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is an Independent Licensee of the Blue Cross and Blue Shield Association

Regence BlueCross BlueShield of Oregon

Asante Open Enrollment Benefits Guide

An introduction to Regence


WELCOME TO REGENCE Your connection to the people, tools and resources for you need


TABLE OF CONTENTS Selecting the Right Health Plan.....................................................7 Which Plan Is Right for Me? Health Plan Comparison

HealthEquity Tax-Free Accounts................................................... 11 Asante Pharmacy Benefits...............................................................15 Make Your Rx Plan Work for You

Value-Added Programs....................................................................19 Asante 2015 Wellness Program Care Management

Online Tools........................................................................................25 Regence.com RegenceRx.com HealthSparq myHealthEquity.com

EOB QuickGuide................................................................................28 Helpful Terms .......................................................................................... 30

ASANTE HEALTH PLAN CONTACT INFORMATION Regence Customer Service

HealthSparq Concierge

1 (866) 240-9580

(Health Care Shopping Assistance) 1 (866) 228-7001

Regence Advice24 1 (800) 267-6729

Regence Case Management 1 (866) 543-5765

Regence Special Beginnings

Regence Health Coach 1 (800) 856-8543 www.Regence.com

1 (888) JOY-BABY

RegenceRx

HealthEquity

1 (888) 437-1508 www.RegenceRx.com

1 (866) 960-8055 www.HealthEquity.com


WELCOME TO REGENCE We’re ready to connect you to the people, tools and resources that matter most to your health. As a new Regence member, you’ll have service, support, advice and answers all within easy reach, and all designed with your health in mind. It’s easy to get started.

Just follow these simple steps:

1.

Take a look at the plans.

2.

Become familiar with the health and wellness programs and incentives available to you.

3.

Explore the online tools.

This guide hits the highlights of your medical, pharmacy, and tax-free savings account options offered by Asante and the services, savings and support that come with them.

Throughout this guide, you will learn about many of the health and wellness programs offered to you by Regence and Asante. In certain cases, your participation in these programs will also be financially incentivized by Asante. These programs often include one-on-one access to a dedicated health coach or a licensed nurse to assist you in navigating your health care needs and meeting your personal wellness goals.

Refer to page 25 in this guide to learn more about the robust online tools available to you including Regence.com, RegenceRx.com, HealthSparq, and myHealthEquity.com.

Here are some helpful tips for your new Regence coverage beginning January 1, 2015. Coverage through Regence BlueCross BlueShield of Oregon will begin January 1, 2015. Your group number is 10017473. Beginning January 1, 2015, please present your new Regence ID Card to your providers and pharmacies when you need service. Your Regence ID Card will arrive at the end of December and should be used for medical and prescription coverage. If you are currently covered by Cigna and Express Scripts, they will continue to handle any services that you receive before January 1, 2015. If you’re taking a medication that will run out during the first few weeks of January, it’s best to get it refilled before the end of December. This will avoid any potential refill delays due to the coverage change. If you are undergoing treatment, are pregnant, or have a medical procedure scheduled that will continue into 2015, please contact Regence Customer Service at 1 (866) 240-9580 to learn about the transition-of-care process.

We’re looking forward to getting to know you. We have friendly, well-trained, professional staff who are all located in the Pacific Northwest ready to serve you, whether it’s explaining your claims or answering health questions. They’re available by phone and via our website, Regence.com. Whatever you need, we’re ready to help you. And again, welcome!

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CUSTOMER SERVICE All calls are answered by live agents located in the Pacific Northwest

First Call Resolution BEST OF BLUE AWARD from the Blue Cross and Blue Shield Association

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#

2013


MEMBER-FOCUSED

CUSTOMER SERVICE Our Asante Customer Service representatives are on standby to assist you. They are available Monday through Friday from 6 a.m. to 6 p.m. Pacfic Time.

Please contact our Asante Customer Service line at 1 (866) 240-9580 for questions about:

• • • •

Ordering an additional Regence ID Card

• • • •

Confirming any prior authorization requirements

Understanding how your health insurance benefits work Finding a doctor, specialist, or urgent care clinic nearby Finding out how much of your deductible or out-of-pocket maximum you’ve met

Your benefit for a specific prescription medication Learning more about generic alternatives for your prescription medications A claim or EOB you’ve received

Our call and claims centers are located right here in the Pacific Northwest. If you have any questions, a live representative is ready to help you.

