FEDERAL EMPLOYEE PROGRAM
For 2010, Federal Employee Program (FEP) 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 following is a sampling of the 2010 benefits for institutional providers:
Benefit |
Standard Option |
Basic Option |
Deductible |
$300 individual/
$600 family |
None |
Hospital Inpatient: Medical/Behavioral Health
Precertification Required |
$200 per admission copayment for unlimited days |
$150 per day up to $750 for unlimited days |
Outpatient Facility Care, except outpatient surgery, behavioral health, and physical, occupational, and speech therapy |
Subject to deductible, 15% coinsurance
|
$75 per day facility copayment
|
Outpatient Surgery |
15% coinsurance |
$75 per day facility copayment |
Outpatient Behavioral Health
Precertification Required |
15% coinsurance
|
$75 per day facility copayment |
Outpatient Physical, Occupational, and Speech Therapy |
Subject to deductible, 15% coinsurance
Benefits are limited to 75 visits per person, per calendar year for physical, occupational, and speech therapy, or a combination of all three. |
$75 per day facility copayment
Benefits are limited to 50 visits per person, per calendar year for physical, occupational, and speech therapy, or a combination of all three. |
Accidental Injury |
Nothing for covered charges for services within 72 hours of accident |
$75 copayment |
Medical Emergency Care |
Subject to $300 calendar year deductible, 15% coinsurance |
$75 copayment |
Home Health
Precertification Required |
15% coinsurance
Up to 2 hours per day, up to 25 visits per calendar year |
$25 copayment per visit
Up to 2 hours per day, up to 25 visits per calendar year |
Hospice
Inpatient care provided on a short-term basis. Benefits are available for inpatient hospice care when provided by a facility that is licensed as an inpatient hospice facility and when:
- Inpatient services are necessary to control pain and/or manage the member's symptoms;
- Death is imminent; or
- Inpatient services are necessary to provide an interval of relief (respite) to the caregiver.
Precertification Required |
Preferred: $200 per admission copayment
Member: $350 per admission copayment
Non-member: $350 per admission copayment plus 35% MAP, and any remaining balance after our payment |
Preferred: $150 per day copayment up to $750 per admission
Member/Non-member: All charges are patient responsibility |
| NOTE: For 2010, benefits are provided for up to 7 consecutive days in a facility licensed as an inpatient hospice facility. Each inpatient stay must be separated by at least 21 days of traditional home hospice care. The member does not have to be enrolled in a home hospice care program to be eligible for the first inpatient stay. However, the member must be enrolled in a home hospice care program in order to receive benefits for subsequent inpatient stays. |
Complete FEP benefit information is available at
http://www.bcbsks.com/CustomerService/Providers/index.htm
FEP eligibility and claim status information is available by calling the BCBSKS customer service center at 785-291-4181 or 1-800-432-0379.
STATE OF KANSAS EMPLOYEE GROUP
The State of Kansas (SOK) employee group renewed for 2010. Options available through BCBSKS continue to include:
- For active employees - Plan A and B
- For retirees (Medicare eligible)
One thing to note is that the voluntary Lab Card program is now included on Plan A as well as Plan B. The following is a sampling of the 2010 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 |
$150 individual/
$300 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) |
$1,200 individual/
$2,400 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 |
Out-Patient Surgery |
Deductible plus 20% Coinsurance
|
30% Coinsurance |
Deductible Plus 50% Coinsurance |
Out-patient Laboratory Services
- Quest Diagnostics – Lab Card
- Other participating/contracting labs
|
Covered in full
Deductible plus 20% Coinsurance |
Covered in full
30% Coinsurance |
Deductible Plus 50% Coinsurance
Deductible Plus 50% Coinsurance |
Major Diagnostic Testing
Includes but not limited to PET scans, CT scans, nuclear cardiology studies, MRI, computerized topography/
angiography
|
deductible plus
20% coinsurance
|
30% coinsurance
|
deductible plus
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 |
$600 copayment per admission plus deductible and 50% coinsurance |
Behavioral Health Inpatient |
Same as medical |
Same as medical |
| Behavioral Health Outpatient |
Same as medical |
Same as medical |
All Plan A members will receive a new identification card.
Kansas Senior Choice Plan C Summary
- Covers the Medicare Part A & B deductible and coinsurance
- The 1st three pints of blood are covered
- No benefits for services not covered by Medicare
- There is no coverage for charges in excess of Medicare's approved amounts
- Skilled nursing – The Member must meet Medicare's requirements including having been in the hospital for at least 3 days and entered a Medicare-approved facility within 30 days of leaving the hospital. Medicare provides benefits for all approved amounts for the first 20 days; subsequently no coverage is needed under Plan C. For the 21st through 100th day Medicare pays all but the amounts in the Chart; therefore, Plan C will pay those amounts. For the 101st day or after Medicare provides no coverage, subsequently Plan C provides no coverage
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 785-291-4185 or
1-800-332-0307. Provider telephone calls will be authenticated and handled by our interactive voice response system.
CG |
