Everything you need to know about your health plan Welcome to Independence Blue Cross Thank you for choosing Independence Blue Cross. Our goal is to provide you with health care coverage that can help you manage your health care needs. This Benefit Booklet will help you understand your Independence coverage so that you can take full advantage of your membership by becoming familiar with the benefits and services available to you. You’ll find valuable information on: • What services are and are not covered by your health insurance. • How decisions are made about what is covered. • How to use our member website, ibxpress.com. • How to get in touch with us if you have a problem. If you have any other questions, feel free to call Customer Service at 1-800-ASK- BLUE (TTY: 711) and we will be happy to assist you. Again, thank you for being a member of Independence Blue Cross. We look forward to providing you with quality health care coverage. Introduction to your health plan You have Personal Choice® PPO coverage, which means you have the freedom to see any doctor or specialist in or out of our large network, without a referral. You will also receive the highest level of benefits when you receive care through our “preferred” network. Using your ID card You and your covered dependents will each receive an Independence Blue Cross identification (ID) card. It is important to take your ID card with you wherever you go because it contains information like what to pay when visiting your doctor, specialist, or the emergency room (ER). You should present your ID card when you receive care, including doctor visits or when checking in at the ER. The back of your ID card provides information about medical services, what to do in an emergency situation, and how to use your benefits when out of network. If any information on your ID card is incorrect, you misplace an ID card, or need to print out a temporary ID card, you may do so through ibxpress.com, our member website. You may also call 1-800-ASK-BLUE (TTY: 711) and we will issue you a new ID card. IBX Wire When you receive your ID card, call the toll-free number on the sticker affixed to the card to confirm receipt. You will also be given the option to sign up for IBX Wire, a free messaging service. IBX Wire is an innovative way for you to receive timely and helpful communications on your smartphone. If you choose to opt in, you will have access to a private message board and will receive text messages about once every other week that communicate helpful, relevant information about your health plan, maximizing your benefits, and wellness programs. Locating a network physician or hospital You have access to our expansive provider network of physicians, specialists, and hospitals. You may search our provider network by going to www.ibx.com/providerfinder. You may search by specialty (e.g. internal or pediatrics), location, gender preference, and distance. You may also call 1- 800-ASK-BLUE (TTY: 711) and a Customer Service associate will help you locate a provider. How to receive care Scheduling an appointment Simply call your doctor’s office and request an appointment. If possible, call network providers 24 hours in advance if you are unable to make it to a scheduled appointment. Obtaining precertification You are not required to obtain precertification when you are treated in a Personal Choice network hospital or facility or by a Personal Choice network physician. If your Personal Choice network provider fails to obtain precertification, you will not be responsible for financial penalties. When you must obtain precertification: If you are receiving care from a BlueCard PPO provider, another Blue plan provider, or an out-of-network provider, you are responsible for initiating precertification or prior authorization. Call 1-800-ASK-BLUE (TTY: 711) to speak with a Care Management and Coordination team member to obtain precertification for your need. Using your preventive care benefits Quality care and prevention are vital to your long-term health and well-being. That’s why we cover 100 percent of certain preventive services, offering them without a copayment, coinsurance, or deductible if received from your in- network provider. Covered preventive services include, but are not limited to:  screenings for: – breast, cervical, and colon cancer – vitamin deficiencies during pregnancy – diabetes – high cholesterol – high blood pressure  routine vaccinations for children, adolescents, and adults as determined by the CDC (Centers for Disease Control and Prevention)  women’s preventive health services, such as: – well-woman visits (annually); – screening for gestational diabetes; – human papillomavirus (HPV) DNA testing; – counseling for sexually transmitted infections; – counseling and screening for human immunodeficiency virus (HIV); – screening and counseling for interpersonal and domestic violence; – breastfeeding support, supplies (breast pumps), and counseling; – generic formulary contraceptives, certain brand formulary contraceptives, and FDA-approved over-the-counter female contraceptives with a prescription. Be sure to consult with your doctor for preventive services and/or screenings. * Medical contraceptive