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PPO Blue Beacon Light ImportantImportant InformationInformation AboutAbout YourYour HealthHealth CareCare BenefitsBenefits DearDear Employee:Employee: Highmark Blue Cross Blue Shield is pleased to offer health coverage that you can depend on, no Highmark Blue Shield Blue Cross is pleased to offer you health care coverage throughEPO Blue, an matter what your health status and care needs. EPO (Exclusive Provider Organization) program. As a Highmark member, you enjoy lots of advantages, including: As you read further, you’ll see that EPO Blue offers you attractive advantages. When you become an EPO• •BlueEXCELLENT member, for CARE example:: Access to health care providers who are focused on integrated, patient- focused care and measurably better care outcomes. •• YouCONVENIENT can enjoy CAREa wide: Accessrange ofto coveragethousands — of including primary care adult physicians and pediatric and specialists preventive and care coverageworld-renowned — when and you community-based receive eligible services hospitals, through medical an EPOcenters Blue and network urgent provider. care facilities. •• EPORESPONSIVE Blue gives CARE you :access Covered to preventivea large network care services of physicians, such as physicalhospitals, exams, and otherimmunizations providers throughoutand health screeningsthe United forStates every and member around of the the world, family so at you’re every covered stage of no health. matter where you live or where your travels take you. •• HEALTH SUPPORT: An exceptional range of online health assessment and education tools Youto help can you call understandMember Service your health toll-free status, when better you managehave questions a chronic regarding health condition, your coverage. even make real health improvement. You can also take advantage of total support – no matter what your current health status. •• ServicesHEALTH include SAVINGS an: exceptionalSpecial member range discounts of health on education hundreds offerings, of fitness online and healthtools toand help you wellness products, services and classes. make appropriate informed care choices and 24-hour access to confidential health information •• andPEACE care OF decision MIND :support. The assurance that no matter where you live or travel, your Blue plan has you covered! Please review this information to learn more about EPO Blue. To locate an EPO Blue network Takeprovider, a few simply minutes call to 1-800-810-BLUE review this information (2583). You to learncan also more visit aboutour websiteyour Highmark at health care coverage.www.highmarkbcbs.com We think you’ll be. pleased with all your program offers you! Thank you for giving Highmark Blue Cross Blue Shield the opportunity to provide your health care Sincerely,benefits. We look forward to serving your health care coverage needs now and in the future. Sincerely, Deborah L. Rice - Johnson President Highmark Health Plan Deborah L. Rice - Johnson P.S.President Log onto www.highmarkbcbs.com today to take advantage of your health education tools Highmark Health Plan 1 2 ENJOY THE ADVANTAGES OF PPO BLUE COVERAGE PPO Blue gives you access to a large network of providers. • You can receive care from the network provider of your choice. PPO Blue does not require that you select a primary care provider to receive covered care. Instead, it gives you access to a large network of physicians, hospitals and other providers. For a higher level of benefits coverage, you must receive care from a network provider. • To locate a network provider near you, or to learn whether your current physician is in the PPO Blue network, go to www.highmarkbcbs.com and click on the “Find a doctor, hospital or other medical provider." Or call myCare Navigator at 1-888-BLUE-428. PPO Blue gives you control over your care. • PPO Blue puts you in charge and gives you control over your care. You decide No referrals needed who provides your care. And you • PPO Blue does not require you or your determine the level of coverage you dependents to choose or receive initial receive. That means, for most services, care through a primary care physician. you can receive care from an out-of- Instead, you can decide for yourself network provider and still be covered. where to obtain care. You’re covered However, services will be reimbursed at a for physician services, specialty care, lower benefit level. hospital services and more. While you never need a referral from a primary care physician, it’s a good idea to choose a doctor to become your “family doctor” – to provide your primary care. He or she will be better able to coordinate medications and treatments since he or she will have your health history. 