News

The health care reform law. This law was passed in two parts. The Patient Protection and Affordable Care Act became law on March 23, 2010. This law was amended by the Health Care and Education Reconciliation Act on March 30, 2010. ACA refers to the final, amended version of the law. Some people also call this law Obamacare.

Coinsurance

The dollar amount or percentage you pay for your covered health care services. For example, if you have an “80/20” plan, your health plan would pay 80 percent of the bill and you would pay 20 percent. The 20 percent you pay is your coinsurance.

Copayment

A set dollar amount you pay each time you receive a health care service. For example, your health plan may have a $20 copayment for a doctor’s office visit. You will pay this amount each time you go to the doctor.

Deductible

The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.

Embedded Deductible

If you select a Blue Option family plan with an embedded deductible, your plan contains two components – an individual deductible and a family deductible. Once a family member meets his or her deductible, then the plan will cover that family member’s covered medical expenses. Once family members have reached the family deductible, then the plan will pay for covered expenses for all family members. The individual deductible is embedded in the family deductible.

Maximum Out of Pocket (MOOP)

The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.

Non-embedded Deductible

If you select a Blue Option plan with a non-embedded family deductible, there is not an individual deductible embedded in the family deductible. You must meet the entire amount of the deductible before your plan will pay any benefits. One family member or a combination of family members can meet the deductible.

Referral

When your doctor sends you to a specialist or health care facility to get certain health care services. Some health plans require you to get this from your primary care physician.

Summary of Benefits and Coverage (SBC Glossary)

Make the Most of My Coverage

Check out these tips to help you make the most of your health care coverage:

Know the best ways to get information about your benefits

We are always happy to answer your questions about benefits or anything else. You have a lot of information at your fingertips.

Send us an email through our secure My Health Toolkit^®. If you are using it for the first time, you will need to create a profile — it just takes a few minutes.
Read your Schedule of Benefits. We send you this when you first become a member, and whenever your benefits change. You can also view your benefits in My Health Toolkit.
View your Member Guide. You can also call us at the number on the back of your ID card to request we mail you a copy of your Schedule of Benefits or Member Guide.

Be familiar with what to do after hours if you need care

If you select a primary care physician (PCP), he or she has an agreement with us to provide 24-hour call coverage. This means no matter when you call your PCP, someone will answer the phone and advise you of the proper action to take based on your condition. If an emergency arises, try to phone your PCP first. If he or she is unavailable, you can go directly to the nearest Doctor's Care or other urgent care provider. But if your condition is life- or limb-threatening, you should go directly to the nearest emergency room. As soon as possible, let your PCP know about any emergency care you have received.

Phone ahead for appointments and cancel at least 24 hours in advance

This helps you receive your medical care on a more timely basis. When you call first, your doctor's staff will arrange for the most appropriate care — either an appointment or advice for an ailment. If you must cancel any appointments, please let your doctor's office know as soon as possible. Some physicians may charge for missed appointments and BlueChoice HealthPlan does not cover those charges.

Make the most of your appointment

Be prepared to ask your doctor questions and provide as much background about your health as you possibly can. On your first visit, bring all the medicines you currently take. Your doctor will need this information to assess your medical condition and monitor possible drug interactions. Here's a helpful checklist to make sure you're keeping up with you and your child's health.

Always bring your ID card with you

Whenever you seek medical care, be sure to identify yourself as a BlueChoice HealthPlan member. When you arrive for your appointment, present your BlueChoice HealthPlan ID card to the office staff.

NEW! Now you can access your digital ID card anytime, anywhere from your computer or mobile device. Your digital ID card is identical to your plastic card. It contains your Member ID number and other coverage details that are unique to you. Unlike your plastic card, you don’t have to worry about losing it or ordering duplicate copies for your family.

To access your card, simply log into your My Health Toolkit account.

On your computer: Under the Insurance Card section on the left, select View Your Card.
On your mobile device: Select Insurance Card from the main menu.

Don’t discard your plastic ID card. Some doctors may still want a copy of it for their records.

Blue Option ID card

Help yourself stay healthy

Take advantage of our Great Expectations^® for health programs. We can help you stop smoking, control your diabetes or decrease your risk for heart disease. You'll learn to breathe easier with our asthma management program. Expectant moms count on our maternity program to provide information and support, which can help them deliver healthy babies. We even have a special program for women only. For more information, call our Health Management department at 855-838-5897.

Choose a primary care physician

BlueChoice HealthPlan strongly recommends you choose a primary care physician (PCP). This is a doctor who specializes in family medicine, internal medicine or pediatrics (for children and adolescents). These doctors are trained to diagnose and treat many illnesses and manage chronic conditions, such as diabetes, high blood pressure and asthma. PCPs also provide preventive care, routine screenings and immunizations. Should you ever need a specialist or other type of doctor, your PCP can recommend one in your Blue Option network and coordinate your care with him or her. Always seek care from your PCP first, unless it's an emergency.

Where You Go Matters!

Where Should I Go For My Health Care Needs?

Where you go matters! We care about you and want to help you take charge of your health. Avoid needless worry, out-of-pocket costs and hours sitting in the emergency room (ER) by knowing how to navigate through the health care system and being familiar with other options for your care.

Primary Care Physician

Your primary care physician (PCP) should be your first choice for health care. See your PCP for common medical issues:

Illnesses such as colds, flu, earaches and sore throats
Minor injuries such as sprains, strains and back pain
Routine physical exams, vaccinations and screenings
A health problem for which you need advice

Don't have a PCP? Find one here. Or, give us a call at 855-838-5897. We can help you find a doctor that fits your needs.

Network Urgent Care Clinics

Urgent care centers provide another option when you need care and your regular doctor is not available. Urgent care centers provide attention for medical problems that need seeing to right away but are not life-threatening, or for problems that could get worse if you wait. An urgent care visit usually takes less time than a hospital emergency room and costs you much less.

Blue CareOnDemand^SM

You can now visit with a doctor faster and more easily than ever. With Blue CareOnDemand, you can visit with a doctor via smartphone, tablet or computer, rather than visiting an office or urgent care facility. Doctors will diagnose and write prescriptions as appropriate.

What types of conditions can Blue CareOnDemand doctors treat?

Colds
Pink Eye
Flu
Ear Infection
Fever
Migraines

When should you use Blue CareOnDemand?

The doctor's office is closed
You are too sick to drive
You are traveling

Download the app via the App Store or Google Play or visit www.BlueCareOnDemandSC.com and sign up for Blue CareOnDemand today!

When Should I go to the ER?

The emergency room is only for very serious or life-threatening problems.

Sudden or unexplained loss of consciousness
Signs of a stroke
Poisoning
Signs of heart attack
Severe shortness of breath
Medication/drug overdose, alcohol poisoning

The ER is not a substitute for a PCP visit. Going to the ER for something that is not a true emergency could result in long wait times and may result in your claim not being paid. The good news is that you have options! And if you're ever in doubt, err on the side of caution and seek immediate care.

For more information about making the most of your benefits and navigating the complex health care system, contact our team:

855-838-5897

Monday–Thursday, 8:30 a.m. – 8 p.m.

Friday 8:30 a.m. – 5 p.m. EST

Our team consists of licensed social workers and certified medical assistants that aim to address and modify the habits of high utilizers and reduce ER visits.

Clone of Health Care Reform

Health Care Reform is also called the Affordable Care Act, or Obamacare. It is a law that was designed to get more Americans health insurance coverage. No matter your income, job status or your health condition, you can now get health insurance. The law requires a standard package of medical benefits for everyone.

When is Open Enrollment?

The open enrollment period for 2019 begins Oct. 15, 2018 and ends Dec. 15, 2018. If you haven't enrolled in coverage by then, you generally can't buy health coverage for 2019 until the next open enrollment period for coverage the following year.

If you're enrolled in a 2018 health plan, your benefit year ends Dec. 31, 2018. To continue health coverage in 2019, you can renew your current health plan or choose a new plan during the 2019 open enrollment period.

You must enroll no later than Dec. 15, 2018 to have your coverage take effect Jan. 1, 2019.

What will my insurance cover?

Standard medical benefits for all plans include:

Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitation and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care

How much will it cost?

Your insurance cost will vary depending on:

Where you live
How old you are
Whether or not you smoke
How many people are in your household

Want to know how much it will cost? Find out here.

Under the law, pre-existing conditions and your gender are not factors in determining how much you will pay for health insurance.

FOCUSfwd Device Integration

The FOCUSfwd^® Wellness Incentive Program offers device integration, an opportunity to earn entries for tracking physical activity through the use of your smartphone or activity tracker.

How To Connect My Smartphone

To use a smartphone to sync your physical activity with FOCUSfwd without an activity tracker, you have to set up Mobile Tracking.

How do I get mobile tracking?

Mobile tracking can be accessed by downloading the Fitbit app on your smartphone.

STEP 1: Get Started
- Download the Fitbit app on your smartphone from the Apple App Store, Google Play Store, or Microsoft Store, and tap “Get”.
STEP 2: If you do not have an account, select "Join Fitbit" and then "No Fitbit Yet?" within the initial app set up.
- Create an account with the instructions on your smartphone.
- If you already have an account, select "Log In":
  - Tap or click the Account settings.
  - Click the option for setting up a new device.
  - Choose MobileTrack.
  - Follow the Mobile Tracking instructions on smartphone.
STEP 3: Connecting to FOCUSfwd Wellness Incentive Program
- Now that you’ve setup a mobile tracking account, let’s review the steps for connecting to FOCUSfwd to begin earning entries!
  - Login through My Health Toolkit^® into the FOCUSfwd Wellness Incentive Program
  - Click on the "Devices" page in the main Navigation Bar.
    - This can always be accessed from any page in the program.
  - Set up Mobile Tracking: Click the “Connect” button under the Fitbit brand
  - You'll automatically be taken to login to your Mobile Tracking account.
  - Allow FOCUSfwd Wellness Incentive Program access to the data needed to track and score your physical activity.
    - This will be ‘Cardholder by ChipRewards’ asking for permission.
    - FOCUSfwd Wellness Incentive Programrecommends you select “Allow All”, as we may track other data in the future for rewards. However, “activity and exercise”, “profile”, and “devices and settings” should be checked. Click the “Allow” button to complete the process

That’s it! You’re now connected and can begin to earn for staying active!

How To Connect my Activity Tracker

If you have a Fitbit, Misfit or Garmin activity tracker, follow these steps to get connected!

**Don’t see your activity tracker? No problem! Just use steps above to track using your smartphone.**

Let’s Get Started!

STEP 1: Login to your FOCUSfwd account, select the “Devices” tab, then Click “Connect” with the device brand you are using.
STEP 2: You’ll automatically be taken to login to your device account.
STEP 3: Allow FOCUSfwd Wellness Incentive Program access to the data needed to track and score your physical activity.
- This will be ‘Cardholder by ChipRewards’ asking for permission.
- FOCUSfwd Wellness Incentive Programrecommends you select “Allow All”, as we may track other data in the future for rewards. However, “activity and exercise”, “profile”, and “devices and settings” should be checked. Click the “Allow” button to complete the process.

That’s it! You’re now connected and can begin to earn for staying active!

FAQs

Can I link more than one device to my FOCUSfwd account?

Yes, you can have more than one device linked to your account, but FOCUSfwd Wellness Incentive Program will only record the steps from 1 device per day. You cannot combine the steps from multiple devices to reach the daily step goal of 5,000 steps.

How long does it take for my steps to sync to my account?

It takes 24-48 hours for your steps to sync from your device and display on the FOCUSfwd Wellness Incentive Programwebsite. Additionally, you must frequently sync the data from your device to your online activity tracker account. This is available through the manufacturer’s website or mobile app. Devices can store up to 30 days of data, so large amounts of data may take longer to sync.

What happens if I change my privacy settings on my device?

If you have recently changed the privacy settings on your device, you may have revoked access of your physical activity data to FOCUSfwd Wellness Incentive Program. FOCUSfwd Wellness Incentive Program is powered by ChipRewards, so you have to allow “Cardholder by ChipRewards” access to your physical activity tracker’s data. If you have revoked access to “Cardholder by ChipRewards”, simply follow the instructions to reconnect your device.

How often should I sync my steps to my account?

Most devices can hold up to 30 days of physical activity data. Therefore, FOCUSfwd Wellness Incentive Programcan sync up to 30 days of physical activity data. If a member does not sync their device data within 30 days of completing the physical activity, FOCUSfwd Wellness Incentive Program will not be able to retrieve the older data.

If you have any additional questions, please call the number on the back of your ID card.

Reminders

Remember, these come with every 2019 Blue Option plan!

Dental Care

Plans include a dental allowance for exams and cleanings. Enjoy an increased reimbursement for preventive care from any South Carolina licensed dentist.

For Adults and Children:

One exam every six months: $50 allowance
One cleaning every six months: $50 allowance

Members will be responsible for paying any additional balance above what we cover. They will need to submit a dental reimbursement form to BlueChoice^® for reimbursement. For example, if your dentist charges you $80 for an initial exam, you will pay your dentist $80 at the time of service. We will reimburse you $50 once we receive your reimbursement form.

Costs incurred from these services do not count toward any MOOP expenses. View our glossary for a definition of MOOP and other health insurance terms.

FOCUSfwd® Wellness Incentive Program

To get started, you’ll need to:

Login in to My Health Toolkit^®
Click on the Health and Wellness tab
Then click on the FOCUSfwd^® Incentive Program link

Don’t have a My Health Toolkit account? No problem, set one up today. It just takes a few minutes.

This program is only available to eligible subscribers and their spouses (aged 18 and older).

Blue CareOnDemand

Visit with a doctor 24/7/365 wherever you are with your smartphone, tablet or computer. Each Blue CareOnDemand^SM visit costs the same amount as an office visit with your primary care doctor. Doctors will diagnose and write prescriptions as appropriate.

Don't wait until you're sick! Download the app via the App Store or Google Play and create a Blue CareOnDemand account today! You can also visit www.BlueCareOnDemandSC.com to create an account as well as have a consult with a doctor via computer. When creating your account, remember to enter your member ID.

Doctors Care

When your doctor is not available and Blue CareOnDemand is not appropriate, choose this option for urgent and after-hours care. You can visit any Doctors Care location across the state for the same price as a primary care physician visit. Find a location and check in at www.DoctorsCare.com.

BlueChoice HealthPlan Wire

We want to make sure you have the most current information about your policy. You can have health information delivered right to your phone with The BlueChoice HealthPlan Wire^SM, our text messaging tool. You'll get important news and updates about:

How to make the most of your coverage
New features or enhancements
Health and wellness reminders

To get started, simply call 844-206-0622. You'll need to have your member ID card ready.

Adult Vision Care

All Blue Option plans include our routine adult vision coverage using the Physicians Eyecare Network (PEN). PEN is an independent company that offers a vision provider network on behalf of BlueChoice HealthPlan.

For adult vision care (ages 19 and over), this includes:

$0 copayment for one routine eye exam or one exam for contact lenses per benefit period
$45 copayment for one standard contact lens fitting per benefit period.
$0 copayment for one pair of eyewear from a designated selection every other benefit period.

For members outside the South Carolina service area, $71 will be allowed toward the routine eye exam and $120 credit will apply to the purchase of eyewear. The member must file claims.

Please note that you must visit an in-network provider to receive this benefit. Consult your PEN provider for information on discounts for which you may be eligible if you elect to receive eyewear/contact lenses outside the standard designated selection.

Costs incurred from these services do not count toward MOOP expenses.

Life Management Services

Everyone needs some advice from time to time. First Sun EAP provides a broad array of services designed to help people and encourage success. Because First Sun is a separate company from BlueChoice HealthPlan, First Sun will be responsible for all services related to life management services. These services are free to members and those in their households. All covered family members will have a total of three free sessions of their choice.

Services include:

Financial counseling
Adult care resources
College consultation resources
Legal services
Child care resources
Parenting/ Adoption resources

Dedicated professionals are available to serve you 24 hours a day, seven days a week. Call 800-968-8143.

This benefit is non-essential and does not count toward any MOOP. View our glossary for a definition of MOOP and other health insurance terms.

Explore Blue Option Today!

Your employer has partnered with BlueChoice HealthPlan to provide you with information about Blue Option. Blue Option has plans to fit your life, all backed by the security and dependability of Blue®. Here you can learn about the individual plan options available to you and your family.

Doctor & Hospital Finder

Find Care

Find in-network doctors, hospitals and other health care professionals.

Find In-Network Providers

Pay My Bill

Recently improved! Need to pay your Blue Option bill?

More Payment Methods

About Us

BlueChoice HealthPlan offers Blue Option to individuals and families seeking health coverage in South Carolina. BlueChoice® has more than 30 years of experience providing security to South Carolinians. Our service, value and quality are evident in all our Blue Option plans!

Our Mission

Our mission is to deliver diversified, affordable and high quality health coverage to our members to help them achieve optimum health and wellness. We will do this by:

Constantly improving our services and products to meet the changing needs of our members.
Using innovative technology to improve efficiency and quality.
Maintaining our commitment to superior service.

Thousands of South Carolinians enjoy the benefits of BlueChoice^®. You can too.

Focus on Prevention

Throughout our history, we have stressed the need for preventive care. We created several programs to help our members stay healthy, including our Great Expectations^®for health programs.

Great Expectations

Our Great Expectations for health programs help educate our members about their overall health. We support members as they make healthy lifestyle changes. Learn more about these programs.

Financially Strong

In December 2019, AM Best Co. reaffirmed the A+ financial strength rating of BlueChoice as part of the group rating for the BlueCross^® BlueShield^® of South Carolina companies. AM Best Rating as of Dec. 10, 2019. For the latest AM Best ratings, go to www.ambest.com.

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

Members

Need to change your current plan? Check out our 2020 Blue Option plans and select a plan that better suits you. Select the button to the right.

As a Blue Option member, you enjoy certain exclusive services such as greater access to care, added convenience and helpful savings. Be sure to check out the Discounts & Added Values. Your member guide allows you to quickly and easily understand how your Blue Option plan works. It includes information on:

Important things to do
Selecting a doctor
Adult Vision, Pediatric Vision and Dental Benefits
Payment and billing
What we pay for
Emergency care and what to do if you need care away from home

2019 Member Guide

Prescription Drugs

Want to know if we cover your prescription drugs? Want to learn how generic drugs can save you money? Find out and learn more about prescription drug coverage.

Start Getting Healthy (or healthier) today with FOCUSfwd!

Our Wellness Incentive Program offers you the chance to win cash rewards. There are winners every week! The more you participate, the better your chance of winning the grand prize of $5,000.

To get started, you'll need to:

Log in to My Health Toolkit^®
Click on the Health and Wellness tab
Then click on the FOCUSfwd Incentive Program link

Don't have a My Health Toolkit account? No problem. It only takes a few minutes to create one.

A faster, easier way to see a doctor.

Did you know there's a faster, easier way to see a doctor now? With Blue CareOnDemand^SM you can visit with a doctor 24/7/365! Read more!

On the Go & Still in the Know

We want to make sure you have the most current information about your policy. You can have health information delivered right to your phone with the BlueChoice HealthPlan Wire^SM, our text messaging tool. You get important news and updates about:

How to make the most of your coverage
Health and wellness reminders
... and more!

To get started, simply call 844-206-0622. Please have your member ID card ready.

My Resources

Here is where you can find information about our online tools as well as resources to help you make the most of your health coverage.

Discounts & Added Values

Get more with your Blue Option coverage. Learn all the ways you can save when you're one of our members!

Always wanted to improve your vision? Take advantage of member discounts on LASIK surgery. Interested in losing weight? Jenny Craig offers our members great discounts on the popular weight-loss program. Check out the video to learn about the discounts that are available to you as a member.

Member Rights & Responsibilities

Member Rights

Members have the right to be treated with respect and recognition of their dignity and right to privacy.
Members have the right to choose their own personal doctors from our list of health care professionals. If members are not happy with their first choice, they have the right to choose another primary care physician from our network.
Members have the right to expect their primary care physicians and their teams to coordinate all the care they need.
Members have the right to participate with their doctors in decision making to help take charge of their own health.
Members have the right to get the information they need to make thoughtful choices before they take any treatment their doctors suggest. BlueChoice HealthPlan does not direct practitioners to restrict information regarding treatment options.
Members have the right to learn about their conditions and treatment in words they understand and to be a part of decisions about their own care.
Members have the right to share their opinions, concerns or complaints constructively.
Members have the right to receive information about BlueChoice HealthPlan, our services, practitioners, providers and members’ rights and responsibilities.
Members have the right to complain or make appeals about BlueChoice HealthPlan or the care they receive.
Members have the right to make recommendations regarding BlueChoice HealthPlan’s rights and responsibilities policy.

Member Responsibilities

Members have the responsibility to treat all medical staff with respect and courtesy as their partners in good health.
Members have the responsibility to work with their doctors to form good relationships based on trust and teamwork.
Members have the main responsibility of keeping up their good health and preventing illness.
Members have the responsibility to ask questions and make sure they understand the information they receive.
Members have the responsibility to give BlueChoice HealthPlan and their doctors as much information as they can so it can be used to help them get well.
Members have the responsibility to work with their primary care physicians to form a treatment plan, and to follow the directions agreed upon.
Members have the responsibility to think about what might happen if they don’t follow their doctors’ treatment plan or suggestions.
Members have the responsibility to keep appointments they schedule. In cases where they may have to cancel or may be running late, members have the responsibility to call the office and let them know.
Members have the responsibility to read all our materials carefully as soon as they sign up for BlueChoice HealthPlan.
Members have the responsibility to follow the rules of their membership.

You can also download a printable version.

Report Fraud

We are committed to stopping insurance fraud. If you suspect fraud, please report it! You can remain anonymous. For more information or to report a suspected case of fraud, please visit our parent company's website.

Privacy & Legal

Here is where you'll find our privacy and legal statements.

Legal Notices

Website Privacy Policy

Privacy Practices

Forms

We've gathered our forms in one place to make it easier to find the one you need.

2020 Application

Do you need 2020 coverage? If so, please review, fill out and submit a 2020 application.

Authorization to Disclose Protected Health Information

You can use this form to give us permission to release information to someone else. Please note that if you're a parent of a minor child, you can still get information about your child without having to complete this form.

Change Request Form

You can use this form to:

Cancel your plan on the next due date
Add/change your bank draft

Claim Form

There may be times when you travel outside our service area or receive emergency services out of network and wish to file a claim. This is the form you use.

Dental Reimbursement Form

Use this form to receive your dental reimbursement. Please note that you have 3 months from the date of service to submit this form.

Designation of Authorized Representative of Appeal Form

Use this form if you need to appeal a claim on behalf of someone else.

International Claim Form

International Claim Form in Spanish

Use this form to submit institutional and professional claims for covered services you receive outside the United States, Puerto Rico, Jamaica and the U.S. Virgin Islands.

Health and Wellness Authorization Form

We offer a variety of disease and health education programs for the entire family. Please complete this authorization form to participate.

HSA Bank Application

HSA Bank is an independent company that offers health savings account (HSA) administration on behalf of BlueChoice HealthPlan.

Online Other Health Coverage Questionnaire

This form gives us information about any other health coverage you may have that can affect how we pay benefits. This is also known as Coordination of Benefits (COB). You can complete this form online by logging into My Health Tookit^®.

Pharmacy Mail-Order Form – 2019

This form offers you the convenience of ordering your prescription drugs by mail.

Pharmacy Mail-Order Form – 2020

This form offers you the convenience of ordering your prescription drugs by mail.

Request for Benefit Extension for an Incapacitated Dependent

The information requested on this form aids in providing BlueChoice HealthPlan the necessary information to make a coverage determination.

Transition of Care Form

This form is for people with an acute injury or illness. Members or covered dependents need to get approval for this short-term benefit.

Pay My Bill

Need to pay your bill? We offer several convenient ways to do just that!

Call Us!

If you would like to pay by phone, please call us at 866-569-5933. You will need routing and account numbers from your checking account.

Online

To pay using a credit card using either a Visa, Discover or Master Card, please visit us online.

Through the Mail

You can also mail your payment to this address:

Attn: LockBox

BlueChoice HealthPlan
P.O. Box 100216
Columbia, S.C. 29202-3216

By Visiting One of Our South Carolina BLUE^SMRetail Centers:

Columbia:

1260 Bower Parkway, Suite A4
Columbia, SC 29212

Monday–Friday 9 a.m. – 5:30 p.m.
Saturdays by appointment only

803-264-9000 (Phone)

Greenville:

Magnolia Park Mall
1025 Woodruff Road, Suite A105
Greenville, SC 29607

Monday–Friday 9 a.m. – 5:30 p.m.
Saturdays by appointment only

864-286-2285 (Phone)

Mount Pleasant:

1795 Highway 17 North, Unit 7
Mount Pleasant, SC 29464

Monday–Friday 9 a.m. – 5:30 p.m.
Saturdays by appointment only

843-216-7760 or 855-492-2583 (Phone)

If you need to cancel a federally funded policy, please call the Marketplace at 800-318-2596 or visit www.healthcare.gov.

*Please note that you have an age-rated policy. This affects anyone on your policy age 15 or older. It means there will be an age-related rate change every year for those members. If you or a member on your policy is age 15 or older in 2018, you will see your rate change starting Jan. 1, 2019, and every January thereafter.

Health and Wellness

Your health is important to us. Learn about our disease and health education programs and discover ways to help keep you and your family healthy. We have a variety of programs for the entire family.

We can help you quit smoking, lose weight, better cope with specific diseases or conditions, teach you how to improve your children's health and much more. Most of our programs are free for members, or have a low, one-time fee.

Allergy Relief

Members Get Preferred Rates on Allergy Relief

Looking for allergy relief? Check out the great discounts that are available!

Beltone Program for Better Hearing

Good hearing lets you savor life. When it's easy to hear, it's easy to stay involved. To share laughter with loved ones, excel on the job, remain independent — good hearing is the key.

Hearing loss is a common problem that can happen to anybody and it often comes gradually with age or is caused by repeated exposure to loud noises. About one in four people suffer from hearing loss.

We’ve partnered with Beltone to offer an extra value-added discount to our members. Beltone has been helping the world hear better for over 79 years. Beltone has led the industry in hearing aid innovation and boasts amazing sound quality and features focused on ease of use. You can wirelessly stream music and other audio from your smartphone and you can even test drive models right in the office.

Members get a discount on Beltone hearings aids and more.

$3,595 Amaze 17 63 includes Amaze Charger
$3,195 Amaze 17 64
$2,995 Trust 17, Boost Max 17
$2,745 Legend 17
$2,995 Amaze 9 63 includes Amaze Charger
$2,595 Amaze 9 64
$2,495 Trust 9, Boost Max 9
$2,245 Legend 9
$2,495 Amaze 6 63 includes Amaze Charger
$2,095 Amaze 6 64
$1,745 Legend 6
$1,495 Ally 3
$1,250 Trust 6, Bold 3
$995 Ally 2, Bold 2
Value-Added Items (all items included):

Hearing screening

Three-year manufacturer’s warranty
Three-year loss & damage coverage (deductible applies)
Three years of batteries (48 cells per year/per hearing aid)
45-day credit return period with re-stocking fee
Program extended to family members
Premium BelCare™ aftercare plan for ongoing care and service free of charge

Visit Beltone’s website at www.beltone.com for additional details.

It’s easy to get started!

Call Beltone at 888-418-6763 to find your nearest Beltone location.
Call your local Beltone provider to schedule your free hearing.
Bring your insurance card with you to your appointment.

This is an added-value discount program. Its services and discounts are in addition to, but not included in, the services and benefits covered under your employer health plan. This page contains a link to a third party site. That organization is solely responsible for the contents and privacy policies on its sites.

Blue365

BlueChoice HealthPlan Members Now Have Access to More Great Discounts Nationwide!

Blue365 is a program that complements your health coverage by giving you exclusive access to health and wellness information, discounts and savings from industry-leading brands that help make it easier and more affordable to make healthy choices.

Blue365 includes:

Discounts on fitness centers
Discounts on weight loss and nutrition programs
Tools and information on eldercare and caregiver options for parents and dependent family members

Blue365 is a valuable collection of online tools and information to help you make important choices about your health care and your future, as well as exclusive discounts on products and services you can use today.

Blue365 Authorization

By choosing the “REGISTER” button on the Blue365 website after reading this:

I authorize my local Blue Company to disclose to the Blue Cross Blue Shield Association (BCBSA) information about me so that BCBSA can make special discounts and offers available to me, including, but not limited to, my name, e-mail address, age, zip code, and status as a member of my local Blue Company;
I authorize both BCBSA and my local Blue Company to send me communications about these special discounts and offers; I acknowledge that some of the offers and discounts are not health related and that BCBSA may receive payments from Blue365 vendors under the Blue365 program; and
If I have questions about a Blue365 vendor or a Blue365 vendor’s products and services and Blue365 or my local Blue Company determines that the vendor is in a better position to respond, I authorize BCBSA and my local Blue Company to forward my question and my e-mail address to the vendor so the Blue365 vendor can respond to my question directly.

I understand that BCBSA is not subject to federal health information privacy laws and any information BCBSA receives will no longer be subject to such laws. This authorization is voluntary. My local Blue Company will not condition payment, enrollment in a health plan, or eligibility for benefits on whether I sign this authorization. I may revoke this authorization by sending a request in writing to: Blue365 Member Services, 225 North Michigan Ave., Chicago, IL, 60601-7680, or alternatively, by sending an email to: support@Blue365deals.com. When I revoke this authorization, the revocation will not affect any disclosure my local Blue Company made before the revocation. This authorization expires one year after I disenroll from my local Blue Company.

I have had full opportunity to read and consider the contents of this authorization. I understand that, by selecting the “I Agree” button, below, I am confirming my authorization for the uses and disclosures of information about me, as described in this form.

Last updated 06/06/2016

Print the Blue365 Authorization

I Agree

I Disagree

Bosley Hair Restoration

BlueChoice® members can now receive a 20 percent discount off the cost of a hair transplantation procedure at Bosley!

Members can now receive a 20 percent discount* off the cost of a hair transplantation procedure at Bosley!

Members with thinning hair can enjoy a discount program that helps them save money while restoring their hair with confidence!

Bosley is a world leader in hair restoration. Bosley's procedure works by surgically transplanting hair from the donor area to the recipient (thinning) area. Surgical hair transplantation is the only permanent and the most significant solution for treating a receding hairline.

Surgical hair transplant surgery is a simple, outpatient procedure. Bosley offers both the Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT) procedure options. Most people can return to work the following day. Affordable financing options are available for qualified applicants.

For more than 40 years, Bosley has pioneered the art and science of hair restoration for both men and women, using world-class clinical resources, research and technology. Bosley’s physicians have performed more than 275,000 hair restoration procedures with patients from all 50 states and over 60 countries.

In addition to hair transplantation, Bosley also offers eyebrow restoration and Federal Drug Administration (FDA)-accepted non-surgical hair restoration solutions, including:

TriGen+ With PRP
Capillus Laser Cap
Bosley Professional Strength Products
Prescription Propecia
SMP (Scalp Micropigmentation)

To learn more about the hair restoration treatment options available to you, call Bosley at 800-510-5357, email Bosley or visit Bosley's website. You can also view the discount flyer for more information.

This is an added-value discount program. Its services and discounts are offered to members in addition to, but not included in, the services and benefits covered under a policy.

This discount does not apply to non-surgical Bosley products. Bosley physicians are only available at Bosley Surgical Offices. Professional services provided by the affiliated physicians of the Bosley Medical Group.

*20% discount applies only to the price of a procedure of 800 grafts or more. Price quoted does not include fees for procedure medications, post-procedure medications, or extra grafts. For procedures less than 800 grafts, you pay Bosley’s standard fees. Offer not valid on Eyebrow procedures. This special offer is not transferable, and may not be used with any other discounts or special offers from Bosley. All information subject to change without notice.

Professional services provided by the affiliated physicians of the Bosley Medical Group (“Bosley physicians”). Bosley physicians are available only at Bosley Surgical Offices. Candidacy for hair restoration can only be determined by a Bosley physician upon examination, diagnosis and prescription of a treatment plan. Your Bosley physician will determine if you are a candidate for hair restoration and recommend the optimal number of grafts to achieve your individual hair restoration goals. A patient may require more than one procedure to achieve their desired results. Ask your Bosley physician during your free consultation about your individual case. Individual results may vary.

Fitness Center Discounts

Our members can take advantage of discounts at a variety of fitness centers. See if there's a participating fitness center in your area!

Children's Fitness

Tivity Health

Participating Fitness Centers

This is an added-value discount program. Its services and discounts are offered to BlueChoice HealthPlan members in addition to, but not included in, the services and benefits covered under a BlueChoice HealthPlan policy.

Natural Blue

Look what Natural Blue can do!

Save More. Live Better.

Natural Blue^SM, a value-added feature of BlueCross HealthPlan members, offers discounts with alternative medicine health care professionals and fitness centers through ChooseHealthy™.

With the ChooseHealthy program, you can save on wellness products and services, and get health improvement tools to help you live healthier every day.

The program allows you to:

Get discounts up to 57 percent on popular products from health and fitness vendors.
Enroll in the Active&Fit Direct™ consumer self-pay fitness program and choose from 9,000+ fitness centers and YMCAs for $25 a month (plus a $25 enrollment fee and applicable taxes).
Save up to 25 percent on services from specialty health care practitioners.
Learn from evidence-based, online health classes and articles offered at no cost.

When participating in ChooseHealthy, you:

Can directly access services from participating health care professionals and you can change professionals at any time.
Pay the member rate directly to the health care professional. You should check any insurance benefits you have before using this discount program, as those benefits may result in lower costs to you than using this discount program.
Have no additional paperwork to complete, other than the health care professional's usual patient history and documentation forms.
Have no annual limits to this access program.
Can purchase a variety of products by visiting the ChooseHealthy website.

Learn more about these services or products by visiting the ChooseHealthy website or you can call 877-335-2746 Monday – Friday, 5 a.m. – 6 p.m. Pacific Time.

Log in or register to take advantage of the discounts. To locate a participating fitness center or YMCA near you, select the Enroll Now button and search by city, ZIP or full address. If you find a fitness center or YMCA that works for you and decide to take advantage of this fitness program, select the “Enroll Now” button. An Active&Fit^® ID card will be generated for you upon enrollment.

This is an added-value discount program. Its services and discounts are offered to members in addition to, but not included in, the services and benefits covered under your employer policy.

The ChooseHealthy program is not insurance. The ChooseHealthy program provides for discounts for specialty health care providers. You are obligated to pay for all services from these providers, but will receive a discount from them for included services. The ChooseHealthy program also includes the Active&Fit Direct program, which provides discounted access to fitness centers and YMCAs. The ChooseHealthy program does not make any payments directly to participating providers or to the Active&Fit Direct program. The ChooseHealthy program has no liability for providing or guaranteeing services and assumes no liability for the quality of services rendered. Discounts on products and services available through the ChooseHealthy program are subject to change; please consult the website for current availability.

The program described above is provided by ChooseHealthy, Inc. and American Specialty Health Fitness, Inc., subsidiaries of American Specialty Health Incorporated (ASH). ChooseHealthy, Active&Fit Direct and Active&FitDirect are trademarks of ASH and used with permission herein.