Scan here with your smartphone to access Regence.com. Once you have received your Regence ID Card and have set up your Regence.com account, Asante Customer Service will be available to help you via instant message through our Live Help feature, or you can send them a secure message in the Message Center. At any time you can visit Regence.com to find what you are looking for.

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SELECTING THE RIGHT HEALTH PLAN Custom health plans, made simple


SELECTING THE HEALTH PLAN

WHICH PLAN IS RIGHT FOR ME? Asante offers you three separate health plans to choose from. The plans have similarities and differences targeted to meet the specific needs of you and your family. All plans cover in-network preventive care at 100% and utilizing an Asante provider will always give you the best benefit, regardless of the plan you choose. The following pages will illustrate the benefits available with each health plan, how your health plan works with a HealthEquity tax-free account, the online resources available to you, and the additional programs that Asante has selected to offer you as a valued employee. This guide should help navigate you in the right direction of choosing the plan that is right for you.

All Asante Health Plan options cover 100% of in-network preventive medical care. ASANTE HEALTH PLAN 1

ASANTE HEALTH PLAN 2

ASANTE HEALTH PLAN 3

Premium: $ Out-of-Pocket: $$

Premium: $$ Out-of-Pocket: $$

Premium: $$$ Out-of-Pocket: $

Good Choice if…

Good Choice if…

Good Choice if…

You prefer lower per pay period contributions, and predictable office visit and prescription drug copays

You are interested in taking advantage of alternative care benefits including chiropractic & acupuncture services

You are interested in an HRA that is funded by Asante when you complete wellness activities.*

You are interested in lower deductibles and willing to pay a bit more per pay period

You prefer a highdeductible health plan while paying less per pay period

You prefer predictable office visits and prescription drug copays

You are interested in taking advantage of alternative care benefits including chiropractic & acupuncture services

You are interested in an HRA that is funded by Asante when you complete wellness activities.*

You would like to plan for your future by opening a Health Savings Account (HSA).

*Learn more about our HRA on page 12.

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ASANTE HEALTH PLAN 1 Medical - Administered by Regence BlueCross Blueshield of Oregon Contributions will be made directly to your HealthEquity Health Reimbursement Arrangement (HRA)

Asante Health Fund Contribution Annual Basic Contribution (Only Full-Time employees enrolled as of 1/1/15 are eligible; contributions will be made in January 2015.)

$0

Annual Incentive Award Contribution (All enrolled employees and spouses are eligible; contributions will be made as incentives are earned.)

Up to $75 each per enrolled employee and spouse

Benefit Category

Asante Providers

Preferred Providers

Out-of-Network Providers

Asante Providers and Regence Preferred Providers will cross-accumulate. No crossaccumulation for Out-of-Network Providers. Deductible applies unless otherwise noted.

Annual Deductible Individual Family

$500

$1,000

$1,000

$2,000

Asante Providers and Regence Preferred Providers will cross-accumulate. No cross-accumulation for Out-of-Network Providers. Out-of-Pocket includes deductibles and copays but does not include prescription drug expenses.

Annual Out-of-Pocket Maximum Individual

$2,500

$3,500

$6,000

Family

$5,000

$7,000

$12,000

Preventive Care

Covered 100%*

Physician Office Visit

$15 copay*

40% $25 copay*

40%

Inpatient/Outpatient Facility

15%

30%

40%

Inpatient/Outpatient Professional

15%

15%

40%

Lab/X-Ray

15%

30%

40%

$25 copay*

$25 copay*

Urgent Care

$15 copay*

Emergency Room

$75 copay* (copay waived if admitted)

Acupuncture ($2,000 annual limit when covered)

Not Covered

Chiropractic ($2,000 annual limit when covered)

Not Covered

Prescription Drug (Rx) - Administered by RegenceRx Medical plan deductible and out-of-pocket maximum do not apply to Asante Health Plan 1 and Asante Health Plan 3 prescriptions, or Asante Health Plan 2 preventive prescriptions, as defined by RegenceRx.

