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SPRING 2015

Take Charge

- Know when to go to the ER

- How we protect your privacy

- Save money on your care

Our online tools make it easier to manage your healthcare

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At Blue Cross of Idaho, we’re always looking for new ways to make your life easier.

Read on to learn about the new tools we’ve introduced that can help you make informed decisions and get the most out of your health insurance (page 4).

Additionally, get helpful tips about knowing whether you should go to the ER or urgent care (page 7). Learn about the steps we take to make sure our members get the right healthcare at the right time and for the right price (page 6).

Our goal is to make using your insurance and maintaining your health easier. Take a moment to check out all the ways you can make the most of your health coverage.

Healthcare Simpler

Let’s Make

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Benefits described in this publication are not a guarantee of coverage. Always check your Blue Cross of Idaho plan description for a list of covered services and costs for your health insurance plan.

= TeRM To le ARn

Out-of-Pocket MaximumA fi xed-dollar amount. This is the most you will pay for deductibles and coinsurance for most covered services during the benefi t period. Once your out-of-pocket maximum is met, most covered services are paid at 100 percent of the allowed amount.

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make your life easier.Read on to learn about the new tools we’ve introduced that can

help you make informed decisions and get the most out of your health insurance (page 4).

Additionally, get helpful tips about knowing whether you should go to the ER or urgent care (page 7). Learn about the steps we take to make sure our members get the right healthcare at the right time and for the right price (page 6).

Our goal is to make using your insurance and maintaining your health easier. Take a moment to check out all the ways you can make the most of your health coverage.

A fi xed-dollar amount. This is the most you will pay for deductibles and coinsurance for most covered services during the benefi t period. Once your out-of-pocket maximum is met, most covered services are paid at 100 percent of the allowed amount.

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The brand-name drugs below have recently been released in a generic form. generics are a safe and effective way to lower the cost of your medications. Ask your doctor or pharmacist if a generic medicine is right for you.

BrAND NAME gENErIC NAME MEDICATION USE

Astepro Azelastine hydrochloride Allergies

Differin Adapalene Acne

Diovan valsartan and hydrochlorothiazide

hypertension

Evista raloxifene hydrochloride Osteoporosis in post-menopausal women

Lipofen Fenofibrate high cholesterol and triglyceride levels

Lunesta Eszopiclone Insomnia

Ortho Evra Norelgestromin and ethinyl estradiol

Birth control

medication update

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T he process behind healthcare coverage decisions can seem mysterious, but when it comes

to paying our providers and claims processors, Blue Cross of Idaho makes decisions based on whether a healthcare service is appropriate for you and covered by your plan.

We never use incentives that could make it harder for you to get the healthcare and customer service you deserve. We also do not pay practitioners or individuals for denying claims and never use incentives to encourage denials.

Blue Cross of Idaho also doesn’t encourage decisions that result in low use of covered benefi ts. We make sure that referral decisions are independent and impartial and do not infl uence hiring, compensation, termination, promotion or any other matter.

YOUR HEALTHCARE IS OUR FIRST PRIORITY

DON’T MISS OUT ON IMPORTANT INFORMATIONIf you move, get a new phone number or change your email address, don’t forget to update your contact information. Be sure to notify your health plan administrator or human resources department if any of this vital information changes so you can stay in the loop when it comes to important healthcare coverage updates.

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At Blue Cross of Idaho, we want to make our members’ lives easier. We’re introducing an array of tools designed to help you get the most out of your health insurance and make informed choices.

$ COST ADVISOROur new CostAdvisor online tool lets you compare the costs of common medical procedures

among providers in your area. Need a knee replacement? Now you can view the average cost of knee replacements done by doctors and facilities in your area who accept your health insurance.

When you know more about how much a healthcare service costs, you can plan, ask questions and work with your doctor to keep your out-of-pocket costs in check. It’s all part of our effort to bring more transparency

to the cost of healthcare and give you the information you need

to make the best choices for you and for your family.

To use the CostAdvisor, all you need is an account at members.bcidaho.com. If you’re already registered, simply visit bcidaho.com/knowbeforeyougo or select CostAdvisor from the right side of the member home page after you log in.

If you don’t have an account, registering is easy. You’ll receive a welcome email from CostAdvisor when your account is ready in a few days.

MOBILE APPWe know that life can move quickly, so to help you keep up, we’ve created the

Blue Cross of Idaho mobile app for smartphones. Download our free app toget key health insurance information whenever and wherever you need it.

With the app, members can search for doctors or urgent care facilities near them, view their progress toward deductibles, see healthcare benefi ts and even view and send member ID cards.

The mobile app is free to download at both the Apple App Store and Google Play, and all you need to access all of its functions is an online member account at members.bcidaho.com. Once you register

START HERE:Sign up at members.bcidaho.com to open the door to many online resources and information. It only takes a few minutes and your account is protected and private.

