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Health

The City of Fall River offers Health Insurance plans to employees, retirees, and surviving spouses through Blue Cross Blue Shield of Massachusetts.  Participants who wish to obtain more information on the plans can stop by Human Resources or view the summaries of benefits through the links provided below.

 

EFFECTIVE 8/1/2014

 

As a result of a process initiated and completed in accordance to M.G.L. c32B, §21-23 the City has negotiated changes to existing health insurance plans with the Public Employee Committee (PEC) and Blue Cross Blue Shield of Massachusetts (BCBSMA). 

 

The City and PEC reached an agreement to implement plan design changes with Blue BCBSMA instead of joining the Group Insurance Commission (GIC). These changes will yield a savings for both the employee and the employer. The following changes will begin on August 1, 2014:

 

  • The current Network Blue New England and Blue Choice of New England plans are being eliminated in favor of a new plan, HMO Blue New England Option v.4. Members currently enrolled in Network Blue and Blue Choice will automatically be transferred to the new HMO Blue New England Option v.4 plan, which includes a tiered provider network.

 

  • The Blue Care Elect plan is changing to the Blue Care Elect Deductible Plan and will only be available to employees and non-Medicare retirees and their survivors who reside outside of New England. Any members currently enrolled in Blue Care Elect will be grandfathered but have the option of enrolling in the lower cost HMO v.4 plan.

 

Advantages of the HMO Blue New England Options Deductible v.4 Plan:

 

  • Lower premiums than plan designs with a similar level of benefits (when using Enhanced Benefits Tier providers).
  • Ability for members to control out-of-pocket costs through provider choice.
  • A plan design that's easy to understand and use.

 

How does the HMO Blue New England Options Deductible v.4 Plan work?

 

Primary care providers (PCPs) and acute care hospitals in Massachusetts are grouped into three benefit levels or tiers based on how they scored on cost and quality benchmarks. When members get care, the amount they pay is based on which tier their provider is in.

 

  • Enhanced Benefits Tier--Includes Massachusetts hospitals and PCPs that meet the standards for quality and are low cost relative to the Blue Cross Benchmark.
  • Standard Benefits Tier--Includes Massachusetts hospitals and PCPs that meet the standards for quality and are moderate cost relative to the BCBS benchark and hospitals that do not meet the standards for quality but are low or moderate cost relative to the BCBS benchmark. Also includes providers without sufficient data for measurement on one or both benchmarks. To ensure members have provider access in certain geographic areas, the Standard Benefits Tier includes some providers whose scores would otherwise put them in the Basic Benefits Tier.
  • Basic Benefits Tier--Includes Massacusetts hospitals that are high cost relative to the BCBS benchmark and PCPs that do not meet the standards for quality or are high cost relative to the BCBS benchmark.

 

If members seek care at an out of state hospital the claims process at the Enhanced Tier with no Deductible (i.e. RI hospitals).

 

Please see the list of tiering levels for hospitals in Massachusetts for a better idea of how this might impact you.

 

Blue Cross Blue Shield of Massachusetts also offers our employee an array of benefits, such as the Blue Care Line, a 24/7 toll free telephone number which can be accessed by calling 1-888-247-BLUE (2583). A specially trained registered nurse is available to answer your health questions.  BC/BS also offers Weight Loss and Fitness Benefits.  For more information or to download forms, log on to www.bcbsma.com and click on the "My Wellbeing" tab.

 

For specific questions about your plan or any claims please call Blue Cross Member Services at 1-800-782-3675.

 

Please CLICK HERE for a breakdown of tiered prescriptions.

 

What do the tiers mean?

Tier 1: Generic Medication

Tier 2: Brand Name Medication

Tier 3: Specialty Medication

 

Both active plans are eligible for Fitness and Weight Loss Benefits. Please click the corresponding links for more information.

 

Fitness Benefit

Weight Loss Benefit

 

Medex is now Medex 2 with Blue Medicare RX (PDP)

 

Blue Medicare RX is administered by CVS Caremark for the New England Joint Enterprise that Blue Cross Blue Shield of Massachusetts co-manages under the Medicare Contract S2893 and is a prescription drug plan (PDP) that complies with the CMS Medicare rules and regulations for a PDP. Please click here for a list of covered medications.


Medex 2 with Medicare RX (PDP) is a Medicare supplement designed for retired employees age 65 or older (or retired employees that qualify for Medicare Part B before the attainment of age 65.

Frequently asked questions about Medicare and supplemental insurance.

 

Open Enrollment

 

A special enrollment period for health insurance only will take place from 6/1/14 through 6/20/14 for employees looking to switch from the Blue Care Elect Deductible Plan to the lower cost HMO Blue New England Option v.4 plan. To help you make this choice please take a look at this benefit comparison. Members currently enrolled in Network Blue and Blue Choice will automatically be transferred to the new HMO Blue New England Option v.4 plan. Employees only need to fill out an enrollment form if they want to switch from Blue Care Elect to the HMO New England Option v.4 plan or opt out and receive the opt-out incentive.

 

Additionally, enrollment in the FSA Plan is ongoing through 8/1/14.

 

Please feel free to contact the Human Resources department if you have any questions.

 
Other Resources

 

To find out how medical information about you may be used and disclosed and how you can get access to this information please review this Notice of Privacy Practices.

 

Take a look at this Overview of Health Insurance Marketplaces through the Massachusetts Health Connector along with some general information.