Asante Outpatient Pharmacies and Participating Pharmacies (30-day supply)

Annual Deductible

Asante Outpatient Pharmacies and Regence Mail Order Pharmacy (90-day supply)

Out-of-Network Pharmacies

N/A

Not Covered

Individual

$2,500

Not Covered

Family

$5,000

Not Covered

Annual Out-of-Pocket Maximum

Generic Rx

$5 copay*

$10 copay*

Not Covered

Brand Formulary Rx (as defined by RegenceRx)

25%* (up to $30)

25%* (up to $60)

Not Covered

Non-Brand Formulary Rx (as defined by RegenceRx)

30%* (up to $100)

30%* (up to $200)

Not Covered

* = Deductible does not apply

10

% = co-insurance (amount you pay)


2015 ASANTE HEALTH PLAN COMPARISON ASANTE HEALTH PLAN 2

ASANTE HEALTH PLAN 3

Contributions will be made directly to your HealthEquity Health Savings Account (HSA)

Contributions will be made directly to your HealthEquity Health Reimbursement Arrangement (HRA)

$200 - Employee only coverage tier $400 - All other coverage tiers

$200 - Employee only coverage tier $400 - All other coverage tiers

Up to $300 each per enrolled employee and spouse

Up to $300 each per enrolled employee and spouse

Asante Providers

Preferred Providers

Out-of-Network Providers

Asante Providers

Preferred Providers

Out-of-Network Providers

Asante Providers and Regence Preferred Providers will cross-accumulate. No crossaccumulation for Out-of-Network Providers. Deductible applies unless otherwise noted.

Deductible applies unless otherwise noted.

Employee only: $1,300 Employee +1 or more: $2,600 Asante Providers and Regence Preferred Providers will cross-accumulate. No cross-accumulation for Out-of-Network Providers. Out-of-Pocket includes deductibles, copays, and prescription drug expenses.

$1,100

$1,500

$3,000

$2,200

$3,000

$6,000

Asante Providers and Regence Preferred Providers will cross-accumulate. No crossaccumulation for Out-of-Network Providers. Out-of-Pocket includes deductibles and copays but does not include prescription drug expenses.

$2,000

$3,000

$5,000

$2,500

$3,500

$6,000

$4,000

$6,000

$10,000

$5,000

$7,000

$12,000

Covered 100%*

40%

10%

15%

40%

15%

30%

40%

15%

15%

15% 10%

Covered 100%* $15 copay*

40% $25 copay*

40%

15%

30%

40%

40%

15%

15%

40%

30%

40%

15%

30%

40%

30%

30%

$25 copay*

$25 copay*

$15 copay*

$150 copay* (copay waived if admitted)

15%

30%

30%

N/A

20%

40%

N/A

20%

40%

N/A

20%

40%

N/A

20%

40%

Asante Outpatient Pharmacies and Regence Mail Order Pharmacy (90-day supply)

Out-of-Network Pharmacies

Asante Outpatient Pharmacies and Regence Mail Order Pharmacy (90-day supply)

Out-of-Network Pharmacies

Asante Outpatient Pharmacies and Participating Pharmacies (30-day supply)

Asante Outpatient Pharmacies and Participating Pharmacies (30-day supply)

Shared with Medical

Not Covered

N/A

Not Covered

Shared with Medical

Not Covered

$2,500

Not Covered

Shared with Medical

Not Covered

$5,000

Not Covered

$5 copay after deductible

$10 copay after deductible

Not Covered

$5 copay*

$10 copay*

Not Covered

25% (up to $30) after deductible

25% (up to $60) after deductible

Not Covered

25%* (up to $30)

25%* (up to $60)

Not Covered

30% (up to $100) after deductible

30% (up to $200) after deductible

Not Covered

30%* (up to $100)

30%* (up to $200)

Not Covered

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HEALTHEQUITY TAX-FREE ACCOUNTS Maximize your health savings

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HEALTHEQUITY TAX-FREE ACCOUNTS

WAYS TO HELP YOU PAY FOR YOUR OUT-OF-POCKET EXPENSES Asante offers a choice of three benefit plans designed to provide for you and your family’s health care needs. For 2015, Asante has partnered with Regence and HealthEquity to manage your health benefits. As discussed in this guide, there are three Asante Health Plan options to choose from. Each plan can be paired with a different type of tax-free account from HealthEquity to help manage your out-of-pocket costs. 1. Asante Health Plan 1 (AHP 1): paired with an HRA and optional Flexible Spending Account (FSA) and/or a Dependent Care Reimbursement Account (DCRA) 2. Asante Health Plan 2 (AHP 2): paired with an HSA and optional Limited Purpose FSA and/or a Dependent Care Reimbursement Account (DCRA) 3. Asante Health Plan 3 (AHP 3): paired with an HRA and optional Flexible Spending Account (FSA) and/or a Dependent Care Reimbursement Account (DCRA)

It’s easy to save with an Asante FSA: No matter which Asante benefit plan you choose, you might also consider enrolling in one of the three FSA plans Asante has to offer. Enrollment in an FSA is always optional. Use the account for out-of-pocket expenses like deductibles, copays, dental and vision expenses, and eligible dependent care expenses. You fund your FSA account through payroll deductions over the course of the plan year and avoid paying taxes on those earnings.

