Quick Reminders – June 2021

Grandchild Dependent Annual Re-certification

According to Texas Insurance Code Section 1251.151, in order to be considered an eligible dependent, your grandchild(ren) must be claimed as a dependent on your income tax return. If you are an employee or retiree covering your grandchild as a dependent, you should have received information regarding the re-certification of your grandchild. Be sure to submit your Certification Form along with documentation to your Human Resources Office. Accepted grandchild documentation is a copy of the portion of your most recent income tax return that states you are claiming your grandchild as a dependent. You may redact (cross out) any financial information. Contact your human resources office if you have any questions. You have until August 31 to submit your documentation.

Cigna Acquisition

New York Life Group Benefit Solutions acquired Cigna Group Insurance. Apart from the name change, you will see no changes to your Long-Term Disability coverage for plan year FY22. The service team will remain the same. Please continue to use the same contact information, phone numbers, and service sites.

 

Understanding Your Explanation of Benefits (EOB)

Your Explanation of Benefits (EOB) lets you know when and how your claims are processed by Blue Cross and Blue Shield of Texas. It isn’t a bill. It gives you a detailed look at the covered services and shows how much you may owe your provider after your benefits have been applied.

EOBs include confirmation of your policy ID, helpful contacts and a glossary of terms. It also provides the following information:

  • Covered patient
  • Provider (doctor, hospital, lab or other provider)
  • How your benefits are applied (amount billed, amount covered and health plan responsibility)
  • Your responsibility including any deductible, copays and coinsurance

Your Benefits Applied – This section shows your list of services and how they’re covered.

  • Amount Billed is the total amount your provider billed for the services.
  • Amount Covered (Allowed) is the amount billed (G) minus any discounts or reductions (H).
  • Health Plan Responsibility is the portion the plan paid to the provider.
  • Your Total Costs is the sum of your copay, deductible and coinsurance. You may owe less if your provider collected any of these payments before beginning services. It also includes any amounts not covered by your health plan. The total cost in this column details the amount shown in the claim summary. It does not include any amounts that a non-participating provider may bill you.

Save a copy of this EOB explanation flyer for your records!

You may sign-up to receive your EOBs online at Blue Access for MembersSM by logging in at bcbstx.com or Text* GOBCBSTX to 33633 to download the mobile app.

* Message and data rates may apply. See terms and conditions and our privacy policy at bcbstx.com/mobile/text-messaging. Source: BCBSTX

Announcement of Baylor Scott & White Health and BCBS Health Plan Discounts in the Brazos Valley

The Texas A&M University System and Baylor Scott and White Health, together with Blue Cross and Blue Shield of Texas (BCBSTX), announced a collaboration which provides discounts to the Brazos Valley. The purpose of the discount arrangement is to improve the Brazos Valley community’s access to health care.

As of February 15th, Texas A&M University System offers employees and retirees new, lower cost, copays and inpatient/outpatient services. Physicians and facilities contracted with Baylor Scott & White and located in the Brazos Valley feature a $15 copay for specialists and a 10% coinsurance for other costs such as hospitalization. Primary care physician copays remain the same.

You must be enrolled in a Blue Cross and Blue Shield of Texas health plan with the A&M System and use a Baylor Scott & White Health facility in the Brazos Valley to take advantage of these discounts. The discount is not available outside of the Brazos Valley. Individuals outside of the service area and those with established provider relationships outside of these facilities will continue to enjoy the same benefits they currently receive, and do not need to change their network plan to take advantage of these reductions.

Baylor Scott & White Health will be contacting their patients directly. Information regarding the discount will be available on the Health page on the A&M System Benefits Administration website, and in corresponding places on the plan rate sheets.

For any questions, employees and retirees are encouraged to speak with their provider, or reach out to our dedicated BCBSTX customer support team at 1-866-295-1212.

Musculoskeletal Pain: Here’s What You Can Do About It!

According to Healthline, musculoskeletal pain refers to pain in the muscles, bones, ligaments, tendons, and nerves. You can feel this pain in just one area of the body, such as your back. You can also have it throughout your body if you have a widespread condition like fibromyalgia.

The causes of musculoskeletal pain vary from damage to muscle tissue, trauma, overuse, and prolonged immobilization. Yes, that is correct, using your muscles too much and too little can both cause musculoskeletal pain!

Symptoms of musculoskeletal pain include pain and body aches, fatigue, and even sleep disturbances.

If you are suffering from musculoskeletal pain, the A&M System has several programs available to you. To use these programs, you must be enrolled in an A&M System medical plan and be an employee, retiree, or dependent. These programs are currently not available to graduate student employees enrolled in the Grad plan.

