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UT S E L E CT2007-2008 E n r o l l m e n t G u i d e CHOOSE WELL Your choice to find the health care you need, when and where you need it www.bcbstx.com/ut Choosing your doctor. Seeing a specialist without a referral. Getting care in a hospital because it’s close to home or because it’s known worldwide. Deciding what’s best for you. It’s all possible with the UT SELECT plan administered by Blue Cross and Blue Shield of Texas for the employees and retirees of The University of Texas System. When it comes to your health care, choice matters. As a UT SELECT member, you’ll be able to choose doctors, hospitals and other providers from one of the largest networks of contracting providers in Texas, and one of the largest in the country. We’ll provide information to help you make the right choices for you and your family. When you have a question, you’ll have access to innovative online information or you can speak with our Customer Service Advocates who make it their priority to get you the answers you need, quickly and accurately. And we’ll be here for you when you need us. Our roots run deep. For more than 60 years, we’ve been helping our members with the health care coverage and services they want and need. As a result, we’re one of the most widely recognized, and most widely respected, health care companies in the state. If you have a choice in health care coverage, be choosy. Choose UT SELECT from Blue Cross and Blue Shield of Texas. Customer Service 1-866-882-2034 8 a.m. to 5 p.m. (Central Time) Monday – Friday If you have enrollment questions regarding UT SELECT benefits and/or network physicians and facilities, Blue Cross and Blue Shield of Texas Customer Service Advocates are available to help you: • Understand what is covered under the UT SELECT health benefit plan • Find a contracting network doctor or hospital • Learn about care management programs • Learn how to use the online tools • Confirm your coverage with providers via conference call • And much more! UT SELECT plan participants can count on consistent, professional assistance and quick resolution of issues – usually with a single phone call. Choose Well: How to use this guide and enroll for coverage This guide summarizes the benefits and features of UT SELECT for the upcoming plan year. The Annual Enrollment period is July 1 through July 31, 2007. Benefit selections will be effective September 1, 2007 through August 31, 2008. Remember to review and update your benefit selections on UT System’s automated enrollment system, UTTOUCH Online. Please refer to The University of Texas System Group Insurance Handbook for additional information on your benefits options and for specific instructions for using UTTOUCH Online. Note: UT System no longer offers an HMO option. If you are currently enrolled in HMO Blue Texas, you will be automatically enrolled in UT SELECT at the same level of coverage, effective September 1, 2007. 1 2 customer service 1.866.882.2034 Choice and Access Choice of Doctors — Each Time You Need Health Care When you choose UT SELECT, you can receive care from any licensed doctor you want. No referrals are required. If you use a network doctor, you’ll pay less out of pocket, you usually won’t have to file any claims and you’ll get the highest level of benefits. If you use a doctor outside of the network, you’ll still be covered, but your out-of-pocket costs will be higher. Access to One of the Largest Networks in Texas — and in the Country By choosing UT SELECT, you have access to one of the largest networks of contracting doctors and hospitals in Texas, with more than 45,000 physicians and specialists and over 400 hospitals. You also have access to the BlueCard network, one of the largest networks in the country, with more than 600,000 doctors and 6,000 hospitals contracting with Blue Cross and Blue Shield Plans nationwide. Chances are, the doctors and hospitals you want to use are in the network. To find a physician or specialist near you, search online at www.bcbstx.com/ut or contact UT SELECT Customer Service toll free at 1-866-882-2034. Even if you visit an out-of-network doctor, you may still save money Blue Cross and Blue Shield of Texas contracts with many non-network doctors and hospitals. ParPlan providers accept the Blue Cross and Blue Shield of Texas allowable amounts for covered services and cannot bill you more. In most cases ParPlan providers will file claims, too. Look for participating doctors and hospitals for UT SELECT at www.bcbstx.com/ut under ParPlan. Traveling away from home? Kids off to school out of state? Through the BlueCard network, you and your covered family members can receive health care coverage at lower out-of-pocket costs from contracting doctors and hospitals almost anywhere in the country and