October 3, 2013

HHA-13-17
DC-13-16
ASC-13-17
MS-13-20

BC-13-20
SA-13-16
HP-13-16

To:

All Blue Cross and Blue Shield of Kansas Contracting Providers

From:

Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Subject:

2014 State of Kansas (SOK) Member Plan Designs and Benefit Descriptions

The State of Kansas (SOK) employee group will be renewing their health plans with BCBSKS for 2014. Options available through BCBSKS include Plans A, B and C and Kansas Senior Plan C.

Benefit Descriptions, as well as other information for SOK employees, are available on the BCBSKS SOK Web Page on the BCBSKS Website and can also be viewed by clicking on the links at the bottom of this newsletter.

Listed below are the primary benefit changes for SOK health plan members enrolled in a plan for 2014. There may be additional changes which appear in the Full Benefit Descriptions.

AUTISM PILOT PROGRAM:
The state's autism benefit has been ongoing as a pilot program since January 1, 2011. This will now be a permanent benefit.

BARIATRIC SURGERY:
A benefit for bariatric surgery has been added to SOK Health Plans A, B and C. To be eligible for this coverage the patient must be an adult age 18 or over, a non-tobacco user and have a documented medical history of two years or more of a Body Mass Index (BMI) that fulfills one of the following requirements:

The patient must complete all of the preparatory requirements (detailed in the Full Benefit Descriptions) to be eligible for coverage of bariatric surgery.

The following bariatric surgical services may be eligible for coverage:

IMPORTANT: These bariatric surgical procedures are covered only when performed at facilities that meet one of the following:

  1. Certified by the American College of Surgeons as a Level 1 Bariatric Surgery Center (program standards and requirements in effect on February 15, 2006)
  2. Certified by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence (program standards and requirements in effect on February 15, 2006).

A list of approved facilities and their approval dates are listed and maintained at the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program website: www.mbsaqip.org/?page_id=56. The patient will also want to verify that the Bariatric Center of Excellence is in the plan's provider network.

PLAN SPECIFIC BENEFIT CHANGES FOR 2014
Plan A:

Plan B:

Plan C:

Retirees:
The Medicare Part D plan for retirees will no longer be administered by Silverscript. Coventry has been awarded a new, three-year contract for this coverage.

BCBSKS encourages our providers to verify member benefits prior to providing any service. Providers can verify BCBSKS member benefits on the web at Availity.com. If you have questions regarding this newsletter, please contact your Institutional Provider Representative. Denny Hartman can be reached at 1-316-269-1602; Cindy Garrison at 1-785-291-8862 and Janne Adams-Denton at 1-785-291-8813.


 

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