DESCRIPTION:

Arkansas BlueCross BlueShield offers our employees a choice of two plans, Comprehensive Major Medical (CMM) and Preferred Provider Organization (PPO).  To receive maximum coverage under the PPO plan, in-network providers must be seen. The PPO is made up of doctors and hospitals who sign contracts with the True Blue PPO Network agreeing to charge lower fees to members who access the True Blue Network.   Access to the in-network provider directory is available by clicking here (select Find a Doctor, TrueBlue PPO).

As required by the Patient Protection and Affordable Care Act (PPACA), the Summary of Benefits and Coverage (SBC) provides information regarding coverage specifications and limitations that apply to NWACC's health insurance plans.

Summary of Benefits and Coverage - PPO Plan Type
Summary of Benefits and Coverage - CMM Plan Type
Glossary of Health Coverage & Medical Terms

Grandfathered Health Plan Notice: Arkansas Blue Cross and Blue Shield believes these plans are “grandfathered health plans” under the Patient Protection and Affordable Care Act (the Affordable Care Act).  As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted.  Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to Arkansas Blue Cross and Blue Shield at 1-800-238-8379. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.

ELIGIBILITY:

All full-time employees are eligible for coverage.  Spouses and legally dependent children up to age 26 may also be eligible.

ENROLLMENT:

New Hires:  All full-time employees are eligible to apply for coverage upon hire.  If election is made upon hire, coverage becomes effective the first of the month following 30 days of employment.  You may be subject to certain waiting periods.

Qualifying Family Status Changes:  Changes to coverage may be made within 30 days of a qualifying family status change.  Examples of a qualifying family status change are birth or adoption of a child, marriage, divorce and loss of other coverage.

Annual Open Enrollment:  Each fall there is an annual open enrollment period in which employees can add, cancel or change their enrollment.

DEDUCTIBLES & COPAYMENTS:

The employee is responsible for a plan year deductible per insured.  The 2013 calendar year deductible is $575 individual; maximum family deductible is $1725. 

The employee is responsible for the entire amount of allowable charges until the deductible is met (aside from copayments for physician office visits – PPO Plan only).  After the deductible has been met, the employee pays a coinsurance.  The coinsurance rates and maximum out-of-pocket amounts vary on the plan elected.

COST:

Monthly Premium Amount paid by Employee as of January 1, 2013:

BENEFITS:

Comprehensive Major Medical coverage includes but is not limited to:

• Preventative Care Services including well baby and well child care and immunizations
• Physician services including specialist visits, surgical services, inpatient medical care and diagnostic testing
• Outpatient services
• Supplemental accident endorsement
• Maternity services
• Other services

Preferred Provider Organization includes but is not limited to:

• Preventative Care Services including adult physical exams, routine mammograms, well baby care and well child care and immunizations
• $20 Office Visit Copayment in network only.  Not covered out of network.
• Specialist visits, surgical services, inpatient medical care, diagnostic testing
• Outpatient services
• Supplemental accident endorsement
• Wellness benefit
• Maternity services
• Other services

PRESCRIPTION DRUG CARD: 34 day supply per Co pay

CLAIMS:

All claims must be filed within 180 days from date of service.

Claims for prescription drugs should be submitted to Caremark Claims Department, PO Box 52136, Phoenix, AZ  85072-2136.  Click here for a copy of a claim form.

All other claims should be mailed to Arkansas BlueCross BlueShield, Claims Processing, 601 Gaines, PO Box 2181, Little Rock, AR  72203-2181.  Click here for a copy of a claim form.

There is no time limit to file an appeal after receiving a denial or benefits decision.

QUESTIONS/CONTACT INFORMATION:

For questions about the benefits offered through this plan, contact your Benefits Coordinator.

For questions about processing a claim or problems in receiving reimbursement, contact Arkansas BlueCross BlueShield, Northwest Regional office in Fayetteville  at 1-800-817-7726, Central Region in Little Rock at 1-800-238-8379 or write to:  Arkansas BlueCross BlueShield, PO Box 2181, Little Rock, AR  72203-2181.

Arkansas BlueCross BlueShield web site is www.arkansasbluecross.com

For names of Out-of-State PPO Providers, call 1-800-810-2583 or visit www.bcbs.com

Admissions outside of Arkansas, call 1-800-451-7302

For Pharmacy Customer Service, call 1-800-863-5561

FORMS:

Enrollment Form
Change Request Form
Prescription Claim Form
Medical Claim Form