around the world. Just like at home, it’s easy to find a provider when you’re away. To find a contracting network doctor or hospital in or outside the U.S., go to the BlueCard Doctor and Hospital Finder under UT SELECT at www.bcbstx.com/ut. When you become a member, you’ll also be able to call our dedicated BlueCard line at 1-800-810-BLUE (2583). www.bcbstx.com/ut Questions & Answers Q. Will I be able to continue seeing my current doctor? A. Since we have one of the largest networks of contracting doctors, it’s likely your doctor is in the network. If not, you can always continue your care for covered services and pay a higher out-of-pocket cost. Q. What if I’m seeing an out-of-network doctor now? A. If you’re pregnant or require ongoing care for a serious illness when you enroll, you may be able to continue seeing an out-of-network doctor while you transition your care to a network doctor. Q. Will I have to file claim forms? A. No, not as long as you use a doctor or hospital in the network. Q. What if I’m outside of Texas and need to see a doctor? A. To pay the lowest out-of-pocket costs for covered services, visit a doctor or hospital in the BlueCard network. If you use an out-of-network doctor, you’ll be covered but you may pay more. Q. What will I do in case of an emergency? A. Call 911 or seek help from any doctor or hospital immediately. You don’t need to try to find a network physician. Your emergency visit will be covered at network benefit levels whether you’re at home or away. However, be sure to have someone notify your network physician within 48 hours or as soon as possible. Choose Well: Increase Your Physical Activity If you need to boost your physical activity, try incorporating some of these calorie-burning ideas into your day to help safeguard your health: • Park further away at work or at the shopping mall • Take the dog for a walk instead of letting him out in the backyard • Take the stairs rather than the elevator • Get involved in your kids’ activities • Strive for 30 minutes of physical activity, such as raking leaves or brisk walking, five or more days a week It’s the little extras that count. By burning extra calories every day, you’ll be doing something very important for your health and your life. 3 4 customer service 1.866.882.2034 Network or Non-Network Care: The Choice is Yours Non-Network General Provisions (Including ParPlan) Any charges over the Allowed Amount are the patient’s responsibility Network If you need to . . . You pay lower out-of-pocket costs if you choose network care You pay higher out-of-pocket costs if you choose out-of-network care Visit a doctor or specialist Visit any network doctor or specialist Visit any licensed doctor or specialist Pay any office visit copay Pay for the office visit Pay any coinsurance and deductible File a claim and get reimbursed for the visit minus any coinsurance and deductible Your doctor cannot charge more than the allowable amounts for covered services Receive emergency care Your costs will be based on allowable amounts; you may be required to pay any costs over the allowable amounts Call 911 or go to any hospital or doctor immediately; you’ll receive network benefits for emergency care Pay any copay (waived if admitted) Pay any coinsurance and deductible Call the preauthorization number within 48 hours Be admitted to the hospital Receive behavioral health or chemical dependency services File a claim Your network doctor will preauthorize your admission You, a family member, your doctor or the hospital must preauthorize your admission Go to the network hospital Go to any licensed hospital Pay any copays, coinsurance and deductible Pay any coinsurance and deductible Call the behavioral health number on your ID card first to preauthorize all care See a network doctor or health care professional, or go to any network hospital or facility See any licensed doctor or health care professional, or go to any licensed hospital or facility Pay any copays, coinsurance and deductible Pay any coinsurance and deductible Claims will be filed for you You may need to file the claim yourself Preauthorization. UT SELECT requires advance approval (preauthorization) by Blue Cross and Blue Shield of Texas for certain services. Preauthorization establishes in advance (or within 48 hours following an emergency hospital admission) the medical necessity of certain care and services covered under UT SELECT. The following types of services require preauthorization: all inpatient admissions, treatment of all serious mental illness, mental health care and chemical dependency, extended care, such as in a skilled nursing facility, through home health care or through hospice; private-duty nursing, home infusion therapy, motorized and customized wheelchairs and certain other durable medical equipment totaling $5,000 