All Blue Cross and Blue Shield of Kansas Contracting Providers
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
2014 Federal Employee Program (FEP) Group Health Plan
The Federal Employee Program (FEP) group health plan will renew with BCBSKS effective January 1, 2014. The 2014 Blue Cross and Blue Shield Service Benefit Plan information can be located on the Blue Cross and Blue Shield Federal Employee Program Website: www.fepblue.org.
The Blue Cross and Blue Shield Service Benefit Plan continues to offer two plan options: Standard Option and Basic Option.
Standard Option members receive services by choosing a Preferred provider from a network of hospitals, physicians, dentists, pharmacies and other healthcare providers. When the member uses a Preferred provider, the provider files the claim, payment is made to the provider and both Preferred and Participating providers must accept the Plan's payment as payment in full, except for any applicable deductibles, co-pays or co-insurance. Members can choose to use Non-participating providers, but the out-of-pocket expenses may be higher than if the member uses Preferred or Participating providers.
Some of the 2014 changes to the Standard Option include:
The calendar year deductible is now included in the out-of-pocket catastrophic protection maximum, in addition to coinsurance and copayments. Previously, the out-of-pocket maximum did not include the member's calendar year deductible.
For Self and Family contracts, the catastrophic out-of-pocket maximum is now $6,000 per year when a member uses Preferred providers and $8,000 per year when a member use a combination of Preferred and Non-preferred providers. Previously, the out-of-pocket maximum was $5,000 for Preferred provider services and $7,000 for both Preferred and Non-preferred providers.
FEP Standard Option will provide benefits for two hours of home nursing care per day, up to a maximum of 50 visits per calendar year. Previously, benefits were only available for up to 25 visits per calendar year.
Basic Option members must receive care performed by Preferred providers, except in certain situations, such as emergency care. Most care under Basic Option is subject to a copayment amount. Preferred providers file your claims and payment will be made to the provider. There are no benefits for care performed by a Non-participating provider and the member will pay all charges.
Some of the 2014changes to the Basic Optioninclude:
For Self Only contracts, the catastrophic out-of-pocket maximum for coinsurance and copayments is now $5,500 per year when you use Preferred providers. For Self and Family contracts, the maximum is now $7,000 per year when you use Preferred providers. Previously, the catastrophic out-of-pocket maximum was $5,000 for Preferred provider services for both Self Only and Self and Family contracts.
Copayment for diagnostic tests such as EEGs, ultrasounds, and X-rays performed by a Preferred professional provider is now $40. Previously, FEP member's copayment for EEGs, ultrasounds, and X-rays was $25.
Copayment for an inpatient admission to a Preferred facility is $175 per day up to a maximum of $875 for unlimited days. Previously, the copayment for an inpatient admission was $150 per day up to a maximum of $750 for unlimited days.
Some of the 2014 changes that are included in both the Standard and Basic Options include:
Services are covered for any licensed medical practitioner when performed within the scope of that license. Preferred provider requirements still apply. For example, Basic Option members can see a licensed acupuncturist beginning in 2014, however it must be Preferred provider. The service must also be considered a covered service and medically necessary.
Benefits will be provided for preventive care for testing for deleterious mutations in BRCA1 and BRCA2 genes in females, age 18 and over, who have not personally been diagnosed with breast or ovarian cancer. Benefits are limited to one BRCA test per lifetime whether the test is covered under Preventive Care benefits or is covered under Diagnostic testing benefits. Previously, Preventive Care benefits were not available for this service.
Benefits will be limited for diagnostic BRCA testing for members with a personal history of cancer to one test per lifetime whether the test is covered under Preventive Care benefits or is covered under Diagnostic testing benefits. Previously, benefits for diagnostic BRCA testing were not subject to a limit.
Benefits will be provided for insulin and diabetic supplies only when obtained from a retail pharmacy or, for Standard Option only, through the Mail Service Prescription Drug Program. This requirement does not apply if you have Medicare Part B as primary. Previously, insulin and diabetic supplies were also covered when obtained from physicians and other health care professionals, including medical supply companies and durable medical equipment providers.
For additional information and details on all the 2014 changes to the Blue Cross and Blue Shield Service Benefit Plan, please click on a link below.
If you have questions regarding the 2014 Service Benefit Plan member benefits, please contact your BCBSKS 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.