Health Tools to Help You

Take Charge

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as a user, you can use that same user name and password to access your personal information on the mobile app.

Learn more about the Blue Cross of Idaho mobile app by visiting bcidaho.com/mobileapp

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. If you’re already registered, simply visit bcidaho.com/knowbeforeyougofrom the right side of the member home page after you log in.

If you don’t have an account, registering is easy. You’ll receive a welcome email from CostAdvisor when your account is ready in a few days.

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as a user, you can use that same user name and password to access your personal information on the mobile app.

Learn more about the Blue Cross of Idaho mobile app by visiting bcidaho.com/mobileapp.

Wellness health insurance isn’t just about treatments for when you’re sick. At Blue Cross

of Idaho, we’re equally concerned with helping our members stay healthy in the first place. That’s why we offer members access to online wellness services designed to help you reach your health goals.

Whether you want to lose weight, stop smoking or keep other health concerns in check, our online wellness program offers easy-to-use tools to help you on your healthcare journey.

Log in to your bcidaho.com online account to start exploring your wellness options.

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A t Blue Cross of Idaho, we consider all the personal information we collect from you to be confi dential, and our

privacy practices apply equally to personal information about future, current and former members.

We only allow our employees and business associates access to your information if it is necessary to conduct business and serve you. All of our employees are trained on our written privacy and security policies, and they are subject to disciplinary actions if they violate them.

Your personal information will never be disclosed unless we are allowed or required by law, or you (or your personal representative) give us permission. We also take numerous

steps to secure both our buildings and electronic systems from unauthorized access.

For detailed information about our privacy practices and your rights with respect to the handling of personal information, see the Blue Cross of Idaho Notice of Privacy Practices on our website at bcidaho.com/about_us/privacy_policy.asp. You can also contact our information privacy offi cer at 877-488-7788 for more information.

Protecting

Utilization Management (UM) is the work we do to make sure you get the right healthcare at the right time and pay the right price.

Our UM team not only looks at healthcare services to make sure they are the right treatments, they also verify that you get the service when you need it—not too early or too late. Additionally, the team compares the treatment you get from your doctor with established medical guidelines and ensures that providers don’t get incentives or rewards for treating you a certain way.

If you have questions about prior authorization, approvals or denials, or if you need clarifi cation related to utilization

What Is Utilization Management?

Your Personal Information

know where to go. It just might save you some money and time!

EMERGENCY ROOMURGENT CARE

management, discharge coordination or transfers from one level of care to another, you can call customer service at 208-331-7347 or toll-free at 800-627-1188, from 9 a.m. to 5 p.m., Monday through Friday.

TDD/TTY is available for callers with questions about Utilization Management at 800-377-1363. For language assistance, please call 800-627-1188.

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Know where to go. It just might save you some money and time!

Your husband twists his ankle in a baseball game. Your daughter trips on the trail and cuts her lip. When you’re in the midst of a medical issue—especially with children

—everything feels like an emergency. But not every health condition is an emergency

and you might just fi nd it’s easier and less costly to visit an urgent care center instead of the ER.

Although we cover emergency services, a trip to the ER for a non-emergency—such as a minor sprain, a cold, minor back pain or a tension headache—may cost you. You’ll save money by using an in-network provider or walk-in clinic for routine ailments.

Here are examples of health conditions that are true emergencies: - Chest pain or pressure or other signs

of a heart attack- Choking- Compound fractures- Coughing up or vomiting blood- Diffi culty breathing- Drowning- Serious trauma or injury- Severe burns- Sudden loss of vision or movement,

weakness, slurred speech or other signs of a stroke

- Unexplained seizures or convulsions

Here are examples of when a walk-in clinic, or urgent care, is a good option:- Cuts that aren’t bleeding a lot, but

require stitches- Flu or fever- Minor broken bones—like fi ngers and toes- Skin rashes- Sprains and strains- Urinary tract infections

It may seem convenient to visit the ER, but it might just cost you more than you bargain for.

EMERGENCY ROOM versus

Wondering if you should call 911? Ask yourself these questions:

- Is the victim’s life or limbs threatened?- Could the victim’s condition worsen or

become life- or limb-threatening on the way to the hospital?

- Could moving the victim cause further injury?

- Does the victim need skills or equipment of paramedics or emergency medical technicians?

- Would distance or traffi c conditions cause a delay in getting the victim to the hospital?

URGENT CARE

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Don’t forget to put your member ID card on your packing list.

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B e ready for any unexpected health emergency or medical need, no matter how far from home you are.

PPO, POS and Traditional members can take advantage of the BlueCard program, which gives you access to top-notch, in-network

benefits just about anywhere you travel, both in this country and abroad.

To find a doctor or medical provider, select Find a Provider on our website, members.bcidaho.com, or call 800-810-Blue (2583).

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