or more and transplants. The number to call for preauthorization is 1-800-441-9188. Choose Well: How to get the most value from your coverage Use in-network doctors and hospitals • Take advantage of your benefits for preventive services which can help you avoid more costly illness-related services later • Discuss cost-effective services and drugs with your providers • Use emergency care only for emergencies • Review your medical bills to make sure they are correct www.bcbstx.com/ut Summary of Benefits (In Area*) Network and non-network benefits apply to eligible employees, retirees and their covered dependents residing in Texas or New Mexico. Payment for non-network (including ParPlan) services is limited to the allowed amount as determined by Blue Cross and Blue Shield of Texas. ParPlan providers accept the allowed amount. Any charges over the allowed amount are the patient’s responsibility and are in addition to deductible, coinsurance and out-ofpocket maximums. In-Area* Non-Network General Provisions Deductible (per plan year) When using Network providers, office visit and related services are not subject to deductible • Individual • Family Out-of-Pocket Maximum (per plan year; includes deductible and coinsurance; does not include copayments, charges exceeding the Allowed Amount or non-covered services and supplies) Benefits will be paid at 100% for the remainder of the plan year once the out-of-pocket maximum is met • Individual • Family Network (Including ParPlan) Any charges over the Allowed Amount are the patient’s responsibility $250 $750 $500 $1,500 $1,750 $5,250 $4,000 $12,000 $25 copayment After deductible, plan pays 60%; you pay 40% of the Allowed Amount $30 copayment After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount $25 copayment FCP $30 copayment Specialist After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 60%; you pay 40% of the Allowed Amount Diagnostic Services (Office) Family Care Physician (FCP) • Family Practice • Internal Medicine • OB/GYN • Pediatrics Specialists (other than Behavioral Health) Chiropractic Care (subject to 20 visit plan year maximum per condition if traditional physical therapy modalities billed) Allergy Services (testing) Allergy Serum/Injections (if no office visit billed) Family Planning Services (birth control management) Plan pays 100% (no copayment required) $25 copayment FCP $30 copayment Specialist After deductible, plan pays 60%; you pay 40% of the Allowed Amount * Out-of-Area member benefits apply to any eligible employees, retirees and their dependents whose residence is outside of Texas or New Mexico. Covered services are subject to $250 deductible and paid at 75% of the allowed amount. 5 6 customer service 1.866.882.2034 In-Area* Non-Network (Including ParPlan) Any charges over the Allowed Amount are the patient’s responsibility General Provisions Network Diagnostic Laboratory and X-ray Services Contrast material administered in conjunction with radiology services is subject to the applicable deductible and coinsurance Diagnostic Tests Plan pays 100% (no copayment required) After deductible, plan pays 60%; you pay 40% of the Allowed Amount $25 copayment FCP $30 copayment Specialist After deductible, plan pays 60%; you pay 40% of the Allowed Amount $25 copayment FCP $30 copayment Specialist After deductible, plan pays 60%; you pay 40% of the Allowed Amount Periodic Physical Exam (one per plan year) $25 copayment FCP $30 copayment Specialist After deductible, plan pays 60%; you pay 40% of the Allowed Amount Well Woman Exam (one per plan year) Mammogram (one per plan year) Well Child Care (under age 2) Immunizations (up to age 6, applies for injection only) $25 copayment FCP $30 copayment Specialist Plan pays 100% (no copayment required) $25 copayment FCP $30 copayment Specialist Plan pays 100% (no copayment required) After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 60%; you pay 40% of the Allowed Amount Immunizations (age 6 and older, applies for injection only) $25 copayment FCP $30 copayment Specialist After deductible, plan pays 60%; you pay 40% of the Allowed Amount $25 copayment FCP $30 copayment Specialist After deductible, plan pays 60%; you pay 40% of the Allowed Amount Infertility Diagnostic Testing Preventive Care After deductible, plan pays 60%; you pay 40% of the Allowed Amount Plan pays 100% of the Allowed Amount Obstetrical Care Initial Office Visit Delivery–Facility (preauthorization required) When using a Network facility: If the mother is a covered participant, she will be responsible for inpatient copayments of $100 per day, not to exceed $500 per stay, in addition to any applicable deductible and coinsurance. A separate inpatient copayment will not be charged for the newborn unless the newborn’s hospitalization exceeds the mother’s or unless the mother is not