January 09, 2009

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

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

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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