. These help consumers play a
more active role in determining their health care.
Generally, they are higher deductible health plans,
which are counterbalanced with lower monthly
premiums. (Note: By law, HSA plans must come with
a high deductible, whereas HRAs may come with
lower deductibles.)
CDHPs typically include:
• Cost-sharing provisions between the insured and
the insurer
• Health reimbursement account or health savings
account
• Tools and resources to help educate consumers
• Generally, higher deductibles (lower premiums
and higher upfront costs for medical services)
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
CDHP Overview
A CDHP is comprised of three main components:
Health
Spending
Account
Deductible
PPO
The member
uses a taxexempt health
account that
covers expenses
up to a certain
amount.
This is followed
by a deductible
(a corridor or
gap in the middle
for which the
consumer is
responsible).
Once the funds
in the health
account are used
up and the
deductible is
met, PPO
benefits begin.
Now, let’s look at the two types of spending accounts that are available with CDHPs.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
CDHP Overview
Health Care Account (HCA)
This tax-exempt spending account is funded solely by
an employer. Outside of HCSC, this type of account is
called an HRA or Health Reimbursement Account.
We’ve put our own brand on it and call it an HCA. This
also distinguishes it from our HRA, the acronym we
use for the Health Risk Assessment.
Employees are reimbursed tax-free for qualified medical
expenses up to a maximum dollar amount for a coverage
period. Employers are billed monthly for claims paid, and
any unused balances remain part of the employer’s cash
flow. An HCA’s funds usually aren’t portable, meaning
employees can’t take the balance with them if they leave
the company. However, the balance may roll over from
year to year as determined by the employer.
When members access care, claims are paid from their
account until the funds are depleted. All PPO eligible
claims are applied toward the deductible. Members are
then responsible for the remaining portion of their
deductible before additional benefits are available.
At HCSC, the HCA is integrated with our claims
processing system. Claims are paid from the HCA at the
discounted PPO rate. Employees receive an Explanation
of Benefits (EOB) that describes the benefits payable
and shows the HCA payment and remaining balance.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
CDHP Overview
Health Savings Account (HSA)
This tax-exempt savings account can be funded by
both the employer and the employee. The account is
member-owned, which means the balance is portable
and the employee can take it with them if they leave
the company.
By law, the HSA must be used in combination with a high
deductible health plan or HDHP. (Note: The HCA may or
may not come with a high deductible.) The money in an
HSA helps pay the deductible and other eligible
expenses (including coinsurance) that aren’t covered by
the plan after the member meets the deductible.
An HSA is similar to an individual retirement account
(IRA) because it can be invested in a variety of
investment vehicles while accumulating tax-free interest.
These funds are not taxed when withdrawn to pay for
qualified medical expenses.
The HSA is an actual physical bank account. Members
can make withdrawals from an HSA for nonmedical
expenses, but they’ll be taxed as normal income and
subject to a 10% penalty if withdrawn before age 65.
At the end of each year, any unused funds in an HSA
remain in the account and continue to earn interest taxfree.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Consumerism at HCSC
Now that we’ve given you a general overview of CDHPs, let’s shift our attention to HCSC. How do we address
consumerism? We've developed our own unique strategy to encourage members to be more accountable with their
health care. We recognize that consumerism is not just providing CDHP options, but rather consumerism is a concept
to be integrated across all aspects of the company, including products, customer service and care management. Our
approach to consumerism has three primary tenets.
1
2
3
Member
Responsibility
Guidance
Hassle-free
Experience
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Consumerism at HCSC
Now that we’ve given you a general overview of CDHPs, let’s shift our attention to HCSC. How do we address
consumerism? We've developed our own unique strategy to encourage members to be more accountable with their
health care. We recognize that consumerism is not just providing CDHP options, but rather consumerism is a concept
to be integrated across all aspects of the company, including products, customer service and care management. Our
approach to consumerism has three primary tenets.
1
Member
Responsibility
Guidance
2
3
Guidance
Hassle-free
Experience
HCSC has created a framework to enable members to be more accountable consumers.