QualSight LASIK

LASIK Is Now Easier for Health Plan Members!

Members receive preferred pricing on LASIK through QualSight providers across the nation with more than 1,000 locations to choose from.

QualSight LASIK features a national network of credentialed surgeons that have collectively performed more than 6.5 million procedures. LASIK surgery is an FDA-approved procedure, and it is performed to correct nearsightedness, farsightedness and astigmatism.

With QualSight LASIK, you can save 40 to 50 percent on the national average LASIK cost. LASIK prices have increased slightly due to advancements in laser technologies. Prices also can vary by the LASIK procedure type and the region of the country.

Preferred LASIK Pricing

$945 per eye for Traditional LASIK
$1395 per eye for Custom LASIK
$1795 per eye for Custom Bladeless LASIK

What is included?

The price includes a pre-operative appointment exam, the LASIK procedure, post-operative visits and a one-year assurance plan. Lifetime assurance plans are also available through participating providers for an additional cost. Flexible financing with 12-month interest free options are available from participating providers to qualified applicants.

How do you take advantage of the discounts?

Please call QualSight at 855-489-2020 Monday through Friday from 8:30 a.m. – 7:30 p.m. ET to schedule a preoperative appointment. A care manager will answer your questions and schedule a preoperative appointment with the physician you select.

To see the most frequently asked questions, view this flier. For more information, please call 855-489-2020 or visit QualSight’s website.

TruHearing

TruHearing Helps Members Save Thousands on Hearing Aids

Don’t let hearing loss hold you back from the things you love. Whether it is socializing with friends and family, engaging in recreational activities or just listening to the birds, hearing clearly enhances your lifestyle — and it shouldn’t cost a fortune!

Hear Better. Feel Better. Don’t let hearing loss hold you back from the things you love. Whether socializing with friends and family, engaging in recreational activities or just listening to the birds, hearing clearly enhances your lifestyle — and it shouldn’t cost a fortune!

TruHearing is an exclusive hearing aid savings program for BlueChoice HealthPlan members. BlueChoice^® members save an average of $980 per hearing aid compared to national average prices. Members can visit any of the more than 5,000 TruHearing locations across the country.

Example prices (per aid):

Sample Product	Avg. Retail Price	TruHearing Price	Savings
Starkey Muse iQ i2000	$2,900	$1,425	$1,475
Oticon Opn 1	$3,125	$2,095	$1,030

See complete pricing on over 100 hearing aid models in 400 styles at www.TruHearing.com or learn more with our TruHearing flier.

How the program works:

Call TruHearing at 855-586-5508. You must schedule all appointments through TruHearing.
TruHearing will answer your questions and schedule a hearing exam with a local hearing health provider.
At your appointment, the provider will conduct a hearing exam and recommend the appropriate hearing aids for you if needed.
The hearing aids will be shipped to the provider and you’ll return to the office 3–10 days later for your fitting and programming.

Along with personal service and great pricing on hearing aids, TruHearing will give you or your immediate family members who are also eligible for the program:

A 45-day trial
120 batteries for only $39, conveniently delivered to your door
Three follow-up visits with a provider for fitting and adjustments
A three-year manufacturer warranty for repairs and one-time loss and damage replacement

Call TruHearing at 855-586-5508 to learn more and to schedule your hearing exam. Customer service representatives are available Monday through Friday, from 8 a.m. to 8 p.m. EST.

This is an added-value discount program. Its services and discounts are offered to BlueChoice members in addition to, but not included in, the services and benefits covered under a BlueChoice HealthPlan policy. This page contains links to a third party site. That organization is solely responsible for the contents and privacy policies on its sites.

Children's Fitness

My Gym Children's Fitness

Members with children can enjoy a discount program to help keep your kids active and save money!

We have partnered with My Gym Children’s Fitness Centers. My Gym offers a variety of structured, age-appropriate weekly classes that incorporate music, dance, relays, games, special rides, gymnastics, sports and other original activities. These classes and programs help keep children active and entertained while also building confidence and self-esteem.

My Gym Children's Fitness Centers is dedicated to improving the lives of children and families. Their mission is to create facilities, programs and services that empower youngsters by helping them acquire the skills, confidence and positive self-image needed to become healthy young adults.

Members in South Carolina receive a 10 percent discount off the cost. The typical age range is 3 months to 9 years old. For more information, visit My Gym, view the My Gym flier or contact:

Northeast Columbia
803-788-1230
Village at Sandhill Marketplace
110-1 Forum Drive
Tammie Donelson

This is an added-value discount program. Its services and discounts are in addition to, but not included in, the services and benefits covered under your employer health plan.

Jenny Craig

Get healthy with Jenny Craig and BlueChoice HealthPlan!

Get Serious About Losing Weight with Jenny Craig

Skip the fads and gimmicky diets and experience real results with Jenny Craig's Special Offer for health plan members:

Free three-month program (plus the cost of food) + $120 in food savings (purchase required)*
OR
Save 50 percent on our premium programs (food cost separate)**

Here’s how the program works:

Dedicated Personal Consultant: Jenny Craig includes a weight loss consultant to help you reach your goal. Together, you’ll create a customized weight loss plan that fits your needs and lifestyle.

Delicious Food: Enjoy around 100 chef-crafted Jenny Craig foods in flavors you’ll love. You get to eat six times a day so you’re always satisfied. Each meal and snack is conveniently prepared for you, no prep or cooking required.

Real Results: Lose more weight than dieting on your own.†

Visit www.jennycraig.com/affinity
OR
Call 877-Jenny70 to schedule an appointment for a FREE and no obligation consultation.

*Valid for 3-month trial membership. Weekly full menus avg. $158 (before discount) and any shipping costs are not included. Food cost subject to change. Discount to be used in $10 increments, weekly over 12 consecutive weeks. Full menu adherence required for food discount. Active program enrollment and eligibility status required, which includes meeting with a consultant weekly and adhering to the full Jenny Craig meal plan. Offer valid at participating centers and Jenny Craig Anywhere. Not valid at jennycraig.com. No cash value. Not valid with any other offers or discounts. One offer per person.

**50 percent discount on enrollment and/or membership fees for eligible premium programs. Weekly full menus average $158 (before any discount) and any shipping costs are not included. Food cost subject to change. Active program enrollment and eligibility status required, which includes meeting with a consultant weekly and adhering to the full Jenny Craig meal plan. No cash value. Not valid with any other offer or discounts. Only available at participating locations and Jenny Craig Anywhere. Not valid at jennycraig.com.

† JAMA. 2010 Oct 27;304(16):1803-10.

This is an added-value discount program. Its services and discounts are in addition to, but not included in, the services and benefits covered under your health plan. This page contains links to a third party site. That organization is solely responsible for the contents and privacy policies on its sites.

Legal Notices

Here is where you will find legal notices that we have received. This information is posted for your convenience and reference. If you have questions about a notice, please contact the persons stated in the notice or consult your personal attorney.

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Privacy Promise

We understand the importance of handling your medical information with care. We are committed to protecting the privacy of your medical information. State and federal laws require us to make sure that your medical information is kept private. Federal law requires that we provide you with this Notice of Privacy Practices, which describes our legal duties and privacy practices with respect to your medical information and your legal rights with respect to our use and disclosure of your medical information. We are required by law to follow the terms of the Notice currently in effect. This Notice is effective September 23, 2013, and will remain in effect until it is changed or replaced.

We reserve the right to change our privacy practices and the terms of this notice at any time, as long as the law allows. These changes will be effective for all medical information that we keep, including medical information we created or received before we made the changes. When we make a material change to our privacy practices, we will provide a copy of a new notice (or information about the changes to our privacy practices and how to obtain a new notice) in a mailing to members who are covered under our health plans at that time.

Uses and Disclosures of Medical Information

Treatment, Payment, Health Care Operations

We may use and disclose your medical information for purposes of treatment, payment and health care operations.

Treatment: We may disclose your medical information to a physician or other health care professional to help him or her provide your treatment.

Payment: We may use or disclose your medical information for these and other activities related to payment:

Paying claims from physicians, hospitals and other health care providers.
Obtaining premiums.
Issuing explanations of benefits to the named insured.
Providing information to health care professionals or other entities that are bound by the federal Privacy Rules for their payment activities.

Health Care Operations: We may use or disclose your medical information in the normal course of conducting health care operations, including such activities as:

Quality assessment and improvement activities.
Reviewing the qualifications of health care professionals.
Compliance and detection of fraud and abuse.
Underwriting, enrollment and other activities related to creating, renewing or replacing a plan of benefits. We may not, however, use or disclose genetic information for underwriting purposes.
Providing information to another entity bound by the federal Privacy Rules for its health care operations, in limited circumstances.

You and Your Family and Friends

We may use and disclose your medical information to communicate with you for purposes of customer service or to provide you with information you request. We may disclose your medical information to a family member, friend or other person to the extent necessary for him or her to assist with your health care or payment for your health care. Before we disclose your medical information to that person, we will give you a chance to object to us doing so. If you are not available, or if you are incapacitated or in an emergency situation, we may, in the exercise of our professional judgment, determine whether the disclosure would be in your best interest. We may also use or disclose your medical information to notify (or help notify, including identifying and locating) a family member, a personal representative or other person responsible for your care of your location, general condition or death.

Your Employer or Organization Sponsoring Your Group Health Plan

We may disclose summary information and enrollment information to your employer (or other plan sponsor). Summary information is a summary of the claims history, claims expenses or types of claims that members of your group health plan have filed. The summary information will not include demographic information about you or others in the group health plan, but your employer or plan sponsor may be able to identify individuals from the summary information provided.

Disaster Relief

We may use or disclose your medical information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.

Public Benefit

We may use or disclose our members medical information as authorized by law for the following purposes that are in the public interest or benefit:

As required by law.
For public health activities, including disease and vital statistics reporting, child abuse reporting, FDA oversight, and to employers regarding work-related illness or injury.
To report adult abuse, neglect or domestic violence.
To health oversight agencies.
In response to court and administrative orders and other lawful processes.
To law enforcement officials in response to subpoenas and other lawful processes concerning crime victims, suspicious deaths, crimes on our premises, reporting crimes in emergencies and to identify or locate a suspect or other person.
To coroners, medical examiners and funeral directors.
To organ procurement organizations.
To avert a serious threat to health or safety.
In connection with certain research activities.
To the military and to federal officials for lawful intelligence, counterintelligence and national security activities.
To correctional institutions regarding inmates.
As authorized by state workers compensation laws.

Your Authorization

You may give us written authorization to use your medical information or to disclose it to anyone for any purpose. You may revoke your authorization in writing at any time. However, this will not affect any uses and disclosures we made while your authorization was in effect. Without your written authorization, we will not use or disclose your medical information for any reason except those described in this notice.

Individual Rights

You have certain rights with respect to the medical information we maintain about you. To exercise any of these rights or to obtain more information about these rights (including any applicable fees), contact us using the information listed at the end of this notice.

Access

You have the right to inspect or receive a paper or electronic copy of your medical information, with some exceptions. To inspect or receive your medical information, you must submit the request in writing. If you request to receive a copy of your records, we are allowed to charge a reasonable, cost-based fee.

Disclosure Accounting

You have the right to request, in writing, a record of instances in which we (or our business associates) disclosed your medical information for purposes other than treatment, payment, health care operations, and as allowed by law. We will provide you with a record of such disclosures for up to the previous six years. If you request a record of disclosures more than once in a 12-month period, we may charge you a reasonable, cost-based fee for each additional request.

Restriction

You have the right to request, in writing, that we place additional restrictions on our use or disclosure of your medical information. By law, we are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). Any agreement to additional restrictions will be made in writing and signed by a person authorized to make such an agreement for us.

Confidential Communications

You have the right to request, in writing, that we communicate with you about your medical information by other means, or to another location. We are not required to agree to your request unless you state that you could be in danger if we do not communicate to you in confidence. In that case, we must accommodate your request if it is reasonable, if it specifies the other means or location, and if it permits us to continue to collect premiums and pay claims under your health plan. We will not be bound to your request unless our agreement is in writing.

Amendment

You have the right to request, in writing, that we amend your medical information. Your request must explain why we should amend the information. We may deny your request if we did not create the information you want amended and the person or entity that did create it is available, or we may deny your request for certain other reasons. If we deny your request, we will send you a written explanation. .

Notice of Breach

We are required to notify affected individuals following a breach of unsecured medical information. explanation.

Electronic Notice

You may request a written copy of this notice at any time or download it from our website.

Questions and Complaints

If you want more information about our privacy practices, or if you have questions or concerns, please contact us using the information below.

If you believe we may have violated your privacy rights, you may submit a complaint to us using the contact information listed below. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with that address upon request.

We support your right to the privacy of your medical information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

Contact Information
Attn: Privacy Officer
I 20 East @ Alpine Road (AC-200) Columbia, SC 29219

803-264-7258 (telephone)
803-264-7257 (fax)

Terms of Use

Blue Cross and Blue Shield of South Carolina, together with its affiliates (collectively referred to as “Company” or “we”) is the owner of this website (this “Site”) and, makes the Site available to you.

1. General Terms

1.1. In consideration for using this Site, you agree to these Terms of Use. IF YOU DO NOT AGREE TO THESE TERMS OF USE OR TO ANY PRIVACY POLICY CONTAINED OR REFERRED TO ON THIS SITE, DO NOT USE THIS SITE. By using the Site (other than to read these Terms of Use for the first time) or clicking on the words “Continue”, “Yes” or “I Agree” or any similar wording anywhere on this Site, you agree to comply with these Terms of Use. Company reserves the right to change these Terms of Use from time to time and you hereby agree to such changes without further notice. We suggest that you re-read the Terms of Use and any privacy policies contained on or referred to on this Site (“Privacy Policy” from time to time so that you stay informed as to any such changes. In any event, by using this Site, you agree that you will be bound by the Terms of Use appearing on this Site at the time you are using the Site. Further, some Company services may require you to agree to additional terms and conditions that apply to the specific Company services. If you agree to those additional terms and conditions, then those additional terms and conditions also shall form a part of these Terms of Use.

1.2. The right to use the Site is personal to you and is not transferable to any other person or entity. You are responsible for protecting the confidentiality of your password and user name, if you have them. You may only use this Site to access information about you or your dependents. Do not use this Site to access information about any other person, including a friend or family member.

1.3. You acknowledge that the Site may experience service interruptions or events that are beyond Company’s control and that Company will not be responsible for any information you may lose while you are using the Site or when you transmit information to the Site via the Internet.

1.4. Your use of the Internet is solely at your own risk. You agree to assume all risks associated with unauthorized users of your login or other information you share with or have access to on this Site and further release us from any and all claims, liabilities and damages, of whatever nature, related to the Site.

1.5. You represent and warrant to us that you are age 18 or older. Use by those under the age of 18 is not authorized. The Site is not directed at children under the age of 13. Company does not knowingly permit registration or submission of personally identifiable information by anyone younger than 13 years of age..

2. Information on the Site

2.1. Company has no legal duty to you to update information on the Site. This means information on the Site may be out of date at any given time. Company also may make improvements or changes to the information, products, or services described on the Site at any given time without notice.

2.2. Company has no legal duty to you to ensure that the Site is correct. By using this Site, you agree not to hold Company liable for any inaccuracy of this information and you assume all the risks associated with its use.

2.3. We may modify, remove, or update information on the Site without notice. Company may change or terminate any feature of the Site, including, but not limited to, content, hours of availability, and equipment needed for access or use. Company may stop providing any information or category of information, may change or eliminate any transmission method, and may change transmission speeds or other aspects of the Site’s operation. If we terminate your access to Site, then this Agreement shall remain in full force and effect and shall survive as the governing terms of your access and use of the website and Services prior to your termination. Furthermore, we may modify or discontinue your access to any or all of the Site in our discretion at any time.

2.4 Depending on your status, you may have access to eligibility and benefits information through the Site. The information you obtain is not a guarantee of payment. Unless otherwise required by state law, any information you obtain regarding eligibility and benefits is not a guarantee of payment. Benefits are subject to all contract limits and member status on the date of service and other terms of your insurance policy or benefit plan. Also, nonpayment of premiums and other contractual limitations may result in denial of benefits or refunds. You should always consult your insurance policy or benefit plan document about what your insurance policy or benefit plan covers.
Accumulated amounts such as deductibles may change as additional claims are processed. Deductible and out-of-pocket limits may not apply for all services under your benefit plan. The deductible and out-of-pocket status information is a standard calculation based on the limits for professional outpatient services performed in a hospital. If your benefit plan does not impose a limit for this service or includes different limits for other types of services, the actual amounts may vary.
The replacement deductible is for the deductible specific to the service type requested. This replaces the global deductible for this service type. Please contact Customer Service for additional information regarding benefits

2.5 Nothing contained, expressed, or implied in the Site is intended as, nor shall be construed or understood as, medical advice. No doctor-patient or other medical provider-patient relationship is established between Company and you by reason of your use of the Site or under any circumstances whatsoever. The information in the Site is for general informational purposes only. If you have questions about medical issues or health information arising from your use of the Site, you should contact your own health professional.

2.6 Nothing contained, expressed, or implied in the Site is intended as, nor shall be construed or understood as, legal or financial advice, guidance, or interpretation. No attorney-client or accountant-client relationship is established between Company and you by reason of your use of the Site or under any circumstances whatever. The information in the Site is for general informational purposes only. If you have questions about any law, statute, regulation or requirement expressly or implicitly referenced in the Site, or its financial ramifications, you should contact your own legal counsel, financial professional, or both.

2.7 Confidentiality of Communications: Communications that you post to the Site are not confidential. You are responsible for your own communications and the consequences of such posting. Some parts of this Site may allow you to post, or to e-mail to Company, materials or information ("Visitor Content"). Communications that you post to the Site are not confidential. You are responsible for your own communications and the consequences of such posting. You grant Company the unrestricted right to use or distribute, free of charge, any Visitor Content posted on this Site by you or anyone using your login information. COMPANY DOES NOT REPRESENT OR GUARANTEE THE TRUTHFULNESS, ACCURACY OR RELIABILITY OF ANY COMMUNICATIONS POSTED BY OTHER USERS OR ENDORSE ANY OPINIONS EXPRESSED BY OTHER USERS. ANY RELIANCE ON MATERIAL POSTED BY OTHERS IS AT YOUR OWN RISK.
Company may review, remove or edit any Visitor Content at its discretion. COMPANY HAS NO RESPONSIBILITY AND ASSUMES NO LIABILITY FOR VISITOR CONTENT POSTED BY YOU OR BY ANY OTHER PARTY.

3. Proprietary Rights

3.1 This Site and all contents posted on the Site are the exclusive property of Company or are licensed to Company for its use. Company is the owner or licensee of the copyright in the entire content (including images, text, and look and feel attributes) of the Site and reserves all rights in that regard. Except as provided in Section 3.3, below, YOU MAY NOT POST, LINK, OR MAKE OTHER MODIFICATIONS TO THE SITE OR COPY MATERIAL FROM THE SITE WITHOUT COMPANY’S EXPRESS WRITTEN CONSENT.

3.2 Company does not transfer or grant any of its intellectual property or other rights to you, including any copyright, trademark, service mark or patent rights, all of which Company expressly reserves for itself. You may not remove or change any copyright notice on any material on the Site.

3.3 You may make reasonable use of the Site and content on the Site for your personal or household purposes. You may not use content on the Site for any commercial purpose. You agree not to distribute, manipulate, create derivative works from, or use the information on this Site for any purpose other than as described above or as expressly authorized by Company. You acknowledge that you do not acquire any ownership rights by copying or downloading copyrighted material. Furthermore, you agree that you shall comply with all applicable laws, regulations or other government directives regarding your use. You agree that you do not have permission to use and will not use the Site: (i) to access any information for which you do not have the legal right to view; or (ii) to distribute or publish any defamatory statements, pornographic material, copyrighted, trademarked or other proprietary material. You may not submit or post any material or information which is illegal, obscene, threatening, defamatory, invasive of privacy, or infringing of proprietary rights of any person or entity, or which contains software viruses, corrupted data, cancel bots, commercial solicitations, or mass mailings or any form of "spam." You may not use a false e-mail address to impersonate any person or otherwise mislead as to the origin of any material or information you submit or post.

3.4 Any violation of this Agreement may result in copyright, trademark, or other intellectual property right infringement that may subject you to civil and/or criminal penalties. The Site contains Company’s copyrighted material, trademarks, and other proprietary information, including, but not limited to, text, software, photos, video, graphics, music, and sound. This content is protected by copyright as a collective work under the United States copyright laws.

4. Security/Privacy; Other Websites; Information Sharing; Mobile Device Information Usage; Consent to Usage of Information; Email Usage; Cookies and Similar Technologies

4.1 Security/Privacy: This Site has security/privacy measures in place to protect against the loss, misuse and alteration of the information under our control. While your Username and Password are used to initially recognize you as an enrolled member, some of the functions offered by the Site may require a higher level of validation and will use your member/group/provider/agent number and date of birth to allow access to these functions. We use your Internet Protocol (IP) address to help diagnose problems with our server, and to administer our website. Your IP address is also used to help identify you and to help gather broad demographic information. Although we have security and privacy measures in place, we cannot guarantee that unauthorized third parties (including computer hackers) will not gain unauthorized access to your information or otherwise misuse the system. Use your own best judgment when sending information via the Internet to an email address or website. Email sent via the Internet may pass through private and public networks with varying levels of security. Some networks may have taken steps to secure email transmissions while others have not, thereby compromising the privacy and integrity of an email. An email may be copied, altered or destroyed.

4.2 Third Party Sites, Terms and Information Sharing: As you navigate through the Site, you will be able to link to other sites for special offers or information. Please note that we provide these links for your convenience, but inclusion of the link does not imply endorsement by us. We do not guarantee any third party’s performance and do not guarantee any of the services or materials provided by any third party. The linked sites are not under our control and we are not responsible for the contents of any linked site or any link contained as a linked site. You may be required to accept a linked website’s separate terms and conditions in order to access such website. Some linked sites may provide particular, personalized services. For the linked site to provide this type of detailed information, it may be necessary for us to provide the linked site with specific information related to your personal information. Your acceptance of this Agreement constitutes your agreement that we may provide such linked sites with necessary personal information. Because we do not control the linked sites, we encourage you to understand the privacy policies of linked sites. Obviously, we cannot be responsible for the privacy practices or the content of such websites. With regard to third party information, we do not endorse or otherwise recommend or approve any product or information located on or available through the Site.

4.3   Mobile Device Usage and Information. You agree to the following:
(a)   Mobile usage includes any program or service accessed or used via your mobile device (e.g. an iPhone or smart phone) and the software modules operating within our mobile environment and appearing on your mobile device that provide you access to a variety of content and services.
       (b)   We collect information for mobile usage, such as your device type and hardware IDs; the request type; your mobile carrier; your mobile carrier’s user ID; the content of your request; basic usage stats about your device; and use of our products and services. This information does not by itself identify you to us, though it may be unique or consist of or contain information that you consider personal.
If you use location-enabled products and services, such as Google Maps for mobile, you may be sending us location information. This information may reveal your actual location, such as GPS data, or it may not, such as when you submit a partial address to look at a map of the area.
Certain use of our products and services allows you to download and/or personalize the content you receive from us. For these products and services, we will record information about your downloads and preferences, along with any information you provide about yourself. If the product or service requires you to log in with a specific account, this information will be associated with your account.
(c)   All requests made via your mobile device must be sent through your mobile carrier's network and your mobile carrier may have access to it. For information regarding your mobile carrier's treatment of your information, please consult your mobile carrier's privacy policies

4.4 Consent to Use Information Supplied; TCPA Consent: In using the Site, you may supply certain information. Please be advised that we may use or share information provided by you as part of any services we provide with third parties for the purposes of providing the Site or any other services, products or benefits or for marketing purposes to the extent allowed by law. This may include, without limitation, our use or our vendors’ or subvendors’ use of automatic telephone dialers or recorded or artificial voices to communicate with you at any telephone number, including, without limitation, any mobile or other mobile device numbers you have provided or any successor to such numbers, for the purposes of supplying any services, products or benefits or for marketing purposes. Your clicking the words “Continue” or “Yes” or “I agree” or any similar phrasing anywhere in using this Site or your use of this Site or any information or services referred to, linked to, or contained on the Site constitutes your written consent given electronically, to the maximum extent allowed by law, to any usage by us or our vendors or subvendors of your personal information (including, without limitation, contact information such as email addresses, mobile or other device numbers) as referred to or otherwise stated in this Agreement and any Privacy Policy.

4.5. Consent to use of Email: You agree Company may use any email address you supply to correspond with you regarding the Site, to provide any services, products, or benefits to you, your spouse or your dependents and to send other communications, including, without limitation, marketing communications, to you, your spouse or your dependents. Company also may retain this email address for such future use as Company may determine. Additionally, Company may send email responses to questions submitted to “Ask Customer Service” or “Ask Provider Services”. If you would like to update your personal information, you may do so either via the website’s Ask Customer Service or Ask Provider Services function or by calling the Customer Service department.

4.6 Cookies and Similar Technologies. Technologies like cookies, pixels, device or other identifiers (collectively, "Cookies and similar technologies") may be used to deliver, secure, and understand products and services offered by Company. Cookies are small files that are placed on your browser or device by the website you are viewing or app you are using. You agree, to the maximum extent permitted by law, that Company may use cookies and similar technologies for any reasons in support of Company’s business, including, without limitation, for marketing purposes and for use with third parties.

5 Limitation of Liability; Warranties

5.1 By using the Site, any programs or tools on the Site, and any third-party sites to which you may link through the Site you agree to (a) release Company from any and all claims, liabilities or damages related to such use and (b) accept all risks related to such use.

5.2 You agree not to hold Company responsible for any damages or injury, whether for breach of contract, tortious behavior, negligence, or under any other cause of action, caused by any failure of performance, error, omission, interruption, deletion, defect, delay in operation or transmission, computer virus, communication line failure, theft or destruction, or unauthorized access to, alteration of, or use of records or information made available on (a) the Site, (b) any program or other tool available at the Site, or (c) any third-party site to which you may link through the Site. Without limiting the foregoing, you specifically agree not to hold Company responsible for the defamatory, offensive, or illegal conduct of any third party using the Site.

5.3 ALL MATERIALS ON THIS SITE ARE PROVIDED AS IS, WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED. COMPANY DISCLAIMS ANY AND ALL EXPRESS AND IMPLIED WARRANTIES, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT..

5.4 COMPANY SHALL NOT BE LIABLE FOR ANY SPECIAL, INDIRECT, PUNITIVE, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, INCLUDING, WITHOUT LIMITATION, LOST REVENUES OR LOST PROFITS, THAT MAY RESULT FROM THE USE OF THIS SITE, THE MATERIALS POSTED ON THE SITE, AND LINKS PROVIDED ON THIS SITE.

5.5 You agree to defend, indemnify, and hold harmless Company and its affiliates and respective directors, officers, employees, and agents, from and against all claims, damages, obligations, losses, liabilities, cost or debt, and expenses, including but not limited to reasonable attorneys’ fees, arising from (a) your use of and access to the Site and any link to a third-party’s site; (b) your violation of any provisions of these Terms of Use ; (c) your violation of any third-party’s right, including (without limitation) any copyright, property, or privacy right; or (d) any claim that content or information you submit causes damage to a third party. This defense and indemnification obligation specifically will survive these Terms of Use and your use of the Site.

5.6 The Site is controlled and operated by the Company from offices in the United States. Company makes no representation that materials provided on the Site are appropriate or available for use in other locations and access to them from locations in which their contents are illegal is prohibited. Those who choose to access the Site from such other locations are responsible for compliance with applicable local laws.

6 Disputes

6.1 By using the Site, you agree that any dispute or claim arising out of or in connection with (a) the Terms of Use, (b) any failure to perform under or breach or termination of the Terms of Use, or (c) your use of the Site or any link to a third-party site, or any products or services provided under or through the Site or any link to a third-party site, shall be brought solely and exclusively in a federal or state court of competent jurisdiction located in Richland County, South Carolina, and you hereby expressly and irrevocably consent to the jurisdiction and venue of such courts and waive any defenses to such jurisdiction, venue or convenience of forum. These Terms of Use and legal issues arising out of, but not exclusive to the use of, the Site or any third-party sites are governed by and in accordance with the laws of the State of South Carolina (exclusive of its rules regarding conflicts of laws).

6.2 You agree that any cause of action arising out of or related to the Site or your use of the Site must commence within one (1) year after the cause of action accrues. Otherwise, such cause of action is permanently barred.

6.3 If any provision of these Terms of Use is determined to be invalid by a court of competent jurisdiction, such invalidity shall not affect the enforceability of any other provision of the Terms of Use and the remaining portions of these Terms of Use shall continue in full force and effect.

6.4 By using this Site, you agree that any claim, suit or dispute resolution proceeding will be conducted only on an individual basis and not in a class or representative action.

7. Miscellaneous

7.1 Electronic Signature and Agreement: You agree that the act of clicking the words “Continue” or “Yes” or “I agree” or any similar phrasing anywhere in using this Site is intended by both parties to be an electronic signature that has the same significance as a signature in ink and that both such signature and this Agreement are considered to be in writing to the maximum extent permitted by law.

7.2 Except as stated in the next sentence, these Terms of Use constitute the entire agreement of the parties with respect to the subject matter hereof. These Terms of Use are not intended to modify or limit any provisions in any Privacy Policies contained or referred to on this Site. In the event of a conflict between this Agreement and any Privacy Policy, the broader stated use shall apply to the extent permitted by law. If you wish to withdraw your consent to this usage of your information, please contact our Customer Service department. No waiver by either party of any breach or default hereunder is a waiver of any preceding or subsequent breach or default.

7.3 You agree that, if you experience any problems in using this Site or need to request assistance in using this Site, you should contact the following: 877-274-1715

7.4 This Agreement does not establish any relationship or partnership, joint venture, employment, franchise or agency between you and us.

7.5 If any provision of this Agreement is determined to be invalid or unenforceable, then all other provisions of this Agreement shall remain in full force and effect. If any provision of this Agreement is determined to be invalid or unenforceable, then the court shall enforce this Agreement to the maximum extent allowed by law or equity.

Revised: December 5 2018

Find Care

If you're looking for in-network doctors, hospitals or other providers, here's how to find them:

Find an in-network provider (effective through 12/31/19)

Find an in-network provider (effective 1/1/20)

Services outside the Blue Option Network are only covered for urgent or emergency care performed in an urgent treatment center or emergency room.

Find a dentist*

Vision Care Providers* (effective through 12/31/19)

Vision Care Providers* (effective 1/1/20)

View our patient-centered medical home practice locations.

Find an independent lab in South Carolina through Quest Diagnostics* and LabCorp*. These are independent companies that provide lab services on behalf of BlueChoice HealthPlan.

*These links lead to third party sites. Those companies are solely responsible for the content and privacy policy on their sites.

My Health Toolkit

We understand the importance of making the right health care decisions, so we created My Health Toolkit®, an online resource to help you better manage your benefits, treatment, financial decisions and wellness.

Want to know if your plan covers a specific procedure? Do you need information about your health and dental benefits? Maybe you just want to check a claim and see if we've paid your doctor. You can find all this and more online! My Health Toolkit^® gives you safe, fast access to your benefits information.

You can:

View claims status and an Explanation of Benefits (EOB).
Read about your benefits and coverage information and check your eligibility.
Ask Customer Service a question about your benefits. When you send a message through My Health Toolkit, our secure email protects your private information. Your message also goes directly to the customer service area that handles your coverage, so you'll get a faster answer!
Access your digital ID card anytime, anywhere form your computer or mobile device. Your digital ID card is identical to your plastic card. It contains your Member ID number and other coverage details that are unique to you. Unlike your plastic card, you don’t have to worry about losing it or ordering duplicate copies for your family.
Update your communication preferences when and how you like. You can choose to receive certain information via email, text or by mail. Simply select the My Profile tab within your account.
And more!

Take advantage of secure, live access to your coverage with My Health Toolkit!

You just got insurance. Now what?

Benefits, what are they and how do they work?

Our helpful video tells you what happens next.

Be sure to Rate Your Visits. Check out this quick video to find out why and how!

How Your Doctor's Visit Becomes an EOB

Understanding your Explanation of Benefits.

What's Preauthorization?

What you need to know before getting additional services.

Why was my claim denied?

Some possible reasons why we denied your claim.

Summary of Benefits and Coverage

We offer an easy-to-understand summary of a health plan’s benefits and coverage, referred to as a Summary of Benefits and Coverage (SBC). An SBC includes plan details, called “coverage examples,” that let you see what the plan covers for certain health conditions or medical situations.

SBC 2020

SBC 2019

Great Expectations for Health Programs

Health Coaching — We’re Here for YOU

Need help reaching a personal health goal? We’re here for you. As part of your health insurance benefits, you have access to a personal health coach who will work with you to create a custom plan that can help you become your best self. Our team of nationally accredited coaches includes nurses, health educators, certified diabetes educators, respiratory therapists, dietitians and more. It’s hard to make changes and stick to them. You don’t have to do it alone.

What is Health Coaching?

What to Expect During Your Coaching Call

How Does Maternity Coaching Work?

Health Coaching Testimonial

We offer telephonic health coaching for:

Adult attention deficit hyperactivity disorder (ADHD)
Asthma
Back care
Bipolar support
Chronic kidney disease
Chronic obstructive pulmonary disease (COPD)
Depression
Diabetes
Healthy and active kids and teens (childhood obesity)
Heart disease
Heart failure
High blood pressure
High cholesterol
Maternity
Metabolic health
Migraine
Recovery support program
Stress management
Tobacco cessation
Weight management

To enroll in a Great Expectations^® program or for more information about health coaching and access to helpful resources, log in to My Health Toolkit^® and select Health and Wellness then Health Coaching. You can also call us at 855-838-5897.

Asthma

Great Expectations^®Asthma helps members learn how to better manage their asthma and improve their quality of life. We automatically enroll all members with asthma at no charge. Ready to get started? Review the asthma guide for tips to help you get on the road to breathing easier.

Our higher risk members enjoy telephone counseling by respiratory therapists and health educators. All members are welcome to call us with their questions about asthma or their coverage for asthma services, medications and supplies.
There's also great online information in the Asthma Center and Allergy Center. This information is courtesy of Caremark, an independent company that offers health education information on behalf of BlueChoice HealthPlan.
Members may receive a free peak flow meter. Good asthma management includes using a peak flow meter every day. To keep track of your peak flow readings, print a copy of the daily diary of peak flow readings.

Asthma can be a serious illness. Fortunately, you can control it with medications and by avoiding your asthma triggers. An important part of asthma management is having an Asthma Action Plan that your doctor has filled out for you. If you don't have one already, you can print a blank Asthma Action Plan or Pediatric Asthma Action Plan (for children) to take with you to your next visit.

Smoking is especially risky for people with asthma. If you smoke and would like help quitting, there are many resources you can access through the Great Expectations^® Smoking Cessation program.

To enroll in a Great Expecations^® program or for more information about health coaching and access to helpful resources, log in to My Health Toolkit and select Health and Wellness then Health Coaching. You can also call us at 855-838-5897.

