Blue Cross Blue Shield of Arizona Changes/Enhancements
for the 2018/2019 Plan Year
WE HEARD YOU!
One of the major challenges facing our PUHSD staff is the rising cost of family medical insurance. To address this challenge, the PUHSD has made some changes to our medical plan structure for the 2018/2019 plan year.
1) The District is changing to a 4-tier structure of Employee, Employee + Spouse, Employee + Child(ren) and Employee + Family (Spouse & Child(ren).
- Because the new tier structure addresses the need for a less expensive option for insuring child(ren), the District will be eliminating the Dual Spouse tiers for 2018/2019.
2) In addition to our current PPO Plan Options (High, Middle & Low), the District will be offering a Low Option - Limited Network Plan via the Alliance Network.
The main difference between our current PPO Plans and a Limited Network Plan is addressed below:
PPO Plans: Have In-Network doctors and hospitals throughout Arizona. The BCBSAZ Statewide PPO network includes 90% of doctors and hospitals in the state.
Limited Network Plans: Include selected In-Network doctors and hospitals that must be utilized for non-emergency care within the state of Arizona. The Alliance Network is made up of contracted hospitals and doctors that are part of Banner Health and HonorHealth (Formerly Scottsdale Healthcare and John C. Lincoln Health).
The 2018/2019 Blue Cross Blue Shield of AZ Employee Premiums are reflected below.
Plan Tier Monthly Premium Blue Cross/Blue Shield High - Employee Only $ 59.81 Blue Cross/Blue Shield High - Employee + Spouse $ 728.44 Blue Cross/Blue Shield High - Employee + Child(ren) $ 426.21 Blue Cross/Blue Shield High - Employee + Family $ 1,326.25 Blue Cross/Blue Shield Middle - Employee Only $ - Blue Cross/Blue Shield Middle - Employee + Spouse $ 602.84 Blue Cross/Blue Shield Middle - Employee + Child(ren) $ 327.52 Blue Cross/Blue Shield Middle - Employee + Family $ 1,131.87 Blue Cross/Blue Shield Low - Employee Only $ - Blue Cross/Blue Shield Low - Employee + Spouse $ 455.80 Blue Cross/Blue Shield Low - Employee + Child(ren) $ 211.99 Blue Cross/Blue Shield Low - Employee + Family $ 904.29 Blue Cross/Blue Shield Low Alliance Network - Employee Only $ - Blue Cross/Blue Shield Low Alliance Network - Employee + Spouse $ 199.34 Blue Cross/Blue Shield Low Alliance Network - Employee + Child(ren) $ 10.49 Blue Cross/Blue Shield Low Alliance Network - Employee + Family $ 507.40
Plan Details and Documents
And introducting BlueCare Anywhere, telehealth services. For more information, please review the BlueCare Anywhere Flyer and FAQs.
Note: Unless stated otherwise, the following FAQs pertain to the Alliance Plan Option Only.
What is the Alliance Network?
The Alliance Network is made up of contracted hospitals and doctors that are part of Banner Health and HonorHealth. All non-emergency services received within the state of Arizona must utilize these providers to be considered In-Network. Note: Sonora Quest is the only contracted lab. For more information on the Alliance Network, please review the Alliance Member Flyer.
How do I Find a Provider Within the Alliance Network?
Does the Alliance Option offer the same coverage as the other BCBSAZ plan options?
Yes, all the District medical options cover the same services, only the member cost-sharing (deductibles, co-pays, co-insurance percentages, maximums, etc.) is different. Please refer to the applicable benefit summary for specifics. Note: The Alliance option mirrors the cost-sharing design of the Low option except for the In-Network network.
What happens if I use a non-Alliance medical provider for non-emergency care in the state of Arizona?
Claim will be processed as Out-of-Network.
What if I need to go to Urgent Care?
Urgent Care is considered non-emergency so provider must be part of the Alliance Network to be considered In-Network.
What if I need emergency care?
Claim will be processed as In-Network (All Plan Options).
What if I need care Out of State?
Claim will be processed through the PPO Network (All Plan Options).
Can I enroll my dependents into a different plan than mine?
No, the employee is the subscriber on the insurance so any dependents would be enrolled as part of the employee's insurance (All Plan Options).
In addition to the new tier structure and Limited Network option, PUHSD has made additional enhancements to our plans.
- Preventative Services Coverage - This benefit plan has made changes to how preventative services will be covered thereby eliminating/reducing most employee cost-sharing. Please see applicable Benefit Plan Summary for specifics.
- Domestic Partner (DP) Coverage - For the purposes of this plan, DPs will fall under the Spouse tiers. Also, per IRS regulations, DP premiums will be deducted Post-Tax. In addition, Employees utilizing this tier will be required to submit an annual Attestation verifying DP status.
- Gender Transition Coverage - This benefit plan will now cover gender transition surgery and medications taken for the purpose of gender transition.