YOUR 2017 BENEFIT BOOKLET - Highmark

YOUR 2017 BENEFIT BOOKLET

my Priority Blue Flex HMO 2750SQE

NEPA-1

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Table of Contents

Thank You for Choosing Highmark ...............................................................

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Language Assistance Services

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Get More from Your Plan ............................................................................ 8

Where to Go for Health Care Services............................................................... 10

Using Your Prescription Drug Coverage .................................................... 12

Get Quality Care .................................................................................. 14

Get Quality Service .................................................................................. 15

Payment and Premium Options ............................................................... 16

Paying for Your Care ................................................................................... 18

Your Rights and Responsibilities ............................................................... 21

How We Protect Your Right to Privacy

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Notice of Privacy Practices ......................................................................... 23

The Value of a Health Savings Account

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Definitions of Health Care Terms ............................................................... 34

How to Use my Priority Blue Flex HMO

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Preventive Schedule .................................................................................. 36

Vision and Dental Coverage ........................................................................ 41

Outline of Coverage

Master Contract

Thank You for Choosing Highmark

Where More Is Yours

Welcome to Highmark. We appreciate your choosing Highmark for your health coverage. You will find that Highmark is more than your insurance provider. We are your partner in good health and want you to get the most from your membership. Your new plan offers resources to help you make smart choices about your care, many easy-to-use health and wellness tools, plus lots of member advantages. Get ready to discover more of what's available to you. Use this checklist to get started.

Register on the Highmark member website, .

When you register, be sure to tell us how you want us to contact you. Go to Account Settings and Contact Preferences. Visit the website often. There, you'll find lots of smart online tools to help you learn about improving your health. You can review your claims and track your spending. Rate your doctor and compare care costs. Print your ID card and find out how to get healthy choice discounts. You can check the Highmark Preventive Schedule to plan your family's preventive care. Find out how your customer care advocate at My Care Navigator can make a doctor's appointment for you and transfer your medical records. Plus, learn how to get health information and support from a health coach 24 hours a day.

Enjoy convenience and security by going green.

Get your health plan Explanation of Benefits (EOBs), plan statements, newsletters and more delivered to you online instead of in your mailbox. On the member website, simply click Go Paperless. Going green will cut down on paper clutter, keep your health information secure and give you access to your health plan documents ? anytime, anywhere, 24/7. You can still print out any documents you need from the website.

You have the right to receive paper copies of documents, such as EOBs, Explanations of Payments and Delay Notices at any time without charge. To update how you receive communications from Highmark at any time, you may:

? Log in to the member website at , select Your Account, select Account Settings, and then Contact Preferences.

? Call the Member Service number on the back of your member identification (ID) card after you receive it.

Pay your premiums the easy way.

Eliminate paper invoices. Set up online payments on the member website with e-Bill.

Find a Primary Care Provider (PCP) and make an appointment.

If you don't have a PCP, it's easy to find one who can help you to stay healthy by coordinating your overall care. Your PCP can also provide preventive care and specialist referrals, and help you to manage any ongoing health conditions. To find a PCP near you, select Find a Doctor on the member website.

Use an urgent care center for immediate care.

Choose an urgent care center instead of the emergency room for non-life-threatening issues like cuts, sprains or the flu. You'll get faster care ? without an appointment ? even in the evenings and on weekends. Find an urgent care center at Find a Doctor on the member website.

In a medical emergency when you think you need medical treatment, go directly to a hospital emergency room or call 911.

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 Learn more about your benefits.

Refer to the Outline of Coverage and Agreement in the back of this booklet, or log in to the member website to access them electronically. They tell you what you need to know about your benefits and exclusions and how your plan works. They also tell you which services are covered, which are not covered and what cost sharing your plan includes. If you are looking for additional plan information, your plan's Summary of Benefits and Coverage is available online at highmarkbcbsne-. If you do not have online access, you can get a free paper copy of your Summary of Benefits and Coverage by calling the Member Service number on the back of your ID card.

Discover all the extras. More choices. More resources. More convenience. More for you.

Help Us to Better Serve You

To get the most from your benefits, you can choose how you want to receive information from us. Go to the Highmark member website and log in to your account to tell us:

? The way you want to get information from us, like mail or email ? The most convenient phone number to reach you ? The days and hours you prefer to get calls ? What special help we can give you if your English is limited ? If you need TTY information

Giving us this information won't affect your benefits in any way. We will protect your personal information and handle it with respect and integrity.

Where You Can Go for Help

For answers to all of your questions: ? You can call us at the Member Service number on the back of your ID card. ? You can visit the member website at . ? If you have any questions or you require special assistance, including accommodations for disabilities or limited English proficiency, please call us at the number on the back of your ID card to request these free services. ? For TTY/TDD Hearing Impaired services, please dial 711 and the number on the back of your ID card.

Service Centers

You can also visit one of our service centers listed below to: ? Get answers to questions about your coverage ? Learn about available health plans ? Pay your premium ? Get information about wellness programs and resources

Wilkes Barre Highmark Blue Cross Blue Shield 19 North Main St. Wilkes Barre, PA 18411

Service Centers are open from 8 a.m. to 4:30 p.m. Please call 1-800-816-5527 to schedule an appointment at the location most convenient for you.

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Highmark Health Insurance Stores

You can also go to a Highmark health insurance store to: ? Get answers to questions about your plan ? Understand your claims and benefits ? Attend a wellness seminar ? Learn to use our member website tools and services ? Enroll in a new Highmark plan ? Pay your premium ? Connect to a Member Service representative

Stroudsburg Bartonsville Plaza 292 Frantz Road, Suite 109 Bartonsville, PA 18360

Dickson City Park Center 1019 Commerce Blvd. Dickson City, PA 18519

Williamsport T.J. Maxx Plaza 1754 East 3rd St. Williamsport, PA 17701

For more information about Highmark health insurance stores, please visit .

Using Your Identification Card

You will receive your identification (ID) card in a separate mailing. Your ID card is your key to letting providers know that you have health coverage. You should carry your card with you. You can also view and fax it to a provider by logging in to the member website with your web-enabled phone.

Show your card to the health care provider when you need care. Use it at the pharmacy when you buy prescription drugs. You can even use your ID card nationwide for emergency and urgent care.

Your ID card is your source for important information. It includes: ? Your name and/or dependent's name (when applicable) ? Your identification number ? Your group number ? Effective date of your plan ? Adult and pediatric vision provider and pediatric dental network information ? Office visit, specialist visit and emergency room copayment amounts (if applicable) ? Pharmacy network ? Toll-free Member Service phone number ? Member website address ? Blues On CallSM nurse line ? Toll-free phone numbers for authorizing services ? Addresses for filing claims that are out of the network or out of the coverage area

If your ID card is lost or stolen, please call Member Service immediately. You can order a replacement ID card on the member website. It's illegal to lend your ID card to anyone who is not eligible to use your benefits.

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Reporting Changes

Important changes that you and your dependents must report include: ? Name or address ? Marriage or divorce ? Adding or removing a domestic partner ? Adding or removing a dependent ? Termination or death of a policyholder or dependent ? Eligibility for Medicare ? Eligibility for employer group health coverage

To report changes: ? If you bought your plan on the Health Insurance Marketplace, please call 1-800-318-2596. ? If you bought your plan from us, please call Member Service at the number on the back of your ID card.

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Language Assistance Services

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