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Benefits of Blue - Q&A

On April 17, 2013 William A. Breskin, Vice President of Government Programs held an online webcast explaining how to maximize your health benefits at no extra cost. An archive of the webcast can be viewed by clicking here. Following the presentation, Mr. Breskin answered a series of questions from FEP members. Their questions and his answers are listed below.

QUESTIONS & ANSWERS

  1. Q: Do you have web access for providers to check eligibility and claims status?
    A: Not at this time. In some states you may be able to check your contracted BCBS Plan’s provider portal as you would for other contracts.

  2. Q: Do members have access to claims online?
    A: Yes. Log in at fepblue.org/MyBlue and click “Check My Claims” under My Benefits.

  3. Q: What's the deal with the SBC I received in the mail? Where's my OPM Brochure?
    A: The Affordable Care Act included a requirement that all health plans provide a summary of the benefits in the same document format so that consumers would be able to easily compare those plans.  The BCBS Service Benefit Plan developed a Summary of Benefits & Coverage (SBC) for Standard Option and Basic Option, as was required by the regulation.

  4. Q: Does your plan cover Acupuncture?
    A: The BCBS Service Benefit Plan offers coverage for acupuncture.  Under Standard Option, benefits for acupuncture are limited to 24 visits per calendar year; the acupuncture must be performed and billed by a physician or licensed acupuncturist.  Under Basic Option, benefits for acupuncture do not include a visit limit, but services must be performed and billed by a physician.  For information about a member’s out-of-pocket costs for acupuncture, please review page 56 of the 2013 Service Benefit Plan brochure.

  5. Q: As a member enrolled in Medicare A and B, what changes will I experience in my prescription drug coverage this year?
    A: For 2013, the BCBS Service Benefit Plan did not make any changes to member copayments or coinsurance percentages for prescription drugs.  For Standard Option only, generic drug replacements available under the Standard Option Generic Incentive Program were changed.

  6. Q: Do you have a chat with a nurse number?
    A: Yes. It is: 1.888.258.3432

  7. Q: Since I have BCBS coverage, do I need Medicare coverage?
    A: For most people, coverage under Medicare Part A is automatically offered.   As for Medicare Part B, coverage is not required.  For many federal retirees, deciding whether to enroll in Medicare is a difficult decision.  Medicare Part B (medical insurance) helps pay for medically necessary doctors’ services, outpatient hospital services and a number of other medical services and supplies that are not covered by Medicare Part A (hospital insurance).  All Medicare Part B beneficiaries pay for Part B coverage. The standard premium is $104.90 a month in 2013. The Medicare Modernization Act requires some individuals to pay a higher premium based on their income. If you elect to take Medicare part B coverage, in addition to keeping your Service Benefit Plan coverage, there are several financial benefits to you.  Your Service Benefit Plan coverage pays for the $147 Medicare Part B deductible as well as the 20 percent coinsurance amounts not covered by Medicare for covered services.  Some members like the peace of mind knowing that likely the only out-of-pocket costs he/she may have are premiums and prescription drug costs.

  8. Q: What does Medicare cover?
    A: For comprehensive information about benefits available under Medicare, we recommend that you visit http://www.medicare.gov/.  You may also review our Medicare and You guide for information about how we coordinate with Medicare when you are covered under both Medicare and the BCBS Service Benefit Plan. Please visit our website at http://www.fepblue.org/benefitplans/medicare/index.jsp to review that information.

  9. Q: Why don’t you have dental coverage?
    A: The BCBS Service Benefit Plan offers limited coverage for dental services, which is unusual under a health plan.  Standard Option dental benefits provide coverage for preventive services as well as some restorative services; benefits are reimbursed according to a fixed dental fee schedule.  Basic Option dental benefits provide coverage for preventive services only.  Please refer to Section 5(g) in the 2013 BCBS Service Benefit Plan brochure for the specific dental services covered under both Standard Option and Basic Option.  You can use the following website link to review our brochure online: http://www.fepblue.org/downloads/2013-service-benefit-plan-brochure_100512.pdf

  10. Q: What is this card number I have to have for my BCBS debit card?
    A: We have provided a PIN number for the incentive card for members who opt to use a debit/PIN transaction at supporting merchants. You can learn more at: fepblue.org/PIN

  11. Q: What do you do with the information I submit on that health assessment?  Do you use this to determine my premium?
    A: The information is not used to determine your premium. The information is used by FEP to suggest opportunities for you to improve your health through coaching modules, or other benefits and services offered by FEP to its members. The suggestions are part of your health action plan at the end of the assessment.