a covered participant on the UT SELECT plan. No more than $500 in copayments will apply to any individual delivery admission. Applicable deductible and coinsurance will be charged for the newborn. Delivery–Physician After $100 copayment per day After deductible, plan pays 60%; ($500 maximum copayment per you pay 40% of the Allowed Amount admission), plan pays 80%; you pay 20% after deductible After deductible and $25 or $30 copayment, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount www.bcbstx.com/ut In-Area* Non-Network General Provisions Lab and Radiology Contrast material administered in conjunction with radiology services is subject to the applicable deductible and coinsurance Voluntary Sterilization–Facility (preauthorization required) Voluntary Sterilization–Physician Network (Including ParPlan) Any charges over the Allowed Amount are the patient’s responsibility Plan pays 100% (no copayment required) After deductible, plan pays 60%; you pay 40% of the Allowed Amount After $100 copayment, plan pays 80%; you pay 20% after deductible After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 60%; you pay 40% of the Allowed Amount Inpatient Care (preauthorization required) Facility • Preadmission Testing • Semi-private Room and Board • Intensive Care Unit (ICU) • Inpatient Hospital Care • Surgery Physician After $100 copayment per day ($500 maximum copayment per admission), plan pays 80%; you pay 20% after deductible After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount After $100 copayment, plan pays 80%; you pay 20% after deductible After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 80%; you pay 20% Plan pays 100% (no copayment required) After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount Outpatient Care Observation (a patient treated in a hospital or clinic instead of in an overnight room or ward) Surgery–Facility Surgery–Physician Lab and Radiology Contrast material administered in conjunction with radiology services is subject to the applicable deductible and coinsurance Diagnostic Tests Medical diagnostic tests such as, but not limited to: immune globulins, therapeutic or diagnostic infusions (excludes chemotherapy), biofeedback, dialysis, gastroenterology, cardiovascular, non-invasive vascular diagnostic studies, pulmonary and neurology Emergency Care Facility–Emergency Room Physician Ambulance $100 copayment (waived if admitted) Plan pays 100% (no copayment required) After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount * Out-of-Area member benefits apply to any eligible employees, retirees and their dependents whose residence is outside of Texas or New Mexico. Covered services are subject to $250 deductible and paid at 75% of the allowed amount. 7 8 customer service 1.866.882.2034 In-Area* Non-Network General Provisions Network (Including ParPlan) Any charges over the Allowed Amount are the patient’s responsibility Extended Care (preauthorization required) Skilled Nursing (subject to 180 day plan year maximum) After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount Home Health Care (subject to 120 day plan year maximum) After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount Home Infusion Therapy After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount Hospice Care (subject to 90 visit plan year maximum) After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount Physical Therapy (subject to 20 visit plan year maximum per condition if traditional physical therapy modalities billed) Occupational Therapy (subject to 20 visit plan year maximum per condition) After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount Speech and Hearing Therapy (subject to 60 visit plan year maximum per condition) Respiratory Therapy After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount Therapy Other Medical Supply/Durable Medical Equipment (preauthorization required)/Prosthetic/Orthotics Hearing Aids ($500 per ear; once every 4 years Plan pays 80%; you pay 20% (no deductible) Serious Mental Illness (preauthorization required) The Serious Mental Illness Benefit is not part of, but is in addition to, the Mental Illness Benefit Inpatient–Facility After $100 copayment per day ($500 maximum copayment per admission), plan pays 80%; you pay 20% after deductible After deductible, plan pays 60%; you pay 40% of the Allowed Amount Inpatient–Physician After deductible, plan pays 80%; you pay 20% After deductible, plan pays 80%; you pay 20% $25 copayment After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 60%; you pay 40% of the Allowed Amount Outpatient Office Visit www.bcbstx.com/ut In-Area* Non-Network General Provisions Network (Including ParPlan) Any charges over the Allowed Amount are the patient’s responsibility Chemical Dependency (preauthorization required; 3 episodes for treatment