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The information you're accessing may not be provided by Excellus BCBS. Dental Blue Options Summary of Benefits - Excellus Member Create an account or login for 24/7 access to your member card, find care, view coverage, estimate medical costs, and track spending. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All Breathe Easy - 6 Steps for Controlling Your Child's Asthma-printable poster (August 2021) Open a PDF. Copyright 2023, Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. Step 1: Select the type of coverage Select Coverage Type Single Family The cost of prescription drugs varies widely, even for medications that are used to treat the same condition. Health Insurance Plans for Excellus BCBS News, good faith estimate and AEOB regulations (PDF), agent and broker fee disclosure regulations, Out-of-network emergency services related to an emergency condition, Certain non-emergency services delivered by an out-of-network provider at an in-network facility, Out-of-network air ambulance services (if the plan covers in-network air ambulance services), Negotiated rates for covered services with in-network providers, Allowed amounts necessary for determining payments to out-of-network providers, Negotiated rates and actual historical prices for all covered prescription drugs from in-network providers (enforcement deferred to a date to be determined). The amount you pay for a drug depends on the tier. Two Tier Formulary with Prior Authorization and Step Therapy B. Consider the number of visits you anticipate each family member for the benefit period, and whether you'll pay just a copayment or if you'll be responsible for the complete costs: How much will You Pay toward Prescription Drug Costs? To talk to one of our dedicated Insurance Advisors today about your options, call 1-888-576-6542. For updated information about the drugs we cover, call our Customer Service Department toll-free at 1-877-883-9577 (TTY: 711), 8 a.m. - 8 p.m., Monday-Friday. Whether your business has five employees or five thousand, we have medical and dental plans to fit your needs. 4 questions to ask when choosing a health plan. Connect with wellness programs and resources. It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of coverage. Weekly Biweekly (26 paychecks/year) Monthly HDHP Other Plan How much will You Pay toward the plan premium $ .00 $ .00 Your Total Annual Premium: $ .00 $ .00 The information you're accessing may not be provided by Excellus BCBS. Let us help you find the right plan. Our three plan options have certain drugs that are not covered on their formularies. 31, representatives also are available weekends from 8 a.m. to 8 p.m. Independent licensees of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. Our searchable drug listwill help you determine if your prescription drug is covered by the Plan or if any utilization edits apply, such as prior authorization or step therapy. Learn more about Requesting an Exception below. Health plans must also allow women to see an OB/GYN without prior authorization. You may be eligible for help paying for your health insurance when you purchase coverage through NY State of Health. For refills, call: 1-877-FEP-FILL (1-877-337-3455), Get prescription advice from a registered nurse. From Oct. 1 to Mar. PDF Rx Program Pharmacy Management - Excellus Prospect Excellus BCBS: Essential Plan 1 A nonprofit independent licensee of the BlueCross BlueShield Association The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. Find a doctor or other health care provider who accepts your plan. Learn more at the New York State Department of Health website. Find out if your medication is covered and what it will cost based on your benefit plan. You have a regular payment, but no unexpected repairs or updates to make. Also, when adding the new generic drug, we may decide to keep the brand name drug on our Drug List, but immediately move it to a higher cost-sharing tier or add new restrictions. CAA Pharmacy Drug Reporting Form - Excellus BlueCross BlueShield You could qualify for the Essential Plan for $0a month based on your age, household income and size, and immigration status. Copyright 2023, Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. Individual & Family Plans If you're under 65 and don't get insurance through your employer, an Individual and Family Plan may be right for you. Disclaimer: This tool is intended only as a guide. Using information you provide and the averages in the marketplace, it takes into account federal subsidies based on income, Medicaid eligibility, and other factors that impact premiums under the Affordable Care Act. Excellus BlueCross BlueShield - Everybody Benefits Certain medications require prior authorization. Find a Prescription Drug. When you go to a network pharmacy, we provide a temporary or transition supply of at least a month's supply (unless the enrollee presents with a prescription written for less) of a drug that isn't on our formulary, or that has coverage restrictions or limits (but is otherwise considered a "Part D drug"). Find providers and estimate costs. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All Home | Providers | Excellus BlueCross BlueShield The amount of extra help you get will determine your total monthly plan premium as a member of our Plan. What is a formulary? If you are in a situation where you have not applied or have not yet been approved for unemployment, you can assume that income as zero until you start receiving unemployment benefits. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All All rights reserved. Our subsidy calculator is designed to estimate federal premium assistance that may be available towards the cost of health insurance purchased directly by an individual (rather than through an employer). If we deny your exception request, you may appeal our decision. rights reserved.BlueCross BlueShield of Tennessee, Inc. is an independent licensee of the BlueCross BlueShield Association. Check eligibility and benefits for members. For more details, refer to the Availity Patient Cost Estimator User Guide*.To register with Availity , gain access to the free PCE tool and find out about other options, visit availity.com , or call Availity Client Services at 800-AVAILITY (282-4548) for assistance. Your doctor must submit a statement supporting your exception request. rights reserved.Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Use the glossary, estimate treatment costs, find out information on forms, high-deductible plans, and how to receive care away from home. Excluded drugs cannot be covered by a Part D plan unless coverage is through an enhanced plan that covers those excluded drugs. Summary: Requires health plans to provide members with a good faith estimate of expected charges and an Advanced Explanation of Benefits (AEOB) upon notification by a provider of scheduled services, or at a members request. When health care is more accessible and affordable. In order to help us make a decision more quickly, the supporting medical information from your doctor should be sent to us with the exception request. Read more about ID card regulations (PDF)Open a PDF, Compliance Date: Pending further rulemaking. We might add a generic drug that is not new to the market to replace a brand name drug or change the cost-sharing tier or add new restrictions to the brand name drug. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Covers a 22 to 90-day supply. If youre eligible and enroll in a plan, the tax credit will be paid directly to the insurance company which will reduce your monthly premium amount. 31, representatives also are available weekends from 8 a.m. to 8 p.m. What online tools are available to help me manage my membership? Select your plan in your location to learn more: Elderly Pharmaceutical Insurance Coverage (EPIC) is a New York State program* for seniors that helps with out-of-pocket Medicare Part D drug plan costs. all important correspondence and health care Ask if the plan covers emergency care anywhere in the world. All rights reserved. View your Summary of Benefits and Coverage. Find a Plan | Excellus BlueCross BlueShield EPIC verifies information with the Social Security Administration and the New York State Department of Taxation and Finance. Individuals under age 65 may be eligible based on New York State household income and size guidelines. Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Fax: Helpemployees transition toHDHP Step Therapy Once you've moved in, you just move ahead with your life. Given the large size of the files, the data has been broken into hundreds of files for each of the two categories (in-network and out-of-network). Communications issued by Capital Blue Cross in its capacity as administrator of programs and provider relations for all companies. Ahigh deductible health plan (HDHP) helps you offer health care to your employees at a lower cost, putting both you and your employees in charge by pairing comprehensive, low-premium plans with tax-advantaged funding accounts. Note: If we approve your exception request for a Part D non-formulary drug, you cannot request an exception to the co-payment or coinsurance amount we require you to pay for the drug. How does a High Deductible Plan compare to other health plans? Login | Providers | Excellus BlueCross BlueShield Specialty: Used to treat complex health conditions. rights reserved.A Division of Health Now New York Inc. An Independent Licensee of the BlueCross BlueShield Association. Blue Shield Association. rights reserved.BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Asking us to pay a lower price for a coveredPart D drug on a higher cost sharing tierthrough the tiering exception process. The information you're accessing may not be provided by Excellus BCBS. In general, the lower the drug tier the more cost effective the drug. This is not a cost estimator. Summary of Benefits and Coverage: What this Plan - Excellus Member See how close you are to meeting your deductible or out-of-pocket limit. Protect Yourself From Falls - Infographic (July 2021) Open a PDF. If you receive coverage through an employer, contact your administrator to see which drug program applies to you. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All Excellus BCBS: Excellus BluePPO Signature Copay 1 A nonprofit independent licensee of the BlueCross BlueShield Association The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. If your estimated tax credit appears as $0, this means that although your income qualifies you for a subsidy, there is an available Silver plan for purchase at a premium below what the government defines as the maximum you can spend on health coverage; therefore, no subsidy would be provided. . For a listing of prescription drugs medications, see Prescription Drugs. Register/Login Frequently Asked Questions What is a High Deductible Health Plan? Home | Brokers | Excellus BlueCross BlueShield We provide this temporary supply in the following situations: New Member or Current Member- We will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you are a new member or during the first 90 days of the calendar year if you were in the plan last year. EXCELLUS BLUEPPO SIGNATURE COPAY 1 WHAT'S COVERED IN FULL? Current member with a level of care change - For members who are being admitted to or discharged from a LTC facility, the Plan will not utilize early refill edits and this will allow appropriate and necessary access to your Part D benefit. To see more specific results, enter more terms. Eligibility is based on your household income and size. Manage your claims, find a doctor or urgent care center, view your benefits coverage, access your member card and more. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All Download Statements & Forms. PDF Summary of Benefits and Coverage: What this Plan Covers & What You Pay The information you're accessing may not be provided by Excellus BCBS. We anticipate additional guidance on how the two sets of requirements will be reconciled. Talk to your broker or Account Sales Manager for more information. Y0028_8830_C. From October 1 to March31, representatives are also available weekends from 8 a.m. - 8 p.m. Excellus BlueCross BlueShield is an HMO plan and PPO plan with a Medicare contract. Spending Accounts We are challenging everything about our health plans and broadening the verydefinition of health coverage to bring you more benefits with lower costs. Our Medicaid plans sponsored by New York State provide free or low-cost health insurance for individuals and families who meet NYS income eligibility requirements. Please contact our Customer Care for any additional questions about our transition policy. Do you believe you have qualified for extra help and that you are paying an incorrect copayment amount? We're here to discuss your needs, answer questions about plans and help you and your employees embrace their health and well-being. Life Eventsinclude:getting pregnant, having a baby, adopting a baby, change in marital status, moving, losing coverage from your employer, or aging off of a parents health plan. Why are we asking how many people live in your household? To retrieve results that include either word A or word B, use uppercase OR between the terms. Specialty drugs are limited to a 30-day supply. And you can log in from anywhere at any time. You can ask us to make an exception to our coverage rules, including waiving our prior authorization, step therapy and quantity limit restrictions on your drug. Forgot Password? Review claim status and request claim adjustments. Calculate Cost Copyright 2023 Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. Lifetime Benefit SolutionsOpen a PDF Tier 2: Preferred Brand Name Drugs Proven to be safe, effective, and favorably priced compared to Non-preferred brands. Employee Healthcare & Benefits / Excellus Blue Cross Blue Shield Summary: Requires health plans to disclose information about direct and indirect compensation of $1,000 or more received for brokerage or consulting services. You can search for words that are near each other by entering uppercase NEAR between the words. Our Prescription Drug Cost Tool lets you check drug costs 24/7. By Phone:For an immediate response, call the number on your Member Card for personalized care. Consolidated Appropriations Act Toolkit | News | Excellus BlueCross BlueShield News Consolidated Appropriations Act Toolkit The Consolidated Appropriations Act and the Transparency in Coverage regulation include a number of provisions relating to health insurance and group health plan coverage. Income verification for the last four weeks. Links marked with an (external site) icon indicate you're leaving the Medicare portion of ExcellusBCBS.com. Health Insurance Plans | Excellus BlueCross BlueShield We use cookies and other technologies to optimize site functionality, analyze website traffic, and share information with social media, advertising, and analytics partners. Based on the information provided, you may qualify for a monthly tax credit through NY State of Health to lower the cost of your premium. Excellus BlueCross BlueShield is an HMO plan and PPO plan with a Medicare contract. With access to a network of more than 13,000 other doctors, urgent care centers, hospitals and specialists, we have kids covered. Make sure youre getting the most value out of your health plan by creating an account online at. Online member tools. Have a question or need help finding coverage? How to Calculate: Add the total from these sources, Gross income from employers or self-employment income that you received or anticipate for this entire year, Total unemployment benefits received or anticipated for this year, Alimony payments received this year from divorces settled after 12/31/2018, All Social Security payments this year, including disability, retirement and survivors benefits, Income from interest, dividends, capital gains and annuities, How to Calculate: Do NOT include these sources, COVID-19 CARES Act economic stimulus payments or COVID-19 pandemic unemployment compensation received in 2020, Citizenship documents, a certificate of naturalization or a permanent resident card, Driver License of NYS Identification Card, Most recent federal income tax return if self-employed. What is a Reimbursement Savings Account? Summary: Requires health plans to provide an estimate of member cost-share information via an internet-based self-service tool and on paper for 500 designated items and services in 2023, and all other items and services in 2024. rights reserved.CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc., which are independent licensees of the Blue Cross and Blue Shield Association. Manage practice information, access staff training and complete attestation requirements. Nothing for the first 4 prescription fills or refills when you switch from certain brand name drugs to specific generic drugs. For more information on how to fill your prescriptions, please review your Evidence of Coverage. Ask about our Auto Enroll HSA Plan to enroll your employees in an HDHP with HSA without the hassle of setting up the HSA. Employees pay a deductible, a percentage of cost called coinsurance, and are protected by an out-of-pocket maximum. For Medicare, refer to our Medicare Advantage Timeline for specifics on when you may switch your Medicare coverage. {{/status_messages.no_results? The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married. Login | Medicare Members | Excellus BlueCross BlueShield Find more about the renewal process, FAQs and helpful how-to videos at: We are challenging everything about our health plans and broadening the very, Medicare Annual Election Period for 2020 Coverage: October 15 - December 7, Medicare plans with $0 premiums and $0 generic drugs, Medicare plans accepted by a large network of doctors and specialists, Knowledgeable local representatives to talk you through your options, Learn how synchronized care ensures lower costs, better care, and easier administration for you and your team, Help your team make the most out of high deductible health plans, Discover how telemedicine is saving employers and employees money and boosting productivity. Excellus BCBS: SimplyBlue Plus Bronze 4 A nonprofit independent licensee of the BlueCross BlueShield Association The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Create an Account. In less than a minute see if your income and household size qualify you for the Essential Plan or other free or low cost plans. Non-Discrimination Statement and Foreign Language AccessCopyright {{ new Date().getFullYear() }} All rights reserved.BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association.