procedures, including implantable contraceptive devices and injectable contraceptives, are covered with no cost-sharing when performed by participating In-network providers. If your health plan includes a prescription drug benefit, certain FDA approved contraceptives are covered with no cost-sharing when the prescription is filled at a participating In-network pharmacy. Other exemptions may apply. Refer to your member handbook and/or benefit booklet to determine if your plan covers in-network preventive services and/or preventive drugs with no cost-sharing. Wellness Guidelines Your health and wellness are important. That’s why we provide you with these nationally recommended tests and screenings to help you and your family stay healthy. We encourage you to take the time to review these guidelines and discuss them with your health care provider. Some of these services may require cost- sharing. * Additional resources along with tips to stay healthy and safe and topics to discuss with your health care provider are included. To download our Wellness Guidelines, log on to ibxpress.com and click on the Health & Wellness Programs tab. Then click on Healthy Living, and then on Wellness Guidelines. * The Wellness Guidelines are a summary of recommendations based on the U.S. Preventive Services Task Force and other nationally recognized sources. These recommendations have been reviewed by our network health care providers. This information is not a statement of benefits. Please refer to your health benefit plan contract/member handbook or benefits handbook for terms, limitations, or exclusions of your health benefits plan. Please contact our Customer Service department with questions about which preventive care benefits apply to you. The telephone number for Customer Service can be found on your ID card. Emergency care In the event of an emergency, go immediately to the emergency room of the nearest hospital. If you believe your situation is particularly severe, call 911 for assistance. A medical emergency is typically thought of as a medical or psychiatric condition in which symptoms are so severe, that the absence of immediate medical attention could place one’s health in serious jeopardy. Most times, a hospital emergency room is not the most appropriate place for you to be treated. Hospital emergency rooms provide emergency care and must prioritize patients’ needs. The most seriously hurt or ill patients are treated first. If you are not in that category, you could wait a long time. Urgent Care Urgent care is necessary treatment for a non-life-threatening, unexpected illness or accidental injury that requires prompt medical attention when your doctor is unavailable. Examples include sore throat, fever, sinus infection, ear ache, cuts, rashes, sprains, and broken bones. You may visit an urgent care center which offers a convenient, safe, and affordable treatment alternative to emergency room care when you can’t get an appointment with your own doctor. Retail health clinic Retail health clinics are another alternative when you can’t get an appointment with your own doctor for non-emergency care. Retail health clinics use certified nurse practitioners who treat minor, uncomplicated illness or injury. Some retail health clinics may also offer flu shots and vaccinations. Not sure what facility to use? Go to www.ibx.com/findcarenow to help you decide where to go for care. ® You’re covered while traveling with BlueCard PPO You can travel with the peace of mind knowing that Blue goes with you wherever you go. With BlueCard PPO, you simply present your ID card to any participating ® ® Blue Cross and/or Blue Shield PPO provider across the country and your costs are the same as if you were being treated by an in-network local doctor or hospital. If you run into a medical emergency when you are far away from home, you have two different options:  In a true emergency, go to the nearest ER.  In an urgent care situation, find a BlueCard provider in the area. Call 1-800-810-BLUE (TTY: 711) to find an in-network provider in the area. You may also visit an urgent care center for medical issues if an in-network provider is unavailable and if you do not require the medical services of an emergency room. You may also visit the BlueCard Doctor and Hospital Finder at www.bcbs.com. Receiving services for mental health, alcohol, or substance abuse treatment Magellan Behavioral Health administers your mental health and substance abuse benefits like outpatient or inpatient mental health or substance abuse services. Call 1-800-ASK-BLUE (TTY: 711). Refer to the terms and conditions of your group health plan to find out if you have coverage for mental health and substance abuse benefits. Stay Connected On ibxpress.com you can conveniently and securely view your benefits and claims information and use the tools that help you take control of your health. As an Independence Blue Cross member, you and your dependents 14 years of age and older can create your own accounts on ibxpress.com. Register on ibxpress.com To register, simply go to ibxpress.com, click Register, and then follow the directions. You will need information from your ID card to register, so be sure to have