Airrosti – Now with Virtual Offerings!

Airrosti provides diagnosis and treatment for most common musculoskeletal and joint conditions, including pain in the neck, back, shoulders, hips, elbows, knees, and feet. Their published outcome data shows their treatment to be effective at helping resolve everything from headaches to plantar fasciitis. Their data also indicates that they are just as effective at solving chronic back pain as they are at resolving acute sports/athletic injuries like pulls and strains, as well as repetitive stress/wear and tear injuries like tendonitis, frozen shoulder, and carpal tunnel syndrome.

Check out Airrosti Remote Recovery for their digital solution at https://www.airrosti.com/remoterecovery/ or visit an Airrosti clinic in your area and present your BCBSTX insurance card. Employees and dependents enrolled in the A&M Care, 65 plus, and J plans are eligible to participate in Airrosti for a specialist copay. Retirees enrolled in a Medicare-primary plan can use the service for 20 percent coinsurance. Graduate student employees enrolled in the Grad plans may participate for a $35.00 copay.

2nd.MD – A Medical Second Opinion

Available to employees, retirees and their enrolled dependents on the A&M Care, 65 Plus and J plans, 2nd.MD offers medical second opinions and consultations with specialists via video or phone conference at no cost to you. If you are suffering from musculoskeletal pain and facing a possible surgery, or just have questions about chronic pain, 2nd.MD can help. You will get peace of mind and confidence in your treatment decisions when you speak directly with an expert in your specific diagnosis. A 2nd.MD doctor will take the time to evaluate your medical records, tests, and imaging to inform you of your treatment options. They can even connect you with a local doctor to start or continue your care.

Contact 2nd.MD by calling 1.866.841.2575​ or visit 2nd.md/tamus.

Hinge Health

If you experience chronic back, knee, hip, neck, or shoulder pain you might want to check out Hinge Health. This is a new, 12-week, coach-led digital musculoskeletal (MSK) program based on proven nonsurgical care guidelines. It is delivered remotely using mobile and wearable technology.

You will go through a clinical screening to determine eligibility. You can submit the screening questionnaire at https://hingehealth.com/tamus if you are interested in the program. Your eligible Blue Cross and Blue Shield insurance plan will cover the program cost if you are accepted!

Hinge Health is only available to A&M System employees, retirees, and their spouses enrolled in the A&M Care, 65 Plus, and J plans.

COVID-19 Updates and Extensions

The current extension of the Public Health Emergency (PHE) for COVID-19 is in effect until 04/20/2021. The following extensions apply to the A&M System medical insurance plans, COVID-19 testing and treatment.

Blue Cross and Blue Shield/A&M Care Plans

  • The co-payments, co-insurance, and deductibles for COVID-19 testing consistent with guidance issued by the Centers for Disease Control and Prevention (CDC) will be waived by the A&M System health plans until the end of the PHE.
  • The A&M System will waive all member deductibles, copays and coinsurance costs for treatment related to COVID-19 for all of the BCBS A&M Care Plans until 03/31/2021.
  • The copay has returned to normal cost for A&M Care plan members who receive telemedicine services from their network physicians who provide it, for medically-necessary, covered medical and behavioral health services.
  • The copay has returned to normal cost for MDLive services.

AHP/Graduate Student Employee Plan

  • The co-payments, co-insurance, and deductibles for COVID-19 testing consistent with guidance issued by the Centers for Disease Control and Prevention (CDC) will be waived by the AHP/Graduate Student Employee health plans until the end of the PHE.
  • The A&M System waiver for member deductibles, copays and coinsurance costs for treatment related to COVID-19 for all of the student insurance plans ended 12/31/2020.
  • The copay has returned to normal cost for those on the student insurance and graduate student employee plan who receive telemedicine services from their network physicians who provide it, for medically-necessary, covered medical and behavioral health services.
  • The copay has returned to normal cost for MDLive services.

Quick Reminders: 1095-C and Medicare Part D Out-of-Pocket Maximum

1095-C Reminder

Form 1095-C for the 2020 tax year is available electronically in Workday at https://sso.tamus.edu.  Once in Workday, click the Benefits Worklet. Select “My ACA Forms” in the View column. Please see our ACA Help page for more information. 

Medicare Part D Out-Of-Pocket Maximum

If you are enrolled in the A&M Care 65 Plus plan and the Medicare Part D Prescription Drug plan, your out-of-pocket maximum restarted on January 1, 2021. Please contact your Benefits Office if you have any questions.