This framework consists of spending account products that come with varied benefit and
network options. We are creating accountability by empowering members to make their
own decisions with their money.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Consumerism at HCSC
Glossary
Now that we’ve given you a general overview of CDHPs, let’s shift our attention to HCSC. How do we address
consumerism? We've developed our own unique strategy to encourage members to be more accountable with their
health care. We recognize that consumerism is not just providing CDHP options, but rather consumerism is a concept
to be integrated across all aspects of the company, including products, customer service and care management. Our
approach to consumerism has three primary tenets.
1
2
3
Member
Responsibility
Guidance
Hassle-free
Experience
Making health care decisions can be complicated so we’ve designed our programs to
make it as easy as possible for members to actively engage. We offer services that give
members the guidance and information needed to successfully navigate their health plan
and make the right choices. For example, our Health Plan Cost Estimator provides
guidance during pre-enrollment. A member can populate information including their zip
code, health status and premium, deductible, copays and coverage options. The tool then
estimates the annual costs of each plan option.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Consumerism at HCSC
Glossary
Now that we’ve given you a general overview of CDHPs, let’s shift our attention to HCSC. How do we address
consumerism? We've developed our own unique strategy to encourage members to be more accountable with their
health care. We recognize that consumerism is not just providing CDHP options, but rather consumerism is a concept
to be integrated across all aspects of the company, including products, customer service and care management. Our
approach to consumerism has three primary tenets.
1
2
3
Member
Responsibility
Guidance
Hassle-free
Experience
We’ve created a product experience that is hassle-free. For example, we’ve designed a
health reimbursement account so that during the claims adjudication process, we debit
the HCA directly, which immediately impacts the spending account balance. This
integration creates a seamless and hassle-free experience for the member, who won’t
have to worry about where their debit card is or how to get money out of the HCA.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
BlueEdge Overview
In 2003 HCSC introduced its answer to consumerism. Our CDHP program BlueEdgeSM is an exciting, cutting edge
product that offers a portfolio of solutions to help our clients and members control rising health care costs.
The BlueEdge plan puts members in
charge of their health by giving them the
power to decide how health care dollars
are spent and by providing resources to
help them make informative decisions
about their health care. It offers the most
popular features of a PPO plan, without
restricting networks or limiting services.
Standard features of the BlueEdge
product include:
• Preventive care and wellness visits
• PPO benefits
• Spending account options
• Innovative online tools
Depending on the health benefit strategy, the employer or the employee has a product to help them achieve it. In fact,
BlueEdge is the broadest portfolio of CDHPs offered in the marketplace. We provide integration of claims, benefits
information and customer service, creating a seamless and hassle-free experience for the member.
The next section provides an overview of our specific HCA and HSA products.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
BlueEdge Overview
The BlueEdge portfolio contains standard HCA and HSA products along with some variations on these products that
were designed to meet specific needs in the marketplace. Listed below are the product options with the type of
spending accounts and features available.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
BlueEdge Overview
How
theand
BlueEdge
HCA works:
The BlueEdge portfolio contains standard
HCA
HSA products
along with some variations on these products that
The
employer deposits
a specific
amount
each
year, with
which
is type
usedoffor
were designed to meet specific needs in• the
marketplace.
Listed below
are the
product
options
the
expenses.
count
toward the annual deductible.
spending accounts and features available. eligible
Click each
productThese
on theexpenses
left to learn
more.
•
When the spending account is depleted, the member pays any remaining
amount of the deductible. Once the deductible is met, PPO benefits begin.
•
When out-of-pocket maximums are reached, services are covered at
100% of the allowable amount for the remainder of the calendar year.
•
Unspent funds roll over each year as long as the employee remains in the
plan. If the employee changes plans or jobs, funds return to the employer.
•
Since this is a PPO plan, no referrals are required. The employee receives
maximum benefits when using in-network services. The employee can
always use services outside the network, but benefits will be paid at a
lower level. Preventative care is generally covered at 100% when received
in network.
•
The HCA provides a seamless approach to claims processing—paying
claims automatically from the HCA or the PPO benefit plan. Employees do
not pay for services up front or submit claims for reimbursement (unless
the expenses are not PPO eligible).