Asante offers three types of FSAs: 1. FLEXIBLE SPENDING ACCOUNT (FSA): Also known as a health care or medical FSA, this plan allows you to elect up to $2,500 for the year for qualified health care expenses including medical, prescription drug, dental, and vision. You can select this plan with AHP 1, AHP 3, or if you waive health plan coverage entirely. If you select this plan, you will receive a debit card to use at your discretion to pay for eligible expenses from your account. 2. LIMITED PURPOSE FSA (LPFSA): Elect up to $2,500 for the year for qualified dental and vision expenses. If you enroll in AHP 2 you can enroll in this plan but you can only use the account to pay for qualified dental and vision expenses. 3. DEPENDENT CARE REIMBURSEMENT ACCOUNT (DCRA): Also known as a dependent care FSA, this plan allows you to elect up to $5,000 for the year for qualified dependent care expenses, such as day care for your children. You can select this option with any health plan or if you waive health plan coverage entirely. Please note that this plan is intended to pay for dependent care expenses, such as day care, that is essential for you and a spouse to work, look for work, or attend school full-time. It is not to pay for your dependent’s health care expenses.

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How does it work?

SIGN UP: You must actively enroll in an FSA during Asante’s Open Enrollment — even if you are currently enrolled in an FSA plan.

CONTRIBUTIONS: You contribute through payroll deductions throughout the year. Typically the amount withheld from your paycheck is equal each pay period.

USE YOUR FUNDS: If you enroll in the FSA, you can use your debit card provided by HealthEquity when you incur a qualified expense. If you enroll in the DCRA or the LPFSA, you can submit the expenses through the HealthEquity online tool for reimbursement. After January 1, 2015, you can create and log into your myHealthEquity.com account to learn more about the debit card and other reimbursement and payment options, including online bill pay. You will receive a Welcome Kit that will provide more details on how to use your FSA.

Use it or lose it! FSA funds do not roll over from year to year. You should use all of your FSA dollars within the plan year or they may be forfeited.

Keep money in your pocket with an Asante HRA: If you choose AHP 1 or AHP 3, you will be automatically enrolled in Asante’s HRA benefit plan. An HRA is another type of savings account, but only Asante can make contributions to it. Asante will only contribute to your HRA if you qualify, and you can use those funds to help pay your out-of-pocket expenses including deductibles, copays, coinsurance, or dental and vision expenses.

How does it work?

• SIGN UP: Choose AHP 1 or AHP 3. • CONTRIBUTIONS: Asante determines the amount of money it will contribute to your HRA based on your employment status and which plan you select. You can also earn money throughout the year by participating in wellness activities. See page 19 for more details on wellness and pages 8-9 for the plan comparisons.

USE YOUR HRA: Once you incur an eligible expense, you will need to submit reimbursement requests to HealthEquity online or complete a claim form and attach your receipts. Any unused funds will roll over to the following year. If you have a current HRA with Cigna, that account will automatically roll over to HealthEquity after the first of the year.

Build personal savings with an Asante HSA: If you enroll in AHP 2, in most cases you can have a Health Savings Account (HSA). An HSA is a personal savings account for your health care. You own it. And you can save and spend the funds you contribute to your account tax free.* If you qualify, Asante will contribute to your HSA to help pay for your qualified out-of-pocket expenses. Unused funds stay in the account and can be used for future needs. There is no “use it or lose it” rule with HSAs as there is with FSAs. 14


How does it work?

SIGN UP: Choose AHP 2. If you indicate during Open Enrollment that you are eligible for an HSA, one will automatically be set up for you. If you already have an HSA with JPMorgan Chase, you will receive information from HealthEquity on how to transfer those funds to HealthEquity. You will need to indicate during Open Enrollment how much you would like to put into your HSA via payroll deductions. You can change this amount at any time throughout the year by contacting Asante Human Resources.

BUILD SAVINGS: You can make contributions to your account and Asante will also make contributions on your behalf in certain cases. Asante determines the amount of money it will contribute based on your employment status. You can also earn money throughout the year by participating in wellness activities. See page 19 for more details on wellness and pages 8-9 for the plan comparisons.

