HEALTH INSURANCE
EMPLOYEE EDUCATION:
PREVENTIVE CARE
Mott Community College Health Benefits Task Force
DISCLAIMER
The content in this presentation is
informational. Each employee should review
the benefit summary and network information
specific to their plan and discuss specific
circumstances and questions with their carrier.
OVERVIEW
Your insurance plan offers many preventive services
at no cost to you as mandated by the ACA.
•
Types of preventive care available
•
Primary care physicians
•
Chronic conditions
•
Tips for accessing preventive care
•
Overcoming obstacles
•
Additional resources
PREVENTIVE CARE
A pattern of nursing and medical care that focuses
on disease prevention and health maintenance. It
includes early diagnosis of disease, discovery and
identification of people at risk of development of
specific problems, counseling, and other necessary
intervention to avert a health problem. Screening
tests, health education, and immunization programs
are common examples of preventive care.
preventive care. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved January 19 2015 from http://medical‐ dictionary.thefreedictionary.com/preventive+carePREVENTIVE CARE
Approved services are covered at 100% for plan enrollees with no deductible or copay liability (no enrollee out of pocket cost)•
Services must be received in network•
Ex: annual physicals, well baby check‐ups, some immunizations, etc.•
Confirm with carrier that scheduled services are preventive•
Refer to the Federal Patient Protection and Affordable Care Act listof mandated preventive services at www.healthcare.gov and to the
benefit summary for your medical plan
•
You may see multiple providers depending on which preventivePRIMARY CARE PHYSICIAN
Establish a relationship with a primary care physician
•
Make a list of attributes you are seeking in a doctor•
Find a doctor who you trust will listen and treat you with respect•
Determine if they are in‐network•
Ask questions (check online for other good questions):o
What should I expect as a patient of yours?o
What steps does your office take to help patients maintain their health?o
Do they refer to in‐network specialists?PRIMARY CARE PHYSICIAN
Once you have established a doctor relationship, keep a
consistent dialogue
•
Am I up to date on my immunizations?
•
What recommendations do you have based on my
family history?
•
What recommendations do you have based on my
current lifestyle and health condition?
PRIMARY CARE PHYSICIAN
Maintain an ongoing relationship
•
Annual visit
•
Notify if:
o Admitted to the hospital o Visited the urgent care or ER o Visited a specialist o Changed medicines o Notice a change in a condition•
Visit as recommended if managing a chronic condition
PRIMARY CARE PHYSICIAN
Make a list prior to each visit
•
What would you like to discuss with your physician?
•
List medications you are currently taking
•
List any info that would be helpful to your physician
(see list of suggested notifications from previous slide)
•
Ask if there is anything you can be doing to
maintain/improve your health
Don’t be afraid to refer to your list during your visit!
CHRONIC CONDITIONS
What if my preventive appointment uncovers health concerns?
•
Tests/appointments associated with a noted concern are not considered preventive services•
Follow‐up appointments/tests/prescriptions associated with management or monitoring of a past or ongoing condition are not considered preventive services•
The examples above are subject to deductible and/or copays in accordance with your plan summary•
Although it’s not considered preventive, it is often less costly to manage a condition rather than to treat an unmanaged conditionCHRONIC CONDITIONS
•
Affect about half of all adults in the U.S.
(as of 2012)
•
86% of health care dollars are spent on chronic
conditions
•
Examples include:
Heart disease, Stroke, Cancer,
Diabetes, Obesity, Arthritis
http://www.cdc.gov/chronicdisease/overview/index.htm; http://www.cdc.gov/chronicdisease/CHRONIC CONDITIONS
Heart disease
• Cause of 1 in 4 deaths in the U.S. annually • Leading cause of death for both men and womenStroke
• Fourth leading cause of death in the U.S.Cancer
• With heart disease, accounts for about 1/2 of all deaths in the U.S. http://www.cdc.gov/heartdisease/facts.htm; http://www.cdc.gov/stroke/; http://www.cdc.gov/chronicdisease/overview/index.htmCHRONIC CONDITIONS
Diabetes
• Increases risk for heart disease, stroke, kidney failure, blindness and premature deathHigh blood pressure
• 1 in 3 Americans have high blood pressure • Increases risk for heart attack, stroke, heart failure and other cardiovascular problemsHigh cholesterol
• About 1 in 3 Americans have high LDL or “bad” cholesterol • Increases risk of heart disease http://www.cdc.gov/bloodpressure/; http://www.cdc.gov/cholesterol/CHRONIC CONDITIONS
Learning to control your condition can help you:
o
Improve your quality of life
o
Save money
o
Avoid disability
o
Prevent untimely death
TIPS FOR ACCESSING
PREVENTIVE CARE
•
Preventive services are the primary reason for your visit•
Confirm you are visiting an in‐network doctor and are referred to in‐ network facilities for any tests•
Call before an appt. to understand what services and tests will be performed•
Ask for a list of diagnosis codes associated with the planned services/tests•
Call Blue Cross customer service to determine how each service and test will be covered under your plan (have the list of codes available) at 877‐790‐2583OVERCOMING OBSTACLES
Who do I contact if my preventive services are not covered at
100%?