Back Care

Great Expectations^®Back Care was created to help you manage any back pain that may be keeping you from completing daily tasks, being active or just fully enjoying life. This new BlueChoice HealthPlan program provides you with educational tools and support. We want to help you take care of your back!

If you suffer from chronic back pain, you could be considered for case management. Our highly skilled and experienced case managers will work with you to assess your condition and treatment options, coordinate services and assist in helping you understand medical and pharmacy benefits.

Learn more about low back pain:

Back Care Program Guide
Get the facts about low back pain
Picture this: anatomy of the spine, plus more great information
Know Your Back

man holding his back with two hands

To enroll in a Great Expectations^® program or for more information about health coaching and access to helpful resources, log in to My Health Toolkit and select Health and Wellness then Health Coaching. You can also call us at 855-838-5897.

Some links on this page lead to third party websites. Those parties are solely responsible for the contents and privacy policies on their sites.

Health Resources Library

Weekly Health Tips on Facebook

Get weekly health tips from us on Facebook at Facebook.com/BCBSSC. Simply go to the page, "Like" us and weekly messages will appear directly in your newsfeed.

Health Messages from the Centers for Disease Control and Prevention

Visit m.cdc.gov on your mobile phone or PDA. Or subscribe to receive a few text messages a week by texting HEALTH to 87000. Standard text messaging rates will apply. You can opt out at any time by simply replying HEALTH QUIT.

Text4baby

Get FREE messages each week on your cell phone to help you through your pregnancy and your baby's first year. Text4baby is an educational program of the National Healthy Mothers, Healthy Babies Coalition, an independent company that offers health information on behalf of BlueChoice HealthPlan.

These are independent companies that offer health information on behalf of BlueChoice HealthPlan. These links lead to third party websites. Those parties are solely responsible for the contents and privacy policies on their sites.

Recipes for Healthy Eating

Following a meal plan with healthy and nutritious foods is very important. It helps you manage weight, pregnancy and chronic disease conditions — like asthma, COPD, heart disease, heart failure and diabetes. These links to healthy recipe books can help you choose delicious and satisfying foods that are also good for you.

Academy of Nutrition and Dietetics
American Diabetes Association
American Heart Association
2016 BlueOption Recipe Book
2015 BlueOption Recipe Book

The Academy of Nutrition and Dietetics, American Diabetes Association and American Heart Association links lead to third party websites. Those parties are solely responsible for the contents and privacy policies on their sites.

Links to Health Sites

This information is courtesy of Caremark, an independent company that offers health education information on behalf of BlueChoice HealthPlan.

Building Better Health
Cool Health Tools
Health Topics A-Z
Self-Care Centers

These links lead to third party websites. Those parties are solely responsible for the contents and privacy policies on their sites.

Case Management

Great Expectations^®Case Management is for members who have extraordinary medical needs or conditions. This includes members with advanced stage cancer, severe trauma, multiple chronic conditions, Hepatitis C, brain injury, transplants and neuro-muscular diseases.

With Case Management, everyone involved in your health care works as a team. This includes you, your family, your doctors and other health care staff, and a BlueChoice HealthPlan case manager. An experienced registered nurse case manager partners with you to help you navigate through the complicated health care system. When you’re in case management, you’re in good hands. Our team of highly skilled case managers includes nurses who typically have more than 20 years of experience and have received a special certification in case management [Certified Case Manager (CCM)].

There are many benefits to participating:

Telephone counseling to assess your issues and treatment options.
Help using and understanding your pharmacy and medical benefits.
Referrals to helpful resources.
Ongoing coordination with your physicians, therapists, home health nurses and social workers.

You can take advantage of Great Expectations Case Management just by being a member of BlueChoice HealthPlan. There is no charge!

We identify members who may qualify for case management. Doctors can also refer their patients who are BlueChoice HealthPlan members, or you can request us to evaluate you for participation in the program. Please call us at 855-838-5897 to make this request. A case manager will review your information to see if you qualify for our case management program.

Patient Safety Tips

Our programs help improve the quality and safety of clinical care our members receive. Here are some helpful tips:

Healthy and Active Kids and Teens

The Great Expectations^® Healthy and Active Kids program will help motivate you and your kids to eat well and stay active. These two important concepts are the focus of this program. The goal is to prevent childhood obesity.

two happy young children on playground

As supportive and encouraging parents, you have the power to influence the decisions that will affect the long-term health of your kids. Healthy habits are best started at an early age. Did you know that kids should engage in at least one hour of moderately vigorous activity every day? Help them reach that goal by limiting how much “screen time” they have watching television, playing video games or using the computer each day.

You may also be able to take advantage of special discounts at a My Gym Children’s Fitness Center. As a BlueChoice HealthPlan member, you will receive a 15 percent discount off the four-week tuition fee for classes and 15 percent off the Lifetime Membership fee. Learn more about special savings at children’s fitness facilities.

Check out our Healthy and Active Kids and Teens program guide. It's full of tips to help your family live a healthy and active lifestyle. Call 855-838-5897 to have the Healthy & Active Kids booklet mailed to you, for more information on this and any other Great Expectations for health programs.

Other Helpful Information

Blast Off Game for Kids
Fun Activity Ideas
More Tips from the Centers for Disease Control and Prevention

COPD

The Great Expectations^®COPD program is our educational program for members with chronic obstructive pulmonary disease (COPD). COPD is a chronic disease of the lungs. It really consists of two diseases — chronic bronchitis and emphysema. Cigarette smoking is the number one cause of COPD, although you can also get it from other environmental factors. Ready to get started? Review the COPD guide to learn about tips to help you better manage your COPD and improve your quality of life. We enroll all members with COPD at no charge.

Members also receive:

Educational materials about COPD, breathing retraining, medications, diet, exercise and lifestyle changes.
They also receive information about BlueChoice HealthPlan's coverage of COPD medications and supplies.
For our higher risk members, we provide telephone counseling by respiratory therapists. All members are welcome to call us with their questions about COPD or their coverage for COPD services, medications or supplies.

COPD can be a serious illness. Fortunately, you can help to manage it with the proper medications and some simple lifestyle changes. If you have COPD, learn how to take action to breathe better now.

An important part of COPD management is having a COPD Action Plan that your doctor has filled out for you. If you don't have one already, you can print a blank one and take it with you to your next visit. Boehringer Ingelheim maintains the COPD Action Plan.

We strongly encourage members enrolled in the program to quit smoking. Although quitting smoking will not reverse lung damage, it will slow the progression of COPD. If you smoke and would like help quitting, there are many resources you can access through the Great Expectations^® Tobacco Cessation program.

Depression

The Great Expectations^®Depression program helps you understand more about depression. We know that depression can be overwhelming. So we provide information and resources to help you manage your depression. For instance, you can check out the Depression Self-Care Center for articles, self-assessments and links to useful websites.

We also help you connect with professionals who can help you. As part of your BlueChoice HealthPlan coverage, you may also have the Depression Management program.* Depression Management is administered by Companion Benefit Alternatives (CBA). CBA is a separate company that manages behavioral health and substance abuse benefits on behalf of BlueChoice HealthPlan.

woman holding young adult in arms who is upset

Depression Management teaches you how to prevent relapses. It also helps you learn how best to talk with your doctors and counselors.

You'll team with a depression disease management specialist. This nurse or social worker will help you plan, coordinate and evaluate services you can use.
Your disease manager will also call you regularly to see how you are doing. He or she will give you follow-up support, coaching and educational materials, as needed.
You'll start the program by taking the Core Assessment. This is a structured telephone interview. Based on the results, we will place you in one of these programs:
- Watchful Waiting – weekly phone calls for up to eight weeks.
- Depression Monitoring – brief, structured assessments during the first 12 weeks of antidepressant therapy.
- Depression Disease Management (for those with depressive disorders) – the disease manager works with these members for 12-24 weeks.
- Referral Management – refers members to specialty care.

Be sure to check out this booklet for more information. If you are interested in the Depression Management program, please call CBA at 800-868-1032, ext. 25835.

Whether you decide to join the Depression Management program or not, there are a few important things you can do to manage your depression:

Be sure to follow your doctor’s plan of care.
Take all prescribed medications.
If you are taking antidepressant medication, use the medicine as directed.
Tell your doctor right away if you have any reactions or unexpected side effects.
You may need to take your medication for one to two months before you notice an improvement.
Keep taking your medication, even if you are feeling better.
Keep scheduled visits with your doctor or other health care professionals.
Contact your doctor with any questions or concerns you have about your treatment.

Diabetes

Great Expectations^®Diabetes helps members learn how to manage their diabetes better. We educate members about how to reduce their risk of getting complications and improve their quality of life. All BlueChoice HealthPlan members with diabetes are eligible to participate in the diabetes program. We automatically enroll all eligible members at no charge. Ready to get started? Review the diabetes guide for information to help you take charge of your diabetes.

You also have access to:

Caremark's Diabetes Center. This information is courtesy of Caremark, an independent company that offers health education information on behalf of BlueChoice HealthPlan.
For our highest-risk members, we provide telephone counseling by staff members who include certified diabetes educators, registered dietitians, nurses and health educators. All members are welcome to call us with their questions about diabetes, or their coverage for diabetes services, medications and supplies.
Members with diabetes who have a history of diabetes-related foot or leg issues may qualify for diabetic shoes or inserts.To learn more, contact customer service by calling the number on the back of your member ID card.

What You Need To Do To Stay Healthy

Diabetes can affect many aspects of your life. It can lead to some serious health problems. By working with your health care team, you can stay as healthy as possible.

Visit your personal physician at least twice a year. At each visit, he or she should check:

Hemoglobin A1c (A1c) — This blood test measures your blood sugar control over the last three months. Check it at least twice a year (more often if out of control). A healthy A1c is 7 percent or lower.
High blood pressure is more common in people with diabetes. It should be measured at every visit. Your blood pressure should be 140/80 or below.
Foot care is especially important when you have diabetes. Always take your shoes and socks off as soon as you go into the exam room, to remind your doctor to examine your feet at every office visit.

At least once each year you should have:

A dilated eye exam. Diabetic eye disease is the leading cause of blindness in adults.
A blood test to check your lipid (cholesterol) profile. This is important because diabetes increases your risk of developing heart disease.

Maintain a healthy lifestyle:

Take all of your medications as personal physican prescribes. Learn about your pharmacy benefits.
Exercise regularly. Be sure and check with your doctor before starting any exercise program.This information is courtesy of Caremark, an independent company that offers health education information on behalf of BlueChoice HealthPlan.
Maintain a healthy diet and a healthy weight. If you need help with losing weight, check out the resources available through Great Expectations^®Weight Management.
Quit smoking. If you smoke and also have diabetes, you are more likely to develop life-threatening complications. Learn about Great Expectations^® Tobacco Cessation.

Heart Disease

Great Expectations^®Heart Disease helps members learn how to better manage their heart disease. We automatically enroll all members with heart disease at no charge. Our goal is to help you understand more about your condition and show you steps you can take toward good health. Our heart disease education guide is a good place to start.

You will also receive:

Information about how we cover your condition.
Occasional updates about heart disease and its treatment.
Great online information in the HeartHub.
Telephone access to cardiac nurses to answer your questions or for counseling.
Educational materials about heart health and reminders for recommended screenings.
Online tools to help you create a heart-healthy action plan using 7 simple steps.

Here are important steps you can take to improve your heart health:

Know your body mass index (BMI). This takes into account your height and weight and is a good indicator of whether you are overweight or not.
Lose excess weight if you are overweight. Being overweight decreases your ability to improve your heart health. If you need help with losing weight, check out the resources available through Great Expectations^®Weight Management.
Become physically active. Physical exercise can help strengthen your heart muscle, even if it’s just for 20-30 minutes on most days. Be sure to check with your doctor before starting any exercise program to discuss what type of exercise is best for you.
Quit smoking. If you smoke, it constricts your blood vessels and reduces the size of your arteries. This increases your risk for a heart attack. If you need help quitting smoking, check out the resources available through Great Expectations^® Tobacco Cessation.
Control your blood pressure. A healthy blood pressure is under 120/80. The new definition of prehypertension is a blood pressure level between 120/80 and 139/89. A blood pressure of 140/90 and above is considered high blood pressure and requires treatment. High blood pressure, or hypertension, is a major risk factor for heart disease. So it’s very important to keep it under control. Studies have shown healthy lifestyle choices, along with medication, can lower blood pressure and may reduce the chance of stroke by 35-40 percent, heart attacks by 20-25 percent and heart failure by more than 50 percent. It's also a good idea to know how your kidneys work.
Control your cholesterol. High cholesterol is one of the major risk factors for developing heart disease. If your cholesterol level is high, you can usually lower it with a heart-healthy diet, exercise and, if needed, medication. Please have your cholesterol tested as ordered by your physician or other health care provider.
Manage your stress. Prolonged stress can have many negative effects on your body. Learn more about how to manage stress at the online Stress Management Center. This information is courtesy of Caremark, an independent company that offers health education information on behalf of BlueChoice HealthPlan.
Limit alcohol intake. Alcohol intake may affect your heart health. Talk to your doctor about how much alcohol (if any) is OK for you.
Keep your scheduled visits with your doctor or other health care professionals. Get your blood work and other tests done, as ordered. Take all your medications your doctor prescribes. Work with your doctor to get your LDL cholesterol under 100, if you have heart disease.
Follow a heart healthy meal plan with good diet and nutrition. Foods lower in fat, salt and sodium are healthier for your heart. You can learn to choose delicious and satisfying foods that are also good for you!
Learn your heart attack risk.

Heart Failure

Great Expectations^®Heart Failure helps members learn how to better manage their congestive heart failure (HF). We automatically enroll all BlueChoice HealthPlan members with HF at no charge. Our goal is to help you learn to manage your symptoms so you can keep doing the things you enjoy. Ready to get started? Review the heart failure guide for tips to help you get on the road to better health. The American Heart Association is an independent organization that provides health information on behalf of BlueChoice HealthPlan.

You will also receive:

Information about how we cover your condition.
Occasional updates about HF and its treatment.
Great online information in the HeartHub.
Telephone access to cardiac nurses to answer your questions or for counseling.

Making lifestyle changes can often help relieve the symptoms of HF, slow down its progression and improve your quality of life.

Here are some of the most important lifestyle changes you can make:

Restrict sodium. Too much salt contributes to water retention, which makes your heart work harder. It can also cause shortness of breath and swollen legs, ankles and feet. A common recommendation for healthy adults is between 1,500 and 2,400 milligrams (mg) a day. Talk to your doctor about the amount of salt that's best for you.
Limit fats and cholesterol. Limit your intake of saturated fat, trans fat and cholesterol. A diet high in fat and cholesterol is a risk factor for coronary artery disease (CAD), which often causes or contributes to heart failure. BlueChoice HealthPlan also has a program for this condition called Great Expectations^®Heart Disease.
Limit alcohol and fluids. Too much alcohol can weaken your heart or cause your heart to beat abnormally, and may worsen HF. Alcohol also may not mix well with some medications used to treat heart conditions. Your doctor may advise you to stop drinking if you have HF. If you have severe heart failure, your doctor also may suggest you limit your intake of fluids.
Exercise. Exercise was once forbidden for people with heart failure. But now we know that moderate exercise may benefit people with HF, because it helps your heart pump better, reducing the demands on your heart muscle. Before you start any exercise program, talk to your doctor about what’s safe and healthy for you.
Stop smoking. Smoking damages your blood vessels, reduces the amount of oxygen in your blood and makes your heart beat faster. For help quitting smoking, check out the resources available through Great Expectations^® Tobacco Cessation.
Weigh yourself. Do this each morning after you've used the bathroom, but before you've had breakfast. Notify your doctor if you experience a rapid weight gain of two to five pounds within one week. It may mean that you're retaining fluids and need a change in your treatment plan.
Manage your stress. When you're anxious or upset, your heart beats faster and you breathe more heavily. This can make heart failure worse, since your heart is already having trouble meeting the body's demands. Learn more about how to manage stress at the online Stress Management Center. This information is courtesy of Caremark, an independent company that offers health education information on behalf of BlueChoice HealthPlan.
Pace yourself. While you can still do many of the things you used to do, it’s important to balance activity with rest periods. To give your heart a rest, try napping or putting your feet up when possible.
Take your medication. It’s very important you follow your doctor’s orders about your medication. Remember the three "rights" — right medicine, right time, right dose.
Learn your heart attack risk. The Centers for Disease Control and Prevention is an independent organization that provides health information on behalf of BlueChoice HealthPlan.

man with a red marker drawing a heart on a window

High Blood Pressure

Great Expectations^®High Blood Pressure is an educational program for members who want to learn more about managing high blood pressure and making lifestyle changes to manage important cardiovascular risk factors. Ready to get started? Start by reviewing the high blood pressure guide. This guide can help you learn to take charge of your blood pressure and live a healthier life.

Benefits of Participating

You’ll receive access to online education and reminders for needed care.
Our staff of experienced health coaches — including cardiac nurses and health educators — is available to answer your questions and offer support.
Depending upon your condition, you may receive phone calls from a health coach to help you set personal health goals to manage your high blood pressure.

Online Educational Resources

My Life Check Assessment will help you identify simple steps to improve your heart health and quality of life.
Create a heart-healthy action plan using Life’s Simple 7 steps.

Important Steps You Can Take to Manage High Blood Pressure

Control your blood pressure. High blood pressure, or hypertension, is a major risk factor for heart disease, stroke and heart attack. So it’s very important to keep it under control. Research has shown healthy lifestyle choices, along with medication, can lower blood pressure and may reduce the chance of stroke by 35-40 percent, heart attacks by 20-25 percent, and heart failure by more than 50 percent.
Blood Pressure Goals
- Under 120/80 – healthy blood pressure
- Between 120/80 and 139/89 – prehypertension140/90 or above – high blood pressure (hypertension)
- Check out these other recommendations.
Manage other health conditions and diseases, like high cholesterol, heart disease, diabetes and pre-diabetes. Work with your primary care doctor on the best plan of care for you and take medications as prescribed. Ask your doctor if taking an aspirin (or baby aspirin) daily is right for you.
Know your body mass index (BMI). BMI takes into account your height and weight and is a good indicator of whether your weight is in a healthy range or if you may be overweight or obese.
Lose excess weight if you are overweight. Being overweight or obese can increase your risk for heart disease. If you need help with losing weight, check out the resources available through Great Expectations^®Weight Management.
Exercise regularly. Physical activity can help you maintain a healthy weight and lower cholesterol and blood pressure. It can strengthen your heart muscle, even if it’s just for 20-30 minutes on most days. Be sure to check with your doctor before starting any exercise program to discuss what type of exercise is best for you.
Quit smoking. Smoking constricts your blood vessels and reduces the size of your arteries. This increases your risk for a heart attack. If you need help quitting smoking, check out the resources available through Great Expectations^® Tobacco Cessation.
Manage your stress. Prolonged stress can have many negative effects on your body. Learn more about how to manage stress at the online Stress Management Center. This information is courtesy of Caremark, an independent company that offers health education information on behalf of BlueChoice HealthPlan.
Limit alcohol intake. Alcohol intake may affect your heart health. Talk to your doctor about how much alcohol (if any) is okay for you.
Keep your scheduled visits with your doctor or other health care professionals. You should have your blood pressure checked at each visit. Also, get your blood work and other tests done, as ordered. Take all your medications your doctor prescribes. Work with your doctor to get your LDL cholesterol under 100, if you have heart disease.
Follow a heart-healthy meal plan. Foods lower in fat and sodium are healthier for your heart. Use these resources for tips to help you choose delicious and satisfying foods that are also good for you!
Learn your heart attack risk.

Some links on this page lead to third party websites. Those parties are solely responsible for the contents and privacy policies on their sites.

High Cholesterol

Great Expectations^®High Cholesterol is an educational program for members who want to learn more about how to lower their cholesterol levels and make lifestyle changes to manage important cardiovascular risk factors. Ready to get started? Review the high cholesterol guide to help you take charge of your cholesterol and get on the path to living a healthier life.

Benefits of Participating

You’ll receive access to online education and reminders for needed care.
Our staff of experienced health coaches — including cardiac nurses and health educators — is available to answer your questions and offer support.
Depending upon your condition, you may receive phone calls from a health coach to help you set personal health goals to manage your high cholesterol.

Online Educational Resources

My Life Check Assessment will help you identify simple steps to improve your heart health and quality of life.

Important Steps You Can Take to Manage High Cholesterol

Control your cholesterol. High cholesterol is one of the major risk factors for developing heart disease, stroke and heart attack. If your cholesterol level is high, you can usually lower it with a heart-healthy diet, exercise and, if needed, medication. Please have your cholesterol tested as ordered by your physician or other health care provider.
Cholesterol Goals:
- Triglycerides: Less than 150 mg/dL
- HDL (“good” cholesterol): 50 mg/dL or higher
- LDL (bad cholesterol): Less than 100 mg/dL
- Total cholesterol: Less than 200 mg/dL
Manage other health conditions and diseases, like high blood pressure, heart disease, diabetes and pre-diabetes. Work with your primary care doctor on the best plan of care for you and take medications as prescribed. Ask your doctor if taking an aspirin (or baby aspirin) daily is right for you.
Know your body mass index (BMI). BMI takes into account your height and weight and is a good indicator of whether your weight is in a healthy range or if you may be overweight or obese.
Lose excess weight if you are overweight. Being overweight or obese can increase your risk for heart disease. If you need help with losing weight, check out the resources available through Great Expectations^®Weight Management.
Exercise regularly. Physical activity can help you maintain a healthy weight and lower cholesterol and blood pressure. It can strengthen your heart muscle, even if it’s just for 20-30 minutes on most days. Be sure to check with your doctor before starting any exercise program to discuss what type of exercise is best for you.
Quit smoking. Smoking constricts your blood vessels and reduces the size of your arteries. This increases your risk for a heart attack. If you need help quitting smoking, check out the resources available through Great Expectations^®Tobacco Cessation.
Manage your stress. Prolonged stress can have many negative effects on your body. Learn more about how to manage stress at the online Stress Management Center. This information is courtesy of Caremark, an independent company that offers health education information on behalf of BlueChoice HealthPlan.
Limit alcohol intake. Alcohol intake may affect your heart health. Talk to your doctor about how much alcohol (if any) is okay for you.
Keep your scheduled visits with your doctor or other health care professionals. Get your blood work and other tests done as ordered. Take all your medications your doctor prescribes. Work with your doctor to get your LDL cholesterol under 100, if you have heart disease.
Follow a heart-healthy meal plan. Foods lower in fat and sodium are healthier for your heart. Use these resources for tips to help you choose delicious and satisfying foods that are also good for you!
Learn your heart attack risk.

Some links on this page lead to third party websites. Those parties are solely responsible for the contents and privacy policies on their sites.

Maternity

Give Your Baby a Great Start!

Congratulations! Pregnancy is an exciting time, but it can be overwhelming. You’ll experience many changes and emotions. And you will have questions. The Great Expectations Maternity Program provides you with information and support throughout your pregnancy.

Enrolling

The Great Expectations Maternity Program is open to all eligible, expectant members. Enrolling is easy! Your obstetrician or primary care physician will contact us. We will send you an invitation to join the program.

Or, you can self-enroll by simply calling 855-838-5897, once your pregnancy is confirmed, and completing a quick assessment. The assessment allows us to understand your needs so we can tailor the program to you.

Once enrolled, you have access to maternity case managers who are registered nurses with experience in obstetrics. If you have questions, you can call a health coach for an answer. You will receive additional materials throughout your pregnancy to:

Help you understand what’s going on at specific points in your pregnancy.
Know what to expect at doctor’s appointments.
Learn how to add your baby to your policy.
Provide tips for a healthy pregnancy.
Give you information about breastfeeding, nutrition and more.

There is even a tobacco cessation program for moms-to-be. Call today! 855-838-5897

Helpful Information

Maternity Welcome Newsletter

Maternity Second Trimester Newsletter

Maternity Third Trimester Newsletter

Maternity Pospartum Newsletter

Before You're Pregnant
Breastfeed Versus Bottlefeed?
Immunizations
Just for Dad
March of Dimes
Pregnancy and Newborn Health Education Center
Preparing for the Arrival of Your Newborn
Shaken Baby Syndrome
Safe sleep for your baby
Exercise During Pregnancy
Fetal Development by Trimester
Gestational Diabetes
Interactive Pregnancy Tools: Ovulate, Due Date and Weight Gain Calculators
Nutrition During Pregnancy
Postpartum Depression
Pre-eclampsia (Toxemia of Pregnancy; Pregnancy-induced Hypertension)
Premature Birth
Virtual Pregnancy and Birthing Classroom
Weight Gain During Pregnancy

Text4baby

Migraine

Great Expectations^®Migraine is a program to help members who suffer from severe, recurrent headaches. The program emphasizes the importance of having a personal physician to guide your headache management. This doctor can help you identify the best medications and dosing to control your headache pain and improve your quality of life. Our migraine guide also provides tips to help you manage your migraines and improve your sense of well-being.

It's also important for people who suffer from headaches to try to identify things that might trigger them. One way to do this is by keeping a headache diary. A helpful website for migraine information is the American Migraine Foundation.

woman with a headache has hands on side of head in pain

Here are some handouts, produced by GlaxoSmithKline. GlaxoSmithKline is an independent company that provides wellness education on behalf of BlueChoice HealthPlan. This information is for educational use only and not intended as a substitute for medical care. Please consult with your physician for advice regarding your particular condition.

Some links on this page lead to third party websites. Those parties are solely responsible for the contents and privacy policies on their sites.

Tobacco Cessation

BlueChoice HealthPlan understands it’s hard to stop smoking. Nicotine is a highly addictive drug, and many people find they need help quitting tobacco. Great Expectations^® Tobacco Cessation can help you kick the habit. We provide information and resources to support you as you become tobacco-free.

To get started read the Tobacco Cessation Guide.

For more information, you can take advantage of the Smoking and Tobacco Self-Care Center, filled with articles, self-assessments and links to useful websites. You can also access information about the South Carolina Tobacco Quitline, a great, free resource for members who live in South Carolina. And if you’re interested in using medication to help you in the quitting process, check out the prescription drugs and nicotine patches that your BlueChoiceHealthPlan prescription benefits now cover.

man breaking apart a cigarette

To enroll in a Great Expectations^® program or for more information about health coaching and access to helpful resources, log in to My Health Toolkit^TM and select Health and Wellness then Health Coaching. You can also call us at 855-838-5897.

Weight Management

BlueChoice HealthPlan knows that changing your eating and exercise habits can be tough. Each year, Americans invest billions of dollars in weight-loss diets and gimmicks with disappointing results. So, how do you ensure success? By making slow, gradual changes that can last a lifetime. That’s why we offer our members the Weight Management program, a program that uses proven strategies to help you make lasting changes that lead to long-term results.

Ready to get started on your weight-loss goals?

Review our Weight Management guide to learn about small steps that can lead to lasting results on your weight loss journey. We also have a guide for Healthy and Active Kids and Teens.
Connect with a weight management health coach by calling 855-838-5897.
Calculate your body mass index (BMI) to see if you are at a healthy weight. Knowing your numbers can help guide your efforts as you work toward reaching your health goals.
Visit the Weight Control Self-Care Center, to access helpful information and tools to help you reach your health goals.
Check out special discounts from Jenny Craig and certain fitness centers offered, to you as a BlueChoice member.

feet of woman about to step on a scale

Life Management Services

Everyone needs some advice from time to time. First Sun Employee Assistance Program (EAP) provides a broad array of services designed to help people and encourage success. Because First Sun EAP is a separate company from BlueChoice HealthPlan, First Sun EAP will be responsible for all services related to life management. These services are free to members and those in their households. All covered family members will have a total of three free sessions of their choice.

Services include:

Financial Counseling - Financial counselors assist with planning for retirement, reorganizing the family budget and dealing with a financial crisis.

College Consultation Resources - Consultants are available for students and working adults who desire assistance in the college search or identifying resources such as financial aid, test preparation and educational plans.

Legal Services - FirstSunEap.com contains a wealth of personal and legal documents, and legal information. You may also call for a free legal consultation. All legal services are provided by licensed attorneys.

School Assistance - Resources are available to help parents choose an appropriate school, prepare children for school and assist children with school achievement.

Adult Care Resources - Receive an assessment from consultants for needs involving elderly and disabled adults. Get resources, referral information and support for caregivers.

Parenting & Adoption Resources - For parents who want to adopt, consultants can provide referrals to adoption attorneys, placement agencies, domestic and international adoption agencies, fertility specialists and clinics, etc.

Child Care Resources - Consultants advise how to select child care resources and address child care needs including routine day care needs, special need care, swing shift needs and summer camps.

Pet Care - Consultants offer comprehensive pet care referral services to assist with veterinary selection, emergency care, grooming, obedience classes, boarding, pet sitting and the like.

Dedicated professionals are available to serve you 24 hours a day, seven days a week. Crisis calls are handled immediately and all appointments will be scheduled in a timely manner. Call 800-968-8143 or visit www.firstsuneap.com. The First Sun EAP website offers detailed information about your benefits, articles, self-assessments and more. Information about financial planning and financial calculators are also available online.

Member Guide

Our 2020 member guide allows you to quickly and easily understand how your Blue Option plan works. It includes information on:

Reminders
Our Wellness Incentive Program, FOCUSfwd^®
Selecting a doctor
When and how to see a doctor via your smartphone, tablet or computer
Payment and billing
How to stay connected while on the go
What we pay for
Emergency care and what to do if you need care away from home

And a lot more!

You can also review your 2019 member guide.

Testimonials

Why should you choose BlueChoice HealthPlan? Learn more from one of our members!

Video Library

These helpful videos will help you make the most of your coverage.

Your favorite features from the website are available in a mobile app!

Want to know more about coinsurance?

Do you know what deductibles are?

Do you know what's in "Network"?

Do you know what benefits are and how they work?

Need to pay your bill? We offer a variety of convenient ways to do just that!

You just got insurance. Now what?

Our helpful video tells you what happens next.

What's an EOB?

Understanding your Explanation of Benefits.

What's Preauthorization?

What you need to know before getting additional services.

Why was my claim denied?

Some possible reasons why we denied your claim.

Member Policy

Access your Blue Option 2020 Member Policy. Our Member Policy gives you answers on:

When your coverage begins and ends
Covered services
Services and supplies we don't cover
General contract provisions
And more

You can review your 2019 Member Policy.

You Just Got Insurance. Now What?

Make the most of your coverage.

Our helpful video tells you what happens next.

Mail-Order Drug Benefit

Your time is valuable. With our mail-service prescription drug program, you can get your prescriptions delivered by mail directly to your home in plain, tamper-evident packaging. When you order by mail, you can get up to a 90-day supply of medication for one low copayment — with no claim forms to file and no waiting for reimbursement! And you'll receive the medication, in the right amount, at the right cost and the right time.

Getting Started

Get a written prescription from your doctor for up to a three-month supply of your medication, with three refills, if appropriate. If you are presently taking medication, ask your doctor for a new prescription.

Print and complete the mail service order. Mail the completed form, your original prescription(s) and copayment(s) to the address listed at the bottom of the form. You can pay by check, money order, MasterCard, Visa, Discover or American Express.

Our mail service will process your order and send your medication to you via U.S. mail or Federal Express, along with instructions for future refills, if you have any. Please allow up to 14 days for delivery from the time you mail your order.

Refills Are Simple

If you already enjoy the benefits of prescription home delivery, it's simple to order your medication refills. Request refills online or by phone at 888-963-7290. (This link leads to a third party site. That company is solely responsible for the content and privacy policies on its site.) Both are available 24 hours a day, seven days a week.

To refill your prescription via the Internet or phone, you will need your prescription number, your five-digit ZIP code, and your credit card number and its expiration date.

A Healthier You Newsletters

A Healthier You is our member newsletter that provides healthy tips and suggestions!

Live Healthy

Use as Directed

Are you taking medications as prescribed?

Nearly 3 in 5 Americans take at least one daily medication. Unfortunately, many don’t take their medicines properly. Taking medications as prescribed by your doctor is known as medication adherence. This includes getting your prescriptions filled, taking the medications at the right times and understanding the directions.

Studies have shown that as many as 50 percent of patients don’t take medications for their chronic conditions as prescribed. This includes medications for diabetes and cardiac conditions such as high blood pressure and COPD.

Poor adherence can have many negative consequences. It can interfere with treating diseases, leading to complications from the illness and a lower quality of life for patients. In addition, more than $300 billion of avoidable health care costs have been attributed to medication non-adherence in the U.S.

It’s important to continue taking your medication as directed, even if you feel better and no longer have symptoms. For example, if you have a bacterial infection and you don’t take the full course of antibiotics, some bacteria may still survive. This could cause a new strain of resistant germs to develop.

Here are some tips to help you make sure you take your medications as directed:

Be sure you understand how long to take the medication. Will you need a refill, or can you stop treatment when the bottle is empty?
Tell your doctor if paying for prescriptions is a problem. Your doctor may be able to prescribe a generic medication or help you find a drug assistance program.
Set daily routines to take medication. Connect taking the medication with normal daily routines such as eating or going to bed.
Keep medications where you’ll notice them. If they must be taken with food, place medications on the dinner table. If medications should be taken in the morning, keep them with your toiletries. Remember, however, that many medications should not be kept in a bathroom.
Use daily dosing containers. Keep medications in compartments labeled with the days of the week.
Keep a written or computerized schedule. Include the medications you take, how often you take them and any special directions.

Following these simple steps can help you improve your medication adherence.

Recipes

Good nutrition is important for good health. Use these simple, delicious recipes to eat well and stay healthy.

