1. finance
2. personal finance
3. insurance
4. health insurance

MICHIGAN PUBLIC SCHOOL
EMPLOYEES RETIREMENT SYSTEM
2015 Health Plan Seminar
Medicare Plus Blue is a PPO plan with a Medicare contract. Enrollment in
Medicare Plus Blue depends on contract renewal.
H9572_S_15MPSERSSem FVNR 1014
AGENDA
• Introductions
• Coverage overview
• Medical plan – BCBSM
• Vision plan – VSP
• Prescription drug plan – CatamaranRx
• Dental plan – Delta Dental
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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MPSERS Medicare Advantage
What is Medicare Advantage?
Medicare Advantage combines Medicare
Parts A and B with supplemental health
coverage from a private insurer.
Medicare Advantage plans provide more
coverage than Original Medicare
Supplement
Drug
A
(Hospital)
B
(Medical)
MEDICARE ADVANTAGE
IMPORTANT:
BCBSM works with your drug
carrier to coordinate your care.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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With your Medicare Advantage plan
You Keep the
Benefits Of:
• Original Medicare
• Original Medicare
rights & protections
• Original Medicare
covered services
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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The importance of having a family doctor
• Familiar with you and your health
– More easily recognizes changes in your health
•
Single point of expertise
– Helps you “connect the dots” with other doctors or
specialists
Research shows that people with a personal doctor
stay healthier as they age.
- International Journal of Health Services
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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How to find a doctor
Multiple ways to help you:
1. Visit our website
2. Call our Customer Service team
1-800-422-9146 (also on the back of your ID card)
3. Consult your Provider Directory
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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Welcome to Medicare exam and annual
wellness visit
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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The Health Assessment
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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The Health Assessment helps you…
• Know where you stand now
• Find ways to improve your health
• Identify a personalized list of
topics to discuss with your doctor
TIP:
BCBSM sends you a
report after you’ve
completed your
assessment – bring
the report with you to
the doctor at your
next scheduled visit.
Your answers will be kept private and won't affect
your enrollment, benefits or health care costs in any
way
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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Costs YOU pay for covered services
Deductible: The amount you must pay for covered
medical services before your plan begins
to pay. You pay 100% of your covered
medical costs until you meet your $650
deductible. Your deductible resets
annually. Counts towards your out-ofpocket maximum.
Copayment The fixed dollar amount you pay to health
(Co-pay): care providers.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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Costs YOU pay for covered services
Coinsurance: A percentage of the allowed amount you are
responsible for. Counts towards your out-ofpocket maximum.
Out-of-pocket The most you will pay in deductibles and
Maximum: coinsurance during the year. After you reach
your out-of-pocket maximum, your plan pays
100% of eligible medical expenses for the
remainder of the year. Your out-of-pocket
maximum resets annually.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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Deductible
Coinsurance
Combined maximum out-of-pocket
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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Covered preventive services include…
Bone mass measurement
Diagnostic hearing exams
Pap smears and pelvic exams
Colorectal screening
Prostate cancer screening
Immunizations
Mammogram
Eye exams
Annual wellness exam
Treatment for eye conditions
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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Hearing care program
First time hearing aid purchasers are required to get a medical clearance exam
Audiometric exam
• Measures hearing ability
Hearing aid
• Includes binaural (both ears)
• Binaural hearing aids must be purchased at the same time
Conformity test
• Evaluates the performance of a hearing aid
Frequency limitation
• Payable once every 36 consecutive months
Approved provider
• Deductible and coinsurance apply
Non-approved provider
• Member pays all charges
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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We’ve got you covered, but…
• Following the guidelines in your
Evidence of Coverage will help
you pay less out-of-pocket
• Straying from the guidelines in
your Evidence of Coverage will
cost you more out-of-pocket
TIP:
When traveling
within the U.S., be
sure to use a
Medicare-approved
doctor.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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Manage your plan with our member site
One site. One stop.
Power to compare.
On the go. Good to
go.
Coverage
& Claims
bcbsm.com
Health &
Wellness
Provider
Search
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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Login or register at bcbsm.com/mpsers
Log in for
member site
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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One site. One stop.
Personal Snapshot
Important alerts
Easy-to-understand
graphics help you
quickly see where
you are in your plan.