USE YOUR FUNDS: You decide when to use the funds for eligible expenses. Your account includes a debit card or you can use HealthEquity’s member portal or mobile app to pay claims. You will receive a Welcome Kit that will provide more details on how to use your HSA. HealthEquity provides monthly statements for your HSA. Electronic statements (E-statements) are free but there is a $1.00 per month charge for paper statements. To switch to E-statements just call HealthEquity any time. When you switch from paper to electronic statements, HealthEquity will automatically reimburse you for any statement fees that have been assessed for the current and prior month.

* HSAs are typically not taxed at a federal income tax level when used appropriately for qualified medical expenses. Refer to IRS.gov for more details. Note: HSAs have special eligibility requirements and contribution limits so please refer to IRS.gov for details.

Tax-Free Account Highlights

HRA

HSA

FSA

P

P

P P

P P

P

P

P

You can contribute pre-tax payroll contributions to this account Asante can contribute to this account** Contributions and eligible distributions are tax-free to you Unused amounts roll over to the next year

**(Refer to page 8, 9, and 19 and plan comparisons for details on Asante contributions)

Online payments are simple and fast using HealthEquity’s online payment system: No matter which option you choose, HealthEquity offers a convenient member portal for you to manage and pay your expenses. Regence sends medical and pharmacy claim information directly to HealthEquity, which is viewable in your online account and providers can be paid directly from the portal.

Need help? HealthEquity is available every hour of every day. When you call you will talk to a live representative ready to answer questions and help you maximize your health savings. HealthEquity also supports multiple languages for those who prefer it. Call anytime at 1 (866)-960-8055. 15


VALUE-ADDED PROGRAMS Get rewarded for your good health

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VALUE-ADDED PROGRAMS

ASANTE WELLNESS PROGRAM 2015 Asante wants to help you get healthy and stay healthy! With this program, you can earn financial rewards for participating in certain healthy activities — the more you do, the more you earn! This wellness program is similar to the program offered in the past by Cigna, but the 2015 program is available to you through Asante’s new partnership with Regence.

Don’t leave $$$ on the table! Check out some great ways to earn financial rewards toward your HRA or HSA for participating in wellness! Both you and your spouse can earn the rewards listed below based on the plan you select. Asante Health Plan 1 Who Is Eligible?

Award Amount

Have a consultation with a Regence Health Coach regarding your Regence Health Assessment results.

Employee & Spouse

$25

Complete a Regence Health Coach Track or meet a goal related to one of the five tracks* or participate in Asante’s onsite BodySmart weight loss program.

Employee & Spouse

$25

Declare your Tobacco Free status or complete the Regence Tobacco Cessation Program with a Regence Health Coach or complete Asante’s onsite Breath for Life Tobacco Cessation Program.

Employee & Spouse

$25

Complete a Preventive Exam.**

Employee & Spouse

$25

Incentive Opportunities

TOTAL Funds Available Per Participant:

Cap Amount (Annual Total)

Asante Health Plan 2 and 3 Award Amount

Cap Amount (Annual Total)

$100

$50

$100

$200

$100

$25

$100

$75

$100 $300

*Five tracks available: Weight Management and Nutrition, Stress Management, Exercise, Sleep Management, and Tobacco Cessation **Age Appropriate Preventive Exams include: Adult Physical, Routine OB/GYN Exam, Colorectal Cancer Screening, Cervical Cancer Screening and Routine Mammogram. Certain limits apply. Award is trigged after Regence processes the claim from your provider.

In addition to the incentive amounts outlined above, pregnant employees/spouses who participate in the Regence Special Beginnings Program can earn additional incentives. To learn more about the Special Beginnings program, please see page 23.

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ASANTE WELLNESS FAQS Understanding your wellness rewards


Earn a $25 Gift Card! As a Regence member, there are many resources to help you improve your health and keep you on track. To help get you started, Regence is offering you and your covered spouse a BONUS $25 gift card for completing the General Health Assessment on Regence.com! This gift card will only be available between January 1, 2015 and August 31, 2015 and is not awarded for completion of the Cigna online health assessment that is part of the Asante Know Your Numbers wellness program.

As an Asante Health Plan member: •

You will receive your Regence ID Card in late December and can register on Regence.com any time after January 1, 2015.

Once you have registered and are on the Regence member dashboard, simply click on the Wellness Tools link, this will take you to the wellness homepage — the General Health Assessment is located under the Health tab.

Frequently Asked Questions

1.

How do I participate in a consultation with a Health Coach to review my Health Assessment results? STEP ONE: Complete the General Health Assessment on Regence.com after January 1, 2015 by logging into Regence.com>Wellness Tools> Health> General Health Assessment.