Berries and Cream
Brussels Sprouts Slaw
Spaghetti and Meatballs

Archived Recipes

November 2019

Buffalo Chicken Egg Rolls
Garlic Cauliflower
Turkey Turnovers

October 2019

Spinach Feta and Artichoke Bake

Mediterranean Sea Bass

Green Bean Salad

September 2019

Almond Tapioca With Banana and Corn

Baked Pork Hawaiian

Garden Caprese Salad

August 2019

Lemon and Ginger Ice Pops

Easiest Slow Cooker Sweet Potatoes

Corned Beef and Cabbage with Horseradish Cream

July 2019

Apricot Pine Nut Couscous

Bacon-Wrapped Shrimp

Balsamic Chicken with Mushrooms

June 2019

Satay Zucchini Noodles

Artichokes with Garlic and Oil

Nuts About Pizza for Breakfast

May 2019

Pecan-crusted Pork Tenderloin with Apples Onions

Shaved Asparagus, Radish and Parmesan Salad

Blueberry Lemon Yogurt Bars

April 2019

Apple Squares

Corn Tomato Avocado Salad

Italian Vegetable Casserole

March 2019

Sicilian Chicken

Trail Mix Truffles

Green Pea and Rice Amandine

February 2019

Whole-Wheat Irish Soda Bread Muffins

Maple Soy Glazed Salmon

Brussels Sprouts Gratin

January 2019

Parmesan Crusted Delicata Squash

Zucchini Banana Cake with Cream Cheese Frosting

Angel Hair with Zucchini and Tomatoes

December 2018

Easy No-Cook Salsa

Leftover Ham Bone Soup with Potatoes and Cabbage

Potato and Broccoli Cakes

November 2018

Cornbread Stuffing

Trail Mix Truffles

Turkey Turnovers

October 2018

Soy Marinated Flank Steak

Roasted Asparagus

Yogurt Chocolate Chip Muffins

September 2018

Baked Zucchini Sticks

Grilled Corn Salad with Feta

Shrimp Scampi Foil Packets

August 2018

Dried Granola and Fruit

Pasta Salad

Shrimp Tacos

July 2018

Pork Chops with Dijon Herb Sauce

Roasted Brussels Sprouts and Butternut Squash

Sweet Potato and Carrot Tots

June 2018

Chili-Cheese Egg Casserole

Cucumber Salad

Spaghetti Squash Lasagna

May 2018

Grilled Chicken with Spinach and Melted Mozzarella

Makeover Spinach Gratin

Czech Crepes with Berries and Cream

April 2018

Roasted Chickpeas
Vegetarian Black Bean Chili
Turkey Bacon-Wrapped Asparagus

March 2018

Garden Veggie Pizza Squares
Roast Pepper and Onion Steak
Garlic Cauliflower

February 2018

Tex-Mex Chicken Fingers
Vegetarian Baked Beans
Italian Sausage Frittata

January 2018

Avocado with Pink Grapefruit

Chocolate Pudding Cake

Roasted Trout with Garlic and Lemon

Sautéed Asparagus, Peppers and Mushrooms

2017 Blue Option Recipe Book

The 2017 Blue Option Recipe Book has 35 tasty and healthy recipes, with easy to follow instructions!

2016 Blue Option Recipe Book

The 2016 Blue Option Recipe Book is chock-full of delicious and nutritious recipes!

2015 Blue Option Recipe Book

The 2015 Blue Option Recipe Book is filled with recipes that are both satisfying and good for you!

Cervical Cancer Screenings

Did you know it is strongly recommended that women ages 21 to 64 have a yearly Pap smear to screen for cervical cancer and get early treatment, if needed?

Find a Doctors Care location closest to you to get your FREE cervical cancer screening today!

Great Expectations for Health Programs

Our Great Expectations^® for health programs help educate you about your overall health. We support you as you make healthy lifestyle changes. Whether you are already healthy and active, have a chronic condition, are pregnant or have serious health challenges, we have a program that can offer you something!

We welcome your participation and hope you'll take advantage of these great programs. Best of all, they're included as part of your health insurance benefits!

For more information, please explore the individual programs here. To enroll in a Great Expectations program, members can log in to My Health Toolkit^®. From the Health and Wellness tab at the top, choose Great Expectations and then follow the instructions. You can also call us at 855-838-5897.

Asthma	Depression	Maternity
Back Care	Diabetes	Men's Health
Before Baby	Heart Disease	Migraine
COPD	Heart Failure	Pre-Diabetes
Case Management	High Blood Pressure	Smoking Cessation
Childhood Obesity	High Cholesterol	Weight Management
Children's Health	Irritable Bowel Syndrome	Women's Health

Blue CareOnDemand℠

All you need is your computer or smartphone device to see a doctor any time, day or night. During your video visit, the doctor will ask questions, answer questions, diagnose your symptoms and, if appropriate, call in a prescription to your local pharmacy.

What types of conditions can doctors treat?

Cold and flu symptoms
Bronchitis and other respiratory infections
Sinus infections
Pinkeye
Ear infections
Allergies
Migraines
Rashes and other skin irritations
Urinary tract infections
And more!

When should you use video visits?

You need to see a doctor, but can’t fit it into your schedule
Your doctor’s office is closed
You feel too sick to drive
You have children at home and don’t want to bring them with you
You’re on business travel and stuck in a hotel room

Get started now!

There are two easy ways to use Blue CareOnDemand. Don’t wait until you’re sick. Create your account now so it’s ready when you need it.

From your computer, go to www.BlueCareOnDemandSC.com
From your mobile phone or tablet, download the “Blue CareOnDemand” app for your Apple or Android device.

Blue CareOnDemand is not a replacement for your primary care doctor. You should continue scheduling office visits for regular checkups and preventive care. For true emergencies and life-threatening issues, go to the emergency room or call 911.

Metabolic Health

We changed the Great Expectations^®Prediabetes program name to Metabolic Health to include metabolic syndrome. Metabolic syndrome is the name for a group of conditions linked to being overweight and obesity.

These conditions may include:

A large waistline
A high triglyceride blood level laboratory value
Low HDL “good” cholesterol
High blood pressure
High fasting blood sugar
Pre-diabetes

These metabolic health conditions qualify you for our program:

A diagnosis of pre-diabetes
Glucose intolerance
Metabolic syndrome
Polycystic ovary disease
A history of gestational diabetes
Other conditions by physician referral

young adult male in gym after workout with towel on his shoulder

If you have one of these conditions, we will automatically enroll you in the program, at no charge. Ready to get started? Check out the metabolic health guide. It has tips and information to help you take charge of your health and get on the path to wellness. There are many benefits to participation:

You may also receive information on how to manage your metabolic health risk factors. This includes helpful information on eating healthy, exercising and losing weight, if you are overweight and managing your blood pressure and cholesterol.
If your doctor recommends you test your blood sugar, we can send you a free monitor. This will allow you to get testing strips at the preferred (middle) copayment, if you have pharmacy benefits with BlueChoice HealthPlan.
We have a staff of experienced health specialists. They include nurses, registered dietitians and certified diabetes educators. These staff members can answer any questions you have about your condition and how you can lower your risk.

There are a lot of things you can do to manage your metabolic health. People who are overweight are at greater risk for developing diabetes. Consider joining our self-paced weight management program. You can also take advantage of one of the many value-added discounts that come with your membership. These include Jenny Craig and some local fitness centers.

Find out more about diabetes prevention at the Diabetes Center. This information is courtesy of Caremark, an independent company that offers health education information on behalf of BlueChoice HealthPlan. For our members who are under the age of 18, please consider our Great Expectations^®Healthy and Active Kids program.

On the Go & Still in the Know

Getting the most of your coverage
New features or enhancements
Health and wellness reminders

To get started call 844-206-0622. You'll need to have your member ID card ready.

Just how easy is it? Watch this quick video!

Special Enrollment Period

If you've had a Qualifying Life Event, such as marriage or the birth or adoption of a child, you will be required to provide proper documentation before your coverage becomes effective. Please send in the proper documentation one of two ways:

Email to BCHPIND@BlueChoiceSC.com
Mail to:
BlueChoice HealthPlan
Attention: Membership (AX-425)
P.O. Box 6170
Columbia, SC 29260-9915

Important Screenings

It is strongly recommended that women get their Pap tests as well as mammograms. Both of these tests check for possible health concerns before they become serious.

Find a Doctors Care location closest to you to get your FREE cervical cancer and/or breast cancer screening today!

Live Fearless

A sense of security. The peace of mind that comes with stability. This is what most people want from their health plan -- and what BlueChoiceHealthPlan provides. Check out www.LiveFearlessSC.com!

Breathe Easier

For most people, breathing is one of the easiest things we do. In fact, we rarely think about it unless we catch a cold or overexert ourselves. But for those who suffer from breathing-related illnesses, such as asthma, chronic obstructive pulmonary disease (COPD) and nasal allergies, every breath can be a struggle.

If you have trouble breathing, you should see a doctor immediately. Finding out what is causing your difficulty is the first step toward learning to manage it with treatment or medication. And once you know you have allergies, asthma, COPD or some combination, your doctor can help identify the triggers that lead to attacks or worsening conditions. By avoiding those triggers, you can lessen the impact your condition has on your breathing.

Stop Smoking

One of the biggest triggers — and in some cases the cause — of your breathing-related illness is smoke. If you are a smoker, stop. It may not be easy, but it’s worth it. Quitting smoking is the single most important thing a smoker can do to live a longer and healthier life. Smoking not only causes COPD, but makes it worse and leads to asthma and allergy attacks. Quitting also reduces your risk of lung cancer, heart disease, stroke and other cancers. If you don’t smoke, don’t start. And avoid exposure to secondhand smoke.

Here are some specific guidelines to help you manage your condition.

Allergies

Your doctor can test you to help determine specific allergens that trigger your reactions. By identifying them and avoiding them, you can minimize your allergic reactions. Common allergy triggers include:

Pet dander and saliva
Dust mites
Pollen
Mold

Some solutions for creating a more breathing friendly home are to keep your windows closed, avoid using fans, use a dehumidifier to reduce mold and wash sheets and pillowcases at least once a week.

Asthma

Many allergy triggers can also cause your asthma symptoms to worsen. Triggers vary from person to person, so it is important to know yours and minimize your exposure. Don’t try to just cope with your asthma — work with your health care provider toward your asthma control goals. If your doctor prescribes medication, take it as directed. To make sure you don’t miss a dose, make sure you refill your prescription, develop a routine, set an alarm or sign up for a free online medication reminder service.

COPD

Smoking is the leading cause of COPD, but other lung irritants can contribute to COPD. Examples include secondhand smoke, air pollution, chemical fumes and dust.

If you have COPD, it's important to get ongoing medical care. Though there is no cure for COPD, you can manage its symptoms. Take all your medications as prescribed by your doctor, and ask whether and when you should get flu (influenza) and pneumonia vaccines.

Other COPD tips:

Do activities slowly.
Put items you need often in one place that's easy to reach.
Find simple ways to cook, clean and do other chores.
Ask for help moving things around in your house.
Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off.

If you have COPD, you may have trouble eating. If that is the case, you may not get all the calories and nutrients you need. Talk with your doctor about an eating plan that will meet your nutritional needs.

Also, talk with your doctor about what types of physical activity are safe. COPD makes it hard to be active, but physical activity can strengthen the muscles that help you breathe and improve your overall wellness.

No matter what your breathing-related condition may be, working with your health care provider to manage or treat your symptoms can help you breathe easier.

Protect Yourself

Itsy-Bitsy, Teeny-Weeny

Think we’re talking about bikinis? Nope, we’re talking about your chances of avoiding skin cancer if you insist on spending time in the sun without protecting yourself.

Skin Cancer Epidemic
Skin cancer is the most common cancer in the United States. In the United States alone, it kills one person every 57 minutes. One in five Americans will develop some form of skin cancer in their lifetime. Each year, more new cases of skin cancer are diagnosed than cancers of the breast, prostate, lung and colon combined. And more people develop skin cancer from tanning than develop lung cancer from smoking.

Killer Cancer
The rarest and most dangerous form of skin cancer is melanoma. It can be lethal if it isn’t caught early. Melanoma has a high probability of spreading to other parts of the body, eventually leading to death. Ironically, while melanoma is the rarest form of skin cancer, it is the most common form of cancer in people ages 25 to 29.

It Gets Ugly
Melanomas aren't the only dangerous skin cancers. Aggressive non-melanoma skin cancers (ANMSCs) can be extremely destructive if not detected and treated early. They’re usually found on the head, face and neck. They tend to grow large and deep, and they spread quickly. They also recur more often and lead to death more often than other types of basal cell and squamous cell carcinomas. And even though removing them runs the risk of ugly scarring, they should be treated aggressively.

Protect Yourself
Ultraviolet radiation is a known human carcinogen — whether from natural sunlight or artificial sunlamps. So avoid tanning beds — period. Remember, skin cancer is deadly. And if you’re going to be outdoors for any length of time, follow these rules:

Use a sunscreen with both UVA and UVB protection and with an SPF of 15 or higher**
Stay in the shade during midday
Buy sunglasses that block UVA and UVB
Examine your skin monthly

The Facts
Here are a few other facts to be aware of. Most cases of skin cancer are caused by exposure to ultraviolet light from the sun and tanning beds. In the northern hemisphere, we are actually closer to the sun during winter months than during summer months. That means the sun’s rays are actually stronger during the winter. Use sunscreen. If you’re near water, even if you’re in the shade, you will be subject to reflected sunlight. Wear sunscreen. If you live or vacation at high altitudes you’re more likely to develop skin cancer because UV rays are more powerful at higher altitudes. Put on the sunscreen! Here’s one last bit of motivation — up to 90 percent of the physical signs of aging are caused by … sun damage.

**According to Florida dermatologist James M. Spencer, on WebMD, an SPF 15 product blocks about 94 percent of UVB rays; an SPF 30 product blocks 97 percent of UVB rays; and, an SPF 45 product blocks about 98 percent of UVB rays. (Seen 3-24-2016: http://www.webmd.com/beauty/sun/high-spf-sunscreens-are-they-better). This link leads to a third-party website. That company is soley responsible for the contents and privacy policies on its site. WebMD is an independent company that provides health information on behalf of BlueChoice HealthPlan.

Children's Wellness Guidelines

Good health is a gift anyone would wish for a child, but it doesn't happen without your effort and involvement. Some things you can do to help keep your child well.

Introduce good nutrition at an early age and be a positive role model
Encourage lots of play and physical activity
Keep up with recommended vaccinations

Children's Health

Put your children on the path to wellness by scheduling regular office visits with a doctor. The doctor will watch your baby's growth and progress, and should talk with you about eating and sleeping habits, safety and behavior issues. According to the Bright Future recommendations from the American Academy of Pediatrics, the doctor should:

Check your child's body mass index percentile regularly beginning at 2.
Conduct a yearly wellness exam beginning at age 3.
Check blood pressure yearly from age 3 to age 18.
Test vision yearly from ages 3 to 6, then at ages 8, 10, 12 and 15.
Test hearing yearly from ages 4 to 6, then at ages 8 and 10.

The American Academy of Pediatrics is an independent organization that provides health information on behalf of BlueChoice HealthPlan.

Make sure your child gets the recommended immunizations shown in the charts. Not only do they protect children from sickness, they also lay the basis for good health in the future. It's never too late to catch up on a missed vaccination. Ask your doctor how to catch up.

Dental Health

Healthy Teeth and a Healthy You

A healthy body starts with a healthy mouth. There are simple strategies that can help you avoid common oral-health problems, including gum disease (also known as gingivitis, and its more advanced form, periodontitis), cavities, and the clenching and grinding that can lead to temporomandibular joint disorder (TMJ).

To prevent gum disease, brush your teeth twice a day using toothpaste and a soft-bristled toothbrush and be sure to floss once a day. You can also rinse daily with an antiseptic mouthwash.

Be sure you are brushing your teeth the right way. Dentists recommend these tips when you are brushing at home:

Place the toothbrush at a 45-degree angle against the gums.
Move the brush back and forth gently in tooth-wide strokes.
Brush the outer tooth surfaces, the inner tooth surfaces and the top of the teeth.
Brush your tongue to remove bacteria and freshen your breath

Taking care of your teeth isn't just about having a nice smile and pleasant breath. Recent research has found a number of links between oral health and overall health. While in many cases, the nature of this link still isn't clear what is certain is that the condition of your mouth is closely tied to your overall physical health.

Chronic Kidney Disease

The Great Expectations Chronic Kidney Disease program helps members with stages 1 – 3 kidney disease learn how to manage their condition and reduce the risk of developing complications. The program consists of educational materials, individualized telephonic coaching and important health reminders. All BlueChoice HealthPlan members with diabetes are eligible to participate in the Chronic Kidney Disease program. We automatically enroll all eligible members at no charge. The program emphasizes the importance of having a personal physician to guide your kidney health management. This doctor can help you identify the best medications and dosing to enhance your kidney function and improve your quality of life. Our chronic kidney disease guide also provides tips to help you manage your health and improve your sense of well-being. Topics include:

What do you need to know about CKD?
What causes CKD?
Five stages
What can you do to keep your symptoms under control?
Don’t neglect your emotional health

Your kidneys remove waste and other products from your body. When your kidneys become damaged, waste products and fluid can build up in your body.
If left untreated, your kidneys may eventually stop working. Loss of kidney function is a serious and potentially fatal condition. Working with your health care team can help improve your health and reduce your risk for complications, such as heart attacks and strokes.

These resources can provide additional information about living well with CKD. These are independent organizations that provide health information on behalf of your health plan.

These links lead to third party websites. Those companies are solely responsible for the contents and privacy policies on their sites.

Are You Sitting Down?

Back pain is a common complaint among adults, especially those who have to sit long hours at work. Studies show that 31 million people in the United States have some type of back pain, and it’s the second most common reason people visit the doctor. Sitting at a desk all day long with back pain can not only be uncomfortable, it may also make you less productive. But there are ways to help alleviate some back pain at work.

The most important key is to support your lower back. It’s best to have an adjustable chair with support, but you can modify your desk space to make yourself more comfortable. You could put a pillow between your back and the chair to give your lower back extra support. You should adjust your chair so you can type with your wrists and forearms straight and level. Your elbows should be by your body in an L-shape. Keep your feet flat on the floor. Avoid crossing your legs, which can contribute to your discomfort. Your computer screen should be at eye level about an arm’s length away, and your keyboard should be 4-6 inches in front of you.

No matter how comfortable you are, prolonged sitting is not good for your back. It’s very important to take breaks during the day. Take a five-minute walk every hour, and spend some time stretching your back, arms, neck and legs. Be sure to hold each stretch for at least 30 seconds. This will help keep your joints, ligaments, muscles and tendons loose, which in turn will help you feel more comfortable and more productive.

There are several other ways you can get back on track when it comes to taking care of your spine. It’s easy to damage something by lifting incorrectly. Lift by bending your knees, not your waist. Keep your back straight. Remaining active will also prevent future back pain. Continue doing the exercises and activities you enjoy, like swimming, biking or even walking. This can help in weight loss, as well, and studies show that being as little as 10 pounds overweight can lead to back problems.

Taking care of your back and neck now can help prevent problems later. Most of the time, the only improvements that need to be made are using better body mechanics. So the next time someone is about to give you some exciting news, and they ask, “Are you sitting down?” You can reply, “Yes, correctly.”

Urgent and Emergency Care- When to Use Them

Not sure whether you need to go to the urgent care or the ER? Making the right choice could save your life. Here's a chart that outlines when and why to use each. Check here if you need to find an in-network provider.

Click here for a printable version of this flyer.

Don't Hit The Panic Button!

It may seem there is no logical reason for your sudden, crushing sense of panic. But the difficulty breathing, the racing heart and nausea are all real. So are the intense feelings of imminent danger and the overwhelming urge to escape.

Panic attacks are no laughing matter. While they are not common, to those who experience them they can be both terrifying and debilitating. The sudden onset of intense fear can have many causes and medical problems should be ruled out, but Generalized Anxiety Disorder can be the root cause. So how do you know if you have anxiety disorder?

Do you experience chronic indigestion, fatigue, muscle tension and/or sleeping issues? Are you overly self-conscious or overwhelmed by stage fright? Have you been immobilized by irrational fears, compulsive behaviors or perfectionism? Only a professional can give you an expert diagnosis, but if you have several of these symptoms, you may want to see a specialist.

The good news is you can treat this disorder in a variety of ways, including prescription medications. If your anxiety symptoms are more manageable and you do not want to try medication, there are many other remedies for anxiety, from mind-body techniques to exercise to calming teas. Some start working right away, while others may help lessen anxiety over time.

Treatments for panic attacks also include individual psychotherapy, family counseling, deep breathing exercises and relaxation techniques. Exercise is also known to calm and relax and has been shown to reduce anxiety. There are now phone apps for anxiety, too. Some of the more popular ones are Calm, Mindspace, CBT-i Coach, Mindfulness Coach and Moodnotes.

Don’t hesitate to seek help if anxiety is disrupting your life. If you or someone you love has experienced general anxiety or panic attacks, discuss it with your health care professional. There is relief. Find your remedy.

Don't have a doctor and need to find one? Check out your options.

Find Your Happy Place

Who isn’t stressed nowadays? It’s a safe bet that everyone you know has complained about feeling stressed at one time or another.

What Is Stress?

Stress is a normal psychological and physical reaction to the demands of life. Your brain is hard-wired with an alarm system for your protection. When your brain perceives a threat, it signals your body to release a burst of hormones to fuel your capacity for a response. This has been called the "fight-or-flight" response.

When the threat is gone, your body is meant to return to a normal relaxed state. However, the pace of modern life can mean that your alarm system rarely shuts off. If your stress-response system is constantly “switched on,” this can disrupt almost all your body's processes.

This can lead to serious health problems over time, including:

Anxiety
Depression
Digestive problems
Headaches
Heart disease
Sleep problems
Weight gain
Memory and concentration impairment

Manage Your Stress

Stress management can give you a range of tools to reset your alarm system. The first step in successful stress relief is to monitor your stress level.

The next step is to identify your stress triggers. When do you experience the most stress? Some causes of stress are easy to spot, such as job pressures, relationship problems or financial difficulties. But other daily demands, such as commuting, caring for family members or being overworked, also can contribute to your stress level. Even positive events can be stressful, like getting married, starting a new job or buying a new house.

Once you've identified your stress triggers, you can develop strategies to deal with them. Identifying what aspect of the situation you can control is a good starting point. Sometimes you may be able to remove the stressor. At other times, you may only be able to change how you react to the situation.

Many people benefit from practicing stress-reduction techniques, such as deep breathing, massage, tai chi or yoga. Others manage stress by practicing mindfulness in meditation or being in nature.

Maintaining a healthy lifestyle also helps manage stress — eat healthy, exercise regularly and get enough sleep. Relaxation techniques are an essential part of stress management. With the demands of work and life, you may put relaxation low on your priority list. But everyone needs to make time to relax and recharge.

Other ways to manage stress can include taking time for hobbies, fostering healthy relationships, having a sense of humor and volunteering in the community.

Stress won't disappear from your life. But by practicing stress management techniques, you can increase your ability to deal with life’s challenges.

Outline of Coverage

Access your Blue Option 2020 Outline of Coverage. Our Outline of Coverage gives you answers on:

Benefits
BlueCard
Inpatient and Outpatient Services
... and more!

Click here to view the 2019 Outline of Coverage.

Beat the Winter Blues

The holidays are not always jolly for everyone. For many people, the holiday season brings all sorts of emotions. And it’s not uncommon to feel down during the holidays. There is the stress of getting everything done in time, traffic jams, crowded shopping centers, family issues, traveling and even a time of sadness. Luckily, there are ways to avoid holiday triggers that can make you feel sad.

Avoid alcohol. Alcohol and holidays may go hand in hand. And you may be tempted to drink more when you’re feeling stressed or depressed. Avoid the temptation to drown your sorrows. Alcohol is a depressant. So if you are feeling depressed, it could make things worse.

Get moving. Make exercise a priority! Not only is it good for your physical health, it can do wonders for your mental health. So get out and get moving! Even if it’s a bit cold outside, being in the outdoors is great because you get sun, fresh air and exercise. Call up a friend or take your dog out for an afternoon walk.

Give from the heart. Don’t break the bank and cause yourself added stress trying to top last year’s extravagant gift. Give gifts from the heart.

Don’t sweat the small stuff. Make a list of the important things that need to be done first, and do not sweat the small stuff. So what if you don’t get the lights on the roof when you’d planned to? Or you couldn’t find a certain ornament? We often let tradition rule our lives this time of year. Don’t let the small stuff send you over the edge. Prioritize your checklist.

Missing a loved one? If you always spent the holidays with a loved one who is no longer with you, avoid the temptation to stay home and dwell on your loss. Start a new tradition to help take your mind off things. Try starting an annual holiday lunch with friends. Or volunteer to serve dinner to the less fortunate. Knowing that you are helping others may seem small, but it can have a huge impact on the lives of others.

Practice gratitude. Make it a habit to start and end your day by reflecting on the things – and people – you are most grateful for.

You don’t have to go it alone. BlueChoice HealthPlan offers telephonic health coaching at NO COST to you. Whether you need help managing your diabetes, quitting smoking, or tips to help you cope with stress or depression, we have a program for you. To learn more about all of the programs we offer, visit the Great Expectations for Health Programs section of our website here. Or call us at 855-838-5897.

Understanding Opioid Addiction

Understanding Opioid Addiction

Did you know that on average, 78 Americans die every day from opioid overdose? Opioid addiction is more common than you think. Millions of Americans are prescribed opiates to treat injuries or illnesses, but most are unaware of the long-term effects on their bodies.

Is it really all in your head?
The key to understanding opioid addiction begins with your brain. How does the addiction occur and why is it so prevalent? If you have ever fractured a bone or had to have surgery, you probably took an opiate for pain. With as many as 100 million people suffering from chronic pain, opioids have become the treatment of choice. It’s what happens to your brain while taking the medication that really holds the answer.

Many people are unaware that opioids are also produced by your body. If you are ever severely injured, naturally occurring opioids provide pain relief until you can seek medical attention. Endorphins are a naturally occurring type of opioid. You probably have heard of the term “exercise euphoria,” which occurs when endorphins are released by the brain. For example, it’s the great feeling you get after working out. Natural opioids trigger receptors in your brain that mimic pleasure and act as a pain reliever. Once your brain gets used to the ingested opiates, your body slows down the production of natural ones.

Unfortunately, the brain doesn’t automatically begin creating opioids once you stop your medication. The human body will take some time to start producing opioids again. It will be a while before your body can create enough opioids to make you feel better.

Recognize the signs
Opioid dependence can happen to anyone. How can you tell if you are addicted? Are you taking more than is prescribed or having trouble discontinuing use? These are some of the early signs that your medication is becoming a problem. Here are the most common symptoms of opioid addiction:

Anxiety
Hot and cold sweats
Irritability
Insomnia
Muscle aches and pains
Nausea and vomiting
Diarrhea

As with any drug addiction, the withdrawal symptoms make it harder for you to stop. The physical symptoms can last somewhere between seven days to a month, while the emotional ones can continue for several months.

The good news
There are several options for treating prescription opioid addiction. Now that you know the signs, talk with your doctor about treatment options. Medically supervised therapies can help alleviate withdrawal symptoms and get you on the road to a healthier you.

The Heart of Good Health

The Heart of Good Health

Healthy eating is one of the most important things you can do for your body. Making smart food choices can help reduce your risk of heart disease and stroke. The good news is, eating right doesn’t have to be hard or require a special diet.

You may be eating plenty of food, but your body may not be getting the nutrients it needs to be healthy. Nutrient-rich foods may have minerals, protein, whole grains or other nutrients but have fewer calories. They may help you control your weight, cholesterol and blood pressure.

Make sure your diet includes:

a variety of fruits and vegetables
whole grains
low-fat dairy products
skinless poultry and fish
nuts and legumes
non-tropical vegetable oils

Limit saturated fat, trans fat, sodium, red meat, sweets and sugar-sweetened beverages. If you choose to eat red meat, compare labels and select the leanest cuts available.

Count Calories
The right number of calories to eat each day is based on your age and physical activity level and whether you're trying to gain, lose or maintain your weight. You could use your daily allotment of calories on a few high-calorie foods and beverages, but you probably wouldn’t get the nutrients your body needs to be healthy. Read Nutrition Facts labels carefully — the Nutrition Facts panel tells you the amount of nutrients in a food or beverage.

Exercise
Regular physical activity can help you maintain your weight, keep off weight that you lose, and help you reach physical and cardiovascular fitness. If it’s hard to schedule regular exercise sessions, try aiming for multiple sessions of at least 10 minutes spread throughout the week.

If you would benefit from lowering your blood pressure or cholesterol, the American Heart Association recommends 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week.

A healthy diet and lifestyle are your best weapons to fight cardiovascular disease. It’s not as hard as you may think! Make these simple steps part of your life for long-term benefits to your health and your heart.

Remember, you can always contact a Health Coach at 855-838-5897 do discuss your options, get helpful tips and more!

Source: American Heart Association

http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/How-to-Eat-Healthy_UCM_307257_Article.jsp#.WA9WM-UrLct
http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.WA9WruUrLcs

The American Heart Association is an independent organization that provides health information on behalf of BlueChoice HealthPlan. This link leads to an independent site. That organization is solely responsible for the contents and privacy policies on its site.

Reducing Your Cancer Risk

More than 1 million people in the United States get cancer each year. Research shows that many of these cases are the result of preventable causes, including tobacco use, being obese or overweight, physical inactivity, poor diet and excess exposure to ultraviolet (UV) light. The good news is that you can avoid some of these cancer risks. Here are four ways you can lower your risk of developing cancer.

Don’t use tobacco
One of the most effective ways to reduce your risk is avoiding or quitting tobacco use. You should refrain from using any type of tobacco, including cigarettes, cigars, pipe tobacco and smokeless tobacco. Cigarette smoking is responsible for one in three cases of cancer diagnosed in the United States each year, and tobacco use can cause 18 types of cancer. It’s never too late to quit. If you need help quitting tobacco, start the conversation with your doctor.

Maintain a healthy weight, be active and eat healthy
Research shows that being obese or overweight can increase your risk for 14 types of cancer. Being active and making healthy choices in the kitchen can help you maintain a healthy weight and, on their own, can reduce the risk for certain types of cancer.

Here are some recommended guidelines:

Engage in at least 150 minutes of moderate activity a week. Being active may lower the risk of breast and colon cancer.
Limit your consumption of red meat and processed meat like bacon and hot dogs, which can increase the risk for colorectal cancer.
Eat at least 2½ cups of vegetables and fruits each day.

Protect your skin
Skin cancer is the most common type of cancer, and the number of skin cancer cases has increased over the past few decades. However, skin cancer is preventable. Excess exposure to ultraviolet light causes most skin cancers.

Here are several ways you can protect your skin from UV rays:

Avoid the midday sun. The sun’s rays are the strongest between 10 a.m. and 4 p.m. Stay in the shade as much as possible when you are outdoors.
Cover your skin. Wear clothing that covers the arms, legs and torso. Hats with a wide brim can shade your face, ears and neck, and sunglasses can protect your eyes.
Properly apply sunscreen lotion of SPF 30 or higher.
Avoid indoor tanning beds and sunlamps.

Get screened
While these lifestyle changes reduce your risk of developing cancer, they can’t guarantee cancer prevention. That’s why cancer screenings are important. Screening tests are used to discover cancer before a person shows any symptoms. Screenings can find precancerous conditions and catch cancer in its early stages, when treatment is most effective. Ask your doctor which screening tests are right for you.

Where You Go Matters!

Where Should I Go For My Health Care Needs?

Primary Care Physician

Your primary care physician (PCP) should be your first choice for health care. See your PCP for common medical issues:

Illnesses such as colds, flu, earaches and sore throats
Minor injuries such as sprains, strains and back pain
Routine physical exams, vaccinations and screenings
A health problem for which you need advice

Don't have a PCP? Find one here. Or, give us a call at 855-838-5897. We can help you find a doctor that fits your needs.

Network Urgent Care Clinics

Blue CareOnDemand^SM

What types of conditions can Blue CareOnDemand doctors treat?

Colds
Pink Eye
Flu
Ear Infection
Fever
Migraines

When should you use Blue CareOnDemand?

The doctor's office is closed
You are too sick to drive
You are traveling

Download the app via the App Store or Google Play or visit www.BlueCareOnDemandSC.com and sign up for Blue CareOnDemand today!

When Should I go to the ER?

The emergency room is only for very serious or life-threatening problems.

Sudden or unexplained loss of consciousness
Signs of a stroke
Poisoning
Signs of heart attack
Severe shortness of breath
Medication/drug overdose, alcohol poisoning

For more information about making the most of your benefits and navigating the complex health care system, contact our team of ER Care Guardians:

855-838-5897

Monday–Thursday, 8:30 a.m. – 8 p.m.

Friday 8:30 a.m. – 5 p.m. EST

Our ER Care Guardian team consists of licensed social workers and certified medical assistants that aim to address and modify the habits of high utilizers and reduce ER visits.

FOCUSfwd® Wellness Incentive Program

shoes, juice, along with a sandwich with vegetables in a container

BlueChoice HealthPlan's FOCUSfwd Wellness Incentive Program is here! Start getting healthy (or healthier) today and have fun while doing it!

FOCUSfwd offers you the chance to win cash rewards. There are winners weekly, monthly and quarterly. The more you participate the better your chances of winning one of the three BIG GRAND PRIZES of $5,000 each! That's right, there will be three grand prize winners drawn in December 2019!

To get started, you'll need to:

Log in to My Health Toolkit^®
Select the Health and Wellness tab
Select the FOCUSfwd Incentive Program link
Enter your email address to be eligible to win

Don't have a My Health Toolkit account? No problem. It only takes a few minutes to create one.
Once logged in, you can choose which task you'd like to complete first. You already get 10 entries just for having a My Health Toolkit account!

*This program is only available to eligible subscribers and their spouses (aged 18 and older). Please note the awards will increase taxable earnings and be subject to applicable taxes.

Why Your Child Needs Vaccines

When germs enter your body, your immune system recognizes them as “foreign invaders” called antigens. The immune system produces antibodies to fight the germs and help you get well.

Your immune system remembers the germs that made you sick, and if they ever try to infect you again — even after many years — your immune system will come to your defense again. This is immunity. It’s what keeps you from getting sick from diseases like measles or chickenpox a second time, no matter how often you are exposed to them.

With vaccination, killed or weakened disease germs are intentionally introduced into the body, usually by injection. Then your immune system goes to work, just as if you were exposed to a disease.

Vaccine safety
Vaccines are generally safe. The protection provided by vaccines far outweighs the very low risk of serious problems. Vaccines have made many serious childhood diseases rare today.
Some vaccines may cause mild, temporary side effects, such as fever, soreness or a lump under the skin where the shot was given. Your doctor will talk to you about possible side effects with certain vaccines.

In special situations, children shouldn't be vaccinated. For example, some vaccines shouldn't be given to children who have certain types of cancer or certain diseases, or who are taking drugs that lower the body's ability to resist infection.

When should my child be vaccinated?
Recommendations about when to have your child vaccinated change from time to time. You can get a copy of the most current child and adolescent vaccination schedules from an organization such as the American Academy of Family Physicians (AAFP) or the Centers for Disease Control and Prevention (CDC). Or you can ask your doctor. Your child usually receives his or her first vaccine soon after he or she is born.

Benefits of vaccines
Vaccines not only help keep your child healthy, they help all children by stamping out serious childhood diseases. The more children in a community who are vaccinated, the harder it is for a disease to spread.

Even a few cases of a contagious disease in a vulnerable population could set off a major outbreak. That’s why we still vaccinate against polio, even though the U.S. has not seen a case of it in more than 10 years.

When you vaccinate your child, you aren’t just protecting him or her. You’re also protecting his or her friends, classmates, family and future generations.

Talk to your doctor if you have any questions about whether your child should receive a vaccine.

Sources: American Academy of Family Physicians and the Centers for Disease Control and Prevention
The AAFP and CDC are independent organizations that provide health care information.

What Are Electronic Cigarettes?

You may have heard of e-cigarettes, e-pens, e-pipes or vaporizers. But what are they? How do they work? And, most importantly, are they safe? Officially known as Electronic Nicotine Delivery Systems (ENDS), they are battery-operated devices that contain a liquid cartridge. When heated, the liquid creates a vapor that is inhaled by the user. This is often called “vaping”. Originally marketed as a safe alternative to traditional cigarettes, consumers were given very little information, if any, about the ingredients of the liquid. Although e-cigarettes do not contain tar or produce tobacco smoke like traditional cigarettes, most do contain nicotine and other potentially harmful chemicals.