•
Since it’s employer-funded, it’s not available to the individual market.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
BlueEdge Overview
The BlueEdge portfolio contains standard HCA and HSA products along with some variations on these products that
the BlueEdge
HSAbelow
works:
were designed to meet specific needs inHow
the marketplace.
Listed
are the product options with the type of
• Deposits
can
be made
by the
and/or the employer or by a selfspending accounts and features available.
Click each
product
on the
left employee
to learn more.
employed member.
• Funds can be used to pay for qualified expenses or left untouched to
work as an investment vehicle.
BlueEdge HCA
BlueEdge HSA
BlueEdge Wellness
Rewards
• When the balance reaches a specific amount, the member can invest the
funds.
• The account belongs to the member so the funds are portable. It’s a
physical account with debit cards, checks and investment opportunities,
whereas the HCA is simply a notational account held on our system.
BlueEdge Vitality
• Employer contributions are not subject to FICA taxes, and employee
contributions are tax deductible. Distributions are not taxable as long as
they are used to pay for qualified health care expenses, as defined by the
IRS.
BlueEdge Limited
Purpose HCA
• As with the HCA, the HSA includes an annual deductible that must be met
before PPO benefits begin.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
BlueEdge Overview
The BlueEdge portfolio contains standard HCA and HSA products along with some variations on these products that
the BlueEdge
Wellness
HCA works:
were designed to meet specific needs inHow
the marketplace.
Listed
below Rewards
are the product
options with the type of
This
is an
add-on
product
option
that’s
getting
spending accounts and features available.
Click
each
product
on the
left to
learn
more.a lot of positive buzz in the
marketplace. As an incentive-based HCA, it motivates members to take
more responsibility for their health and make healthy lifestyle choices. It
can come as a standalone product or alongside other products. It allows
additional funds to be contributed when members perform pre-determined
BlueEdge HCA
healthy behaviors
(e.g. visit a doctor for screenings, complete a Health Risk Assessment).
BlueEdge HSA
BlueEdge Wellness
Rewards
BlueEdge Vitality
BlueEdge Limited
Purpose HCA
•
It’s available to large custom-insured and self-funded groups.
•
The employer decides what activities earn rewards and how the
funds can be used.
•
Funds roll over each year, but the employer determines limits.
•
Funds can accumulate as the member completes certain
activities and/or the employer contributes a lump sum.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
BlueEdge Overview
The BlueEdge portfolio contains standard HCA and HSA products along with some variations on these products that
were designed to meet specific needs inHow
the marketplace.
Listed
below
areworks:
the product options with the type of
the BlueEdge
Vitality
HCA
spending accounts and features available.
ClickBlueEdge
each product
onHCA
the left
to learn
more.
• The
Vitality
provides
employers
a unique, cost-effective
post-retirement option to offer to their employees.
BlueEdge HCA
• The employer funds the account on a regular basis or through incentive
programs like the Wellness Rewards HCA. These funds become available
when the employee retires.
BlueEdge HSA
• As with other HCAs, the funds can be rolled over each year.
BlueEdge Wellness
Rewards
BlueEdge Vitality
BlueEdge Limited
Purpose HCA
• When the employee becomes eligible for Medicare, the funds cover only
healthcare premiums and other services designated by the employer.
• Preventive care may be covered at 100% or a dollar cap, and it is not
included in the deductible.
• The employer can let members access funds upon retirement even if they
don’t retire with their company. HCSC will track and maintain balance and
support pay out upon retirement if we continue business with that
employer.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
BlueEdge Overview
The BlueEdge portfolio contains standard HCA and HSA products along with some variations on these products that
were designed to meet specific needs in the marketplace. Listed below are the product options with the type of
spending accounts and features available.
Click
productLimited
on the left
to learn
more.
How
theeach
BlueEdge
Purpose
HCA
works:
• This HCA can be partnered with the BlueEdge HSA and is typically
• purchased for coverage of benefits such as dental and vision.