STEP TWO: Engage with a Health Coach! Select ‘Yes’ to the Opt-In pop-up to have a Health Coach contact you or call 1 (800) 856-8543 to speak with a Health Coach!

What do I get from the Health Coach program? How do I enroll? The Regence Health Coaches are a dynamic team of six health experts located in the Pacific Northwest who offer personal guidance and confidential coaching. The Health Coach program has five tracks available: Weight Management and Nutrition, Exercise, Stress Management, Sleep Support, and Tobacco Cessation. To complete a track, you and your Coach will work through a workbook with health education content, goal setting parameters, and more! To earn the incentive, you will need to work with a Health Coach to either complete one of these five tracks, or accomplish a goal while working with a Health Coach through a track.

LEARN MORE ABOUT HEALTH COACHING! Log into Regence.com> Wellness Tools> Health Coach

2.

3.

How do I certify my current tobacco status? To certify your current tobacco status, you will need to log onto Regence.com after January 1st. From the Regence Member Dashboard, select Wellness Tools and on the wellness page, you will see an area titled Asante Tobacco Declaration; select the most accurate statement with regards to your current tobacco use here.

4.

How will I earn credit for completing these items? All you have to do is participate and leave the tracking to our partners at Regence! Once you have completed a task that earns you HSA or HRA dollars from Asante, you will see those dollars appear in your account within a few weeks.

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CARE MANAGEMENT A trained case manager will be your advocate to help you gain personal insight, provide education and maximize your health benefits


HEALTH SUPPORT

CARE MANAGEMENT is for health challenges, big and small. Facing a health issue? Need help through the health care system? Our team of professionals is here for you. You’re never alone. No matter what kind of help you need—from quick medical advice to intense condition management—we have people and programs for you. These programs are not insurance but are offered in addition to your Asante Health Plan to help you get information and support when you need it.

Case Management 1 (866) 543-5765 If you ever face a serious or sudden medical issue, case managers—experienced registered nurses and social workers—are here to answer questions and help you feel good about your decisions. They work with you and your doctor to support a treatment plan based on your needs, support system and benefits. Case managers also work with disease managers and behavioral health clinicians to help with chemical dependency, depression and other chronic conditions.

Regence Condition Manager 1 (800) 267-6729 If you have diabetes, asthma, chronic obstructive pulmonary disease (COPD), heart failure or coronary artery disease (CAD), this program can help you. Health care professionals help you understand and stay with a treatment strategy. Experienced nurses are available 24/7 to answer questions. Also visit Regence.com to better understand and manage your health. By signing up, you’ll receive helpful information such as newsletters and care reminders.

Regence Advice24 1 (800) 267-6729 Sick or hurt and just want to talk to someone to see what you should do? Call our 24/7 nurse line. Registered nurses will help you decide when to visit the emergency room, see your doctor or treat your condition at home. Calls are free and confidential.

Special Beginnings® 1 (888) JOY-BABY (1-888-569-2229) When you’re expecting, your main goal is to have a healthy, full-term baby. This program gives you prenatal education and support to increase your chances of doing just that. The program also offers a 24/7 nurse advice line. Asante is offering an incentive for joining Special Beginnings — contact us and earn $150 if you enroll in the 1st trimester and $75 if you enroll in the 2nd trimester. The money earned will be deposited into your HRA or HSA.

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ASANTE PHARMACY BENEFITS Save the most with Asante Outpatient Pharmacies

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ASANTE PHARMACY BENEFITS

MAKE YOUR RX PLAN WORK FOR YOU Save time and money with these programs and tips. Can you fill a 90-day supply? Should you switch to a generic? Get these answers and more. Prescription in hand—now what? Head for an Asante Outpatient Pharmacy or a participating pharmacy! Most pharmacies in your area are probably in our network. We have participating pharmacies across the United States. Visit RegenceRx.com to find one near you. Show your Regence ID Card. The pharmacist will use it to send Regence your claim online and tell you right then and there how much you owe. You’ll be on your way in no time.