it handy. Once you’re registered, log on to ibxpress.com to: • view your benefits information; • review claims information; • review annual out-of-pocket expenses; • request a replacement ID card and print a temporary ID card; • view and print referrals; • download forms. Online tools to help make informed health care decisions The ibxpress.com website also provides you with tools and resources to help you make informed health care decisions: • Provider Finder and Hospital Finder help you find the participating doctors and hospitals that are equipped to handle your needs. Simple navigation helps you get fast and accurate results. Plus, when you select your health plan type your results are customized based on your network, making it easy to locate a participating doctor, specialist, hospital, or other medical facility. You’ll even be able to read patient ratings and reviews and rate your doctors and write your own reviews. • Health Encyclopedia provides information on more than 160 health topics and the latest news on common conditions. • Treatment Cost Estimator helps you estimate your costs within certain geographic areas for hundreds of common conditions — including tests, procedures, and health care visits, so you can plan and budget for your expenses. You even have access to tools and programs to help you make lifestyle changes by helping you get started, setting reachable goals, and giving you ways to track your progress. • Personal Health Profile gives a clear picture of what you are doing right and ways to stay healthy. After completing the Personal Health Profile, you will receive a confidential and personalized action plan. • My Health Assistant is a personal coaching tool that provides an interactive, targeted approach to healthy behavior change. • Health Trackers allow you to track your blood pressure, cholesterol, body fat, and even exercises.  Personal Health Record helps you store, maintain, track, and manage your health information in one centralized and secure location. Your Personal Health Record is updated once we process claims received from participating providers. Save money with wellness discounts from Blue365®. You can enjoy exclusive value-added discounts and offers on programs and services from leading national companies. Blue365 gives you an easy-to-use, valuable resource to save on healthy programs and services. Visit www.blue365deals.com to see the latest discounts. Manage your health on the go with the IBX App Download the free IBX App for your smartphone to help you make the most of your health plan. The IBX App gives you easy access to your health care coverage 24/7, wherever you are. Use the Doctor’s Visit Assistant on the IBX App to:  view and share your ID card  check the status of referrals and claims  access your health history and prescribed medications  record notes and upload photos of symptoms to discuss with your doctor The IBX App also offers expanded provider search capabilities and other ways to manage your health on the go:  find doctors, hospitals, urgent care centers, and Patient-centered Medical Homes  access benefit information  track deductibles and spending account balances  Download from the App store or Google Marketplace. Log in to the App with the same username and password you use for ibxpress.com. Connect with us on Facebook and Twitter “Like” the Independence Blue Cross page on Facebook or follow us on Twitter, and you’ll find a whole new approach to making healthy lifestyle changes, one step at a time.  Receive health and wellness tips that can help you improve your well-being.  Enter contests and promotions.  Connect with other health-minded fans. Customer Support When you need us, we’re here for you. You can contact us to discuss anything pertaining to your health care, including:  benefits and eligibility  claims status  requesting a new ID card  wellness programs Email To send a secure email to Customer Service, log on to www.ibxpress.com and click on the Contact Us link. On the Contact Us page you will see a link that allows you to send your inquiries or comments directly to Customer Service. Mail Independence Blue Cross 1901 Market Street Philadelphia, PA 19103-1480 Our walk-in service, located at 1919 Market Street, 2nd Floor, is open Monday through Friday from 8 a.m. to 5 p.m. Call Call 1-800-ASK-BLUE (TTY: 711) to speak to one of our experienced Customer Service team members, who are available to answer your questions Monday through Friday, 8 a.m. to 6 p.m. Services for members with special needs If a language other than English is your primary language, call Customer Service at 1- 800-ASK-BLUE (TTY: 711) and they will work with you through an interpreter over the telephone to help you understand your benefits and answer any questions you may have. Key terms You will find key terms and definitions in detail included in the benefit booklet. You may also view the glossary of key terms in Health Care Reform by visiting ibx.com/HCR_Glossary. Using your prescription drug benefits Find out how to fill prescriptions Independence Blue Cross Prescription Drug Program Your prescription drug benefit program, administered by FutureScripts®, an independent company, provides many advantages