per lifetime) Inpatient–Facility (subject to 30 day plan year maximum) After $100 copayment per day ($500 maximum copayment per admission), plan pays 80%; you pay 20% after deductible After deductible, plan pays 60%; you pay 40% of the Allowed Amount Inpatient–Physician (subject to 30 day plan year maximum) After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount Outpatient (subject to 20 visit plan year maximum for outpatient and office combined) After deductible, plan pays 80%; you pay 20% After deductible, plan pays 60%; you pay 40% of the Allowed Amount Office Setting (subject to 20 visit plan year maximum for outpatient and office combined) $25 copayment After deductible, plan pays 60%; you pay 40% of the Allowed Amount $25 copayment After deductible, plan pays 60%; you pay 40% of the Allowed Amount Smoking Cessation Outpatient/Office Setting (subject to 20 visit plan year maximum) Other Mental Illness (preauthorization required) Inpatient–Facility (subject to 30 day plan year maximum) Inpatient–Physician (subject to 30 day plan year maximum) Outpatient (subject to 20 visit plan year maximum for outpatient and office combined) Office Setting (subject to 20 visit plan year maximum for outpatient and office combined) After $100 copayment per day ($500 maximum copayment per admission), plan pays 80%; you pay 20% after deductible After deductible, plan pays 80%; you pay 20% After deductible, plan pays 80%; you pay 20% $25 copayment After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 60%; you pay 40% of the Allowed Amount After deductible, plan pays 60%; you pay 40% of the Allowed Amount * Out-of-Area member benefits apply to any eligible employees, retirees and their dependents whose residence is outside of Texas or New Mexico. Covered services are subject to $250 deductible and paid at 75% of the allowed amount. Choose Well: Small Steps Lead to Big Strides for Your Health There’s no limit to the small steps you can take toward achieving a healthier lifestyle. Here are some basic ideas to help you get started: • Eat at least five fruits and vegetables a day • Strive to keep a positive attitude and manage your stress • Buckle up anytime you are in a vehicle • Use sunscreen to protect your skin from harmful rays • Boost physical activity by parking further away at work or when shopping 9 10 customer service 1.866.882.2034 Choose Well: Achieve a Healthier Life with the Help of Blue Care Connection Sometimes managing your health requires more than doctor visits, lab tests and prescriptions. Blue Care Connection from Blue Cross and Blue Shield of Texas is an umbrella of programs that offers you guidance to achieve higher levels of wellness. Through outreach, educational resources and health advocacy, we help guide you through the often-complex health care system so you can focus on what matters most — getting healthy and staying well. Blue Care Connection programs assist UT SELECT plan participants living with current serious medical conditions, as well as those considered “at risk.” If you, or a covered dependent, are considered "at risk," the Blue Care Connection programs are uniquely designed to detect health care needs early. Early detection allows Blue Cross and Blue Shield of Texas to provide appropriate outreach and meaningful intervention to help prevent future medical complications. Blue Care Connection programs are available at no additional cost and include: 24/7 Nurseline Around the clock access through a toll-free number to experienced registered nurses who understand and can help with your health care concerns. Good health starts by asking the right questions at the right time. And we all know that sometimes those questions come up unexpectedly, like when the doctor’s office is closed. Whatever the time, you can get the answers to your health care questions with the 24/7 Nurseline from Blue Cross and Blue Shield of Texas. To take advantage of this free service and to talk to a 24/7 nurse, call toll-free: 1-888-315-9473. Special Beginnings® A maternity program that offers on-going contact with obstetric nurses who provide prenatal risk assessment education and can coordinate care with your physician. Blue Cross and Blue Shield of Texas is offering a $50 Reward Card from Target for women who enroll in their first trimester and complete the Special Beginnings program through six weeks after delivery. Call 1-800-462-3275 to enroll or ask questions about the program. Condition Management Voluntary health improvement programs that can help members with: cancer, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, asthma, diabetes, metabolic syndrome (high cholesterol, high blood pressure and obesity) and low back pain. Care Management Focuses on traditional elements of medical care management with targeted outreach if you are an “at-risk” member. Case Management Assists if you are a higher-risk plan participant coping with a complex or catastrophic condition. Enroll Today To enroll in any Blue Care Connection program, or ask questions about the program, please call toll-free at 1-800-462-3275. www.bcbstx.com/ut New! Effective September 1, 2007—More Blue Care Connection Programs In addition to the Blue Care Connection programs already listed, some new programs will be available to UT SELECT plan participants for the 2007-2008 plan year, effective September 1. Blue Care Advisors Blue Care Advisors are a multi-disciplinary team composed of RNs, Licensed Professional Counselors and Licensed Master Social Workers. Blue Care Advisors reach out to at-risk plan participants, providing early chronic disease prevention in hopes of achieving overall improved health. Blue Care Advisors: • Simplify the coordination of your health care benefits • Educate and empower you to make informed choices about your health care • Support wellness by aiding your understanding of preventive care guidelines, personal risk assessments and preventive screenings • Support behavior modification and readiness to change by providing techniques that promote a healthy lifestyle • Champion your care when assistance is needed • Provide lifestyle coaching through the Obesity/Weight Management Program (as needed) Personal Health Manager With Personal Health Manager, the support and resources you need to manage your health online will be just a click away. By logging onto Blue Access® for Members through www.bcbstx.com/ut and clicking on Personal Health Manager you can: • Earn Blue Points SM every time you use the health and wellness features in the For Your Health section. Receive up to 1,000 points a week when you set up and track the progress of an exercise or meal program, read and rate health and wellness related articles, or e-mail your health-related questions to licensed professionals • Complete a health risk assessment to evaluate your health status • Request fitness and weight loss advice with Ask A Dietitian • Receive help on managing stress, workplace conflicts or other issues with Ask A Life Coach • Ask registered nurses health-related questions online with the Ask A Nurse feature • Receive targeted wellness information via e-mail to help manage specific medical conditions, including alerts for screening tests, and set up reminders for medical appointments and medication refills • Access wellness tracking tools, videos and interactive tutorials. • Get information on exercise, nutrition and lifestyle issues in the For Your Health section Behavior Modification Obesity/Weight Management Program UT SELECT coverage will also feature new lifestyle management programs, comprised of Licensed Master Social Workers and Licensed Professional Counselors who promote wellness through a holistic approach of behavioral coaching, clinical coaching, education and condition management. Regardless of your personal health status — every UT SELECT plan participant can take advantage of important health and wellness resources from Blue Cross and Blue Shield of Texas. Call 1-800-462-3275 to enroll or find out more about how Blue Care Connection programs can help you. 11 12 customer service 1.866.882.2034 Blue Extras SM Blue Extras arranges for UT SELECT plan participants and covered dependents to have access to discounts on a variety of alternative and complementary health care services and products. Savings on Hearing Aids Blue Cross and Blue Shield of Texas has arranged for a discount program through TruHearing** that offers digital hearing aids at a reduced price. This program allows you to receive discounts of 30% to 60% off manufacturer suggested retail price for the latest technology digital hearing instruments. The program also includes a free hearing screening, hearing instrument fitting and related services through the TruHearing network of participating providers. As a UT SELECT plan participant, your children, parents and grandparents can also access this discount hearing program. To access the program, call the TruHearing toll-free phone number, 1-877-882-2020, during the hours of 8 a.m. to 8 p.m., Monday through Friday to locate a provider, schedule an appointment and obtain a referral to the provider. It’s that easy! For additional information, you may also visit the program’s Web site at www.TruHearing.com. **The relationship between Blue Cross and Blue Shield of Texas and TruHearing is that of independent contractors. Jenny Craig Membership Discounts discounted joining fee to Jenny Craig. To learn more and register for the Jenny Craig discounts, log onto Blue Access for Members through www.bcbstx.com/ut and click on the My Coverage tab, then Your Discounts, then the Jenny Craig logo. Fill out the registration form and click