Save time and money. 90-Day Supply Many of the medications you take on a regular basis may be eligible to be filled at a 90-day supply through an Asante Outpatient Pharmacy. This option saves you trips to the pharmacy and may save you money through lower copays. For assistance with obtaining a 90-day supply of your medications, contact an Asante Outpatient Pharmacy at 1 (541) 789-5850. You also have the option of receiving a 90-day supply of your medication through Regence’s mail order pharmacy. Contact RegenceRx for more details. Specialty Pharmacy If you take a specialty medication (medications for rare conditions and those that need special handling), you will likely have lower out-of-pocket costs when you use your Asante Outpatient Pharmacy. When needed, your plan allows one fill at a participating retail pharmacy then requires that you use an Asante Outpatient Pharmacy for your specialty medication refills. Generics Ensure that you receive the lowest copay by choosing a generic. Generics and brand-names have the same strength, quality and purity. But generics generally cost 20% to 60% less, so ask your doctor if a generic alternative is right for you. Then be sure to check out the formulary (preferred drug list) at RegenceRx.com.

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WELL TIP

24

Fill a 90-day supply at Asante Outpatient Pharmacies. Less trips to the pharmacy!


Formulary* This list of preferred prescription drugs—called a formulary—helps you and your doctor choose the medication that’s best for your health and your wallet. We’ve done extensive research to narrow our formulary options to the safest, most effective and budget-friendly available. By choosing a formulary option you’re choosing a lower copay. Non-formulary or non-preferred brand-name medications aren’t found on our formulary. You can still use these medications, but your cost will be higher. *Regence and Asante are working together to minimize potential impacts to members moving to Regence.

Prior Authorization** Some brand-name medications require prior authorization before they will be covered. If your doctor writes you a new prescription for one of these medications, you’ll need to have him or her submit a prior authorization request to Regence for approval before the medication will be covered by the health plan. Regence will review the request along with your medical or medication history that will be submitted along with the request in order to make a determination on plan coverage. **Regence and Asante are working together to minimize potential impact for members moving to Regence who are currently taking a medication that requires prior authorization.

25


ONLINE TOOLS You can access Regence.com on your mobile device


ONLINE TOOLS

REGENCE.COM Get everything you need to know about your medical and prescription plan — your complete source of health, wellness, benefit and claims information. Consider health care decisions and explore options:

• • • • •

Manage your claims online and review your Explanation of Benefits. Find details on your benefits. Learn about medical conditions and medications. Explore health articles and videos. Discover tools that help you track your coverage and make informed decisions about your health care.

Regence.com is also where you can find the health and wellness programs available to you and learn about your benefits and incentives. To access your account, visit Regence.com after January 1, 2015. To create your online profile, you will need your Regence ID number and group number found on your ID card.

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REGENCERX.COM Your tool for pharmacy and medication questions. At RegenceRx.com, you can find:

The latest formulary (or preferred medication list), a glossary of insurance terms, prior authorization information, a pharmacy locator, specialty program information, facts about generics, and much more.

Visit today to take advantage of the tool that will help you make the most of every dollar spent on medications. You will not need to create a profile to access RegenceRx.com.

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Healthsparq: Shop, compare and save on health care.

See reviews and prices for over a million treatments, doctors and hospitals. Your health plan comes with new online tools that support informed decision making when it comes to your health:

Search for a condition, doctor or facility and easily compare prices for treatments and services.

Find Asante providers and other preferred providers that will offer the best benefit under the plan.

The HealthSparq tool will be available after January 1, 2015. You will receive information on how to access HealthSparq in early 2015. Prior to January 1, 2015 go to Regence.com and key in ‘Asante Provider Directory’ in the topright search bar. Click on the PDF to view available providers. Search doctors, treatments and facilities

Review treatment plan timelines

See your out-of-pocket cost estimates

Check out patient reviews and ratings

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MYHEALTHEQUITY.COM Use the HealthEquity member portal to check your FSA, HSA, or HRA balance, view medical and pharmacy claims, pay providers and more. If you enroll in AHP 1 or AHP 3, this site will give you everything you need to understand and use your HRA that comes along with your plan. Likewise, if you enroll in AHP 2 and indicate during Open Enrollment that you are HSA-eligible, or are already enrolled in AHP 2 and are transferring your current JPMorgan Chase HSA over to HealthEquity, this site will be your go-to resource for managing your HSA.

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Regence is connected to HealthEquity, so your medical and pharmacy claims will be automatically uploaded to HealthEquity’s site to make it even easier to pay your providers online from your account or submit for reimbursement.

To access your account, visit myHealthEquity.com after January 1, 2015. To create your online profile, you will need your name, birth date, and the last four digits of your social security number.

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EXPLANATION OF BENEFITS

EOB QUICK GUIDE We will send you an Explanation of Benefits whenever we are billed for medical services you have received. The report explains how the bill was applied to your health care benefits. You will see a description of the billed charges and payments we have made.