Prominent
recent claims
activity
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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2015 plan updates
2014
2015
Deductible
$500
$650
Out-of-pocket
maximum
$1,300
$1,450
Durable medical
equipment and
supplies, prosthetics
and orthotics
Participating provider:
Participating provider:
Covered in full
10% coinsurance plus
deductible
Non-participating provider:
Non-participating provider:
20% coinsurance plus
deductible
30% coinsurance plus
deductible
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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MPSERS Non-Medicare PPO
When you turn 65…
• You will become eligible for Medicare.
• Some individuals may become eligible before they turn 65, for example, if
they are permanently disabled. You must tell ORS if you or a family
member become eligible for Medicare before age 65
• Make sure you are enrolled in both Medicare Parts A and
Part B.
– Part B is required to enroll in Medicare Advantage
• You will receive a red, white, and blue Medicare card in
the mail.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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When you turn 65… (cont.)
• Your Retirement System will submit your enrollment
application to Blue Cross automatically.
• We may reach out to you for additional information if we
need it to enroll you in Medicare Advantage.
NOTE: Services are not payable for Medicare-eligible members
until they are enrolled in the Medicare Advantage Plan
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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2015 plan updates
2014
2015
Deductible
$650
$850 or $650*
Out-of-pocket
maximum
$800
$800
Durable medical
equipment and
supplies, prosthetics
and orthotics
SUPPORT supplier:
Participating provider:
Covered in full
10% coinsurance plus
deductible
Non-SUPPORT supplier:
Non-participating provider:
20% coinsurance plus
deductible, plus difference in
cost
30% coinsurance plus
deductible, plus difference in
cost
*Members who complete the steps to enroll in LivingWell can lower their deductible to
$650.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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LivingWell Program
• Wellness program for MPSERS
members
• Provides tools to help you work
towards a healthier lifestyle
• Non-Medicare members can
complete three steps to receive a
reduction in their deductible
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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LivingWell Program Steps
1
2
3
BONUS
• Complete the health assessment
• Select a primary care physician
• Get an annual routine physical
• Choose a Patient-Centered Medical home
doctor
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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What is a Patient-Centered Medical Home?
• A Patient-Centered Medical
Home is a team approach to
better health care.
• Your PCMH doctor leads a
team of health care
professionals who work together
to:
– Improve your health
– Help you reach your health
goals
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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What do Patient-Centered Medical Homes offer?
• 24-hour access to your care
team
– Extended office hours
– Phone access
– Online resources for medical
information and support
– Appointment reminders
• Tailored care plans to help you
reach your health goals
– Manage chronic conditions
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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Standard vs. Patient-Centered approach
Standard approach
Patient-centered approach
Sarah is a 44 year old type 2
diabetic.
Sarah is a 44 year old type 2
diabetic.
She schedules appointments with
her primary care physician when
she is sick.
Her office care team identifies
Sarah in their diabetic patient
registry. They call her to
schedule an appointment.
She feels ill on a Saturday. Her
doctor’s office is closed, so she
visits the ER and is admitted.
She feels ill on a Saturday. She
visits her doctor the same day
because they have extended
office hours.
Sarah is discharged and
instructed to follow up with her
doctor.
She can’t get an appointment to visit
her doctor for several weeks. She
ends up being readmitted to the
hospital.
Her doctor sends her to the
hospital to be admitted and
treated.
When she’s discharged, the
hospital works with her PCMH to
ensure she is discharged in the
right setting with the right
treatment.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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THANK YOU
QUESTIONS?
MPSERS
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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Your BlueVisionSM Coverage
• BCBSM has partnered with VSP Vision Care since
1998
• BCBSM and VSP Vision Care work together to offer
you BlueVisionSM coverage
• To learn more about your vision coverage, visit
vsp.com
• To find a participating provider, visit
vsp.com/advantage
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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New Vision ID Card
• Members received a new ID card in January 2014.
(Members do not need an ID card to receive services)
• Members have a dedicated toll-free number for vision
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Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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Plan Design
Vision Care Services
In-Network
Out-of-Network
Reimbursement
Exam
$10 copay
$40
Lenses
Single
Bifocal
Trifocal
$15 copay
$15 copay
$15 copay
$16
$23
$27
$0 copay,
$120 allowance
$23
$15 copay, $120 allowance
$0 copay
$35
$96
Frames
Contact Lens
Conventional
Medically Necessary
Frequency
Exam
Lenses
Frames
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Once every 24 months
Once every 24 months
Once every 24 months
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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