BlueEdge HCA
•
Coverage is limited to these expenses:
- Workers’ Compensation
- Tort liabilities
- Property/landowner liabilities
- Insurance for a specified disease/illness
- Insurance paying a fixed amount per day of hospitalization
- Dental
- Vision
- Long term care
- Accidents
- Disability
•
When the account is depleted, the member pays any remaining
deductible. Once the deductible is met, PPO benefits begin.
BlueEdge HSA
BlueEdge Wellness
Rewards
BlueEdge Vitality
BlueEdge Limited
Purpose HCA
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
BlueEdge Overview
Members have access to various online health tools through our self-service website—Blue Access® for
Members. Through BAM, members can better manage their health care and access important information to
help them make more cost-effective decisions. They can review their claims activity, use a health care cost
calculator, compare hospitals and find prescription drug information. All of these innovative tools help to engage
our members.
Personal Health Manager
Hospital Comparison Tool
Health Risk Assessment
Treatment Cost Advisor
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Key Points
• Consumerism refers to a strategic shift in the health care industry to move some of the responsibility for health
care to the consumer. This is done by increasing their awareness and financial responsibility, while enabling
them to make smart decisions that improve health outcomes.
• CDHPs are PPO plans which work in conjunction with tax-advantaged spending or savings accounts that the
member uses to pay for eligible medical expenses.
• An HCA is a tax-exempt spending account that’s funded solely by an employer. Outside of HCSC, this type of
account is called an HRA or Health Reimbursement Account. We call it HCA to avoid confusion with HRA, the
acronym we use for the Health Risk Assessment.
• An HSA is a tax-exempt, high deductible savings account that can be funded by the employer and/or the
employee or by a self-employed member. The account is member-owned, which means the balance is portable
and the employee can take it with them if they leave the company.
• BlueEdge is our CDHP portfolio. It contains standard HCA and HSA products, along with Wellness Rewards,
Vitality and Limited Purpose options.
• Blue Access for Members provides several online tools to help members make more cost-effective decisions
about their health care.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Ancillary Products
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Ancillary Products
HCSC also offers a broad spectrum of Ancillary
products to our members. These provide
coverage for prescription drugs, dental, vision
and hearing. Other options include life
insurance.
The next section introduces you to some of our
key Ancillary products.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Ancillary Products
By no means is this list exhaustive, but it will introduce you to some of our core products.
Rx Drug Benefits
Prime Therapeutics
Fort Dearborn
BlueCare®
Life Insurance
Dental Plans
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Ancillary Products
By no means is this list exhaustive, but it will introduce you to some of our core products.
Rx Drug Benefits
Rx Drug Benefits
HCSC offers a comprehensive prescription drug benefit program that includes:
• Access to an extensive network of retail and mail service pharmacies.
• Member education materials to promote the use of generic drugs.
• Convenient online tools. Members can locate pharmacies, review claim
history, order refills through PrimeMail, search the formulary and find
information about generic drugs, other medications, drug pricing and
coverage.
• Pharmacy clinical programs to help manage costs and utilization (e.g.
specialty pharmacy, Step Therapy and Prior Authorization).
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Ancillary Products
More Information on Our Prescription Drug Benefits
Rx Drug Benefits
Three-Tier Copayment Design (generic, preferred brand and non-preferred brand
drugs – Note: These are sometimes referred to as generic, formulary brand and
non-formulary brand drugs.)
The three-tier formulary program is designed to save members and employers
money through utilization of lower-priced generic and formulary drugs
through contracting pharmacies. The copayments selected allow members to know
in advance the cost of their prescription when they use a contracting pharmacy.
Non-HMO Home Delivery Prescription Drug Program
The Home Delivery Prescription Drug Benefit Program is a standard part of the Blue
Cross prescription drug program. Medications are conveniently delivered to their
home, and members can take advantage of the discount arrangement with the
home delivery pharmacy.
HMO 90-Day Supply Program
The 90-day supply program can save members both time and money. The program
gives members the option of obtaining a 90-day supply of maintenance medications
through a network of contracting retail and mail service pharmacies.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Ancillary Products
By no means is this list exhaustive, but it will introduce you to some of our core products.
