Blue Cross Newsletter
 

 

December 21, 2009  

 

BC-09-16
SA-09-15
HP-09-12


 

HHA-09-12
DC-09-12
ASC-09-13
MS-09-15


To: All Blue Cross Contracting Providers
From:

Cindy Garrison, Education/Communication Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Subject:

2010 Special Groups Update

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


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
    • Plan A and B
  • For retirees (Medicare eligible)
    • Kansas Senior Plan C

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