On the rise
The popularity of e-cigarettes and other ENDS have caught the attention of the Centers for Disease Control (CDC) and other governmental agencies. Recently, the Food and Drug Administration (FDA) stepped in to regulate ENDS products. New FDA regulations classified the devices as tobacco products, and you now must be 18 years of age or older to purchase them. In 2016, the Surgeon General’s report warned about the increase of e-cigarette use amongst Americans, especially middle and high school aged children. The report also found that e-cigarette manufacturers were specifically targeting youth in the same way tobacco companies did in the past. Nicotine addiction is greater in young people because it affects their developing brains. Nicotine can also harm long-term cognitive thinking and increase the risk of addiction to other drugs.

Fear the unknown
Scientists are still studying the long-term effects of e-cigarettes. Research continues on the safety of vaporizing nicotine and other chemicals found in ENDS. The FDA has not approved any ENDS device as a smoking cessation aid. Don’t leave your health up to chance. Talk with your doctor about finding a clear and safe path to a smoke-free you!

NICU Case Management

We offer the Great Expectations^®NICU Case Management program to educate and support the parents of infants with certain medical needs or conditions. This includes, but is not limited to, complications associated with premature birth, congenital birth defects, seizures, cystic fibrosis and genetic disorders. We provide this value-added service at no charge just for being a member of BlueChoice HealthPlan.

With NICU Case Management, everyone involved in your infant’s health care works as a team. This includes you, your family, your doctors and other health care staff, and a BlueChoice^® case manager. An experienced registered nurse case manager partners with you to help you navigate through the complicated health care system. Our team of highly skilled neonatal intensive care unit (NICU) case managers includes nurses who typically have more than five years of maternal-neonatal experience.

There are many benefits to participating:

Health coaching from a clinically experienced, certified nurse case manager.
Educational materials.
Referrals to community and/or professional resources.
Helping members use and understand their pharmacy and medical benefits.
Ongoing communication and coordination with all involved doctors, therapists, home health nurses and social workers.

We identify members who may qualify for NICU Case Management. Doctors can also refer their patients who are BlueChoice members, or you can request us to evaluate your infant for participation in the program. Please call us at 855-838-5897 to make this request. A case manager will review your information to see if your infant qualifies for our NICU Case Management program.

Helpful Resources

These are independent organizations that provide health information on behalf of BlueChoice. These links lead to independent sites. Those organizations are solely responsible for the contents and privacy policies on their sites.

You Gotta Move

Does the thought of exercise give you nightmares? Would you rather go to the dentist than the gym? Do you despise aerobics? There’s nothing wrong with you. Those activities may not be comfortable. But neither is getting winded when doing basic household chores. Here’s the good news. You don’t have to exercise to be healthy — you just gotta move!

In our current sedentary society, what we lack is physical motion. Alternative exercise may be the solution. Alternative exercise is simply engaging in a physical activity that falls outside the parameters of what we think of as “normal” exercise. And physical activity helps combat a plethora of health conditions, such as heart disease, high blood pressure, high cholesterol — the list goes on.

Alternative exercise can be as simple as roughhousing with your kids or playing with your dog. Yardwork and gardening count, too. The key is consistency. It’s simple. Find something, anything, that moves you and makes you move … every … single … day.

Get Back To Your Youth
Go back to your childhood. What did you do for fun? At some point, you probably played hide-and-seek, tag or kickball. Did you know that many cities now have kickball leagues for adults? Were you a Little Leaguer in football, baseball or basketball? You don’t have to get up a game (but games are always fun) — just get out in the yard and play catch or shoot some hoops. Can you throw a Frisbee disc? Great exercise. How about Frisbee golf? Even better. Or Ultimate Frisbee. Now that’s intense.

Whether you get back to your childhood roots or learn something new, different and unfamiliar, there are thousands of ways to get your fanny off the sofa.

Perhaps you hate all things competitive. No problem. Take a dance class — or yoga or tai chi. Go sightseeing or birdwatching or hiking. Remember, your body was never designed to be sedentary. Simply get more active throughout your day. Take the stairs instead of the elevator, rev up your household chores or take a brisk 30-minute walk. Just find something that moves you!

Why, Why, Why?
Regular physical activity can help you fall asleep faster and deepen your sleep. It can put the spark back into your love life. Regular physical activity can improve energy levels and physical appearance. It also stimulates various brain chemicals that may leave you feeling happier and more relaxed.* These benefits are the same as traditional forms of exercise. You burn calories, tone muscles, reduce stress and more. So, get out there and find something that moves you!

* http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise/art-20048389

Tivity Health

Tivity Health offers access to nearly 10,000 different fitness locations for just $29 a month. Visit any participating fitness location anytime, anywhere as often as you like.

Find a Location

Diabetes Control in the Summer

Heat and humidity may affect people with chronic conditions more than it does others.

If you have diabetes, here are some general tips to keep you safe when the weather is at its hottest.

Prevent dehydration. Both hot weather and high blood sugar can cause dehydration. So, if you have diabetes, it's doubly important to drink plenty of fluids throughout the day. Water is best. Avoid sugary beverages and sports drinks.
Avoid alcohol. Alcohol can affect your body's ability to regulate body temperature.
Strategically plan exercise and outdoor activities. Exercise and do outdoor yard work and other activities during the cooler hours of the day. Alternatively, consider walking in a shopping mall or department store.
Dress appropriately. When humidity is high, your sweat can't evaporate as well. If the heat index reaches 91 F (33 C) or higher, wear clothing that allows sweat to evaporate easily.
Test your blood sugar occasionally. When outside in the heat, it doesn't hurt to occasionally test your blood sugar. Low and high blood sugar can be a problem during hot weather.

Recognize and treat heat exhaustion to avoid heat stroke

Heat exhaustion symptoms

If you have diabetes, you're at greater risk of heat exhaustion, which occurs when you're exposed to high temperatures for a long period of time and don't replace the fluids you lose. Your body produces more heat than it can release.

Symptoms of heat exhaustion include:

Cool, moist skin with goose bumps when in the heat
Heavy sweating
Dizziness
Fatigue
Weak, rapid pulse
Low blood pressure upon standing
Muscle cramps
Nausea
Headache

If you experience any of these symptoms on a hot, especially humid day, it's important that you take steps to avoid heat stroke.

Avoid heat stroke

Follow these tips to cool down if you experience any symptoms of heat exhaustion.

Find a cool, shady spot to rest. An air-conditioned building is even better. Rest on your back with your legs elevated.
Drink plenty of cool fluids. Avoid alcohol, which can worsen dehydration.
Take a cool shower or bath. If not possible, you can also wipe down with a cool cloth.
Adjust clothing. Loosen your clothing, and remove any unnecessary clothing.

If you don't feel better within one hour after taking these measures, seek prompt medical attention. This information is courtesy of the Mayo Clinic.

Are you enrolled in our Great Expectations^® Diabetes program? This program helps you learn how to manage your diabetes better.

Protect Your Pearly Whites

Cavities, also called tooth decay, are one of the most common chronic conditions in the United States. It occurs when bacteria feed off of sugars in your mouth and produce acid. The acid attacks your tooth enamel — the hard, outer layer of your teeth. Over time, these acids can form a cavity in your tooth. More than 80 percent of people have had at least one cavity by age 34. The good news is that tooth decay is preventable.

Keep it clean

Preventing tooth decay starts with practicing good dental hygiene. Here are some tips to follow to keep your mouth, gums and teeth healthy.

Brush your teeth for two minutes twice a day.
Use fluoride toothpaste.
Clean between your teeth with floss or another type of interdental cleaner once a day.

Chew on this

Not only can your diet affect your overall health, but what you eat and drink can also impact your dental health. Sugar of any kind in food and drinks can contribute to tooth decay. Sugary drinks like soda, sports drinks and juice are major culprits. When reaching for a beverage, choose water instead.

Snacking smart can also make a difference. Chips and crackers contain carbohydrates that break down into sugar. These foods also tend to get stuck in your teeth. You should also avoid sticky foods like dried fruit and candy. Enjoy a nutritious choice, such as cheese, yogurt, fruits, vegetables or nuts instead.

Open wide

Visiting your dentist regularly for a professional cleaning and exam is important to maintaining your dental health. These visits can help prevent dental problems from happening in the first place or the dentist can spot them early when they are easier to treat. During a dental checkup, the dentist or dental hygienist will remove dental plaque, check for signs of tooth decay, and apply a fluoride gel or varnish if necessary. Your dentist can help determine how often you need a checkup.

Do you need to find a dentist?

Sleep on This!

Human beings need sleep to survive. And while there is no record of a human dying from sleep deprivation, animal research strongly suggests it could happen. The seemingly simple act of slumber actually involves a complex choreography of biochemical and physiological processes that keep us functioning.

While You Sleep

At bedtime, your cortisol hormone level dips significantly (it slowly increases through the night so you are alert come morning). Your heart rate and breathing slow. As you sleep, your blood pressure plunges, and your body temperature drops. You pump out growth hormones and regulate your hunger hormones. And your brain cleans house.

You are not in a deep sleep most of the night. You cycle through stages all night long, even waking for a second before each cycle begins again. You probably don’t even realize you wake up. While your body rests during sleep, your brain remains active controlling body functions —like breathing — even as it rejuvenates.

There are two sleep states — rapid eye movement, or REM, where dreams occur, and non–rapid eye movement, or NREM. REM sleep is active sleep. You dream, your breathing and heart rate increase and become irregular, your muscles relax and your eyes flutter. NREM sleep has four stages, going from drowsiness to deep sleep. The restorative effects of sleep occur during deep NREM sleep. Yet, even during deep NREM sleep, your mind is processing information.

Benefits of Sleep

When you sleep, your brain recharges, your cells repair themselves and your body releases important hormones that heal and rejuvenate. A restful night’s sleep helps keep your brain sharp, your immune system strong, your waistline trim and your skin healthy. It also lowers your risk for depression, diabetes, obesity, high blood pressure and heart disease.

While sleep won’t actually help you shed unwanted pounds, regular restful nights can prevent weight gain. How, you wonder? Insufficient sleep increases secretion of a hormone called ghrelin, which signals hunger. Along with this, there is a decrease in the hormone leptin, which transmits the feeling of fullness. And the lack of sleep may actually diminish your capacity to fight the urge for junk food — because that is just what your body will crave.

Getting enough quality sleep protects your mental health, physical health, quality of life and safety. Sleep helps keep you happy, which in turn bolsters all your relationships. It can prevent headaches. It lowers your risk of a car crash. A good night’s sleep even raises your pain threshold. Quality sleep time is essential for your good health. Perhaps that’s why it’s called golden slumber.

Health Checklist

Adult Health - for Ages 18 and Over

Preventive care is very important for adults. By making some good basic health choices, women and men can boost their own health and well-being. Some of these positive choices include:

Eat a healthy diet
Get regular exercise
Don't use tobacco products
Limit alcohol use
Strive for a healthy weight

Adult Recommendations

Screenings

Physical Exam	Every year, or as directed by your doctor.
Body Mass Index (BMI)	Every year.
Blood Pressure (BP)	At least every two years.
Colon Cancer Screening	Beginning at age 50 — colonoscopy every 10 years, or flexible sigmoidoscopy every five years, or fecal blood test annually.
Diabetes Screening	Those with high blood pressure or high cholesterol should be screened. Others, especially those who are overweight or have a close family history of diabetes, should consider being screened.

Immunizations

Tetanus, Diphtheria, Pertussis (TD/Tdap)	Get Tdap vaccine once, then a Td booster every 10 years.
Influenza (Flu)	Every year.
Herpes Zoster (Shingles)	One does given at age 60 and over, regardless of whether you had a prior episode of shingles.
Varicella (Chicken Pox)	Two doses if no evidence of immunity.
Pneumococcal (Pneumonia)	Both types of vaccine recommended at age 65 or older. Number of doses of each depend on indication.
Measles, Mumps, Rubella (MMR)	One or two doses for adults ages 18–59 if no evidence of immunity.
Human Papillomavirus (HPV)	Three doses for women ages 19–26 if not already given. Three doses for men ages 19–21 if not already given.*
Hepatitis A	Two or three doses for adults age 19 and over.**
Hepatitis B	Three doses for adults ages 19 and over.**

Women's Health

Women have their own unique health care needs. To stay well, they should make regular screenings a priority. Women should discuss the recommendations listed on the chart with their doctors.

Mammogram	Every year for women beginning at age 40.*
Cholesterol	Ages 30–35 should be tested if at high risk. Women age 45 and over should be tested.
Pap Test	Women ages 21–65: Pap test every three years. Another option for ages 30–65: Pap test and HPV test every five years. Women who have had a hysterectomy or are over age 65 may not need a Pap test.*
Osteoporosis	Beginning age 65, or at age 60 if risk factors are present.*
Aspirin Use	At ages 50–79, talk with your doctor about the benefits and risks of aspirin use.
Pelvic Exam	Every year for ages 21 and over.*
Folic Acid	Women planning/capable of pregnancy should take a daily supplement containing .4–.8 mg of folic acid for prevention of neural tube defects.

Men's Health

Men are encouraged to get care as needed and make smart choices. That includes following a healthy lifestyle and getting recommended preventive care services. Men should discuss with their doctors the recommendations shown below.

Cholesterol	Ages 20–35 should be tested if at high risk. Men age 35 and over should be tested.
Prostate Cancer Screening	Ages 50 and over, discuss the benefits and risks of screening with your doctor.*
Abdominal Aortic Aneurysm	Once between ages 65 and 75 if you have ever smoked.
Aspirin Use	At ages 50–79, talk with your doctor about the benefits and risks of aspirin use.

Don't have a PCP? Find one by visiting www.BlueOptionSC.com/FindADoc. Or, give us a call at 855-838-5897. We can help you find a doctor that fits your needs.

* Recommendations may vary. Discuss screening options with your doctor, especially if you are at increased risk.

Sources: American Cancer Society, U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention, U.S. Preventive Services Task Force. These are independent agencies that provide health information on behalf of BlueChoice HealthPlan.

Allergy Control Products

Allergy and Asthma Relief Start Here!

For more than 35 years Allergy Control Products has been working hard to find effective products to offer allergy, asthma and sinus sufferers relief from the effects of indoor allergies. Allergy Control Products’ goal is to help make allergy sufferers’ homes and lifestyles healthier and more manageable.

Save 25 Percent on Select Doctor Recommended Products!

Allergy-free bedding
Air purifiers and filters
Home essentials
Asthma products
Health and body
Humidifiers and dehumidifiers
Vacuums and steam cleaners
And many more new and quality brand products

Don't see the product you were looking for? Please call us and let us help you! Find expert advice at 1-800-ALLERGY (255-3749), or 24/7, live online support on the Allergy Control website at http://www.AllergyControl.com/allergydiscount.

Use member discount code ACP1HEALTH at checkout! No minimum order required. Enjoy free shipping on all orders over $79.00 when shipping ground within the contiguous U.S.

*Some discount exclusions may apply on certain products. Please call our customer service for further details or alternative products that offer discounts.

National Allergy

Allergy and Asthma Relief Start Here!

For more than 40 years, doctors have trusted National Allergy^® as their patient resource for non-drug allergy, asthma and sinus relief products. Best of all, the products are satisfaction guaranteed and sold at competitive prices to relieve you even more!

Save 25 Percent on Select National Allergy Doctor Recommended Products!

Allergy bedding
Air purifiers and filters
Home allergy products
Personal care
Humidifiers and dehumidifiers
Vacuums and steam cleaners
Many more new and high quality products for a healthier lifestyle

Don't see the product you were looking for? Please call us and let us help you! Visit our website at http://www.natlallergy.com/allergydiscount for relief information, expert advice or 24/7 live online support.

You can also call us at 1-800-522-1448.

Use member discount code NAS1HEALTH at checkout! No minimum order required. Enjoy free shipping on all orders over $79.00 when shipping ground within the contiguous U.S.

*Some discount exclusions may apply on certain products. Please call our customer service for further details or alternative products that offer discounts.

Substance Use (Recovery Support Program)

When you or a loved one begins the journey to healthier living, we want you to know you are not alone. Companion Benefit Alternatives (CBA) offers a Recovery Support Program for members and their families through health coaching.

CBA is a separate company that manages behavioral health benefits on behalf of BlueChoice HealthPlan. The Recovery Support Program is a free, voluntary program.

Recovery is a process that requires ongoing maintenance. The program is built around supporting you through your recovery, one day at a time. We’ll help you plan for success and help you stay focused on your goals for healthy living.

You’ll work one-on-one with a specialized behavioral health coach. Because everyone’s journey is different, your coach will help you create a personalized action plan to help you overcome the challenges of addiction.

Through scheduled phone calls, your coach will help you:

Set short- and long-term goals for sobriety.
Identify risky behaviors and relapse triggers.
Develop coping strategies to deal with cravings.

You’ll get support and encouragement to help you feel better and face the future with confidence.

If you or someone you love could benefit from this program, please contact CBA’s health coaching team at 800-868-1032, ext. 25835.

Don't InFLUence Others

Avoiding the crud this cold and flu season can be as easy as 1-2-3.

Get a flu shot
Wash your hands … A LOT
Cover your coughs and sneezes

Sound simple? Surprisingly, many adults don’t do enough to stop the spread of germs. There are over 200 different viruses that cause the common cold, and each new strain of the flu leads to more than 200,000 Americans being hospitalized each year. You can stop what’s going around by following these three simple steps.

Hit me with your best shot
Each year, the Centers for Disease Control and Prevention (CDC) estimates that 20 percent of the U.S. population will contract the flu. With only about 45 percent of people getting the vaccine, many Americans are unprotected, with a greater risk of spreading germs. A flu shot can reduce chance of getting sick by 60 percent in adults and 74 percent in children. You are protecting yourself from illness as well as those around you, such as young children, the elderly and people with chronic health conditions. The flu vaccine can also make your symptoms milder if you do get sick. Be sure to visit an in-network pharmacy or your Primary Care Physician to schedule your flu vaccine. Need to find an in-network pharmacy? *Please note that copay cost(s) may apply if other services are provided when you visit your PCP.

Clean hands, healthier you
Wash your hands for at least 20 seconds and help children do the same. If soap and water are not available, use an alcohol-based hand gel or sanitizer. Viruses that cause colds can live on your hands, and regular hand-washing can help protect you from getting sick. Avoid touching your eyes, nose and mouth with unwashed hands. It’s also a good idea to disinfect areas you often touch at home, work and school.

Run for cover
Did you know that a single sneeze can spray 100,000 germs into the air? Gross. Don’t underestimate the power of a tissue. And throw used tissues away immediately. Don’t have a tissue? Cough or sneeze into your upper arm or elbow area. Covering your mouth and nose during coughs and sneezes helps contain germs and protects others around you.

Other tips
Stay home when you are sick. The more you limit your contact with others, the less you can spread germs. If you have a fever, you should stay at home and avoid people for at least 24 hours after your fever has ended. Let your body rest and recover before resuming your regular routine.

Adult ADHD

Health Coaching for Adult ADHD

Attention deficit hyperactivity disorder (ADHD) is a common condition that affects both children and adults. ADHD often causes impulsive behaviors, excessive activity and problems with focusing. Because of this, ADHD can cause people to appear forgetful, disorganized or restless.

Almost everyone experiences these things from time to time, but people with ADHD struggle with them every day. Sometimes, this can cause difficulty at work and at home, and with social activities.

Managing Your ADHD

There is no cure for ADHD, but it can get better with treatment. The most common treatments include medication, therapy or a combination of the two.

A good treatment plan will include close monitoring by a qualified professional and follow-up care. With treatment, people who struggle with ADHD can lead successful lives.

Getting Help

Companion Benefit Alternatives (CBA) offers professional help for adults with ADHD through health coaching. CBA is a separate company that manages behavioral health benefits on behalf of BlueChoice HealthPlan. Health coaching for adult ADHD is a free, voluntary program.

When you join the program, you’ll work with a clinically trained behavioral health coach. Your coach can help you better understand ADHD and the best ways for you to manage it.

Through three scheduled phone calls, you coach will help you:

Set short and long-term goals.
Identify outpatient providers and community resources.
Provide tools to help you manage your medications and appointments.

Be sure to check out this booklet for more information. If you or someone you love could benefit from this program, please contact CBA’s health coaching team at 800-868-1032, ext. 25835.

Bipolar Disorder

Bipolar disorder is a mental illness that causes extreme shifts in a person’s mood and temper. While each individual is unique, there are some common characteristics of bipolar disorder.

If you suffer from bipolar disorder, you may experience intense mood shifts that range from the lows of depression to the highs of mania. Mood shifts may occur only a few times a year, or as often as several times a day.

Mania often includes hyperactivity, rapid speech, irritability and impulsive behaviors. Phases of depression may include periods of intense sadness, loss of energy, lack of interest in normal activities and difficulty in concentrating or making decisions.

If bipolar disorder is untreated, behavior shifts can result in damaged relationships, trouble maintaining a normal work or school schedule, and even death or suicide. The good news is that bipolar disorder is treatable. It is important to start treatment as soon as symptoms are recognized. Treatment for bipolar disorder can be extremely effective in controlling symptoms.

Companion Benefit Alternatives (CBA) offers health coaching for bipolar disorder to help members manage their condition. CBA is a separate company that manages behavioral health benefits on behalf of BlueChoice HealthPlan. Health coaching for bipolar disorder is a free, voluntary program.

Through scheduled phone calls, your coach will help you:

Personalize your plan for better health.
Set short- and long-term goals.
Supply family members with educational resources.

You are not alone. With treatment and support, you can get back to feeling like yourself. You can lead a full and productive life.

Be sure to check out this booklet for more information. If you or someone you love could benefit from this program, please contact CBA’s health coaching team at 800-868-1032, ext. 25835.

Moms Support Program

Having a baby can be one of the most exciting and rewarding events in your life. It can be very stressful too. For many women it’s a time of confusion, fear and sadness. That’s why depression during and after pregnancy is a common problem. The Great Expectations® Moms Support Program is here to help moms suffering from depression.

How Do I Know if I Am Depressed?

Many new mothers will experience the baby blues. The baby blues are perfectly normal and usually go away within a couple weeks. The symptoms of depression last longer and are more severe than the baby blues.

You could have a more serious condition if you experience any of these symptoms:

Feeling sad, anxious or overwhelmed
Feeling overwhelmed with normal tasks
Feeling angry, irritable or helpless
Fear you might harm yourself or your baby
Fear of being left alone
Regret having a baby
Trouble sleeping
Isolating yourself from friends and family
Difficulty concentrating

Certain factors may increase your risk of depression during and after your pregnancy. If you have a personal or a family history of depression or anxiety disorder, you may be at a higher risk. You may be more likely to have symptoms of depression if you had problems with previous pregnancies. Women who have depression during pregnancy are also more likely to have symptoms postpartum.

What Should I Do If I Have Symptoms of Depression?

Depression can interfere with your ability to function, including your ability to care for yourself and your child. It is important to seek treatment as soon as possible if you are suffering from any of the symptoms. Don’t wait.

Health Coaching Works

Treatment for depression works and help is available. Our health coaches can offer you extra support while helping you get your life back to normal.

We do this by:

Providing guidance and support through scheduled phone calls.
Setting short and long term goals throughout the recovery process.
Identifying facilities and providers to best suit the mother’s needs.
Supplying family members with educational resources to better help their loved one.

You are not alone. With early treatment and support, you can get back on the road to happy motherhood.

No Cost to You!

Our Moms Support Program is available to you for free, as part of your behavioral health care coverage. There are no hidden charges, fees or copayments. If you decide the program is not right for you, you can leave at any time.

To enroll in the Great Expectations^®Moms Support Program or for more information about health coaching and access to helpful resources, log in to My Health Toolkit^® and select Health and Wellness, then Health Coaching. You can also call us at 855-838-5897.

Stress Management

The Great Expectations^® Stress Management program is an early intervention program designed to help members develop a personalized plan to deal with stressors in a way that does not adversely affect their health. The program assesses, empowers and educates members using evidenced-based interventions for symptom monitoring. This program allows members to set their own goals. They may also receive educational mailings and access to online resources to assist.

woman with hands on face holding glasses

If you or someone you love could benefit from this program, please contact the Companion Benefit Alternatives, Inc. (CBA) health coaching team at 800-868-1032, ext. 25835.

Website Privacy Policy

WEBSITE PRIVACY POLICY
Effective 10/01/2017

Your privacy is important to us. Blue Cross Blue Shield of South Carolina, together with its subsidiaries and affiliates (collectively referred to as “Company” or “we”), protects your privacy on this website (the “Site”). This Website Privacy Policy is part of the Company’s Terms of Use, which you may access here. This notice describes the information we collect on this Site, how we use and disclose the information, and how we safeguard any information we collect when you visit this Site. Some pages on this Site may supplement this notice by describing privacy practices that apply to information on (or provided through) those pages.

The Information We Collect, Use, and Disclose

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We also may use cookies, pixel tags, and similar technologies in order to assist your use of the Site and to monitor and manage the Site so that we can improve, revise, and add material to the Site. Cookies are small files that are placed on your browser or device by a website. Pixel tags (also called clear GIFs, web beacons, or pixels) are small blocks of code on a website that allow them to do things like read and place cookies and transmit information to us. We use cookies and similar technologies for a variety of reasons, such as allowing us to show you content and material that's most relevant to you, improving our products and services, and helping to keep our products and services secure. While specific names of the cookies and similar technologies that we use may change from time to time as we improve and update our products and services, they generally fall into the following categories of use: authentication, security, insights and measurements, and site features and performance. You may use your browser controls to refuse to allow cookies to be placed on your computer. Refusing cookies disables our ability to include information about your visit in regular monitoring of Site traffic and may impact the way the Site functions on your computer.

We may hire third-party contractors to monitor, evaluate, and help improve users’ experience on our website. These contractors may have access to the information described above, subject to contractual obligations to comply with privacy and security requirements.

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Once you download Protected Health Information from the Site, it is your responsibility to safeguard the information. We are not responsible for any third party’s access to your Protected Health Information once you have downloaded it.

Privacy and Security
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Third-Party Links
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Children
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Changes to this Privacy Policy
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Breast Cancer: Reduce Your Risks

Nearly everyone knows someone touched by breast cancer. It’s a scary disease. But there is good news. Treatments are improving, and we are learning more than ever about ways to prevent breast cancer.

Some risk factors, such as family history, can't be changed, but there are lifestyle changes you can make to reduce your risks.

Not every one applies to every woman, but together, they can make a difference.

Screening Saves Lives
Studies show that breast cancer screening with mammography saves lives. It doesn’t help prevent cancer, but it can help find cancer early, when it’s most treatable. For most women, regular mammograms can begin at age 40, but specific recommendations vary by age and risk.

Find Out Your Family History
You may be at high risk of breast cancer if you have a mother or sister who developed breast or ovarian cancer (especially at an early age), or if you have multiple family members (including males) who developed breast, ovarian or prostate cancer.

Be Physically Active
Physical activity can help you maintain a healthy weight, which, in turn, helps prevent breast cancer. For most healthy adults, the Department of Health and Human Services recommends at least 150 minutes a week of moderate aerobic activity or 75 minutes of vigorous aerobic activity weekly, plus strength training at least twice a week.

Keep Weight in Check
Maintaining a healthy weight is an important goal for everyone. Being overweight can increase the risk of many different cancers, including breast cancer, especially after menopause.

Eat Healthy and Avoid Too Much Alcohol
A healthy diet can help lower the risk of breast cancer. Try to eat a lot of fruits and vegetables and keep alcohol at moderate levels or lower (one drink a day or less). While moderate drinking can be good for the heart in older adults, even low levels of intake can increase the risk of breast cancer.

Don't Smoke
Evidence suggests a link between smoking and breast cancer risk, particularly in premenopausal women. Not smoking is one of the best things you can do for your overall health.

Breastfeed, If Possible
Breastfeeding for a total of one year or more (combined for all children) lowers the risk of breast cancer. It also has great health benefits for the child.

Avoid Exposure to Radiation
Many medical-imaging methods use high doses of radiation. While more studies are needed, some research suggests a link between breast cancer and radiation exposure. Have such tests only when absolutely necessary.

For more information about lowering your risk of breast cancer, talk to your doctor. Do you need a doctor? Find one here.

Keeping an Eye on Diabetes

Diabetes is a serious disease, but fortunately there are ways to manage it. Taking care of yourself and your diabetes can prevent complications and help you feel better. With careful monitoring and regular visits to health care providers, you can keep your diabetes under control.

Monitoring

Blood glucose monitoring is an important tool for many people living with diabetes. These checks are performed with a blood glucose meter. The meter shows your blood glucose level at that moment.

When your blood glucose is at normal levels, you will likely have more energy, be less tired and thirsty, heal better, and need to urinate less frequently. You will also reduce your chance of health problems caused by diabetes, such as heart attack, stroke, eye problems, kidney problems, teeth and gum problems, pain, and tingling or numbness in your hands and feet.

Many factors can affect blood glucose levels, including food, physical activity, stress, illness and dehydration. Monitoring your levels can help you make decisions about eating and being active. If you have trouble reaching your blood glucose goals, talk to your health care team, as you may need to change your diabetes care plan.

Regular Doctor Visits

Good medical care is important when you have diabetes. In addition to your doctor, your diabetes care team may include nurses, an eye doctor and a dietitian. If you have any complications, your doctor may refer you to a specialist. Your health care team will create the best treatment plan for you.

How often you see your doctor depends on a number of factors, including if you take insulin, have trouble meeting your blood glucose goals, have any complications, or are starting a new medicine or insulin program. Your doctor will determine how often you should return for a visit. Need help finding a doctor?

Regular Diabetic Eye Exams

People with diabetes have a higher risk of certain eye problems than people without it. The American Diabetes Association recommends that people with diabetes see their eye care professional — an optometrist or ophthalmologist — at least once a year for a dilated eye exam. These checkups are the best way to detect diabetic eye disease. You should also see your eye care professional if you have issues with your vision, such as blurry vision, seeing double, trouble reading signs or books, or if your eyes hurt.

The American Diabetes Association is an independent organization that provides health information on behalf of BlueChoice HealthPlan.

Leave the Stress Behind

Long-term stress can harm your health. Says who? The National Institute on Mental Health. It also warns that stress affects everyone.

And stress doesn’t just affect your thoughts, feelings and behavior — it affects your body, too. Stress can increase your blood pressure and depress your immune system. It’s also known to cause multiple thyroid problems. And, according to the Cleveland Clinic, stress is linked to the six leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver and suicide. Bet you didn’t even realize just how dangerous stress could be.

The drastic increase of stress in our daily lives is a worldwide phenomenon. That’s why we’re constantly devising ways to combat stress — from relaxation techniques and deep breathing exercises, to meditation, muscle relaxation and mental imagery techniques. Some use sounds and/or music. Others use biofeedback. Yet one of the best, and easiest, is physical exercise.

Exercise — in any form — can act as a stress reliever. Regular exercise improves your overall health and sense of well-being. That alone puts more pep in your step, say the experts at the Mayo Clinic. But exercise has other stress-busting benefits. Physical exertion boosts secretion of endorphins. Endorphins are chemicals in the brain that resemble opiates and act as a natural morphine. You’ve probably heard it referred to as the runner’s high. The good news is, you don’t have to go running or participate in an aerobics class to get those “feel good” endorphins released into your body. You just have to exercise. All forms of exercise help reduce the effects of stress on the body and mind by releasing endorphins into the bloodstream. Even yoga and walking.

If that’s more than you want to do, work in the garden. Gardening is peaceful, solitary and good for the soul. Believe it or not, gardening is a great way to work your major muscle groups, such as your abs, back and glutes. With all that bending, squatting, pulling, pushing, you could burn as much as 184 calories in just a half-hour!

There are thousands of ways to get moving. And abundant activities relevant to the time of year — flag football, basketball, Frisbee golf, trampoline parks, mud runs, water aerobics, swimming and other water sports, corn hole and horseshoes, to name a few. Physical activity helps you unwind and connect with family or friends in a fun, social setting. And that reduces stress, too.

Regular physical activity will improve your strength and endurance. It can help you fall asleep faster and deepen your sleep. Exercise delivers oxygen and nutrients to your tissues and helps your cardiovascular system work more efficiently. And when your heart and lung health improve, you have more energy to tackle daily chores … and stress.

The bottom line on any physical activity — it’s a great way to feel better, boost your health and have fun. Let’s leave the stress behind.

Remember, our Great Expectations^® Stress Management program is available. This program is designed to help you develop a personalized plan to help deal with the stressors in a way that does not adversely affect your health. You can also call our health coaching team at 800-868-1032 ext. 25835 to discuss your options.

The National Institute on Mental Health, the Cleveland Clinic and the Mayo Clinic are independent organizations that provide health information on behalf of your health plan.

Diabetes Awareness

Diabetes is a chronic disease that affects how your body turns food into energy. If you have diabetes, your body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should.

A1C Test
One method used to determine if you have diabetes is the A1C test. Testing is simple and results are usually available quickly.

A1C is a blood test used to:

Provide information about a person’s average level of blood sugar, called blood glucose, over the past three months.
Help diagnose Type 2 diabetes, the most common type of diabetes.
Help diagnose prediabetes, a condition in which your blood sugar is higher than normal, but not high enough to be called diabetes.
Monitor your condition if you have diabetes.

This test measures how much glucose has been sticking to your red blood cells. Since each red blood cell is replaced by a new one every three to four months, this test tells you how high the glucose levels have been during the life of the cells. If most of your recent blood glucose readings have been near normal, the A1C test will be near normal (usually about 6 to 7 percent). If you’ve had many readings above normal, the extra glucose sticking to your red blood cells will make your A1C test read higher.

Eye Exam
Diabetic eye disease is a serious problem that can lead to loss of sight. Because diabetic eye disease can develop even when your sight is good, regular dilated eye exams are important for finding problems early. Some people may experience vision change. If you have trouble reading, if your vision is blurred or if you see rings around lights, dark spots or flashing lights, you may have eye problems. Be sure to tell your health care team or eye doctor about any eye problems. You should have your eyes dilated and examined once a year.

Blood Pressure
About 70 percent of adults with diabetes have high blood pressure or use prescription medications to lower high blood pressure. Maintaining normal blood pressure control can reduce the risk of eye, kidney and nerve disease by approximately 33 percent, and the risk of heart disease and stroke by approximately 33 to 50 percent. Healthy eating, medications and physical activity can help you bring high blood pressure down.

Diabetes Health Coaching Program

If you are diagnosed with diabetes, there is a free diabetes health coaching program available to you. Your coach will work with you to establish goals for your health, then help you work toward achieving your goals. Call 855-838-5897 to enroll!

Source: Centers for Disease Control and Prevention
https://www.cdc.gov/diabetes/home/index.html
https://www.cdc.gov/diabetes/basics/getting-tested.html
https://www.cdc.gov/diabetes/basics/diabetes.html

Don't Let Flu Get the Best of You!