Prime Therapeutics
Prime Therapeutics
Our pharmacy drug benefits programs are administered by Prime Therapeutics, a
national Pharmacy Benefit Manager (PBM). By working with Prime, we have greater
control over pharmacy costs and how we manage pharmacy benefits for our
customers. Prime offers all the services of a PBM, including claims processing,\
formularies, rebates, clinical programs, reporting and national network management.
Here are some of additional features of Prime:
• Owned by 10 BCBS Plans, including Health Care Service Corporation, with 12
million+ members across 50 states.
• Offers more than 58,600 network pharmacies nationwide for convenient access.
• No affiliation with pharmacy chains or pharmaceutical manufacturers; all savings
from discounts are passed through to employer groups.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Ancillary Products
By no means is this list exhaustive, but it will introduce you to some of our core products.
Fort Dearborn Life Insurance
Fort Dearborn
Life Insurance
HCSC offers a full range of life insurance and disability options through Fort Dearborn
Life (FDL), a subsidiary of Preferred Financial Group (part of the HCSC umbrella of
companies). Fort Dearborn Life ranks first for total number of Group Life contracts
and provides coverage to over three million members. Our life insurance product
portfolio includes the following options:
• Group term life
• Accidental Death & Dismemberment
• Dependent life
• Short-term and long-term disability
• Voluntary dental
• Premium-only plan
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Ancillary Products
By no means is this list exhaustive, but it will introduce you to some of our core products.
BlueCare® Dental Plans
BlueCare®
Dental Plans
Fort Dearborn
Life Insurance
We offer flexible dental benefit plans through our BlueCare Dental program, which is
administered by Dental Network of America (DNoA). DNoA provides network
management, claims processing, customer service and support to our
Marketing/Sales teams. BlueCare Dental offers:
• A choice of multiple managed care dental options: the Dental PPO with a national
network of nearly 77,000 dentists or the Dental HMO where members and
dependents select a primary care dentist.
• Significant Dental PPO discounts. Average overall average discount is 25.4%.
• Ability to customize plans for groups over 150 lives.
• Online tools for members: Provider Finder, dental claims and EOBs.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Ancillary Products
More Information on Our Dental Products
BlueCare®
Dental Plans
BlueCare Dental HMO (DHMO)
Dentists in the BlueCare Dental HMO network have agreed to accept lower,
predetermined fees for covered services. The plan encourages members to
maintain good dental health by offering full coverage for preventive and diagnostic
care. Members and their families can each select a primary care dentist. When they
visit their selected dentist, preventive and diagnostic care are covered at 100%.
There are no deductibles, no out-of-pocket cost and no claim forms to fill out. Costs
for dental services with an HMO are usually less than those of other dental plans.
BlueCare Dental Preferred Choice (DPPO)
In a PPO plan, costs are typically reduced when members receive care from
network providers. Dentists in the DPPO network have agreed to pre-determined
fees for their services. The plan’s Schedule of Maximum Allowances (SMA), on
average, is lower than usual and customary fees. Employers and employees realize
the most savings when care is received from PPO dentists. Members can see any
dental specialist within the network without a referral.
Passive PPO Plans
We offer "passive" dental PPO plans, where the benefit level is the same for both
network and non-network dentists. Passive plan options pay out-of-network services
at usual and customary fees.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Ancillary Products
HCSC also offers other Ancillary products such as vision, hearing and wellness programs.
Vision Discount
Programs
Hearing Aid
Discount Program
Health and Wellness
Programs
Members can receive discounts
on eye exams, eyewear, laser
vision correction surgery and
disposable contact lenses
through a national network of
contracting providers.
Members can receive
discounts on digital hearing
aids.
Expanded discount program for
health and wellness products
and services.
Product Portfolio 2: Consumer-Driven Health Plans and Ancillary Products
Now that you have completed a high level overview of our CDHP and Ancillary
products, you should be able to:
• Describe the basic features of CDHP and Ancillary health care products.
• Differentiate between an HSA and an HCA.