to help you easily and safely obtain the prescription drugs you need at an affordable cost. Take a look at the advantages: • Easy to use. A national network of retail pharmacies will recognize and accept your member identification (ID) card. • Low out-of-pocket expenses. When you use a participating pharmacy, your out-of-pocket costs are based on a discounted price, fixed copayments, or coinsurance. • No paperwork. You don’t have to file a claim form or wait for reimbursement when you use a participating pharmacy. • High level of safety. When you fill a prescription at a participating pharmacy, your pharmacy can identify harmful drug interactions and other dangers by viewing your drug history. • For maintenance drugs needed to treat ongoing or chronic conditions – Home delivery. Your program may allow you to receive drugs right at your door when ordered through the mail order service, eliminating time spent waiting in line at the pharmacy counter. – Mail order purchases allow you to get a larger supply of drugs than what might be available to you at the retail pharmacy. And, depending upon your plan design, your out-of-pocket expenses may be lower and you won’t have to visit the pharmacy as often. How to fill your prescription at a retail pharmacy Present your ID card and your prescription at a FutureScripts participating pharmacy for your plan. The pharmacist will confirm your eligibility for benefits and determine your share of the cost of your prescription. Your doctor may also electronically submit your prescription to your pharmacy. Participating pharmacies A pharmacy is considered participating if it is in the FutureScripts pharmacy network for your plan. The FutureScripts network is a large national network of retail pharmacies. When you’re traveling, you will find that most of the pharmacies in all 50 states accept your ID card and can fill your prescription for the same cost you pay at home, if you use a participating pharmacy. There is no need to select just one pharmacy to fill your prescription needs. To locate a participating pharmacy, visit www.ibxpress.com or call the number on your ID card. Non-participating pharmacies If your prescription is filled at a pharmacy that does not participate in the network for your plan, you will have to pay the pharmacy’s regular charge right at the counter. Then, depending on your plan design, you may submit a prescription reimbursement claim form for partial reimbursement to the address noted on the form. Your reimbursement check should arrive within 14 days from the day your claim form is received. Keep in mind that your plan sponsor selected Independence Blue Cross (IBC) and/or its subsidiaries based in part on the discounted drug prices that FutureScripts has negotiated. When you use a non-participating pharmacy that has not agreed to charge a discounted price, it costs your plan more money; part of that cost is passed on to you. Understanding your prescription A brand drug is manufactured by only one company, which advertises and sells its product under a special trade name. In many cases, brand drugs are quite expensive, which is why your share of the cost is higher. Generic drugs are typically manufactured by several companies and are almost always less expensive than the brand drug. Generic drugs are approved by the U.S. Food and Drug Administration (FDA) to ensure they are as safe and effective as their brand counterparts. However, not every brand drug has a generic version. We provide our members with comprehensive prescription drug coverage. The drug formulary includes generic drugs and a defined list of brand drugs that have been evaluated for their medical effectiveness, positive results, and value. The formulary is reviewed regularly to ensure its continued effectiveness. To check the formulary status of drugs, simply log onto ibxpress.com. In addition to the drug formulary, you will also find helpful information on these related topics:  Prior authorization process  Age and quantity level limits If you’re not sure if brand or generic drugs are right for you, talk to your doctor. The pharmacist may, on occasion, discuss with your physician whether an alternative drug might be appropriate for you. Let your physician know if you have a question about a change in prescription or if you prefer the original prescription. Your physician makes the final decision on the necessity of you getting a brand drug. Certain controlled substances and other prescribed medications may be subject to dispensing limitations. If you have any questions regarding your medication, please call the Pharmacy Benefits number on the back of your ID card. Preventive drugs for adults and children IBC’s prescription drug plans include 100-percent coverage for some preventive medications when received from an in-network pharmacy. This means that you won’t have to pay copays, coinsurance, or deductibles for certain preventive medications with a prescription from your doctor. Receiving this preventive care will help you stay healthy and may improve your overall health. For a list of preventive drugs eligible for 100-percent coverage please go to www.ibx.com or call the phone number on the back of your ID card.