We’ve all seen the headlines; this season’s flu is one of the worst in recent years. Despite all the bad news, there are several things you can do to keep yourself (and others) healthy this cold and flu season:

Think of hand-washing as a survival skill. Wash your hands thoroughly and wash them often.
Avoid touching your mouth, nose or eyes, especially without washing your hands first.
Don’t share food and drinks with others.
Encourage family members to cover their mouths with a tissue when they cough and to sneeze into the inside of their elbow to prevent the spread of germs.
Don’t share personal items, like toiletries, towels and wash cloths.
Get a flu shot. Experts say that even when the shot does not prevent you from catching the flu, it may make your symptoms less severe and shorten the length of time that you’re sick. Check out where you can get your flu shot!
If you have symptoms of a cold or flu, stay home!

Keep It Down!

What’s going on

Having high blood pressure (also known as hypertension) is more common than you think. It is estimated that about 75 million Americans have high blood pressure, yet 1 in 5 adults don’t even know they have it. When the pressure of the blood in your vessels rises or is too high, you may not have any symptoms. And hypertension can occur slowly over time. The best way to reduce the risk of heart disease, heart attack and stroke is to check your blood pressure on a regular basis.

Danger zone

Knowing the risk factors for high blood pressure is a good first step to guard against heart disease. Family history, age, gender and race can all play a part in whether you develop high blood pressure. It is always important to know if your parents or siblings have high blood pressure or other conditions. Unfortunately, you can’t control hereditary factors. Talking with your doctor about your family health history is vital to your overall health.

Just beat it

Luckily, there are lifestyle-related risk factors you can control. Lowering your blood pressure might be as easy as:

Maintaining a healthy weight
Eating a healthy diet
Being active
Limiting salt and alcohol intake
Eliminating tobacco use

Your lifestyle choices can have a direct impact on your blood pressure. Being overweight puts a strain on your heart and could increase your chances for other health issues, such as diabetes. Adding more fresh fruits and vegetables to your diet can aid in weight loss and help prevent heart disease. Lowering your sodium intake and staying away from foods high in saturated fat and cholesterol is a good idea, too.

If you smoke — quit as soon as possible. Smoking damages your arteries as well as your lungs. Reduce your alcohol intake. Drinking too much alcohol can raise your blood pressure and cause many other heart-related issues like irregular heartbeat and heart failure. And finally, exercise is a key to good heart health. Lowering your blood pressure can be as simple as taking a brisk walk three times a week. These lifestyle changes can help you get your blood pressure under control and they might just save your life.

If you are diagnosed with high blood pressure, there is a free high blood pressure coaching program available to you. Your coach will work with you to establish goals for your health, then help you work toward achieving your goals. Call 855-838-5897 to enroll!

Managing Your Medication

Medications may take some getting used to. You may worry about cost, convenience, side effects or a host of other concerns. But taking your medication exactly as directed is important for managing your health.

Here are some tips:

Understand your condition. It's important to understand your condition and how your medicine will help manage it. Understanding how a drug works can help you see why taking it regularly is important. Talk to your doctor or pharmacist about your condition and the medications being used to treat it.
If your medicines are too expensive, ask your doctor about samples or generic alternatives. Generics are safe and effective. Take advantage of one of the lower-cost generic programs through your local pharmacy.
Continue taking your medicine, even if you feel fine. Once you feel better, it's natural to question your need for medicine. If you reduce or stop taking your medication, your symptoms could come back. Never stop taking your medications without discussing it with your doctor first.
Understand how to read the label on your medications. Here's a look at the most common drug label you'll see.

Don't Miss the Early Screening

Early screenings aren’t just for the movies! When it comes to cancer, early screenings save lives. If you have a family history of cancer, especially breast, colon or cervical cancer — you should consider preventive cancer screenings. Mammograms, colonoscopies and Pap tests look for abnormalities that may be cancer or precancerous cells. When these cells are found early, your health care team can begin treatment before serious symptoms appear.

Why Should I Be Screened?

Thanks to an increase in preventive screenings, the overall cancer rate in the United States fell by 13 percent between 2004 and 2013. This is especially good news for women’s health. Since the number of women having regular Pap tests has increased over the past 40 years, cervical cancer is no longer the leading cause of death for U.S. women. Measures to detect and treat breast cancer have also reduced the mortality rate for women in the U.S. by 38 percent from 1989 – 2014. We could prevent 60 percent of colorectal cancer deaths with screenings. And a colonoscopy is the only screening test that can stop colon cancer by removing precancerous polyps during the exam. Ask your doctor about your risk for cancer and if you should be screened.

When Should I Be Screened?

Talk to family members about your family’s health history. If any close relatives — parent, sibling, grandparent — have had cancer, you should discuss earlier screenings with your health care team. People with no family history of cancer can follow these recommended guidelines:

Beginning at age 21, women are advised to have a Pap test every 3 years.
Women over 40 should consider having a mammogram every 1 – 2 years.
For women and men over 50, colonoscopies are recommended every 10 years. Talk to your doctor about alternative colon cancer screening tests.

Can I Reduce My Cancer Risk?

You can’t completely foil cancer, but there are actions, besides screenings, that can reduce your risk. Take as many of these steps as you can, not only to be healthier, but to reduce your risk of cancer:

Maintain a healthy weight.
Be physically active at least 30 minutes, five times a week or more.
Eat a healthy diet full of leafy greens and antioxidants.
Reduce or eliminate alcohol and nicotine.

Making positive lifestyle changes and participating in early screenings can improve your chances of beating cancer if it does occur. These same lifestyle changes can also increase the odds of living a healthier, longer life. So please — get screened.

Need to find a doctor?

My Health Toolkit App

Your favorite features from the website are now available in a mobile app. With the My Health Toolkit app, you can:

Check the status of your claims.
View and share your digital ID card.
Confirm your coverage for services.
Find a doctor or hospital in your network.
Manage your medical spending accounts.
And more!

Just grab your mobile device and search for “My Health Toolkit” in the App Store or Google Play. Once you download, you can log in with your existing username and password.

Childhood Well Visits & Vaccinations

It’s a dangerous world

But with recommended immunizations, your child doesn’t have to live in a bubble.
Parenting is an enormous responsibility. You may want to keep your child in a bubble so you know he or she is always safe and healthy. But, with proper immunizations and health screenings, the armor is already there.

Early Childhood Well Visits and Vaccinations

It’s important your child get to his or her wellness visits as recommended. Wellness visits allow your child and you to touch base with the pediatrician. While you’re there, you can talk about your child’s nutrition, physical activity, current BMI (body mass index) percentile and more. For children and tweens, BMI (based on height and weight) is age- and gender-specific. In children, a high or low amount of body fat can lead to weight-related diseases and other health issues.

During these visits, your child will also need certain vaccinations. These vaccinations help prevent diseases like whooping cough, which kills an average of 20 babies each year in the United States. They also help prevent measles, which is still present in the United States. Measles causes pneumonia, encephalitis and even death. Vaccinating your child according to the recommended schedule provides the best chance to prevent whooping cough and measles, and these 12 other serious diseases:

Haemophilus influenza type b (Hib)
Diphtheria
Hepatitis A
Hepatitis B
Influenza
Mumps
Pneumococcal disease
Polio
Rubella (German measles)
Tetanus (lockjaw)
Rotavirus
Varicella (chickenpox)

Preadolescent Well Visits

When your child is older, you may think wellness visits are going to get easier. Unfortunately, they aren’t. Not only are there some vaccines that require periodic boosters, there are also screenings that need to take place for tweens.

Starting at ages 11 and 12, your kids should be receiving the HPV vaccine. This vaccine can help prevent several kinds of cancer, including cervical. It doesn’t just affect women, either. Every year, 31,000 men and women are diagnosed with cancers caused by HPV infections that the vaccine might have prevented.

Need to find a Primary Care Physician (PCP)?

5210 Let's Go

5210 Let’s Go! is a nationally recognized program that incorporates:

Five or more servings of fruits and vegetables
Two hours or fewer of recreational screen time
One hour or more of physical activity
Zero sugary drinks, more water and low-fat milk

5210 focuses on smart lifestyle changes. Similar to quitting smoking or wearing your seatbelt, it’s a modification of daily habits. It is designed to increase healthy eating and active living for children and parents.

Many of the alternate activities are family group activities.

5: A diet rich in fruits and vegetables provides vitamins and minerals, important for supporting growth and development, and for optimal immune function. Most fruits and vegetables are low in calories and fat, making them a healthy choice anytime. It’s easier than you might think. Add fruits and vegetables to foods you already make, like pasta, soups, casseroles, pizza, rice, etc. Add fruit to your cereal, pancakes or other breakfast foods. Let the kids help you plan the menu.

2: Watching TV is associated with more snacking and increased obesity. Too much TV is linked to lower reading scores and attention problems. It’s important to limit all screen time, including: TV, computer, smartphones and video games. So, limit recreational TV or computer use to two hours or fewer. What to do instead? Work a puzzle. Turn on some music and dance. Read a book or magazine. Play some board games or charades. Or just hang out and catch up with your family.

1: Move at least one hour every day. It doesn’t have to be all at once. Make gradual changes to increase your level of physical activity. It’s easy to integrate physical motion into your daily routine. Take a walk after dinner, and encourage family members to join you. Go hiking or dancing. Choose toys and games that promote physical activity. Remember to make it fun.

0: Eliminate all sugary drinks from your diet. They are especially harmful to children. Daily consumption can lead to obesity, Type 2 diabetes and tooth decay. Sodas, fruit-ade and most juices are empty calories. If you do serve juice, be sure to buy 100 percent juice. Still, water is the best option for thirst.

Resources

Centers for Disease Control and Prevention

Resources for Parents

http://www.letsgosc.org/

These links lead to third party websites. Those websites are solely responsible for the content and privacy policies on their sites.

My Health Toolkit App is Here!

Your favorite features from the website are now available in a mobile app. With the My Health Toolkit app, you can:

View and share your digital ID card.
Check the status of your claims.
Confirm your coverage for services.
Find a doctor or hospital in your network.

And more!

Just grab your mobile device and search for “My Health Toolkit” in the App Store or Google Play. Once you download, you can log in with your existing username and password.

Be one of two lucky winners to win a $250 American Express gift card by downloading the app and creating an account or logging in to your existing account before April 18, 2018.

*Restrictions apply. Must enter before 4/18/18 midnight. Winners will be drawn and contacted by 4/30/18. This drawing is not an inducement to buy or renew health insurance with BlueChoice HealthPlan of South Carolina.
American Express is not a sponsor of this promotion. These terms and conditions govern your use of the American Express® Gift Card ("Terms and Conditions"). By purchasing, signing or using the American Express Gift Card ("Card"), you are agreeing to these Terms and Conditions. The terms "you" and "your" refer to the person who purchased the Card and/or the person who is using the Card. The term "we" "our" and "us" refer to American Express Travel Related Services Company, Inc. and its subsidiaries and licensees that issue prepaid cards, including American Express Prepaid Card Management Corporation ("AEPCMC"), the issuer of the Card.

Selfie Time

Selfie Time!

Who’s taking care of you? For many women, nurturing others is second nature. This marvelous trait has probably done more for the survival and advancement of humanity than any other human characteristic. However, constantly putting others’ needs ahead of your own can have serious, even deadly, consequences. And you can’t take care of anyone else if you’re out of the picture.

Stay in the Picture

As a woman, you need to nurture yourself, too. That’s not being selfish — it’s being prudent. You know the routine, but do you follow it?

Schedule all recommended health screenings.
Eat a healthy, balanced diet.
Get regular exercise.
Don’t smoke.
Drink in moderation, if at all.
Take private time to unwind and decompress.
Get a good night’s sleep.

The first one is essential — especially if you’re having trouble following the other six. Because even if you’re managing your weight and staying healthy, you may have health issues lurking beneath the surface that, as of yet, present no symptoms.

Vive la Différence

Women have more complicated anatomy than men and different health issues. For instance, while diabetes affects women and men in almost equal numbers, it affects women differently. Women with diabetes have higher risk for heart disease, blindness and depression. And chlamydia, a common STD that infects both men and women, has the potential to permanently damage a woman’s reproductive system. It can lead to infertility or a potentially fatal tubal pregnancy.

Take it seriously if your doctor or health care provider recommends screenings for chlamydia, cervical cancer, breast cancer and/or diabetes. Almost every cancer patient has a better survival rate when the cancer is caught early. And did you know that cervical cancer is the easiest gynecologic cancer to prevent, with regular screening tests and follow-up?

Stay Focused

Take care of yourself — for yourself and those you love. Do the things you know you should. If you mess up, don’t get down on yourself. Schedule all recommended health screenings. Need to find a primary care physician? Remember: You can’t take care of anyone else if you’re out of the picture.

Know Your Stats

Did you collect baseball cards as a kid? If so, you probably memorized your favorite players’ statistics, like home runs and RBIs. You may not be a pro ballplayer, but there are some important personal stats you should keep track of.

Blood Pressure

High blood pressure raises your risk for heart disease and stroke. The only way to know if you have it is to measure your blood pressure.

To determine whether your blood pressure is normal, your doctor examines your systolic and diastolic pressures, which the gauge measures in millimeters of mercury (abbreviated as mmHg).

The normal range is:

Systolic: less than 120 mmHg
Diastolic: less than 80 mmHg

If you have high blood pressure, your doctor may prescribe medication and lifestyle changes:

Diet. Eat a healthy diet that is low in salt, fat and cholesterol.
Be active. Take a brisk, 10-minute walk three times a day, five days a week.
Don’t smoke. If you smoke, quit as soon as possible.

Diabetes

There are several types of blood-sugar tests to determine if you have prediabetes, Type 1 or Type 2 diabetes. Normal blood glucose readings are between 70 and 140 milligrams per deciliter.

If you're diagnosed with diabetes, a diabetes educator can help you:

Develop a healthy eating plan.
Learn to test your blood sugar and record the results.
Recognize the signs of high or low blood sugar and what to do about it.
Monitor your feet, skin and eyes.
Manage stress and deal with diabetes care.

BMI

Body Mass Index, or BMI, is a person’s weight in kilograms divided by the square of height in meters. BMI does not measure body fat directly, but research has shown that BMI is moderately correlated with more direct measures of body fat.

A high BMI can indicate high body fat. BMI can be used as a screening tool, but it does not diagnose body fat or health. Even if two people have the same BMI, their level of body fat may differ. Athletes may have a high BMI because they are more muscular, not because they are fat. The standard BMI weight ranges for adults are:

BMI Weight Status

Below 18.5 Underweight

18.5 – 24.9 Normal or Healthy Weight

25.0 – 29.9 Overweight

30.0 and Above Obese

Colorectal Cancer

Another thing to watch out for is colorectal cancer. Colorectal is the third most commonly occurring cancer in men and the second leading cancer killer in the U.S. Screening tests can find precancerous polyps, so they can be removed before they become cancer. If you are 50 years or older, get screened now. Ask your doctor which test is right for you and how often to get tested.

Lower Back Pain

Something else you may need to take care of is lower back pain. If you suffer from lower back pain, your doctor may prescribe over-the-counter or prescription medication. Physical therapy is another treatment option. A physical therapist can use treatments such as heat, ultrasound, electrical stimulation and muscle-release techniques to reduce pain.

Make sure you know your stats. Your doctor can perform appropriate assessments to evaluate your health status and risks. Need to find a Primary Care Physician (PCP)?

Know Where to Go

It could save you time and money.

When you or a loved one is sick or injured, you want care as quickly as possible. Your first instinct may be to go to the emergency room, but if it isn’t a true emergency, there is a better option. You can save time and money by going to an urgent care facility instead of the emergency room. Emergency room visits can cost thousands of dollars, but, depending on your insurance, you can go to an urgent care facility and only spend the amount of your copay. Also, you can often be in and out of an urgent care facility in 30 minutes or less, while the wait time alone at the emergency room can be hours. You can also use the Blue CareOnDemand^SM app or website to have a virtual visit with a licensed professional from the comfort of your home.

Knowing where to go can make a huge difference. Here are some true emergency situations. Call 911 or go to the emergency room if someone has:

Stopped breathing
A head injury with unconsciousness, fainting or confusion
An injury to the neck or spine
A severe burn
Signs of a heart attack, such as severe chest pain or pressure
A seizure
Uncontrollable bleeding
Broken bones
Signs of a stroke, such as numbness of the face, arm and leg on one side of the body
Become unable to speak, see, walk or move
An unusual or bad headache
Severe allergic reactions
Ingested or inhaled poison
A life-threatening injury or symptom

Here are some situations where an urgent care or Blue CareOnDemand visit is your best option:

A cold
Flu symptoms
Earache
Sore throat
Migraine headache
Low-grade fever
Sprain, strain or back pain
Minor injuries
Cuts or wounds if bleeding is controlled
Medical problem if not life-threatening but needs immediate attention

If your problem is not life-threatening or there is no risk of disability, but you can’t wait to see your primary care physician, go to an urgent care facility or use Blue CareOnDemand. No appointment is necessary.

Flu Immunization

If you’re not protected, you could get infected.

Importance of flu shots

Did you know that a flu shot is your single best bet to avoid catching the flu? In fact, the national Centers for Disease Control and Prevention (CDC) recommends annual influenza vaccinations for every person — with few exceptions — age 6 months and older.

Don’t worry: You cannot get the flu from a flu shot. The flu vaccine uses dead viruses that trigger your immune system to produce antibodies. These new antibodies then help protect you if you’re exposed to the flu. Unfortunately, last year's vaccine may not protect you from this year's flu, because the viruses mutate and evolve. This is why new flu vaccines are needed each year.

Vaccination is especially important for people at high risk of influenza complications, including pregnant women, older adults and young children. Other chronic medical conditions also increase the risk of complications from the flu:

Asthma
Cancer or cancer treatment
Chronic obstructive pulmonary disease (COPD)
Cystic fibrosis
Diabetes
HIV/AIDS
Kidney or liver disease
Obesity

Importance of childhood immunizations

Why get your child immunized? Vaccines not only help prevent certain deadly diseases in infants, children and teens — they are the most effective means to fight and eliminate infectious diseases. In fact, the elimination of smallpox is a direct result of widespread, worldwide vaccinations. As are the major reduction of polio, measles and tetanus. The safety and effectiveness of vaccinations have been widely studied and verified. Since the 1880s, when Louis Pasteur first introduced vaccines for chicken cholera, rabies and anthrax, we have developed vaccines for 18 dangerous and/or deadly diseases.

Dangers of Human Papillomavirus (HPV)

Hopefully, you’ve heard about HPV. Approximately 14 million people contract it each year. This includes teenagers. The scary part is, HPV infections are directly linked to six types of cancer — cervical, vaginal, vulvar, penile, anal and throat. That’s why the CDC recommends girls and boys get HPV vaccination at age 11 or 12, before they become sexually active. Yes, even just kissing.

For more information on where you can go for the flu shot, please visit here.

Protect yourself and your family. Get all recommended vaccinations.

Breathe In, Breathe Out

Breathing is not something we often think about, because it happens even if we aren’t aware of it. But breathing doesn’t come easily to everyone. The air isn’t always as pure or clean as it seems, and it’s filled with invisible particles that can affect our breathing. These particles — that range from air pollutants to pet dander to artificial fragrances — can compromise the lungs’ natural defense system. For people who have breathing issues like asthma or chronic obstructive pulmonary disease (COPD), unclean air can take their breath away.

COPD causes obstructed airflow because the lungs become chronically inflamed. People who have COPD often experience difficulty breathing, coughing fits, mucus and wheezing. The condition is caused by repeated exposure to irritating particulate matter like cigarette smoke or air pollution. COPD increases the risk of heart disease and lung cancer.

Asthma causes the airways to the lungs to narrow and produce extra mucus, which makes breathing difficult. Coughing, wheezing and shortness of breath usually accompany asthma attacks. The severity of asthma varies from person to person and can change as someone ages.

People with breathing issues need to reduce their exposure to lung triggers. But it’s also helpful for people who don’t have breathing issues to do what they can to lower the amount of triggers in the air. Some of these changes are simple, such as not wearing perfume in public places. Others — like reducing air pollution by driving less or not burning yard waste — can take more time to implement.

Exposure can happen indoors and outdoors. When using irritating chemicals during activities like painting, cleaning or other home improvements, use a mask. This will lower exposure to harmful volatile organic compounds (VOCs) that come from cleaning chemicals or oil-based paints. Radon is another indoor pollutant that can cause breathing difficulties. Radon is a radioactive gas that occurs naturally when uranium breaks down in the ground. It can leak into a house through cracks in the foundation and walls, and is the main cause of lung cancer among nonsmokers.

There are a lot of irritants outdoors, too, especially in the summer months. Sometimes limiting outdoor activities is critical, especially exercising. Pay attention to the Air Quality Index. Summer months are known for having the worst air quality.

Besides reducing exposure to harmful chemicals, it is also possible to strengthen your body’s natural defenses against weakened lungs. Aerobic exercise and specific breathing exercises can improve lung function in some cases. And a 2010 study found that the risk of lung cancer was cut in half for people who consumed the most cruciferous vegetables, such as broccoli, cauliflower, cabbage, kale and bok choy.

Keeping the air quality healthy is a job for everyone, even those who don’t have breathing issues. Think about ways to reduce air pollutants not only for your own health and that of your family, but for the health of the world — because we all breathe the same air.

Visit our Great Expectations for health pages to learn more on how BlueChoice HealthPlan can help you with asthma and COPD.

Hurricane Florence

Virtual doctors' visits and emergency prescription refills available to BlueChoice HealthPlan of South Carolina members.

Virtual Visits Available 24/7 to All Impacted Areas

Beginning Wednesday, Sept. 12, 2018, Blue CareOnDemand℠ is offering access to general medical care at no cost to residents of the zones impacted by Hurricane Florence.

Go to www.BlueCareOnDemandSC.com to have a video visit at no cost. If you are using a mobile device, you will be instructed to download the mobile app. Log in or register for your Blue CareOnDemand account, then select the Hurricane Support option to start your visit.

For emergency medical issues, please dial 911.

30-Day Emergency Prescription Refills

If a state of emergency has been declared for your area, CVS Caremark can approve a one-time emergency refill for a 30-day supply of medication. We recommend contacting CVS Customer Care at 888-963-7290 to request approval for your medication(s) before visiting your local pharmacy. Alternate delivery arrangements may be available to those taking specialty medications.

CVS Caremark is an independent company that provides pharmacy benefits management on behalf of BlueChoice^®.

Health is your Superpower

Did you know many illnesses can be avoided with early detection and preventive health screenings? The key to staying healthy begins with you. Only you can sense if something isn’t right. And some diseases, like breast cancer, are usually found after symptoms appear. That is why screenings are so important. Knowing when to see your doctor can be tricky. Following is a list of general guidelines for women:

•   Physical Exams – Every year, or as directed by your doctor.
•   Body Mass Index (BMI) – Every year.
•   Blood Pressure – Every two years.
•   Mammogram – Every two years starting at age 50. At age 40, start discussing breast cancer screenings with your doctor. If you have a family history or other risk factors consider being screened earlier.
•   Pap Test – Ages 21–65, every three years.
•   Diabetes Screening – Beginning at age 45. If you have a family history, high blood pressure or other risk factors consider being screened earlier.
•   Colon Cancer Screening – Beginning at age 50. If you have a family history or other risk factors consider being screened earlier.

Knowledge is Power

Prepare questions for your doctor’s visit. Also, make sure your physician knows your family history and any concerns you might have about your health. Bring a list of medications — including over-the-counter medications, vitamins and any other supplements — to your visit, as well.

Empower Yourself

Your overall health can be improved by making simple changes to your daily routine. Start by making good eating choices. A low-sodium, low-fat diet that includes fruits and vegetables can help you maintain a healthy weight. Incorporating a daily walk or other exercise can also help improve your well-being. Reducing your alcohol intake and eliminating tobacco use can lower your risk for many diseases. Just remember, you are your own best spokeswoman.

Focus on the Fundamentals of Diabetes Care

Diabetes can affect many parts of the body. People with the disease are at a higher risk for serious health problems. Monitoring your blood sugar levels, controlling your blood pressure and getting an annual eye exam are essential parts of diabetes care that can help prevent or delay complications.

Get the A1C Test

Regularly monitoring your blood sugar is one of the most important ways to manage diabetes. There are two ways to measure your blood sugar. The first is a blood sugar check that you can do yourself. It shows your blood sugar level at the time of the test. The second is the A1C test, which is done in a lab or at your health care provider’s office.

The A1C test measures average blood sugar levels over a period of three months. It shows how well your diabetes treatment plan is working or if changes need to be made. People with diabetes get this test at least twice a year. Some will need the test more often if their results are higher than their goal number or if there is a change in their diabetes treatment plan. Your provider will tell you how often you need the test. He or she will also help determine your personal A1C goal.

Control Your Blood Pressure

People with diabetes are more likely to develop heart disease and are at a higher risk for a heart attack or stroke. High blood pressure raises your risk for heart attack, stroke, eye problems and kidney disease. Controlling your blood pressure is an important way to protect your heart health and prevent other diabetes complications.

If you have high blood pressure, work with your provider to find a treatment plan for you. Treatment may include healthy lifestyle changes and medicine, if your provider prescribes it for you. Lifestyle changes may include eating a healthy diet, getting physically active, maintaining a healthy weight and quitting smoking.

Get an Eye Exam

Diabetes can harm your vision. A common complication is diabetic retinopathy. High blood sugar and high blood pressure can damage the blood vessels in your retina and lead to permanent vision loss. People with diabetes are also at risk for cataracts and glaucoma. The good news is that finding and treating problems early can help protect your eyesight.

According to the Centers for Disease Control and Prevention (CDC), people with diabetes should have a dilated eye exam at least once every year. During the exam, your eye doctor will put drops in your eyes to enlarge your pupils. This will help your provider see into your eyes and check for problems.

You should also let your doctor know if you have any changes in your vision, including:

Having blurry vision.
Seeing black lines or spots.
Seeing red spots or red fog.
Seeing rings around lights or flashing lights.

If you need help finding a doctor, you can find one here.

Be sure to visit our Great Expectations for Diabetespage for more information on how we can help.

Sources:

https://www.cdc.gov: Blood Glucose Monitoring
https://www.niddk.nih.gov: Heart Disease & Stroke
https://www.cdc.gov: Healthy Eyes Matter
https://www.cdc.gov: Vision Health Factsheet
https://www.cdc.gov: Diabetes - Managing Problems
https://www.cdc.gov: Know Your Blood Sugar Numbers
http://www.diabetes.org: Blood Pressure

These links lead to third party websites. Those companies are solely responsible for the privacy policies and content on their sites.

Rate Justification

2019 Blue Option Rate Increase Justification

2018 Blue Option Rate Increase Justification

2017 Blue Option Rate Increase Justification

2016 Blue Option Rate Increase Justification

2015 Blue Option Rate Increase Justification

BlueChoice HealthPlan was a qualified health plan issuer in the Federally Facilitated Marketplace (FFM). To review the transparency in coverage data report for our previous FFM plans, please use this link:

Blue Option^SM Transparency Data

Pediatric Vision Care*

We still offer pediatric vision on all of our Blue Option plans through the Physicians EyeCare Network (PEN). PEN is an independent company that offers a vision network on behalf of BlueChoice HealthPlan.

For children (ages 0-18), this includes:

$25 copayment for one comprehensive vision exam every benefit year.**
$50 copayment for one pair of glasses (lenses and frames) per benefit year.**
Single vision, lined bifocal, lined trifocal or lenticular lenses covered in full (after materials copayment).
A standard selection of frames are covered in full (after materials copayment).
In lieu of eyeglasses, elective contact lens services and materials are covered with a minimum three months’ supply for any of these options:
- Standard (one pair annually)
- Monthly (six-month supply)
- Bi-weekly (three-month supply)
- Dailies (three-month supply)
Necessary contact lenses are covered in full for members who have specific conditions for which contact lenses provide better visual correction.

Please note that you must visit an in-network provider to receive this benefit.

Costs incurred from these Pediatric services count toward maximum out-of-pocket (MOOP) expenses. View our glossary for a definition of MOOP and other health insurance terms.

*For dependent children through the age of 18. Adult vision care begins on the first day of the month following their 19th birthday.

**These copayments do not apply to Catastrophic plan members. After the deductible has been met, pediatric vision services will be covered at 100 percent.

What You May Not Know About Opioids

Fast Relief

You’re in pain. A lot of pain. Luckily, your doctor prescribes a drug that excels at relieving pain. It’s an opioid. You are taking opioids if your doctor has prescribed one of these:

Codeine
Morphine
Oxycodone (OxyContin and Roxicodone)
Hydrocodone
Tramadol
Methadone
Hydromorphone
Tapentadol
Anileridine
Levorphanol
Buprenorphine
Fentanyl

You take your medicine. You soon feel much better. That’s a good thing … for now.

The Opioid Effect

Opioids can be very effective when you’re in pain. They’re also highly addictive. The Centers for Disease Control and Prevention (CDC) says opioid dependency can begin within three days of taking the drugs. Opiates change how the brain perceives pain. They produce feelings of pleasure or euphoria. The impact on the brain’s reward system is what leads to addiction. They also slow essential bodily functions like heart rate and breathing. The stronger the opiate, the faster and more powerful the effects. Over time, the body gets used to opioids, and they stop working as well. To get the same relief, you need to take more and more.

If you use them long term, you have a 1 in 4 chance of becoming addicted. Addiction carries serious side effects and risks. Every day — addicted or not — hundreds of people end up in the emergency room overdosed on opioids. The risk of overdose with opioids is high because the amount that can cause an overdose is not much higher than the amount used to treat pain. And unfortunately, some don’t even make it to the emergency room. Every day, more than 100 of those who overdose on opioids end up dead.

In fact, opioid overdose is the leading cause of death for Americans under the age of 30. And 40 percent of all opioid overdose deaths involve a prescription.

Reversing the Trend

Thankfully, the staggering number of deaths attributed to the opioid epidemic has gradually begun to decline, largely because doctors are prescribing far fewer of them to treat chronic pain, such as arthritis, low back pain or frequent headaches. Chronic pain is a common reason people see their doctor. Twenty percent of these patients leave with an opioid prescription. And while opioids’ ability to manage pain makes them an easy option, it doesn’t necessarily make them the best option. Many alternative pain management programs — cognitive behavioral therapy, acupuncture, medical massage, physical therapy — have proven to be effective alternatives to opioid prescriptions. Even the CDC reported these alternative strategies were all useful in providing relief for chronic pain.

Speak With Your Doctor

Even if you’re taking them for legitimate pain relief, opioid use can quickly turn to opioid dependency or addiction. And that’s a road you don’t want to travel. Talk with your doctor about other pain management options. Ones designed to treat chronic, long-term pain without opioids — and not just because opioids are so addictive. Opioid use may also produce unpleasant side effects:

Nausea
Vomiting
Itching
Constipation
Problems breathing
Problems urinating
Mental disturbance and confusion

If your doctor says opioids are necessary, know how to protect yourself:

Take the lowest dose
Know the side effects and risks
Use only as directed

And remember, never take medications from a friend or family member that were not prescribed for you. Likewise, never share your medications. And please, dispose of all medicines you no longer need.

SOURCES:
https://blogs.cdc.gov/publichealthmatters/2017/11/opioids/
https://www.forbes.com/sites/alicegwalton/2016/04/09/why-fentanyl-is-so-much-more-deadly-than-heroin/#52a038bb7f6a
https://blackbearrehab.com/opiates/how-do-they-work/
http://www.choosingwisely.org/patient-resources/medicines-to-relieve-chronic-pain/

These links go to third-party sites. Those sites are soley responsible for the content and privacy policies on their site.

Listen Up! Get an A1C Test

Millions of adults haven’t gotten the message about A1C tests. The A1C is a blood test that shows how well your diabetes management plan is working.

The test measures your average blood sugar level over the past two or three months. An A1C below 5.7 percent is normal, between 5.7 and 6.4 percent indicates you have prediabetes, and 6.5 percent or higher indicates you have diabetes.

Taking the A1C Test

If your diabetes is well-controlled and your blood sugar levels are stable, the American Diabetes Association recommends you have the A1C test twice a year. Your doctor may want to run the test as often as every three months if your A1C is not within your target range.

A simple finger stick can be done in your doctor’s office, with results available in about 10 minutes. The A1C test results provide insight into how your treatment plan is working, and how it might be modified to better control the condition.

What the A1C Results Mean

Your A1C goal is specific to you. Several factors come into play, such as your age, how advanced the diabetes is and any other heath conditions you have. A common A1C goal for people with diabetes is less than 7 percent. If you can keep your A1C number below your goal, you help reduce the risk of diabetes complications, such as nerve damage and eye problems.

Get Regular Eye Exams

Diabetic eye disease can develop even when your sight is good, so annual dilated eye exams are important for finding problems early. If you have trouble reading, if your vision is blurred or if you see rings around lights, dark spots or flashing lights, you may have eye problems. Tell your health care team or eye doctor about any eye problems.

Check Your Blood Pressure

About 70 percent of adults with diabetes have high blood pressure or use prescription medications to lower high blood pressure. Maintaining normal blood pressure control can reduce the risk of eye, kidney and nerve disease by approximately 33 percent, and the risk of heart disease and stroke by approximately 33 to 50 percent. A healthy diet and physical activity can help you lower your blood pressure.

As a member, you have access to our Great Expectations^® for Diabetes program. This program helps you learn how to manage your diabetes better, puts you in touch with a health coach and more. To enroll or get more information, call 855-838-5897.

Take Control

According to the Centers for Disease Control and Prevention, approximately one-third of all adults in the U.S. have high blood pressure. That’s 75 million people. Yet roughly half of them don’t keep it under control. Undiagnosed or uncontrolled hypertension can cause serious complications, such as:

Aneurysms
Chronic kidney disease
Eye damage
Heart attack
Heart failure
Peripheral artery disease
Stroke
Vascular dementia

If you’ve been diagnosed with hypertension and your doctor has prescribed medication — take your meds! However, if you’re not on medication, or you want your doctor to take you off medication, there are solutions.

Control Without Medication

The staff at the Mayo Clinic identified 10 lifestyle changes that help lower your blood pressure and reduce your risk of heart disease without medication.

Lose extra pounds and watch your waistline.
Exercise regularly.
Eat a healthy diet.
Reduce sodium in your diet.
Limit the amount of alcohol you drink.
Quit smoking.
Cut back on caffeine.
Reduce your stress.
See your doctor regularly.
Get support.

We’re all familiar with most, if not all, of these, right? But what about number eight: Reduce your stress? Chronic stress (even occasional stress) is known to contribute to high blood pressure. And according to the list, you can’t relieve your stress by eating unhealthy food, drinking alcohol or smoking. So what should you do?

Control What You Can

Lifestyle plays an important role in stress. So, make time every day to relax and indulge in activities you enjoy. Whether it’s reading, solving a puzzle or tending a garden, take at least 20 minutes to pamper yourself.

There are numerous and varied techniques people have developed to calm the spirit. Go online and experiment with a few. From simple deep breathing to yoga; from dancing to tai chi; from communing with nature to prayer — somewhere out there, there’s a free fix for your stress. Go find it, then … RELAX!

Please note that going off your medications can lead to unexpected consequences. It's important to work closely with your doctor when making changes to your treatment plan.

