Members - Using Your Health Plan

Coverage for Regular Visits and Medical Emergencies

You can reduce your out-of-pocket expenses and paperwork by using Premera's contracted network of physicians, hospitals and other providers. Your benefits also include specialist care without referrals (in most cases) and emergency care worldwide.

Choosing a Doctor or Other Provider

Your benefits and out-of-pocket expenses often depend on which providers you choose. Your health plan offers you access to a network of doctors, hospitals and other health-care professionals.

You'll find them listed in the Provider Directory where you can search for doctors, and other providers by name, location, specialty and other criteria.

You can save time and money by choosing to see a network provider when you need care.

·  You get the highest level of benefits and lowest out-of-pocket costs. You're responsible only for your coinsurance, copayment, deductible and any charges not covered by your health plan. If you decide to see a non-network provider instead of a network provider, your out-of-pocket expenses may be higher and, depending on your plan, services may not be covered.

·  You'll rarely handle claims paperwork because network providers have agreed to submit your claims directly to us. We'll send claim payments directly to the provider.

·  Since in-network providers are familiar with your network, they can help you make informed decisions to get the health care you need while keeping your out-of-pocket expenses to a minimum.

Please check your Benefit Booklet for further details about using network and non-network providers . If you need care that you or your physician believes is not available in your plan's network, please call Customer Service at 1-800-722-1471.

Your HealthChoice Premera plan offers specific levels of health-care benefits wherever you live or travel, across the country and worldwide. Your BlueCard benefits are indicated by a suitcase symbol on your member ID card.

Please refer to your Benefit Booklet for details about your BlueCard program benefits. Of course, if you believe you have a medical emergency, call 911 or seek emergency care immediately, no matter where you are.

The BlueCard PPO Program

With this program you have access to a national and worldwide network of Blue Cross Blue Shield plan contracted health-care providers, called "Blue Plan" providers. As a member of Premera Blue Cross, you have access to the BlueCard Program no matter where you live or travel, across the country and worldwide. Here's how:

Find a nearby Blue Plan provider:

• Call the BlueCard Provider Locator number on the back of your member ID card.

• You can also use the Premera Provider Directory available at www.premera.com. Make sure you choose the PPO network option if your card shows the PPO letters.

Visit the Blue Plan provider and show your member ID card. The provider will verify your Premera membership and coverage.

After you receive medical attention, the provider will submit the claim to the local Blue Cross or Blue Shield plan, and they'll route it to us. You're responsible only for the out-of-pocket expenses you would normally pay under the requirements of your plan, as if you were at home.

Please note: Some groups may have a different contact phone number. Please confirm your contact number on the back of your ID card before calling. For more detailed information about your benefits, please refer to your Benefit Booklet or contact Premera customer service.

Disease Management
AWB HealthChoice plans include disease management support to help improve the quality of life for members with chronic conditions. The programs help members take a central role in managing their care and fostering a sense of responsibility for their own health. Programs focus on providing members with education and support and are designed to respect, enhance and support the physician's care plan. All programs are based on national clinical guidelines. Members eligible for these programs are identified through claims analysis, physician referral or self-referral. These programs are completely voluntary and comply with all federal and state regulations, including the Health Insurance Portability and Accountability Act (HIPAA).

Disease Management services include:

· Helping members learn how to effectively manage their condition through educational materials and self-management tools and strategies.

· Providing members with information regarding dietary recommendations as well as preventive and prescribed test screenings.

· Supporting members with medication usage and compliance.

· Offering regular member updates and reports to physicians to ensure optimal coordination of care.

Collaborative Programs that Support the Patient-Doctor Relationship

Care Facilitation Healthy Connections programs are a series of programs that help members take a more active role in managing their overall health and enable us to assist physicians in providing the highest quality care. To facilitate patient-provider health care decisions, Premera acts as a resource to support those decisions with information and data.

Care Facilitation Programs

Care Management
Care Management covers everything from providing assistance with hospital discharge planning to coordinating care on complex medical cases. We strive to ensure that members get care in the most appropriate setting.

For more information, please visit: https://www.premera.com/stellent/groups/public/documents/xcpproject/mwa_care_facilitation.asp

Wellness Programs
Tools and resources for managing a healthy lifestyle are available at:
http://www.premera.com/stellent/groups/public/documents/xcpproject/mwa_health_information.asp

Choice in Filling in Your Prescriptions

Your health plan gives you access to Premera’s comprehensive, nationwide network of retail pharmacies and access to a convenient mail order pharmacy, Medco By Mail.

You can also order your Specialty drugs for the treatment of complex or rare conditions through our Specialty Pharmacies, Caremark or Accredo Health Group (a Medco company).

Retail Pharmacy
Premera’s nationwide retail pharmacy network offers you choice and convenience.
· Select from more than 60,000 retail pharmacies in the Premera Custom Network administered by Medco. Use the Provider Directory to find participating retail pharmacies, or call the toll-free Pharmacy Locator line at 1-800-391-9701.

Mail Service Pharmacy
If you take long-term medication, using mail service through Medco By Mail may save you money and provide the convenience of delivery through the mail.
· Use the Medco By Mail pharmacy service for new and refill prescriptions
· Register with MyPharmacyPlus to access convenient and easy to use services

Specialty Pharmacy
If you take Specialty drugs, Caremark or Accredo Health Group (a Medco company) can provide additional services and clinical support. More information is available at: https://www.premera.com/stellent/groups/public/documents/xcpproject/mwa_pharmacy_specialty.asp

Premera pharmacy forms are available at:
https://www.premera.com/stellent/groups/public/documents/xcpproject/mwa_forms_pharmacy.asp

More pharmacy information is available at:
https://www.premera.com/stellent/groups/public/documents/xcpproject/mwa_pharmacy.asp


Premera Customer Service
· 1-800-722-1471 toll free
· TDD for hearing-impaired: 1-800-842-5357