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Explanations:

1 - Date this claim was processed Explanations: 2 - Reference number relating to this particular claim

6 - Total amount billed 7 - Amount not covered

3 - Name of the doctor or facility providing medical care

8 - Amount applied to patient’s deductible (when applicable) 1 – Date this claim was processed 7 – Amount not covered 9 - Amount in excess of the contract benefits limits. This is the patient balance 52- Date services were rendered Total amount paid to provider(s) – Reference number relating to10 -this 8 – Amount applied to patient’s deductible 11 - Total patient expense particular claim (when applicable) 3 – Name of the doctor or facility providing 9 – Amount in excess of the contract benefits medical care limits. This is the patient balance. 4 – Description of services 10 – Total amount paid to provider(s) 5 – Date services were rendered 11 – Total patient expense 6 – Total amount billed 4 - Description of services

Questions on an EOB you received? Call Customer Service at 1 (866) 240-9580.

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HELPFUL TERMS We know that insurance terms can be confusing, so here’s what they really mean: Allowed amount The lower prices that network providers have agreed to accept as payment in full for the medical services they provide to you.

Coinsurance An amount you may be required to pay as your share of the cost for services or prescription drugs after you pay any deductibles. Coinsurance is usually a percentage (for example, 30%).

Copay A flat dollar amount you may be required to pay at the time you receive a medical service or supply, like a doctor’s visit, hospital outpatient visit or prescription drug. For example, you might pay $25 for a doctor’s visit or prescription drug.

Deductible The amount you must pay out of your own pocket each calendar year before your plan begins to pay. Some services, such as preventive care, are covered by your plan before you meet your deductible.

Durable medical equipment (DME) Certain medical equipment that is ordered by your doctor for medical reasons. Examples are walkers, wheelchairs or hospital beds.

Explanation of benefits (EOB) A statement that explains how your health plan processed your claims, how much the plan paid and how much you owe the provider.

Exclusions Health plans do not cover all health care services. Exclusions are those services not covered by, or excluded from, the health plan.

Formulary (list of preferred drugs) A list of prescription medications covered by your plan. The drugs on this list are selected by a committee of doctors and pharmacists. The list includes both brand-name and generic drugs.

Generic drugs A prescription medication that is approved by the Food and Drug Administration (FDA) as having the same active ingredient(s) as the brand-name drug. Generally, a generic drug works the same as a brand-name drug and usually costs less.

Limitations Some benefits are limited to a set number of days or visits, or even dollar amounts, per calendar year. For example, 60 physical therapy visits or 90 days of skilled nursing care.

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Out-of-network providers Facilities or health professionals that are not contracted with your plan to deliver covered services to you. Your costs are usually higher when you use out-of-network providers.

Out-of-pocket costs The costs you pay out of your own pocket for your covered care. Examples are coinsurance, copays and deductible amounts.

Out-of-pocket maximum The most you will have to pay out of your own pocket for covered care in a calendar year (in deductible, copays and coinsurance). Once you meet the out-of-pocket maximum, your plan pays 100% for covered care for the rest of the year.

Preferred providers Medical professionals and facilities that have agreed to accept a lower price (called an allowed amount) as payment in full for services that they provide to you.

Preventive services Health care, such as screenings and immunizations, that help keep you well.

Primary care physician (PCP) The doctor who many people see first for preventive care and general health concerns. He or she makes sure you get the care you need to keep you healthy and can connect you to specialists when needed.

Provider A facility, doctor or other health professional that provides you with medical care or related services.

Specialist An expert in a particular area of medicine. For example, dermatologist, allergist or cardiologist.

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QUESTIONS? Our customer service specialists are here to help.

(TTY: 711)

To find out more about your specific Asante plan, contact Regence Customer Service at 1 (866) 240-9580. Our call and claims centers are located right here in the Pacific Northwest. If you have any questions, a live representative is ready to help you. You can also visit Regence.com for assistance 24/7.

Spanish – Para asistencia en español, por favor llame al teléfono de Servicio

07399-LG-or/02-14 © 2014 Regence BlueCross BlueShield of Oregon

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Regence Health Care Benefits Guide  

A benefits guide to present Regence Health Care and Asante new health and wellness programs in 2015 to Asante members affected by the merger...

Regence Health Care Benefits Guide  

A benefits guide to present Regence Health Care and Asante new health and wellness programs in 2015 to Asante members affected by the merger...

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