MIIA - Blue Cross Blue Shield Proposed Benefits

Plan Offerings

• HMO Blue New England (HMO)

• Blue Care Elect Preferred (PPO)

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HMO Blue New England HMO

Blue

Use HMO Blue Network Providers PCP Required – Change Anytime Referrals To Network Specialists No Referrals For: OB/GYN Care, Chiropractic

Care, Outpatient Behavioral Health Visits, Routine Vision Exam, Emergency Or Out-Of-Area Urgent Care

Blue Care Elect Preferred (PPO)

• No Primary Care Physician Needed

• No Referrals Needed For Specialty Care

• National Network – Ability to have services rendered out of state at the same out of pocket cost as HMO members

Find A Blue Cross Network Provider

Visit www.bluecrossma.com Call Physician Selection Service 1-800-821-

1388 Ask Your Providers If They Are In The HMO

Blue Network

Proposed Changes

• Addition of a plan year deductible for some services - $250 Per Individual, $750 Per Family

• Primary Care Physician Office Visits

• Specialist Office Visits

• Emergency Room Visits

• MRI, CT and PET Scans

• Prescription Drugs

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Services That Are Not Subject

to the Deductible

SERVICES THAT ARE NOT SUBJECT TO DEDUCTIBLE

Preventive Visits, Related Tests & Immunizations: You Pay $0 (no change)

Diagnostic PCP, OB/GYN, Nurse Practitioner Visits: You Pay $20 (today you pay $10 to $20 per visit)

Mental Health Office Visits You Pay $15 (today you pay $10)

Other Professional Providers & Specialist Visits: You Pay $35. (today you pay $25)

Prescription Drugs You Pay 10/25/50 for a 30 day supply, 20/50/110 through Mail Service. (today you have a 10/20/40 for retail, 20/40/90 mail.)

Chiropractic Visits – You pay $20 (today you pay $15)

Short Term Rehabilitation Therapy – You Pay $20 (today you pay $15)

Speech, hearing, and language disorder treatment – You Pay $20 (today you pay $15)

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Services Subject To The

DeductibleAfter You Pay $250/$750. Plan Year Deductible, Then: Diagnostic Labs, X-Rays & Other Tests: You Pay $0 (today you have no

deductible) CT, Pet Scans and MRI - $100 per category of tests ( today you pay $0

with no deductible) Emergency Room: You Pay $100 (today you pay $100 with no

deductible). Inpatient Admissions: You Pay $300 at a lower cost hospital, $700 at a

higher cost hospital. (today you pay $200 for Lower cost hospitals and $400 for higher cost hospital with no deductible)

Surgical Day Care – You Pay $150 per admission after deductible (today you pay $150 and have no deductible)

Hospice and Home Health Care - $0 after deductible (today you pay nothing with no deductible)

Durable Medical Equipment You Pay $0 after Deductible (today you pay $0 with no deductible)

Prosthetic Devices – You pay Nothing after deductible – (today you pay 20% co-insurance)

Why Change?

• Benefits will not change for a period agreed upon by management and labor)

• No hidden out of pocket costs

• No off anniversary rates increases

• Deductible is plan year not calendar year

Out-Of-Pocket Maximum

Current Plan:

$600 Enhanced Tier admission out of pocket maximum

$1200 out of pocket maximum for Standard or basic tier admission

$300. out of pocket maximum for Surgical Day Care Admissions.

New Plan:

$1200 out of pocket maximum for all inpatient admissions

$600 out of pocket maximum for surgical day care admissions

Healthy Living

$150 Fitness Benefit $150 Weight Loss Benefit Childbirth Class Benefit Living Healthy Babies Blue Care Line: 1-888-247-BLUE (2583) Living Healthy Vision Discounts Living Healthy Naturally Discounts Safe Beginnings Discounts

Member Central Account

Visit www.bluecrossma.com

Create An Online Account, Then You Can: Change Your PCP Request An ID Card Review Your Plan Benefits Review Your Claims Track Your Deductible & Coinsurance Enroll In My Blue Health

Questions?

For Provider Information Or Questions

On Your Membership, Benefits, Referrals Or Claims

Call Member Service Toll-free Number On ID Card

Monday - Friday, 8 a.m. - 6 p.m.

Or Visit www.bluecrossma.com