submit. Once you submit, your special offer coupon will appear on the screen. Print the coupon and bring it with your UT SELECT ID card to your free consultation. To find the nearest Jenny Craig Centre, log onto www.jennycraig.com or call (800) 597-Jenny (5366). Be sure to identify yourself as a Blue Cross and Blue Shield of Texas member and UT SELECT plan participant. Curves Membership Discounts A regular exercise program is vital to achieving and maintaining a healthy weight. Curves is the first fitness and weight loss facility to target women and provide them with affordable, one-stop exercise and nutritional information. UT SELECT plan participants and covered dependents can join Curves for a special $49* joining fee. To take advantage of the discount, present your UT SELECT ID card to any Curves location**. For more information, you can log onto Blue Access for Members at www.bcbstx.com/ut, click on the My Coverage tab, then click Your Discounts. You may also visit www.curves.com or call (800) CURVES-30. * Additional regular monthly fee applies. **Franchisee participation and discount may vary. Good health requires more than good intentions – especially when it comes to weight management and fitness! Blue Cross and Blue Shield of Texas now offers you and covered dependents a Your Health is a Personal Matter And we have taken measures to keep it that way. We understand that your health care information should be treated confidentially, so we have procedures in place to help ensure that occurs. Your doctors and other contracting providers must also comply with applicable laws, professional standards and policies regarding the confidential treatment of medical information. www.bcbstx.com/ut Transitional Benefits If you or a covered dependent are currently being treated for a chronic or ongoing medical condition at the time of enrolling in UT SELECT and your doctor is not in the PPO network, ongoing care with your current doctor may be requested for up to three months. Some medical conditions that are eligible for transitional benefits include: • Pregnancy (if you are in your third trimester on September 1) • Cancer • Allergy Treatments Organ Transplant • Heart Failure • Physical Therapy • Behavioral Health Care • Diabetes • Transitional benefits are subject to approval. To request transitional benefits, complete a Transitional Benefits form available from your campus Benefits Office or online at www.bcbstx.com/ut. Instructions for submitting the request to Blue Cross and Blue Shield of Texas are on the form. If the transitional care request is approved, you or your covered dependent may continue to see the non-network doctor and receive the network level of benefits from the UT SELECT plan for up to three months. If the transitional care request is denied, you may still continue to see your current doctor, but benefits will be paid at the non-network level. If your doctor is in the network, you do not have to complete a Transitional Benefits form. Choose Well: What you can do to help keep your costs down • Work with your doctor to understand treatment options and costs to make sure you’re getting the most for your health care dollars • Visit your doctor instead of the emergency room for non-emergency care • Talk with your doctor about choosing generic drugs when possible, which can help reduce prescription costs • Work with your doctor to learn ways to stay healthy through exercising, eating a balanced diet, reducing alcohol consumption and other preventive measures UT SELECT and Medicare If you are enrolled in Medicare and your physician accepts Medicare Assignment of benefits: • You do not have to see a network physician to get the highest level of benefits. • UT SELECT will pay 100% of the covered services approved but not paid by Medicare. • UT SELECT will cover your annual deductibles, copayments and coinsurance. 13 14 customer service 1.866.882.2034 Point Click Go! Now, getting information about your health care benefits is easier than ever at www.bcbstx.com/ut. When you go online, you’ll have the health and benefit information you need right at your finger tips. Here you will find the most up-to-date hospital and provider information. You can view and download the online directories already designated by regions in the state of Texas. Provider Finder also allows you to search, customize and print a list of providers tailored to your specific needs. While customizing your search, you will also find other useful provider information, such as: • Office hours • Board certification • Languages spoken • Provider’s gender • Hospital and facility affiliations BlueCompare Provider Finder® • Online mapping to the provider’s location Choose Well: Enhancement Choosing a doctor can be difficult. That’s why we built BlueCompare, a component of Provider Finder on