3 HOW YOUR PPO BLUE PROGRAM WORKS PPO Blue lets you get the medically necessary and appropriate care you want from the PLEASE NOTE: All inpatient hospital provider you select. When you or a covered care (except maternity care) must be family member needs medical care, you can choose between two levels of health care precertified to assure it is covered. A services: Network or Out-of-Network. toll-free precertification phone number is included on the ID card you will Network Care is care you receive from providers in the PPO Blue network. receive after you enroll to make this precertification convenient. This network includes primary care providers and a range of specialists, as well as hospitals Some programs require members to and a variety of treatment facilities. precertify other services, so please refer When you receive health care from a PPO Blue to the specific coverage information you network provider, you enjoy maximum coverage will receive after you enroll. and convenience. You present your ID card to the provider who submits your claim to the local Blue plan. The local plan works with Highmark Finally, you may need to file your own claims and Blue Cross Blue Shield to ensure prompt and obtain precertification for inpatient care. accurate claims payment. Out-of-Network Care is care you receive from providers who are not in the PPO Blue network. Even when you do not go to a network provider, you will still be covered for most eligible services. In these instances, you will be covered at your program’s lower level of benefits. Refer to your Summary of Benefits for your program’s specific coverage. You may also be responsible for paying any difference between the provider’s actual charge and the plan’s allowed amount. When you receive care from an out-of-network provider, coverage is paid at the lower level – even if you were directed to the out-of-network provider by a network provider. That’s why it is important, in all cases, to check to see that your provider is in the network before you receive care. 4 BLUE DISTINCTION®: THE SIGN OF QUALITY SPECIALTY CARE NOTE: Blue Distinction® Centers met If you're facing a serious medical procedure overall quality measures for patient or surgery, look for the Blue Distinction safety and outcomes, developed with designation of quality. The Blue Cross and Blue input from the medical community. Shield Association awards the Blue Distinction Blue Distinction® Centers+ also met cost designation to hospitals that deliver superior measures that address consumers' need outcomes for high-risk, high-cost procedures, such as bariatric surgery, cardiac care, complex/ for affordable healthcare. Individual rare cancers, knee/hip replacements, spine outcomes may vary. National criteria surgery and transplants. is displayed on www.bcbs.com. A local The Blue Distinction® Center designation is Blue Plan may require additional criteria awarded to hospitals that meet stringent quality for facilities located in its own service measures, focused on patient safety outcomes. area. To find out which services and The Blue Distinction® Centers+ designation providers (including hospital based indicates that the facility has met both quality physicians) are covered under your and cost criteria. policy, or to learn about local Blue Plan Blue Distinction® Centers are available criteria, contact your local Blue Plan; and nationwide, so you can find quality care contact your provider before making wherever you live, work or travel. an appointment to verify its current To find a Blue Distinction Center, use the online network and Blue Distinction Centers address or Member Service number found on status. Each hospital's Cost Index is the back of your Member ID card, or go to calculated separately, based on data www.bcbs.com/bluedistinction/bdcfinder. from its local Blue Plan. Hospitals in portions of CA, ID, NY, PA and WV may lie in areas served by two local Blue Plans, resulting in two Cost Index figures; and their own local Blue Plans decide whether all hospitals in these areas must meet Blue Distinction Centers+ national criteria for one or both Cost Index figures. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for damages, losses, or non-covered charges resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers. To find out more, contact your local Blue Plan. Blue Distinction and Blue Distinction Centers are registered service marks of the Blue Cross and Blue Shield Association. 5 YOU GET A RANGE OF COVERED CARE PPO Blue provides comprehensive health care coverage. You’re covered for everything from sick care to inpatient and outpatient hospital care. The following are some of your coverage highlights: Preventive Care Emergency Care This vital care can help you stay on top of your More than anything, you want the reassurance medical needs and establish a healthy lifestyle. of knowing that you’re covered when you need That’s why we encourage members to take care most. PPO Blue covers emergency care advantage of the PPO Blue’s excellent preventive received within or outside the PPO Blue provider care benefits. Women are also covered for network. Emergency care received at an out-of- routine gynecological exams and Pap tests.

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