Blue Cross Newsletter
 

 

January 09, 2009

 

BC-09-01
HP-09-01
SA-09-01



 

HHA-09-01
DC-09-01
MS-09-01
ASC-09-01

To: All Blue Cross Contracting Providers
From: Cindy Garrison, Communications Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
Subject:

2009 Special Groups Update

  • Federal Employee Program (FEP)
  • State of Kansas Employee Group

FEDERAL EMPLOYEE PROGRAM

For 2009, 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 2009 for institutional providers include:

Basic Option

  • Copay for outpatient facility care at Preferred hospitals is now $50 per day per facility. Previously, it was $40 per day.
  • Copay for emergency room care related to an accidental injury or medical emergency is now $75 per visit. Previously, it was $50 per visit.

Standard Option

    • Prior approval is required for all inpatient admissions.  Failure to do will result in penalties or denial of services.
    • In 2009, the copay for all inpatient care at Preferred hospitals is now $200 per admission (unlimited days). Previously, it was $100 per admission.
    • In 2009, prior approval is required before receiving any outpatient Mental Health/Substance Abuse services and the member must see a Preferred provider.  Failure to obtain prior approval may result in the denial of benefits.

    Changes to both Standard and Basic Options

    The surgical services listed below require prior approval when they are to be performed on an outpatient basis. This requirement applies to both the physician services and the facility services from Preferred, Participating/Member, and Nonparticipating/Non-member providers.

        • Outpatient surgery for morbid obesity;
        • Outpatient surgical correction of congenital anomalies; and
        • Outpatient surgery needed to correct accidental injuries to jaws, cheeks, lips, tongue, roof and floor of mouth.

    You must obtain prior approval for both the procedure and the facility, for the following transplant procedures:

        • Blood or marrow stem cell transplant procedures
        • Autologous pancreas islet cell transplant
        • Heart
        • Heart-lung
        • Intestinal transplants (small intestine with or without other organs)
        • Liver
        • Lung (single, double, or lobar)
        • Pancreas
        • Simultaneous liver-kidney
        • Simultaneous pancreas-kidney

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

    STATE OF KANSAS EMPLOYEE GROUP

    The State of Kansas employee group renewed for 2009.  Options available through BCBSKS continue to include:

    • For active employees - Plan A and B
        • Plan A and B use Blue Choice, our preferred provider organization (PPO).
    • For retirees (Medicare eligible)
        • Kansas Senior Plan C

    The following is a sampling of the 2009 benefits for institutional providers:

     

    Cost to member when receiving services from network providers Cost to member when receiving services from non-network providers

    Plan A

    Plan B

    Plan A and B

    Annual Plan Deductible

    $50 individual/$100 family

    none

    $500 individual/$1,500 family

    Coinsurance For All Eligible Expenses (unless otherwise noted)

    20% coinsurance

    30% coinsurance

    50% coinsurance

    Annual Coinsurance Maximum (does not include copay)

    $1,100 individual/$2,200 family

    $2,200 individual/$4,400 family

    $3,650 individual/$7,300 family

    Lifetime Benefit Maximum

    none

    none

    None

     

    Inpatient

    deductible plus 20% coinsurance

    30% coinsurance

    $600 copay per admission plus deductible and 50% coinsurance

    Emergency Room

    $100 copay, deductible plus 20% coinsurance

    $100 copay plus 30% coinsurance

    $200 copay plus deductible and 50% coinsurance

    Copay does not apply toward annual coinsurance maximum

    Home Health (services must be prior authorized)

    deductible plus 20% coinsurance

    30% coinsurance

    deductible plus 50% coinsurance

    Hospice (services must be prior authorized)

    deductible plus 20% coinsurance

    30% coinsurance

    deductible plus 50% coinsurance

    Rehabilitation – Inpatient and Outpatient Facility

    deductible plus 20% coinsurance

    30% coinsurance

    deductible plus 50% coinsurance

    Mental Health Inpatient

    deductible plus 20% coinsurance

    30% coinsurance

    $600 copay per admission plus deductible and coinsurance -Limited to 60 days per calendar year

    Copay for mental health do not apply towards annual coinsurance maximum
    Mental Health Outpatient
    visits 1-3 covered 100%; $20 copay on additional visits
    deductible plus 50% coinsurance
    Copay for mental health do not apply towards annual coinsurance maximum

    Alcohol and Chemical Dependency Treatment - Inpatient

    deductible plus 20% coinsurance

    30% coinsurance

    $600 copay per admission plus deductible and coinsurance

    Limited to 60 days per calendar year
    Limited to 30 days per calendar year
    Copay for alcohol and chemical dependency treatment do not apply towards annual coinsurance maximum
    Alcohol and Chemical Dependency Treatment - Outpatient
    visits 1-3 covered 100%; visits 4-25 $25 copay; all subsequent visits 50% coinsurance (limited to 25 visits per calendar year)
    visits 1-3 covered 100%; visits 4-25 50% coinsurance (limited to 25 visits per calendar year)
    Copay for alcohol and chemical dependency treatment do not apply towards annual coinsurance maximum

    For complete information about the SOK benefit package, visit our Web site at http://www.bcbsks.com/CustomerService/Members/State/index.htm 

    State of Kansas eligibility and claim status information is available at the BCBSKS Web site www.bcbsks.com or by calling the BCBSKS customer service center at 785-291-4183 or 1-800-432-0272.  Provider telephone calls will be authenticated and handled by our interactive voice response system.

     

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