www.bcbstx.com/ut, which will allow UT SELECT plan participants and non-plan participants to research care practices and affordability for physicians and professional providers in the BlueChoice PPO network. To give a more complete view of how a chosen physician compares to those in his or her peer group, BlueCompare uses blue ribbons to designate physicians’ performance according to evidencebased measures guidelines. Similarly, a scale that indicates “more,” “average” or “less” provides an overview of which doctors and professional providers are more affordable when managing the care of patients who have similar medical conditions and access care within the same geographic area. BlueCompare is not meant to tell you which doctor you should select. This is a very personal choice, and you should not decide based only on BlueCompare information. www.bcbstx.com/ut • Review list of important phone numbers, mailing addresses and other contact information • Learn more about UT SELECT and access enrollment and benefits information, including frequently asked questions and downloadable forms • Locate network providers • Log on to Blue Access for Members As a UT SELECT member, you have immediate, secure access to your medical claims information. Blue Access for Members lets you: • Check the status of your claims and your claims history • Confirm who in your family is covered under your plan • View and print an Explanation of Benefits (EOB) for a claim • Select the option to stop receiving EOBs in the mail • Sign up to receive claim status e-mail alerts • Request e-mail notification of finalized claims • Request a new or replacement ID card or print a temporary ID card. To register for Blue Access for Members, you will need your group and identification numbers from your UT SELECT ID card. You will be asked to create a user ID and password for immediate and secure access to your personal information. Choose Well: Take a Health Risk Assessment Learn about your health status and risks by completing a confidential Health Risk Assessment (HRA) available through Blue Access for Members. By completing the HRA, you can receive recommendations for improving your health and share the information with your physicians. The HRA focuses on four key areas—stress, sleep, fitness, and nutrition. 15 16 customer service 1.866.882.2034 Choose Well: How to plan for good health and take care of yourself Set health improvement goals for next week, next month, next year and reward yourself for meeting them. Research shows that at least 50 percent of health status is based on lifestyle choices. • Quit smoking • Be active—exercising can help you lose weight or maintain a healthy weight and lower or control blood pressure and cholesterol levels • Maintain a healthy weight—if you are already at a healthy weight, maintain your weight; if you are overweight, lose weight • Control your blood pressure—regular exercise, a healthful diet and reducing your intake of salt and alcohol can help control your blood pressure • Control your blood cholesterol levels—regular exercise, a healthful diet and losing weight can help control your cholesterol levels. Eat a healthful diet—a diet low in cholesterol, saturated fats, salt and other sodium and high in fiber from fruits, vegetables and whole grains • Reduce your stress levels—exercise, relaxation, breathing techniques and meditation are inexpensive and healthful ways to help lower stress • Control your blood sugar levels • Choose Well: Curbing unhealthy choices at the drive-through Whether scrambling to grab breakfast on the way to work or picking up dinner before baseball practice or piano lessons, Americans are spending more and more time eating meals on the go. Here’s how to make fast food menu choices that are quick and healthy: • Keep portion sizes small, such as choosing a regular or children’s-size hamburger rather than burgers with two to three beef patties • Substitute fries or onion rings with healthy side dishes like a salad or fruit bowl • Opt for grilled items and avoid fried or breaded foods that are high in fat and calories • Ask for healthier, low-fat options for condiments that come with entrees • Save calories by ordering water, diet soda, unsweetened ice tea, sparkling water or mineral water If life has you eating on the run, take a little time to slow down and make smart, healthy choices when you’re in the fast food lane. UT Claims Address Blue Cross and Blue Shield of Texas P.O. Box 660044 Dallas, Texas 75266-0044 Customer Service 1-866-882-2034 8 a.m. to 5 p.m. (Central Time) Monday–Friday Online Provider Directory and Website www.bcbstx.com/ut Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, provides administrative claims payment services only and does not assume any financial risk or obligation with respect to claims. 47642.0407