As a member, you have access to our Great Expectations^® for High Blood Pressure program. This program helps you learn how to manage your stress, puts you in touch with a health coach and more. To enroll or get more information, call 855-838-5897.

Have You Scheduled Your Colonoscopy?

Early detection may save your life.

The best way to avoid many illnesses is prevention. A routine checkup, even if you are feeling fine, is the best way to stay healthy. Yearly exams or physicals are a good time to have a conversation with your doctor about important health screenings and when you should get them.
For example, starting at age 50, you should have a colonoscopy to screen for colon cancer. If there is a family history of colorectal cancer, your doctor may recommend you be screened earlier. There are several other tests to check for colon cancer. You can discuss with your doctor the best option for you and how often you should be screened.

Why should I be screened?

Colon cancer is the second leading cause of cancer deaths in the U.S. Colorectal cancer usually develops from small abnormal growths (polyps) in your colon. A colonoscopy helps find the precancerous polyps before they develop into cancer. Colon cancer sometimes goes undetected because you may not feel any symptoms until it’s too late. That is why regular screenings are so important.

What to expect

During a colonoscopy, a thin lighted tube is used to look inside your colon and rectum. During the procedure, precancerous polyps and/or small signs of cancer can be removed. It only takes a few hours and is done as an outpatient procedure.

What are the risk factors?

As with most types of cancer, there are several risk factors for colon cancer. It’s important to know what types of things can increase your risk.

Lifestyle factors — things you can change:

Obesity
Lack of exercise
Diet
Smoking
Alcohol

Other risk factors — things you can’t change:

Age
Family history
Ethnic background
Having diabetes
Having Crohn’s disease or ulcerative colitis

When colon cancer is found early, the survival rate can be as high as 90 percent. If you’re over 50, talk with your doctor about getting a colonoscopy. It can save your life.

Don't Be Couch Potatoes!

Kids copy the behaviors of the adults they are around as a way to learn how things work in the world. Sometimes they mimic undesirable behaviors, such as repeating bad words. Other times they repeat positive actions, such as covering their mouths when they sneeze. Kids also watch what adults do in their downtime and follow along. This means that when adults flop on the couch after a long day of work, kids often join them, leading to sedentary behavior that isn’t healthy — for the adults or the kids.

Why Exercise?

Kids need to be taught why they should exercise, including what counts as good exercise. Children who carry extra weight early in life have an increased risk of developing health problems now or later in life. In the short term, children can have breathing problems from exertion, joint pain, high blood pressure or high cholesterol.

Children who are overweight have a higher risk of carrying excess weight into adulthood, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD). The NIDDKD is an independent organization that offers health information that you may find helpful.

The Game Plan

The Centers for Disease Control and Prevention (CDC) guidelines specify that children should get an average of an hour of moderate to vigorous exercise each day. The CDC is an independent organization that offers health information that you may find helpful. Children from the ages of 6 through 17 should do 60 minutes or more of moderate to vigorous physical activity a day, including aerobic activity three days a week, bone-strengthening activity three days a week, and muscle-strengthening activity three days a week as part of their daily activities. Some examples of moderate intensity physical activity include:

Walking briskly
Playing tag
Jumping rope
Playing soccer
Swimming
Dancing

Kids who are not used to being active don’t have to jump straight into an hour of movement — several short bursts of 5 to 10 minutes of activity throughout the day are just as good. From there, they can gradually build up to 60 minutes of activity.

Get Up Together

Adults need 150 to 300 minutes of moderate to vigorous activity per week, so get the whole family involved in being healthy! The same physical activities that kids enjoy are just as enjoyable to adults, but can also include necessary chores like heavy yard work — think digging, raking or lifting bags of soil. Fun activities are more likely to get children interested in being part of the action, so take a walk or bike ride together as a family, enjoy a game of tennis, or jump rope outside together.

To get children moving, the NIDDK recommends limiting children’s screen time to less than two hours per day outside of school work. Screen time includes time spent in front of the television, mobile devices and cell phones. The American Academy of Pediatrics (AAP) doesn’t recommend television time for children under the age of two. The AAP is an independent organization that offers health information that you may find helpful.

Only 1 in 3 kids are physically active every day and 80 percent of adults do not meet the guidelines for aerobic or muscle-strengthening activities. So don’t be couch potatoes. Get the whole family up and moving together in a variety of fun ways that everyone can enjoy!

Heart & Soul

As a woman in today’s world, there are constant demands on your time. So you must make the conscious choice that your own health and well-being are priorities. That means smart choices — choices about your physical health and your mental health … your body and mind … your heart and soul.

The Body

Did you know that the leading cause of death among U.S. women is cardiovascular disease? It kills five times more women than breast cancer. The number-three cause is stroke. And the number-six cause is unintentional injuries. Most of those deaths can be traced back to bad choices. A poor diet. Alcohol and tobacco use. Not wearing a seatbelt.

While there’s no guarantee that making smart choices will extend your life, or even improve your quality of life, odds are in your favor. You know most of these:

• Maintain a healthy weight

• Don’t smoke

• Get regular screenings

• Stay active

• Wear sunscreen

• Limit alcohol consumption

The basics of good health are the same no matter your age. But sometimes things like “staying active” seem too hard.

You know, you don’t have to “exercise.” Consider some creative alternatives. Gardening is a great low intensity workout. It will strengthen your grip and your hands. The bending and twisting work your core and improve flexibility. Standing and squatting work your legs. And even if you’re in your own backyard, you’re communing with nature. Or, how about window shopping or sightseeing in your own hometown? Just make sure you have comfortable shoes. (Hint: Don’t buy by size, buy by fit.)

The Mind

Don’t ignore your mental health. And don’t be embarrassed to ask for help. The stigma is gone. Each year, one in three U.S. adults report a diagnosable mental health problem. Depression is the most common mental health problem for women. Women are also twice as likely as men to have panic disorders, general anxiety and specific phobias. They are also more likely to develop PTSD after a traumatic event.

If you’re just stressing, make time for yourself:

• Read a book

• Soak in a tub

• Meditate

• Have a cup of tea

• Hang out with friends

Exercise can also help relieve symptoms of some conditions, such as depression.

Remember two things: Stay active. Make smart choices.

Body and mind. Heart and soul.

Prevent a Hairy Situation

June is Men’s Health Month — a good time to remember that prevention can go a long way to keeping you healthy. Preventive screenings can help you catch health problems early when they may be more easily treatable.

BMI

Body mass index, or BMI, is a way to determine if you’re at a healthy weight for your height. BMI is a person’s weight in kilograms divided by the square of height in meters.

A BMI from 18.5 to 24.9 is considered to be healthy.

If your BMI is below 18.5, you are probably underweight.
If your BMI is 25 or over, you are probably overweight.
If your BMI is over 30, you are classified as obese.

BMI is not a magic formula. It does not diagnose body fat or health. Your doctor will look at other factors as well.

Colorectal Cancer

Colorectal cancer is the third-most commonly occurring cancer in men. Screening can find precancerous polyps so they can be removed before they become cancer. If you are 50 years or older, get screened. Your doctor will tell you what test is right for you and how often to get tested.

Blood Pressure

The only way to know if you have high blood pressure is to measure it. High blood pressure raises your risk for heart disease and stroke. Your doctor examines your systolic and diastolic pressures, which are measured in millimeters of mercury (abbreviated as mmHg).

The normal range is:

Systolic: less than 120 mmHg
Diastolic: less than 80 mmHg

If you have high blood pressure, your doctor may prescribe medication and lifestyle changes.

Diabetes

There are several types of blood-sugar tests to determine if you have prediabetes, Type 1 or Type 2 diabetes. Normal nonfasting blood glucose readings are between 70 and 140 milligrams per deciliter.

If you're diagnosed with diabetes, a diabetes educator can help you:

Develop a healthy eating plan.
Learn to test your blood sugar and record the results.
Recognize the signs of high or low blood sugar and what to do about it.
Monitor your feet, skin and eyes.
Manage stress and deal with diabetes care.

Lower Back Pain

About 80 percent of adults experience back pain at some point. Most back pain is short term, lasting a few days to a few weeks. It tends to get better on its own. Unnecessary imaging studies, such as X-rays, MRIs and CT scans, are not associated with improved outcomes. Your doctor should avoid imaging unless there is evidence of an underlying condition.

Centers for Disease Control and Prevention, National Institute of Neurological Disorders and Stroke, and National Committee for Quality Assurance are independent organizations that offer health information that members of BlueCross BlueShield of South Carolina may find helpful.

Sources:

https://www.menshealthforum.org.uk/what-bmi

https://www.ncqa.org/hedis/measures/use-of-imaging-studies-for-low-back-pain/

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

https://www.cdc.gov/healthyweight/assessing/bmi/index.html

https://www.mayoclinic.org/diseases-conditions/back-pain/diagnosis-treatment/drc-20369911

https://www.cdc.gov/cancer/colorectal/

https://www.cdc.gov/bloodpressure/

https://www.cdc.gov/bloodpressure/docs/ConsumerEd_HBP.pdf

https://www.cdc.gov/diabetes/managing/index.html

https://www.cdc.gov/diabetes/pdfs/library/takechargeofyourdiabetes.pdf

This article contains links to third party websites. Those organizations are solely responsible for the contents and privacy policies on their sites.

Where Should You Go When You're Hurt?

Where Should You Go When You’re Hurt?

When you or a loved one is sick or injured, you want relief fast. But that doesn’t necessarily mean the ER. Emergency room visits can cost thousands of dollars. And the average wait to be seen is more than two hours. So the big question is, “How bad is it?”

How Bad Is It?

If you or a loved one is experiencing any of the following symptoms, call 911 or head for the emergency room.

• Severe difficulty breathing or stopped breathing

• Head or eye injuries

• An injury to the neck or spine

• Seizures

• Coughing up or vomiting up blood

• Uncontrolled bleeding

• Vaginal bleeding with pregnancy

• Broken bones and dislocated joints

• Severe cuts that may require stitches

• Facial lacerations

• Confused mental state — unable to speak, see, walk or move

• An unusual or bad headache

• Severe allergic reactions

• Severe abdominal pain

• Ingested or inhaled poison

• Chest pain or difficulty breathing

• Weakness/numbness on one side

• Signs of stroke — slurred speech, numb face, arm and leg on one side

• Fainting/change in mental state

• Serious burns

• Concussion/confusion

• Fever with a rash

• Severe cold or flu symptoms

If your condition poses no threat of death or disability, consider an urgent care facility or virtual visit online or via smartphone. And if it’s just routine care, of course, wait and see your doctor.

Telemedicine

When it’s not an emergency but it needs urgent attention, use your smartphone, tablet or personal computer for fast, easy access — no matter where you happen to be. Or, visit an urgent care clinic. Don’t end your vacation due to sun poisoning when all you want is relief.

Here are some situations when an urgent care or telehealth visit is your best option:

• A cold

• Flu symptoms

• Earache

• Sore throat

• Migraine

• Low-grade fever

• Rash

• Pinkeye

• Sprain, strain or back pain

• Minor injuries

• Cuts or wounds if bleeding is controlled

• Medical problem if not life-threatening but needs immediate attention

Always ask yourself, “Is this a true emergency?” If your problem is not life-threatening and there is no risk of disability, but you can’t wait to see your primary care physician, consider going to an urgent care facility, or using Blue CareOnDemand^SM to see a licensed professional from the comfort of your own home … or anywhere else you may happen to be. A virtual visit can connect you to a doctor within minutes. No appointment is necessary. Most can even write prescriptions.

Knowing where to go can save you time and money.

Vaccines Keep You and Your Community Healthy

Measles, mumps, whooping cough, diphtheria, tetanus, rubella and polio. These dangerous diseases, among others, used to be common. Now, thanks to advances in medicine, they can be prevented with vaccinations. Vaccines have greatly reduced — and in some cases eliminated — the spread of these diseases and have saved millions of lives around the world.

How Vaccines Work

Vaccines allow our immune systems to protect us from serious illnesses without making us sick. A vaccine contains a small amount of weak or dead germs. When you receive a vaccine, your immune system responds to those germs by releasing antibodies to attack them. Your immune system will remember the germ if you encounter it again and can quickly fight it off. Vaccines are our best defense against these infectious diseases.

Community Immunity

Perhaps surprisingly, if you get vaccinated, it helps protect the health of everyone in our community. Some babies and children are too young to be vaccinated. Some people can’t receive vaccines for medical reasons, such as severe allergies or a weakened immune system. To help keep them safe, it is important that you and your children who can be vaccinated are fully immunized. This helps prevent the spread of disease through what is called herd immunity, or community immunity. When enough people are vaccinated, the germs can’t spread as easily from person to person. This protects the health of the entire community.

Childhood Immunizations

Babies and children are at a high risk for developing complications from serious diseases. Vaccination is a safe and effective way to protect them. The childhood vaccination schedule recommended by the Centers for Disease Control and Prevention (CDC) protects children from 14 different diseases by the age of 2. Talk to your child’s doctor about vaccines for your child.

Flu Shot

The flu shot is another vaccine that can help keep you healthy. The CDC recommends that everyone 6 months and older get a flu shot before every flu season. Some people who get the flu only experience mild illness for a couple of weeks. For others, the flu can cause serious complications resulting in hospitalization or even death. People who are more likely to have flu-related complications include adults 65 and older, young children, pregnant women and people with chronic health problems including asthma, heart disease, diabetes, HIV/AIDs and cancer.

While the flu vaccine can help protect you from the flu, it is still possible for you to get sick. But, according to the CDC, the flu vaccine has been shown to reduce the severity of symptoms in those who received the vaccine but still got sick. Talk to your doctor about the right flu vaccine for you.

If you are having flu symptoms, such as fever, cough, sore throat, runny nose and muscle aches, connect with a doctor on your phone, tablet or computer though Blue CareOnDemandSM. You don’t even have to get out of bed. Visit www.bluecareondemandsc.com or download the app from the App Store or Google Play to get started.

Sources:

https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm
https://www.cdc.gov/vaccines/vac-gen/howvpd.htm
https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Pages/Immunization-Schedule.aspx
https://www.vaccines.gov/basics/work/protection
https://www.cdc.gov/flu/highrisk/index.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fflu%2Fabout%2Fdisease%2Fhigh_risk.htm
https://www.cdc.gov/flu/prevent/flushot.htm

Men's Health

Prevent a Hairy Situation

It's a good time to remember that prevention can go a long way to keeping you healthy. Preventive screenings can help you catch health problems early when they may be more easily treatable.

BMI

Body mass index, or BMI, is a way to determine if you’re at a healthy weight for your height. BMI is a person’s weight in kilograms divided by the square of height in meters.

A BMI from 18.5 to 24.9 is considered to be healthy.

If your BMI is below 18.5, you are probably underweight.
If your BMI is 25 or over, you are probably overweight.
If your BMI is over 30, you are classified as obese.

BMI is not a magic formula. It does not diagnose body fat or health. Your doctor will look at other factors as well.

Colorectal Cancer

Blood Pressure

The normal range is:

Systolic: less than 120 mmHg
Diastolic: less than 80 mmHg

If you have high blood pressure, your doctor may prescribe medication and lifestyle changes.

Diabetes

There are several types of blood-sugar tests to determine if you have prediabetes, Type 1 or Type 2 diabetes. Normal nonfasting blood glucose readings are between 70 and 140 milligrams per deciliter.

If you're diagnosed with diabetes, a diabetes educator can help you:

Develop a healthy eating plan.
Learn to test your blood sugar and record the results.
Recognize the signs of high or low blood sugar and what to do about it.
Monitor your feet, skin and eyes.
Manage stress and deal with diabetes care.

Lower Back Pain

Sources:

https://www.menshealthforum.org.uk/what-bmi

https://www.ncqa.org/hedis/measures/use-of-imaging-studies-for-low-back-pain/

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

https://www.cdc.gov/healthyweight/assessing/bmi/index.html

https://www.mayoclinic.org/diseases-conditions/back-pain/diagnosis-treatment/drc-20369911

https://www.cdc.gov/cancer/colorectal/

https://www.cdc.gov/bloodpressure/

https://www.cdc.gov/bloodpressure/docs/ConsumerEd_HBP.pdf

https://www.cdc.gov/diabetes/managing/index.html

https://www.cdc.gov/diabetes/pdfs/library/takechargeofyourdiabetes.pdf

This article contains links to third party websites. Those organizations are solely responsible for the contents and privacy policies on their sites.

Women's Health

Heart & Soul

The Body

While there’s no guarantee that making smart choices will extend your life, or even improve your quality of life, odds are in your favor. You know most of these:

• Maintain a healthy weight

• Don’t smoke

• Get regular screenings

• Stay active

• Wear sunscreen

• Limit alcohol consumption

The basics of good health are the same no matter your age. But sometimes things like “staying active” seem too hard.

The Mind

If you’re just stressing, make time for yourself:

• Read a book

• Soak in a tub

• Meditate

• Have a cup of tea

• Hang out with friends

Exercise can also help relieve symptoms of some conditions, such as depression.

Remember two things: Stay active. Make smart choices.

Body and mind. Heart and soul.

Get Schooled on Vaping

Vaping, as it is most commonly known, is the act of inhaling and exhaling the aerosol vapor produced by an e-cigarette or similar device. They are also known as e-cigarettes, e-cigs, mods, vape pens, vapes, tanks, electronic nicotine delivery systems (ENDS), or by brand names such as JUUL, or the verb Juuling (pronounced joo-ling). There are still more street terms used to talk about vaping being coined every day by young adults.

There’s a lot we don’t know about vaping or e-cigarettes and the effects they can have on people’s health. But there has been a lot of research done in the past several years, as vaping has been on the rise in America, particularly among teenagers. Nearly 4 million teenagers have used a vape in the past 30 days in a 2018 survey, which include 20.8 percent of high school students and nearly 5 percent of middle school students. Research indicates that e-cigarettes are not safe for certain subsets of people, such as youth, young adults, pregnant women or adults who do not currently use tobacco products.

Some of these devices are made to look like regular cigarettes or pipes, but others are disguised to look like writing pens, USB drives or other ordinary household items. It’s not always easy to know if a teenager is talking about or using a vaping device based on the many easily available ways to conceal this activity. Vaping, like smoking, is not good for your lungs.

Frequent Users

Vaping is most frequently done by young people. Forty percent of e-cigarette users who were between the ages of 18 and 24 in 2015 had never been regular cigarette smokers. But adult vapers over the age of 45 were mostly former or current cigarette smokers; 1.3 percent had never smoked.

Many people try vaping as a form of tobacco cessation, but some just become users of both e-cigarettes and regular cigarettes and never actually stop using tobacco at all. This is called dual use, and it can be dangerous because even smoking a few cigarettes a day is unhealthy. The Food and Drug Administration (FDA) does not currently approve e-cigarettes as an aid to quit smoking, but two randomized controlled trials found that e-cigarettes that contain nicotine can help smokers quit cigarettes long term, compared to non-nicotine-containing cigarettes. So in the end — if e-cigarettes are used as a quit-smoking aid, the e-cigarettes should cease to be used eventually, too.

It’s Toxic

People have been falsely led to believe that vaping shields them from the harmful toxins in cigarette smoke and nicotine, but e-cigarettes have their own toxic effects. The aerosol that users inhale from the device and exhale back out into the world contains numerous potentially harmful substances. Among them are nicotine, diacetyl (a chemical linked to lung disease), heavy metals, such as nickel, tin and lead, plus volatile organic compounds and ultrafine particles that can get deep into the lungs of users. Unfortunately, manufacturers are not required to disclose what is in their products, which can make people think they are smoking zero-nicotine products when they are, in fact, using nicotine.

Nicotine is already known to be toxic to humans and highly addictive, too. It can harm the development of developing fetuses, adolescent brains, and isn’t good for anyone breathing the air nearby, either.

Vaping and smoking can also cause problems for people with asthma and chronic obstructive pulmonary disease (COPD). According to the American Academy of Allergy, Asthma & Immunology (AAAAI), high school juniors and seniors who reported e-cigarette use had twice the risk of reporting respiratory symptoms of chronic bronchitis. In May 2018, the first evidence that linked COPD and e-cigarettes was presented. E-cigarettes have been found to trigger inflammation and depress immune function in the lungs. Exposure to e-cigarettes produces changes to the lungs’ air sacs.

Feel schooled on vaping now? It’s a complex topic that both scientists and society are not sure how to fully tackle or comprehend since it’s so new. But the bottom line is that people, especially teenagers, who do not currently smoke at all, should not take up vaping, as it has no health benefits. More studies may show further health risks associated with vaping and e-cigarette use. Until then, just not vaping is the best way to make the grade.

Sources: https://tobacco.ucsf.edu/first-evidence-linking-e-cigs-copd-population
https://www.aaaai.org/conditions-and-treatments/library/allergy-library/electronic-cigarettes-allergy-asthma

The Time is Now!

To get started, you'll need to:

Log in to My Health Toolkit^®
Select the Health and Wellness tab
Select the FOCUSfwd Incentive Program link
Enter your email address to be eligible to win

Hurricane Dorian

We are taking steps to ensure our members’ health care coverage needs are continuous and flexible in the event of a storm. SCEMD (South Carolina Emergency Management Division) has a page dedicated to Hurricane Dorian updates to help you plan and prepare.

30-Day Emergency Prescription Refills

With the threat of Hurricane Dorian impacting the Southeast, we are preparing to ensure that members’ access to their prescription medications remains uninterrupted. As a result, we are working with CVS Caremark to implement emergency procedures to allow members to have their prescriptions filled should they be impacted by the impending storm.

All network pharmacies will be able to approve one-time emergency refills of a 30-day supply of medication for retail, mail and specialty prescriptions. For overrides for Prior Authorizations, Step Therapy, Quantity limit edits (new or renewal), please call the Customer Service number on the back of your member ID card. Caremark Help Desks are available 24 hours a day, 7 days a week.

Additional Pharmacy Resources

Rx Open helps patients find nearby open pharmacies in areas impacted by disaster. CVS.com is up-to date on pharmacy status as well.

Virtual Visits Available 24/7 in All Impacted Areas

Starting Tuesday, September 3rd at noon, Blue CareOnDemand℠ is offering access to general medical care at no cost to residents of the zones affected by Hurricane Dorian. Blue CareOnDemand is offered by American Well (AmWell).

If your doctor’s office is closed or you’re away from home, Blue CareOnDemand virtual visits are a great option for non-emergency health issues. Through a video chat, you can talk to a doctor about issues like cold and flu symptoms, allergies, sinus infections, migraines, rashes, urinary tract infections, pinkeye and more. The doctor can even call a prescription in to the pharmacy nearest you if appropriate.

Go to www.BlueCareOnDemandSC.com to have a video visit at no cost. If you are using a mobile device, you will be instructed to download the mobile app. Log in or register for your Blue CareOnDemand account, then use the code "Dorian" to start your visit.

For medical emergencies, please dial 911.

Digital ID Card

The My Health Toolkit^® mobile app offers quick and easy access to your insurance information— including a digital version of your ID card that you can share by text or email. To download the app, search for “My Health Toolkit” in the App Store or Google Play.

CVS Caremark is an independent company that provides pharmacy benefits management on behalf of BlueChoice^®.

AmWell is an independent company that provides telehealth hosting and software services on behalf of BlueChoice.

Women Can't Wish Away Cancer

However, there are steps women can take to reduce the risk of cancer. An estimated 18 percent of cancer cases and 16 percent of cancer deaths are attributable to the combined effects of excess body weight, alcohol consumption, physical inactivity and eating an unhealthy diet. The Mayo Clinic, the American Cancer Society and the CDC all offer advice that may help prevent cancer in women. What follows are basic guidelines they all pretty much agree on.

Get regular medical care.

Schedule all recommended health screenings — specifically, BMI, chlamydia, cervical cancer and mammogram. Regular self-exams and screenings for various types of cancers (such as cancer of the skin, colon, cervix and breast) can increase your chances of discovering cancer early when treatment is most likely to be successful. Ask your doctor about the best cancer screening schedule for you.

Eat a healthy, balanced diet.

This can't guarantee cancer prevention, but it might reduce your risk. So, eat plenty of fruits, vegetables, whole grains and beans. Limit processed meats. In addition, women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts might have a reduced risk of breast cancer. If you choose to drink alcohol, do so only in moderation. The risk of various types of cancer — including cancer of the breast, colon, lung, kidney and liver — all increase with the amount of alcohol you drink and the length of time you've been drinking regularly.

Don't use tobacco.

Using any type of tobacco puts you on a collision course with cancer. Smoking has been linked to various types of cancer — including cancer of the lung, mouth, throat, larynx, pancreas, bladder, cervix and kidney.

Maintain a healthy weight and be physically active.

Maintaining a healthy weight might lower the risk of various types of cancer, including cancer of the breast, lung, colon and kidney. Women who participate in any amount of physical activity gain some health benefits. Strive for 150 minutes a week of moderate aerobic activity. In addition to helping you control your weight, physical activity on its own might lower the risk of breast cancer and colon cancer.

Protect yourself from the sun.

Skin cancer is one of the most common kinds of cancer — and one of the most preventable. Try these tips: Avoid midday sun. Stay in the shade. Wear tightly woven, loose fitting clothing that covers as much of your skin as possible. Don't skimp on sunscreen. Use a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days. Avoid tanning beds and sunlamps.

Get vaccinated.

Cancer prevention includes protection from certain viral infections. Talk to your doctor about vaccinations against hepatitis B and human papillomavirus (HPV). Hepatitis B can increase the risk of developing liver cancer. HPV is a sexually transmitted virus that can lead to cervical and other genital cancers, as well as squamous cell cancers of the head and neck.

October is National Breast Cancer Awareness Month.

It was founded by the American Cancer Society in October 1985 to promote mammography as the most effective means of fighting breast cancer. Recently, the United States Preventive Services Task Force (USPSTF) published new recommendations on when women should begin mammography exams. The concern is that women have been over-diagnosed and/or over-treated. Speak with your doctor about what schedule is best for you.

The Mayo Clinic, the American Cancer Society, the CDC and the USPSTF are independent organizations that offer health information that members of BlueChoice HealthPlan of South Carolina may find helpful.

2020 Pharmacy Benefits

Beginning Jan. 1, 2020, your health plan's pharmacy benefit will be administered by OptumRx. OptumRx is a Pharmacy Benefits Manager, an independent company that has been contracted by BlueChoice HealthPlan of South Carolina to provide certain services related to your health plan's prescription drug coverage. Here are some Frequently Asked Questions. Any questions about your pharmacy benefit can be answered by calling member services. Just call the number on the back of your member ID card.

You can view the Covered Drug List to see if we cover your prescription drugs.
Use our Drug Cost Tool to look up the price of a drug.
Use our Pharmacy Locator to find a pharmacy.

Frequently Asked Questions

What happens to my prescription drug coverage on Jan. 1, 2020?: Beginning Jan. 1, 2020, the pharmacy benefit will be administered by a new pharmacy benefits manager (PBM). The new PBM, OptumRx, is an independent company that has been contracted to provide certain services related to your health plan’s prescription drug coverage.
Will I receive a new ID card?: All members will be sent a new ID card in mid December to replace their current one. As before, the new ID card is to be used for both medical and pharmacy benefits. Be sure to show your new card at the pharmacy when you have your first prescription filled in 2020. In addition, you can access an electronic version of your ID card by logging into My Health Toolkit.

How will this change affect me?: There will be little or no effect for most members. You will, however, be sent a new ID card to use in 2020. Some members may experience additional changes to their prescription drug coverage on Jan. 1, as part of their health plan’s regular pharmacy benefit updates.
Will the drugs covered by my plan change?: For most members, the drugs covered by their plan will not change beyond the minor updates that take place routinely at the beginning of each year. If your coverage is changing in any way on Jan. 1, you will receive a letter in November with information about these changes and what they may mean for you.

Will I have to change the pharmacy I use to fill my prescriptions?

Our current pharmacy network includes almost all the same pharmacies as our new 2020 pharmacy network. There are almost 55,000 pharmacies, including CVS, Walmart and Kroger, plus many grocers and independent pharmacies. If, for some reason, a pharmacy you are using will not be part of the new network, we will send you a letter in December to inform you and suggest other network pharmacies that are nearby. Please note this network excludes Walgreens.

Beginning October 15, you can use the "Find the Pharmacy" locator to search for 2020 network pharmacies. Always make sure to check your plan materials for information about specific network information that may apply to your plan.

Will CVS pharmacies still be part of the network?

CVS pharmacies are included in our new national pharmacy network.

Will the price I pay for prescription drugs change?: Your pharmacy benefit is based on tiers. Tiers are the different cost levels you pay for medications. For most members, the drugs you take will stay at their current tier. However, from time to time, some drugs may move to a higher tier. If a drug you’re taking will be moving to a higher tier on Jan. 1, we will send you a letter to let you know. The price you pay is also determined by your pharmacy benefit, so if that is changing in some way, the price you pay may also change.
What is a specialty drug?: Specialty prescription drugs treat complex or chronic medical conditions. They may require patient-specific dosing and careful clinical monitoring.

I take a specialty drug. Will there be a new specialty pharmacy?: Yes. We will have a new specialty pharmacy, BriovaRx, which is a division of the new PBM. If your specialty prescription is now being filled by CVS Specialty Pharmacy*—and you have refills remaining—your prescription will be transferred to BriovaRx Specialty.
Do I need to take any action regarding my specialty prescriptions?: Existing prescriptions will be transferred from CVS Specialty to BriovaRx around Jan. 1, 2020. Current members can call 877-259-9428 to get set up to use BriovaRx.

I use mail service to receive some prescription drugs. Will anything change for me?: Members who use mail service receive up to a 90-day supply of medications they take regularly. Beginning Jan. 1, 2020, mail service will be provided by OptumRx Home Delivery. Open prescription refills will be transferred from CVS Mail Service* to the new home delivery pharmacy around Jan. 1, 2020.
What will happen to existing mail-order scripts?: Open prescription refills will be transferred from CVS Mail Service to OptumRx Home Delivery pharmacy. Some scripts will not transfer (compounds, controlled substances and prescriptions with no refills left). We will inform you if you need a new prescription(s) to continue filling via mail.

Do I need to take any action regarding my mail-service prescriptions?: Although most prescriptions will be transferred, you will need to set up a profile with the new mail-service pharmacy. At that time, you can provide the new pharmacy with credit card information and select automatic refills. You can call 855-811-2218 to get set up. After Jan. 1, you can call or use the web to set up your profile.
What if I need a new prescription for mail service?: If you need a prescription for mail service, be sure to let your doctor's office know that you have a new mail service pharmacy. Your doctor can e-prescribe directly to OptumRx Home Delivery pharmacy, or you can submit a copy of the prescription with a mail service form.

A drug I take required prior authorization. Will anything change for me?: All active prior authorizations (PAs) will be transferred around Jan. 1 and remain active.

Will I still have access to my pharmacy claims history?: OptumRx will be loading one year of historical data for each member. This will be available when you log in to My Health Toolkit. For older information, please log into the Caremark website.
What pharmacy information can I find within My Health Toolkit?: The type of information you can find by signing into the secure portion of our website is the same as you can access now, including a drug cost search tool, information on drugs covered by your plan and pharmacy claims history.

Will I still be able to get to my pharmacy benefits through My Health Toolkit?: Yes. The first time you use this feature, you will have to create a login. After that, you will be able to access this information by signing into My Health Toolkit.

*CVS Mail Service and Specialty Pharmacy are divisions of CVS Health, an independent company that currently provides mail order and specialty pharmacy services to our members.

Prescription Drugs

Now you can view the Covered Drug List to see if we cover your prescription drugs. With Blue Option, you have access to a wide variety of prescription drugs. Our goal is to give you a choice of safe and effective drugs, while also keeping your drug costs affordable.

2020 Pharmacy Benefits

Print a 2019 copy of our covered drug list.

Blue Option Pharmacy Network

You should always check with your pharmacy to see if it is part of our network before you have your prescriptions filled.

With more than 55,000 network pharmacies to choose from, it's easy to find one that's near you! This network offers access to a wide variety of pharmacy options, including all CVS/pharmacy, Walmart, Kroger and Safeway locations, plus many grocers and independent pharmacies. Please be sure to view a new comprehensive list of South Carolina pharmacies as well as a new list of all national retail chains and some independent pharmacies in South Carolina. Note that filling prescriptions at a pharmacy that is not in the Advanced Choice Network will require you to pay full price. Please note this network excludes Walgreens.

Where can I get my flu vaccine and other vaccines?

Effective immediately, you get your seasonal flu vaccine covered at $0 copay through your pharmacy benefit by visiting any network pharmacy. Find a participating pharmacy within South Carolina or the entire U.S. Or, you can visit your primary care physician. Don't have one? Find one here.

You can also visit a participating pharmacy within South Carolina or the entire U.S. to get some non-seasonal preventive care vaccines at a $0 copay. Below is a chart of these vaccines:

**This vaccine is only covered for those ages 60 or older. *This vaccine is only covered for those ages 50 and older.

Six tiers

Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you.

Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket.

Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs.

Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs.

Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents

Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive.

Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.

NOTE: Specialty medications are not available through the mail-order program for a 90-day supply. This only applies to generic or brand drugs in these tiers.

What are drug management programs?

They are quality programs that promote the safe use of medications. Prior authorization requires your doctor to get prior approval for some medications. Quantity and dose management limit the amounts of some medications that we cover each month. Step therapy asks you to try alternative medications before we provide benefits for some medications.

What happens at the pharmacy?

You will take your prescription to a network pharmacy and give it to the pharmacist, along with your member ID card. The pharmacist will use a computer to check your benefits and determine the amount you pay for prescriptions. The computer will also alert your pharmacist if there are any special requirements that apply to your prescription, such as a drug management program. If you don’t present your ID card or you don’t use a network pharmacy, you’ll have to file a claim for your purchase and you may not be reimbursed for the full amount you paid.

How much will I pay for my drugs?

When you use a participating pharmacy, the amount you pay depends on the specific plan you have and your medication. Depending upon your plan, you may have a copayment (a set dollar amount) for each prescription or you may pay a percentage of the cost for each prescription (coinsurance). Some of our plans may require that you pay a deductible (an amount you pay before your insurance starts to pay) before any coinsurance percentage is applied. Under Health Care Reform, the ACA requires most plan to cover certain drugs at $0 cost to members. See your schedule of benefits for more information.

What is a generic drug?

A generic drug is a drug that’s identical to its brand-name counterpart in dosage, safety, strength, quality, the way it’s used and the condition it’s used to treat. Generics become available when patents expire on brand-name drugs. The color and shape of a generic drug may be different from its brand-name counterpart, but the Federal Drug Administration (FDA) requires that their active ingredients be the same. To learn more about generic drugs, talk to your doctor or pharmacist.

Are generic drugs safe?

Absolutely! The FDA approves all generics and holds them to the same high safety standards as brand-name drugs. And best of all, generics will usually cost you less than brand-name drugs.

Is there a generic drug available for me?

Most likely. There are generics available to treat many conditions, and many commonly prescribed drugs have generic versions. In fact, nearly eight out of every 10 prescriptions are now filled with generics.

What are specialty drugs?