  12. Q: My daughter is covered under my plan and is pregnant; I can cover my grandchild correct?
    A: Under the Federal Employees Health Benefits Program (FEHBP), grandchildren are not eligible dependents.  Therefore, your BCBS Service Benefit Plan coverage cannot be extended to your grandchild.

  13. Q: When I change plans do I have to worry about a waiting period for a pre-existing condition?
    A: There are no exclusions or waiting periods for pre-existing conditions under the Federal Employees Health Benefits Program (FEHBP).  You may want to visit the Office of Personnel Management’s (OPM’s) website, www.opm.gov, for more information.  Page 7 of the 2013 BCBS Service Benefit Plan brochure includes this information as well.  Use the following website link to review our brochure online: http://www.fepblue.org/downloads/2013-service-benefit-plan-brochure_100512.pdf

  14. Q: I am a federal employee. Will I have to go into these exchanges or can I keep my FEHB coverage?
    A: As a federal employee, your health insurance coverage will continue through the Federal Employees Health Benefits Program (FEHBP) in 2014.

  15. Q: I hear that you pay for gym memberships is that true and what gyms?
    A: Although the BCBS Service Benefit Plan does not include a benefit for gym memberships, those federal employees or retirees who are enrolled under our plan have access to a network of over 8,000 fitness facilities nationwide through Healthways Fitness Your Way. Members pay a $25 initiation fee and a $25 monthly fee per person, by credit card, directly to Healthways.  Members are entitled to unlimited visits to network facilities and all amenities included in a general membership.  Members are not limited to a specific facility; they can choose to use any facility that participates in the network. There is a three-month commitment required. If members stop participating for three months or more, they are required to pay an additional $25 initiation fee. For more information or to enroll, go to http://www.fepblue.org/healthwellness/discounts/health-club-memberships.jsp. Individuals must be 18 or older to purchase a membership.

  16. Q: What is the difference between your Standard and Basic option?
    A: The Service Benefit Plan offers two types of coverage: Standard Option and Basic Option. Standard Option gives you the freedom to receive covered services from both Preferred and Non-preferred providers. Basic Option members must receive care performed by Preferred providers, except in certain situations like emergency care. Standard Option also has a calendar year deductible, while Basic Option does not. Most care under Basic Option is subject to a copayment amount.   There are other differences between Standard and Basic Option, so we recommend that you review our website to do a side-by-side comparison of both products.  That comparison is found at http://www.fepblue.org/benefitplans/compare/index.jsp.

  17. Q: Can I submit a claim to you electronically when I am traveling outside of the US or can I only do it via mail?
    A: Yes, overseas medical and pharmacy claims can now be submitted online for faster processing and rapid claims payment.   If you choose to, you still have the option of mailing or faxing your overseas claims.  Detailed instructions for both options are available on our website at http://www.fepblue.org/benefitplans/overseas-benefits/index.jsp.

  18. Q: Are spouses covered under the Smoking Cessation Program?
    A: Yes, as long as the spouse is a Service Benefit Plan member and 18+ years of age.

  19. Q: I am interested in switching to a high deductable savings account. Do you offer one of these plans?
    A: We do not offer a high deductible health plan.

  20. Q: How do you find out if a provider is a "preferred" provider, under the Basic plan, when using the provider directory?
    A: All providers in the provider directory are "preferred" for both Standard and Basic Option. Note that a change in contracting status of a provider may NOT   immediately be reflected in the tool, so be sure to call the provider and verify that they are a preferred provider.

  21. Q: Can I at a later time change from Basic Option to a Standard Option?
    A: You can change options during the Federal Benefits Open Season held each fall.  Otherwise if you have a qualifying life event (QLE) – such as marriage, divorce, or the birth of a child – outside of the Federal Benefits Open Season, you may be eligible to change your enrollment, or cancel coverage. For a complete list of QLEs, visit the FEHB Web site at www.opm.gov/insure/lifeevents. If you need assistance, please contact your employing agency, personnel/payroll office, or retirement office.

  22. Q: If I have Blue Cross Basic and Medicare Part B and I see a provider who does not accept Medicare assignment, do you still waive your co-payment?
    A: Although we still waive copayments when Preferred providers do not accept Medicare assignment, you pay the difference (if there is one) between the “limiting charge” or the physician’s charge (whichever is less) and our payment combined with Medicare’s payment.  Please see page 135 of the 2013 Service Benefit Plan brochure for more information.

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Cost Conscious, Online Tools, Benefits and Services

Page last updated: April 30, 2013

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