Blue Cross/Blue Shield of TN (Preferred Provider Organization or PPO)
Phone toll free at 1-800-558-6213. Customer Service hours are 8:00 am - 5:00 pm EST, Monday through Friday.
Enhanced Flu Benefits (10/15/09)
Effective immediately (1) You can get your seasonal flu, H1N1 and pneumococcal (pneumonia) vaccines without having to meet your deductible or paying coinsurance or copays (2) The health plans will now pay for vaccines regardless of whether you receive them from a pharmacist or at your doctor's office and (3) The copays for the critical flu-related prescription drugs will now be lower - only $25.00 - with a prescription from your doctor. You can get additional information from your insurance carrier (i.e., BlueCross BlueShield of Tennessee, Cigna, and United HealthCare) about where you can get your flu and other important vaccines. If you have already had your flu shots or flu medication, please check with your insurance carrier about reimbursement.
Tobacco Use Surcharge Delayed until 2011 (7/1/09)
The Tobacco Use Surcharge has now been delayed for one year. The December 2010 deduction for January 2011 coverage will be the first to include the surcharge for covered employees and spouses who use tobacco products. Although the surcharge has been delayed for a year, the lowered co-payments for tobacco quit aids will still be available until Dec. 31, 2009. You can use your health insurance card to obtain certain prescription drugs and over-the-counter nicotine replacement therapies for very low copay. To use this benefit, you must have a prescription, even for the over-the-counter products.
Change in Prescription Coverage (3/31/09)
Effective May 1, 2009, the PPO Plan will only cover generics for certain medications that control stomach acid and relieve heartburn. These medications are called proton pump inhibitors, or PPIs, and include brand-name drugs like Aciphex, Nexium, Prevacid, Prilosec, Protonix and Zegerid. Coverage
will continue for generic PPIs such as omeprazole and pantoprazole. The plan will not cover the brand-name drug unless prior authorization is given by Blue Cross/Blue Shield to the member's physician. If you have questions, please contact customer service.
- Member Home Page
- 2009 Member Handbook
- 2010 Member Handbook
- Provider Search (select Blue Network P)
- Blue Access (order replacement ID cards, check claim status, verify your benefits)
- Forms
- Group Insurance Enrollment
- Basic Life Insurance Beneficiary must also be submitted
- 2009 Rates for PPO, POS, HMO
- 2010 Rates for PPO, POS, HMO
- Frequently Asked Questions
- 2009 Plan Highlights
Annual Medical Deductible (In-Network): $350/individual; $875/family
Annual Medical Out-of-Pocket Maximum (In-Network): $1,350/individual; $2,700/family
Physician Office Visit, Lab & X-Ray (In-Network): 90% of MAC (maximum allowable charge)
Emergency Room Use: $75 per visit (This applies only if not admitted to the hospital.)
Prescription Drug Copay: 34-day supply at retail pharmacies
Tier 1 (generic drugs): $5 copayment
Tier 2 (preferred brand-name drugs): $25 copayment
Tier 3 (non-preferred brand-name drugs): $75 copayment
Prescription Drug Copay: 102-day supply by mail order or participating "mail at retail" pharmacies
Tier 1 (generic drugs): $10 copayment
Tier 2 (preferred brand-name drugs): $50 copayment
Tier 3 (non-preferred brand-name drugs): $100 copayment
Annual Pharmacy Copay Maximum: $1,620/individual
Diabetic Supplies (strips, lancets, syringes): Coinsurance waived when using In-Network Provider
Diabetic Prescription Drug (oral and insulin): Copay waived for generic and preferred brand when using In-Network Provider; $75 for 34-day supply for non-preferred brand; $100 for 102-day supply for non-preferred brand
Prescription Benefit
Prescriptions may be filled by participating providers (choose Pharmacy Network RX04) or
receive a 102-day supply of medication for one copayment from either Caremark Home Delivery or a retail pharmacy that participates in the home delivery pharmacy retail network. You will need a written prescription from your doctor for a 102-day supply of medication, with three refills, if appropriate.
Mail at Retail Pharmacies
The following chain stores participate in the home delivery pharmacy network: Bi-Lo, CVS, KMart, Publix, Rite-Aid, Sam's Club, Walmart. View a complete listing of the home delivery pharmacy retail network or contact Member Services at 1-800-558-6213. If you utilize a retail pharmacy that does not participate in the home delivery network, you will only be able to obtain up to a 34-day supply of your medication for one copayment.