Specialty drugs treat conditions like cancer, hepatitis, multiple sclerosis or rheumatoid arthritis, to name a few. You will have a higher copayment for specialty drugs. Specialty drugs that you take by mouth or self-inject will have to be filled by our preferred specialty pharmacy for you to have payment under your plan. Also, some specialty drugs require prior authorization. Your specialty prescriptions will be delivered directly to your home.

What are drug management programs?

What is mail order?

Another way you can get your prescriptions filled is by using mail order. This is used for prescriptions that you take on an ongoing basis. You can get up to a 90-day supply at a time if your doctor writes the prescription that way. One advantage is that your prescriptions are delivered conveniently to your home.

Reminders

Remember, these come with every 2020 Blue Option plan!

All-Inclusive Office Visit Copayments: All-inclusive office visit copayments cover all diagnostic and treatment services provided at the medical office of a participating provider. This includes preventive services, diagnostic procedures, surgical procedures, medical supplies and more!
Vision Care: All Blue Option plans include routine adult and pediatric vision coverage through an independent company, Physicians Eyecare Network (PEN). PEN provides vision services through the Physician Eyecare Plan (PEP) network on behalf of BlueChoice HealthPlan. In-network providers include Walmart Vision Center, Target Optical, LensCrafters and more!

Dental Care: All plans include a dental allowance for exams and cleanings. This benefit covers an allowed amount per benefit period for exams and cleanings by any South Carolina-licensed dentist.
FOCUSfwd^® Wellness Incentive Program: The FOCUSfwd Wellness Incentive Program is being redesigned to showcase its four unique programs, plus a few new perks! More Rewards — Members are now rewarded for completing activities that are an important start to their overall health! Sweepstakes — Members can still win $1,000 quarterly and annual cash
rewards of $5,000 for completing activities in all areas of FOCUSfwd! GET FIT — Members receive exclusive FOCUSfwd prizes and rewards for stepping up to the challenge. Nutrition — We are giving members the knowledge and tools to take control of their health. Members can search recipes, create meal plans, obtain nutritional overviews of their meals for the entire day, search by vitamin and mineral needs and much more!

Blue CareOnDemand℠: All you need is your computer or smartphone device to see a
doctor anytime, anywhere, even when you are outside of South
Carolina. During your video visit, the doctor will ask questions,
answer questions, diagnose your symptoms and, if appropriate,
call in a prescription to your local pharmacy.
Doctors can treat most common, non-emergency medical issues, such as:
• Cold and flu symptoms
• Bronchitis and other
respiratory infections
• Sinus infections
• Pinkeye
• Ear infections
• Allergies
• Migraines
• Rashes and other
skin irritations
• Urinary tract infections
And more!
Mental Health and Breastfeeding Support services are also available through Blue CareOnDemand℠
Doctors Care: When your doctor is not available and Blue CareOnDemand is not appropriate, choose this option for urgent and after-hours care.
You can visit any Doctors Care location across the state for the same price as a primary care physician visit. This includes visits for injuries and illnesses that may be considered as regular doctor’s visits, after-hours visits and urgent care visits.

Life Management Services: All members can have access to three free sessions of their choice
for services such as:
• Financial counseling
and planning
• Adult care resources
• College consultation resources
• Legal consultations and
documents
• Child care resources
• Parenting/adoption resources
Life management services are offered through First Sun EAP. Because First Sun EAP is a separate company from BlueChoice, First Sun is solely responsible for all services related to individual assistance programs.
Personal Health Assessment: Take a smart step toward living healthier. By completing your confidential assessment, you’ll receive personal guidance and insights on your risk for developing certain chronic conditions, so you can take preventive action. You’ll also receive entries into the FOCUSfwd Wellness Incentive Program!

Discount Programs: As a Blue Option member, you get discounts on many items:
• Blue365^® — exclusive access to health and wellness information,
discounts and savings from industry-leading brands
• Jenny Craig^®
• Bosley^®
• Discounts at a variety of fitness centers
Great Expectations^®for health: Great Expectations for health includes more than 20 wellness, disease management, and behavioral health programs that focus on the early detection of illness and the prevention of disease. Members with chronic conditions also receive more targeted educational information and contact with our staff of highly trained health specialists. Those with intensive needs receive care coordination and the support of our caring team of nurses. You can earn entries in the FOCUSfwd Wellness Incentive Program prize drawings for participating in some of these programs.

BlueChoice HealthPlan Wire

How to make the most of your coverage New features or enhancements

To get started, simply call 844-206-0622. You'll need to have your member ID card ready.

Health and wellness reminders

Health Care Reform

When is Open Enrollment?

The Open Enrollment period for 2020 coverage began Oct. 15, 2019 and ends Dec. 15, 2019. If you haven't enrolled in coverage by then, you generally can't buy health coverage until the next open enrollment period for coverage for the following year.

If you're enrolled in a 2019 health plan, your benefit year ends Dec. 31, 2019. To continue health coverage in 2020, you can renew your current health plan or choose a new plan during the 2020 Open Enrollment period. You must enroll no later than Dec. 15, 2019 to have your coverage take effect Jan. 1, 2020.

What will my insurance cover?

Standard medical benefits for all plans include:

Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitation and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care

How much will it cost?

Your insurance cost will vary depending on:

Where you live
How old you are
Whether or not you smoke
How may people are in your household

Want to know how much it will cost? Find out here.

Under the law, pre-existing conditions and your gender are not factors in determining how much you will pay for health insurance. Your receipt of a federal premium subsidy, taking any action to enforce your rights under applicable law, Health Status-Related Factors, race, color, national origin, present or predicted disability, sex, gender identity sexual orientation, expected length of life, degree of medical dependency or quality of life will not effect your eligibility or premiums for this coverage.

Glossary

What Goes Up Can Come Down

Could you have prediabetes? Having prediabetes means that your blood sugar levels are higher than normal, but they are not yet high enough to be considered Type 2 diabetes. According to the American Diabetes Association, 70 percent of people with prediabetes will progress to full-blown diabetes if it’s left untreated.

Hearing that you have prediabetes can be overwhelming, but it is also a chance to prevent or delay diabetes. Prediabetes can often be reversed, and blood sugar levels returned to a normal range, with simple lifestyle changes.

Approximately 84 million American adults have prediabetes, and 90 percent of them don’t know they have it. That’s because prediabetes typically has no symptoms and often goes undetected. However, there are several simple blood tests that can show if you have prediabetes, including the A1C test.

Risk factors for prediabetes include:

Being 45 years or older.
Being overweight.
Having a close relative with Type 2 diabetes.
Being physically active fewer than three times a week.
Having had gestational diabetes.

African Americans, Latino Americans, American Indians, Pacific Islanders and some Asian Americans are at a higher risk of developing prediabetes. Be aware of your risk factors, and ask your doctor if one of the blood tests is right for you.

If you do have prediabetes, you can prevent or delay the onset of Type 2 diabetes. The Centers for Disease Control and Prevention (CDC) recommends managing your weight, getting active and eating a healthy diet. Incorporating small changes into your daily routine can add up to make a big difference.

Manage your weight.

Losing a small amount of weight can help reduce your risk of diabetes. The CDC recommends losing 5 – 7 percent of your body weight, which is 10 – 14 pounds for a 200-pound person.
Don’t do it alone. Involving friends, family members or coworkers can provide a support system. Lifestyle changes are long-term changes, and having people cheering you on can help you stick with it.

Get active.
Regular exercise can help you lose weight and regulate blood sugar levels. The CDC recommends getting at least 150 minutes of physical activity a week. That’s 30 minutes a day, five days a week. Remember to check with your doctor first before starting any exercise program.

If you haven’t been getting regular exercise, start with five to 10 minutes a day, and gradually build up to 30 minutes.
Aim to get active doing things you enjoy, whether that’s working in your yard, playing basketball with friends, swimming laps or taking your dog for a walk.
Schedule time on your calendar for physical activity. Make an exercise schedule and stick with it.

Eat a healthy diet.
It can be hard to maintain big changes to your diet all at once. Start small and gradually add changes. Talk to your doctor about what changes will be beneficial for you.

Forget frying. Try roasting, broiling, grilling, steaming and baking instead.
Cut out drinks with added sugar, like soda and fruit juice.
Keep a food diary to keep track of what you’re really eating. It can be eye-opening.
Take some time to plan meals each week. See where you can swap in healthier options, like brown rice in place of white rice or a quick salad instead of a fast food meal.
Focus on produce, whole grains and lean protein, like chicken and fish.

It can be challenging to make lifestyle changes last, but staying motivated can help stop the progression of Type 2 diabetes.

Sources:
https://www.washingtonpost.com/national/health-science/to-reverse-pre-diabetes-lifestyle-changes-can-make-a-big-difference/2018/02/05/977d1bba-eb40-11e7-9f92-10a2203f6c8d_story.html?utm_term=.b67917f4efcd
https://doihaveprediabetes.org/reverse-prediabetes/prediabetes-weight-loss/
https://www.webmd.com/diabetes/features/prediabetes-diagnosis-what-to-do#2
http://www.diabetesforecast.org/2019/03-may-jun/facts-to-know-about.html?loc=morefrom&_ga=2.85353689.1380180168.1560978870-1048429212.1558643003
http://www.diabetesforecast.org/2018/02-mar-apr/how-to-prevent-and-treat.html?loc=morefrom&_ga=2.85353689.1380180168.1560978870-1048429212.1558643003
http://www.diabetes.org/diabetes-basics/gestational/how-to-treat-gestational.html?loc=db-slabnav
http://www.diabetes.org/food-and-fitness/weight-loss/food-choices/the-best-food-choices/

Glossary

Affordable Care Act (ACA): The health care reform law. This law was passed in two parts. The Patient Protection and Affordable Care Act became law on March 23, 2010. This law was amended by the Health Care and Education Reconciliation Act on March 30, 2010. ACA refers to the final, amended version of the law. Some people also call this law Obamacare.
Allowed Amount: The dollar amount that a health plan determines is appropriate for a covered service. Blue Option network health care providers have agreed to accept the allowed amount as full payment (minus applicable copayments), which means you pay less for your care.

Authorization: The approval of medically necessary care by a managed care or insurance company.
Benefit: Payment provided for covered services under the terms of the policy. The benefit may be paid to the member or to others on the member’s behalf.

Coinsurance: Percentage of covered expenses that the member must pay. For example, if your physician charges $100 for a service and your health plan has a 20 percent coinsurance payment, you would be responsible for paying $20 of the charges and your health plan would pay $80.
Copayment: A specific amount of money you pay for certain services, such as office visits or medications, each time you use that service, as your plan defines. For example, if your health plan has a $15 copayment for an office visit, you would be responsible for paying $15 every time you visit your doctor’s office.

Covered Service: Medical service that your health plan will pay for. We outline covered services in your Schedule of Benefits or Certificate of Coverage.
Deductible: The amount of medical expenses that the member must pay during a particular period (usually a year) before certain benefits payable by the health plan become effective. For instance, if your health plan has a $200 deductible per 12-month period, you would be responsible for paying $200 worth of covered medical services within 12 successive months before your health plan would begin reimbursing for covered services. Please note that coupons for medical services and/or prescription drugs may not be used to satisfy the deductible when a generic prescription drug is available.

Embedded Deductible: If you select a Blue Option family plan with an embedded deductible, your plan contains two components – an individual deductible and a family deductible. Once a family member meets his or her deductible, then the plan will cover that family member’s covered medical expenses. Once family members have reached the family deductible, then the plan will pay for covered expenses for all family members. The individual deductible is embedded in the family deductible.
Exclusions: Specific conditions or circumstances the contract does not cover.

In-Network Care: Refers to services you receive from physicians who participate in the Blue Option network.
Maximum Out of Pocket (MOOP): The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefi ts that are provided by in-network providers. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualifi ed medical expense for the essential health benefi ts. This limit does not have to count premiums, balance billing amount for non-network providers, health care your plan doesn’t cover or coupons for medical services and/or prescription drugs when a generic prescription drug is available.

Medically Necessary: Health care services and supplies that are appropriate and necessary based on diagnosis and cost-effectiveness, and are consistent with national medical practice guidelines as to type, frequency and length of treatment.
Network: The hospitals, physicians and other medical professionals who contract with BlueChoice HealthPlan in the Blue Option network to provide care for you. Also referred to as participating or in-network providers.

Network Provider: Network providers are doctors, hospitals and other health care providers that we have contracted with to provide health care services to our members. Network providers are also called “in-network” providers or “participating” providers.
Open Enrollment Period: The yearly period when you can enroll in or make changes to your health insurance coverage. Open enrollment for 2020 runs from Oct. 15, 2019 to Dec. 15, 2019.

Out-of-Pocket Costs: Your costs for health care that your health plan doesn’t pay. Depending on your plan, this may include your deductible, coinsurance and copayments for covered services.
Out-of-Network Care: Services you receive from physicians who do not participate in the Blue Option network.

Participating Providers: Physicians, hospitals, skilled nursing facilities, home health agencies, hospices and other providers of medical services and supplies who agree to participate in the Blue Option provider network.
Primary Care Physician: Doctors who provide primary care include pediatricians, family medicine doctors and internal medicine doctors. The physicians usually treat the whole person and may provide preventive care and routine checkups, as well as sick care or treatment of chronic illnesses.

Referral: When your doctor sends you to a specialist or health care facility to get certain health care services. Some health plans require you to get this from your primary care physician.
Special Enrollment Period (SEP): A special enrollment period (SEP) is a time outside of the yearly open enrollment period when you can enroll in a health insurance plan. You qualify for an SEP if you’ve had certain life events like losing health coverage, moving, getting married, having a baby or adopting a child.

Contact Us

We want to make sure your question or concern ends up in the right place! Please select from these questions.

Are you a Blue Option member?

Thank you for choosing Blue Option. If you need to update any of your information, please fill out this form. For any questions you may have, please contact Member Services at 855-816-7636 from 8:30 a.m. until 5 p.m. Eastern Time, Monday through Friday or write us at Member & Guest Services, BlueChoice HealthPlan, P.O. Box 6170, Columbia, SC 29260-6170.

Need help with your coverage — claims, eligibility or benefits? Log into My Health Toolkit^®. (If it's your first time, you'll have to create a simple profile first.) Use the "Ask Customer Service" feature to send a confidential email to the right person to help you.

Do you need help selecting a plan?

Call us at 877-252-0635 and we'll be glad to assist you.

Do you need technical assistance?

Please contact us for technical assistance.

Would you like to visit one of our retail centers?

We have three retail centers throughout the state. Please stop by and let us know how we can help you. If you do not have a retail location near you, we can come to you!

Find out if one of the South Carolina BLUE^SM RVs is coming to your area by calling 855-382-BLUE (2583) or emailing Mobile@SCBlueRetailCenters.com.

Columbia

1260 Bower Parkway, Suite A4
Columbia, SC 29212

Monday–Friday 9 a.m. – 7 p.m.
Saturday 10am – 4 p.m.

Sunday by appointment only

803-264-9000 (Phone)
803-732-3468 (Fax)
Columbia@scblueretailcenters.com

Greenville

Magnolia Park Mall
1025 Woodruff Road, Suite A105
Greenville, SC 29607

Monday–Friday 9 a.m. – 7 p.m.
Saturday 10am – 4 p.m.

Sunday by appointment only

864-286-2285 (Phone)
864-297-6929 (Fax)
Greenville@scblueretailcenters.com

Mount Pleasant

1795 Highway 17 North, Unit 7
Mount Pleasant, SC 29464

Monday–Friday 9 a.m. – 7 p.m.
Saturday 10am – 4 p.m.

Sunday by appointment only

843-216-7760 or 855-492-2583 (Phone)
843-856-4059 (Fax)
charleston@scblueretailcenters.com

Use as Directed

Are you taking medications as prescribed?

Nearly 3 in 5 Americans take at least one daily medication. Unfortunately, many don’t take their medicines properly.

Taking medications as prescribed by your doctor is known as medication adherence. This includes getting your prescriptions filled, taking the medications at the right times and understanding the directions.

Here are some tips to help you make sure you take your medications as directed:

Be sure you understand how long to take the medication. Will you need a refill, or can you stop treatment when the bottle is empty?
Tell your doctor if paying for prescriptions is a problem. Your doctor may be able to prescribe a generic medication or help you find a drug assistance program.
Set daily routines to take medication. Connect taking the medication with normal daily routines such as eating or going to bed.
Keep medications where you’ll notice them. If they must be taken with food, place medications on the dinner table. If medications should be taken in the morning, keep them with your toiletries. Remember, however, that many medications should not be kept in a bathroom.
Use daily dosing containers. Keep medications in compartments labeled with the days of the week.
Keep a written or computerized schedule. Include the medications you take, how often you take them and any special directions.

Following these simple steps can help you improve your medication adherence.

Sources:
https://www.fda.gov/consumers/consumer-updates/are-you-taking-medication-prescribed
https://catalyst.nejm.org/optimize-patients-medication-adherence/
https://www.pharmacist.com/medication-adherence
https://millionhearts.hhs.gov/tools-protocols/medication-adherence.html
https://www.heart.org/en/health-topics/consumer-healthcare/medication-information/medication-adherence-taking-your-meds-as-directed
https://www.excellusbcbs.com/wps/portal/xl/health-wellness/preventive-health/take-as-directed/
https://www.bcbs.com/news/press-releases/excellus-bcbs-shares-upstate-ny-medication-adherence-survey-findings

5 Questions to Ask Your Doctor Before You Get Any Test, Treatment or Procedure

1. Do I really need this test or procedure? Medical tests help you and your doctor or other health provider decide how to treat a problem. And medical procedures help to actually treat it.

2. What are the risks? Will there be side effects? What are the chances of getting results that aren't accurate? Could that lead to more testing or another procedure?

3. Are there simpler, safer options? Sometimes all you need to do is make lifestyle changes, such as eating healthier food or exercising more.

4. What happens if I don't do anything? Ask if your condition might get worse or better if you don't have the test or procedure right away.

5. How much does it cost? Ask if there are less-expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs.

Use these 5 questions to talk to your doctor about which tests, treatments and procedures you need — and which you don't need.

Some medical tests, treatments, and procedures provide little benefit. And in some cases, they may even cause harm.

Talk to your doctor to make sure you end up with the right amount of care — not too much and not too little.

www.choosingwisely.org/patient-resources

On the Go & Still in the Know

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2020 Coverage

2019 Coverage

My Health Toolkit®

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$2,400/$4,8000
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$8,150/$16,300
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$45 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$45
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$85 copayment first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$85 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	50% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	50% after deductible
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Emergency Room Emergency Room Emergency services you get in an emergency room.	$450, then 50% after deductible
Ambulance Ambulance Emergency medical transportation.	50% after deductible
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $25 retail/$50 mail order; Tier 2: $25 retail/$50 mail order; Tier 3: $55 retail/$110 mail order; Tier 4: $85 retail/$170 mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: $300 retail/$600 mail order; Tier 6: $300 retail/$600 mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	50% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	Deductible, then 50%; 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitative per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 6002

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$6,000/$12,000
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$6,000/$12,000
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$55 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$55 copayment per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$100 copayment first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$100 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	Deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	Deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Emergency Room Emergency Room Emergency services you get in an emergency room.	$400, then deductible
Ambulance Ambulance Emergency medical transportation.	Deductible
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $30 retail/$60 mail order; Tier 2: $30 retail/$60 mail order; Tier 3: $55 retail/$110 mail order; Tier 4: Deductible retail/Deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: Deductible retail/Deductible mail order; Tier 6: Deductible retail/Deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	Deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	Deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Catastrophic

Plan type:

Catastrophic

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$8,150/$16,300
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$8,150/$16,300
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$25 for first three visits; deductible thereafter
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$25 for first three visits; deductible thereafter
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	Deductible
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	Deductible
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	Deductible
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	Deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	Deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	Deductible
Ambulance Ambulance Emergency medical transportation.	Deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	Deductible
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: deductible retail/deductible mail order; Tier 2: deductible retail/deductible mail order; Tier 3: deductible retail/deductible mail order; Tier 4: deductible retail/deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: deductible retail/deductible mail order; Tier 6: deductible retail/deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	Deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	Deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice HealthPlan-participating facility must provide services.

Bronze 5550

Plan type:

Bronze

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$5,550/$11,700
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$7,900/$15,800
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	20% after deductible
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	20% after deductible
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	20% after deductible
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	20% after deductible
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	20% after deductible
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	$500 copayment, then 20% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	20% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	$500 copayment, then 20% after deductible
Ambulance Ambulance Emergency medical transportation.	20% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: 20% after deductible retail/20% after deductible mail order; Tier 2: 20% after deductible retail/20% after deductible mail order; Tier 3: 20% after deductible retail/20% after deductible mail order; Tier 4: 20% after deductible retail/20% after deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: 20% after deductible retail/20% after deductible mail order; Tier 6: 20% after deductible retail/20% after deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	20% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	20% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services and we will treat covered transplants the same as any other medical condition.

Bronze 6900 HD

Plan type:

Bronze

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$6,900/$13,800
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$6,900/$13,800
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	Deductible
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	Deductible
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	Deductible
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	Deductible
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	Deductible
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	Deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	Deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	Deductible
Ambulance Ambulance Emergency medical transportation.	Deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	Deductible
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: deductible retail/deductible mail order; Tier 2: deductible retail/deductible mail order; Tier 3: deductible retail/deductible mail order; Tier 4: deductible retail/deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: deductible retail/deductible mail order; Tier 6: deductible retail/deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	Deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	Deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services and we will treat covered transplants the same as any other medical condition.

Bronze 6500

Plan type:

Bronze

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$6,500/$13,000
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$8,150/$16,300
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$40 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$40 copayment per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$90 copayment first visit, then 20% after deductible
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$90 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	$500 copayment, then 20% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	20% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	$500 copayment, then 20% after deductible
Ambulance Ambulance Emergency medical transportation.	20% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $35 retail/$70 mail order; Tier 2: $35 retail/$70 mail order; Tier 3: 20% after deductible retail/20% after deductible mail order; Tier 4: 20% after deductible retail/20% after deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: 20% after deductible retail/20% after deductible mail order; Tier 6: 20% after deductible retail/20% after deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	20% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	20% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Bronze 7300

Plan type:

Bronze

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$7,300/$14,600
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$8,150/$16,300
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$40 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$40 copayment per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$90 first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$90 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	$500 copayment, then 50% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	50% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	$500 copayment, then 50% after deductible
Ambulance Ambulance Emergency medical transportation.	50% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $25 retail/$50 mail order; Tier 2: $25 retail/$50 mail order; Tier 3: 50% after deductible retail/50% after deductible mail order; Tier 4: 50% after deductible retail/50% after deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: 50% after deductible retail/50% after deductible mail order; Tier 6: 50% after deductible retail/50% after deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	50% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	50% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Bronze 6000

Plan type:

Bronze

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$6,000/$12,000
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$7,900/$15,800
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	20% after deductible
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	20% after deductible
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	20% after deductible
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	20% after deductible
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	20% after deductible
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	$500 copayment, then 20% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	20% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	$500 copayment, then 20% after deductible
Ambulance Ambulance Emergency medical transportation.	20% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: 20% after deductible retail/20% after deductible mail order; Tier 2: 20% after deductible retail/20% after deductible mail order; Tier 3: 20% after deductible retail/20% after deductible mail order; Tier 4: 20% after deductible retail/20% after deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: 20% after deductible retail/20% after deductible mail order; Tier 6: 20% after deductible retail/20% after deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	20% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	20% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services and we will treat covered transplants the same as any other medical condition.

Silver 6850

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$6,850/$13,700
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$7,800/$15,600
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$25 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$25 copayment per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$60 first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$60 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	40% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	40% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Emergency Room Emergency Room Emergency services you get in an emergency room.	40% after deductible
Ambulance Ambulance Emergency medical transportation.	40% after deductible
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $25 retail/$50 mail order; Tier 2: $25 retail/$50 mail order; Tier 3: $45 retail/$90 mail order; Tier 4: $80 retail/$160 mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: $300 retail/$600 mail order; Tier 6: $300 retail/$600 mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	40% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	40% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 7350

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$7,350/$14,700
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$7,350/$14,700
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$40 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$40 copayment per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$80 copayment first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$80 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	Deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	Deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Emergency Room Emergency Room Emergency services you get in an emergency room.	Deductible
Ambulance Ambulance Emergency medical transportation.	Deductible
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $35 retail/$70 mail order; Tier 2: $35 retail/$70 mail order; Tier 3: $60 retail/$120 mail order; Tier 4: $75 retail/$150 mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: $300 retail/$600 mail order; Tier 6: $300 retail/$600 mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	Deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	Deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 5004 HD

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$5,000/$10,000
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$5,000/$10,000
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	Deductible
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	Deductible
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	Deductible
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	Deductible
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	Deductible
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	Deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	Deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	Deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	Deductible
Ambulance Ambulance Emergency medical transportation.	Deductible
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: Deductible retail/Deductible mail order; Tier 2:Deductible retail/Deductible mail order; Tier 3: Deductible retail/Deductible mail order; Tier 4: Deductible retail/Deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: Deductible retail/Deductible mail order; Tier 6: Deductible retail/Deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	Deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	Deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 6250

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$6,250/$12,500
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$7,800/$15,600
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$20 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$20 copayment per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$55 copayment first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$55 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	25% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	25% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	25% after deductible
Ambulance Ambulance Emergency medical transportation.	25% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $20 retail/$40 mail order; Tier 2: $20 retail/$40 mail order; Tier 3: $40 retail/$80 mail order; Tier 4: $90 retail/$180 mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: $300 retail/$600 mail order; Tier 6: $300 retail/$600 mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	25% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	25% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 2000

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$2,000/$4,000
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$7,500/$15,000
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$35 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$35 copayment per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$75 first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$75 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	$400 copayment, then 50% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	50% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	$400 copayment, then 50% after deductible
Ambulance Ambulance Emergency medical transportation.	50% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $20 retail/$40 mail order; Tier 2: $20 retail/$40 mail order; Tier 3: 50% after deductible retail/50% after deductible mail order; Tier 4: 50% after deductible retail/50% after deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: 50% after deductible retail/50% after deductible mail order; Tier 6: 50% after deductible retail/50% after deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	50% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	50% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 3200

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$3,200/$6,400
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$7,900/$15,800
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$35 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$35
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$80 copayment first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$80 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	50% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	50% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	$400, then 50% after deductible
Ambulance Ambulance Emergency medical transportation.	50% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $25 retail/$50 mail order; Tier 2: $25 retail/$50 mail order; Tier 3: $50 retail/$100 mail order; Tier 4: $90 retail/$180 mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: $300retail/$600 mail order; Tier 6: $300 retail/$600 mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	50% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	50% after deductible; 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 3500

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$3,500/$7,000
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$8,000/$16,000
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$40 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$40 copaymenet per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$80 copayment first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$80 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	40% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	40% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	$350 copayment, then 40% after deductible
Ambulance Ambulance Emergency medical transportation.	40% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $25 retail/$50 mail order; Tier 2: $25 retail/$50 mail order; Tier 3: $70 retail/$140 mail order; Tier 4: $95 retail/$190 mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: $300 retail/$600 mail order; Tier 6: $300 retail/$600 mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	40% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	40% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 4600 HD

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$4,600/$9,200
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$4,600/$9,200
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	Deductible
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	Deductible
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	Deductible
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	Deductible
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	Deductible
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	Deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	Deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	Deductible
Ambulance Ambulance Emergency medical transportation.	Deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	Deductible
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: Deductible retail/Deductible mail order; Tier 2: Deductible retail/Deductible mail order; Tier 3: Deductible retail/Deductible mail order; Tier 4: Deductible retail/Deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: Deductible retail/Deductible mail order; Tier 6: Deductible retail/Deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	Deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	Deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 4500

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$4,500/$9,000
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$8,150/$16,300
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$40 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$40 copayment per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$80 copayment first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$80 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	50% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	50% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	50% after deductible
Ambulance Ambulance Emergency medical transportation.	50% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $15 retail/$30 mail order; Tier 2: $15 retail/$30 mail order; Tier 3: $60 retail/$120 mail order; Tier 4: $90 retail/$180 mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: $300 retail/$600 mail order; Tier 6: $300 retail/$600 mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	50% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	50% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services. We will treat covered transplants the same as any other medical condition.

Silver 5001

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$5,000/$10,000
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$7,900/$15,800
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$30 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$30 copayment per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$60 copayment first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$60 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	30% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	30% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	$400 copayment, 30% after deductible
Ambulance Ambulance Emergency medical transportation.	30% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $20 retail/$40 mail order; Tier 2: $20 retail/$40 mail order; Tier 3: $40 retail/$80 mail order; Tier 4: $80 retail/$160 mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: $300 retail/$600 mail order; Tier 6: $300 retail/$600 mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	30% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	30% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Bronze 5800

Plan type:

Bronze

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$5,800/$11,600
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$8,150/$16,300
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$45 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$45 copayment per visit.
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$90 copayment first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$90 coapayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 coapayment per visit
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	$500 copayment, then 20% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	20% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	$500 copayment, then 20% after deductible
Ambulance Ambulance Emergency medical transportation.	20% after deductible
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $40 retail/$80 mail order; Tier 2: $40 retail/$80 mail order; Tier 3: 20% after deductible retail/20% after deductible mail order; Tier 4: 20% after deductible retail/20% after deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: 20% after deductible retail/20% after deductible mail order; Tier 6: 20% after deductible retail/20% after deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	20% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	20% after deductible. 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services. We will treat covered transplants the same as any other medical condition.

Bronze 7900

Plan type:

Bronze

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$7,900/$15,800
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$7,900/$15,800
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$45 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$45 copayment per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$900 first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$90 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	$500 copayment, then deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	Deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	$500 copayment, then deductible
Ambulance Ambulance Emergency medical transportation.	Deductible
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $35 retail/$70 mail order; Tier 2: $35 retail/$70 mail order; Tier 3: Deductible retail/Deductible mail order; Tier 4: Deductible retail/Deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: Deductible retail/Deductible mail order; Tier 6: $Deductible retail/Deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	Deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	Deductible; 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 5550

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$5,550/$11,100
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$7,350/$14,700
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$45 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$45 copayment per visit
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$100 first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$100 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	$500 copayment, then 20% after deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	20% after deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	$500 copayment, then 20% after deductible
Ambulance Ambulance Emergency medical transportation.	20% after deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	$200 per visit
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: $15 retail/$30 mail order; Tier 2: $15 retail/$30 mail order; Tier 3: $35 retail/$70 mail order; Tier 4: 20% after deductible retail/20% after deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: 20% after deductible retail/20% after deductible mail order; Tier 6: 20% after deductible retail/20% after deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	20% after deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	20% after deductible; 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 4200 HD

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$4,200/$8,400
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$4,200/$8,400
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	Deductible
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	Deductible
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	Deductible
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	Deductible
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	Deductible
Inpatient Hospital Services Inpatient Hospital Services Treatment at a hospital that requires the individual to stay there.	Deductible
Outpatient Hospital Services Outpatient Hospital Services Treatment at a hospital that does not require the individual to stay there.	Deductible
Emergency Room Emergency Room Emergency services you get in an emergency room.	Deductible
Ambulance Ambulance Emergency medical transportation.	Deductible
Freestanding Ambulatory Surgical Center Freestanding Ambulatory Surgical Center A facility that is licensed for Outpatient Surgery only and doesn't provide overnight accommodations or around-the-clock care. The care must be provided under the supervision of a Physician. It also must provide nursing services by or under the supervision of an on duty registered nurse (RN). The facility must not be an office or clinic for the private practice of a Physician.	Deductible
Mental Health and Substance Abuse Mental Health and Substance Abuse Conditions defined, described or classified as psychiatric disorders or conditions in the latest publication of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.	Covered as any other medical benefit.
Gynecologist Exam (two exams per benefit year) Gynecologist Exam (two exams per benefit year) Full scope of services provided in the care of or related to the female reproductive system and breasts. Pap smears are the examination of the tissues of the cervix or the uterus for the purposes of detecting cancer.	$0
Routine Screening Mammogram Routine Screening Mammogram A radiological examination of the breast for purposes of detecting breast cancer.	$0
Routine Screening Colonoscopy Routine Screening Colonoscopy An examination that uses a long, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon.	$0
Prescription Drugs Prescription Drugs Drugs and medications that, by law, require a prescription. We also cover syringes for diabetes. Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you. Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket. Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs. Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs. Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents.	Tier 1: deductible retail/deductible mail order; Tier 2: deductible retail/deductible mail order; Tier 3: deductible retail/deductible mail order; Tier 4: deductible retail/deductible mail order
Specialty Pharmaceuticals Specialty Pharmaceuticals Medications that treat a complex clinical condition with complex delivery of care and distribution requirements. They include, but are not limited to, infusible specialty drugs for chronic disease; injectable and self-injectable specialty drugs for acute and chronic diseases; and specialty oral drugs. Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive. Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.	Tier 5: deductible retail/deductible mail order; Tier 6: deductible retail/deductible mail order
Durable Medical Equipment Durable Medical Equipment Equipment and supplies a health care provider orders for everyday or extended use. Coverage for durable medical equipment may include oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.	Deductible
Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Physical Therapy, Speech Therapy, Occupational Therapy and Habilitation Services that help a person improve skills and functioning that have been lost or impaired due to an illness or injury. These services may include physical, occupational and speech therapy services in a variety of inpatient and/or outpatient settings. A licensed physical, occupational or speech therapist must provide the service. Habilitation: services that help a person keep, learn or improve skills and functioning. Examples include therapy for a child who isn't walking or talking at the expected age.	Deductible; 30 combined visits for physical therapy, speech therapy and occupational therapy per benefit year. 30 visits for habilitation per benefit year.
Transplants Transplants Medical and surgical services a member receives for human organ and/or tissue transplants, such as single/double kidney; pancreas and kidney; heart; single/double lung; liver; pancreas; heart and single/double lung; and bone marrow transplants.	A BlueChoice-participating facility must provide services.

Silver 8150

Plan type:

Silver

Details:

Plan Benefits	In Network Only
Deductible (single/family) Deductible (single/family) The amount you must pay for covered services before your health plan starts to pay. For example, your plan has a $500 deductible. You must pay the first $500 of allowable charges for covered services before your plan starts to pay benefits. Your health plan may pay some benefits before you meet your deductible. For example, your plan may pay some preventive services at 100 percent even if you have not met your deductible.	$8,150/$16,300
Maximum Out Of Pocket (single/family) Maximum Out Of Pocket (single/family) The MOOP is the most you pay during a policy period (usually one year) before BlueChoice HealthPlan starts to pay 100 percent for covered essential health benefits in-network providers provide. This limit must include deductibles, coinsurance, copayments and/or similar charges. It also includes any other expenditure that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing or spending for non-essential health benefits.	$8,150/$16,300
Primary Care Physician Services Primary Care Physician Services A physician (M.D.-Medical Doctor or D.O.-Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services. This includes providers in family practice, internal medicine and pediatrics, and nurse practitioners.	$0 copayment per visit
Doctors Care/Blue CareOnDemand Doctors Care/Blue CareOnDemand	$0
Maternity Care Maternity Care Routine Maternity Physician Services for first visit only.	$50 copayment first visit
Specialist Visit Specialist Visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.	$50 copayment per visit
Urgent Care Urgent Care Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.	$75 copayment per visit
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