Call Blue Cross customer service at 877‐790‐2583Who do I contact for my medical records or to appeal a denied
claim?
Call Blue Cross at 866‐346‐7299Who do I contact with questions about getting approval for a
procedure?
Call Blue Cross at 800‐572‐3413BLUE CROSS BLUE SHIELD
RESOURCES
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Create a Blue Cross account online at www.bcbsm.com: o Online health assessment o Informational resource library, calculators and quizzes o Smoking cessation toolsHow to register at the new bcbsm.com
• Go to bcbsm.com
•Click LOGIN in upper right corner •Click on Register now
•Verify Eligibility
•Create Your Account
•If unable to register with this process, a letter will be sent with a personal PIN to complete the process •Demo
Blue Health Connection
• Healthy Basics offers health care support and innovative online resources
– Engagement Center
– Engage online health management solution – Health Assessment
– Complex Chronic Condition Management – Case Management
Engagement Center
• Monday through Saturday 8am to 8pm EST 800-775-BLUE (2583) • Conduct doctor and hospital searches
• Answer questions regarding wellness and care management • Provide information on program discounts
• Guide you through online Health Assessment
Engage Online Health Management Solution
• Make an online health connection at bcbsm.com
• Digital health coaching – access to 11 digital health coaching programs • Health Assessment
• Offers more than 90,000 medically-reviewed resources
– Libraries, encyclopedias and dictionaries
– News on recent developments in clinical research, treatment options and medical advances – Videos, calculators, podcasts and animations
BHC – Health Assessment
• Take the Succeed Health Assessment
– Go to bcbsm.com – Log in as a member
– Click the Health & Wellness tab, then click Take Assessment Now
• Results include
– Picture of your current health and health risks and tips on reducing the risks – Lifestyle score
– Tailored action plan
Digital Health Coaching
• Provide a personalized plan and supportive tips on how to live a healthier lifestyle.
– Care for Pain
– Care for your Back – Relax
– Overcoming Binge Eating – Balance
– Breathe
– Overcoming Depression – Care for Diabetes
– Overcoming Insomnia – Nourish
BHC Complex Chronic Condition Management
• Get personal health to better manage conditions such as:
– Diabetes – Heart Failure
– Chronic obstructive pulmonary disease – Coronary artery disease
BHC Complex Chronic Condition Management
• A team of registered nurses, social workers and registered dietitians work with you to manage your condition
– Coordinated care – Education
BHC Case Management
• Complex medical conditions, multiple chronic conditions, or injuries and illnesses with serious, long-term effects.
• A dedicated nurse case manager will work with you, your family and your treating physician to
– Coordinate care
– Inform you about your disease and treatment options – Provide information on Blues doctors and hospitals – Refer you to community resources
BHC 24-hour Nurse Line
• 800-775-BLUE (2583)
• Access to registered nurse health coaches, 24 hours a day, seven days a week.
– Symptom Management – Health Information – Audio Health Library
Discounts
• Save money and live healthier with Healthy Blue Xtras and Blue365
• Show your Blues ID card at participating retailers or type in the online code. • Visit bcbsm.com/xtras to access over $7,000 in savings offers
• Blue365 offers health and wellness discounts across the nation.
– Weekly deals on products and services – Discounts on fitness centers
– Discounts on LASIK and eye health services
• Healthy Blue Xtras offers discounts on Michigan-based products and services
