January 18, 2007

BC-07-06
HP-07-05
SA-07-05

HHA-07-05
DC-07-05

2007 Update

• Federal Employee Program (FEP)
• Medigap Plan K
• State of Kansas Employee Group
  
  

FEDERAL EMPLOYEE PROGRAM

For 2007, Federal Employee Program subscribers who choose health care coverage through BCBSKS can select either the Basic or Standard Option benefit programs.  These same options were available to them last year. 

The significant benefit changes to these programs for 2007 for institutional providers include:

Basic Option

• in 2006 there was a $40 daily copay for diagnostic, neurological and psychological tests provided for a mental health diagnosis in the outpatient facility setting. For 2007, the $40 copay no longer applies to these services.

Basic and Standard Option

• in 2006 there was coverage for penile implants for patients that were diagnosed with prostate cancer and who had received prostate cancer surgery.  For 2007, penile implants are covered for the diagnosis of erectile dysfunction (code 607.84 and does not need to be the primary diagnosis code) and no longer does there need to be evidence of prostate cancer.  If this diagnosis code is not on the claim, no coverage.
• in 2006, gastric bypass surgery and gastric stapling procedures for morbid obesity were covered but not gastric bands. In 2007, gastric procedures for morbid obesity including laparoscopic adjustable gastric bands will be covered for patients 18 years and older.  This includes the following codes: 43770, 43771, 43772, 43773, 43774, 43842, 43843, 43845, 43846, 43847, 43848, 43886, 43887, and 43888.   This service is not covered for patients under 18.

Complete FEP benefit information is available at http://www.bcbsks.com/CustomerService/Providers/federal.htm

MEDIGAP PLAN K

The Medigap Plan K out-of-pocket maximum is indexed each calendar year based on Medicare increases.  The maximum for 2006 was $4,000 and has increased to $4,140 for 2007.

STATE OF KANSAS EMPLOYEE GROUP

The State of Kansas employee group has also been renewed for 2007.  Options available through BCBSKS continue to include:

• For active employees and early retirees
• Premier Blue
• Kansas Choice

• For retirees (Medicare eligible)
• Premier Blue
• Kansas Choice
• Kansas Senior Plan C

For complete information about the SOK benefit package, visit our Web site at http://www.bcbsks.com/CustomerService/Providers/StateKS_emply/stateKS_emply.htm or review the Institutional Provider Manual http://www.bcbsks.com/CustomerService/Providers/publications/institutional/manuals/index.htm
Eligibility and claim status information is available at the BCBSKS Web site www.bcbsks.com or by calling the BCBSKS customer service center 1-800-432-3990.  Provider telephone calls will be authenticated and handled by our interactive voice response system.

drb