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HomeMy WebLinkAboutResolution - 2010-R0326 - Early Retiree Reinsurance Program Application - 07/22/2010Resolution No. 2010-RO326 July 22, 2010 Item No. 5.3 RESOLUTION :BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the City Council of the City of Lubbock does hereby designate City Tanager Lee Ann Dumbauld, or her duly authorized designee, as the City's Authorized Representative in all things connected with the United States Department of Health and Human Services' Early Retiree Reinsurance Program, and does further acknowledge and ratify the "Early Retiree Reinsurance Program Application" and all related documents igned on behalf of the City of Lubbock by City Manager Lee Ann Dumbauld, as the ,Authorized Representative of the City. A true and correct copy of said "Early Retiree einsurance Program Application" is attached hereto and incorporated in this resolution s if fully set forth herein and shall be included in the minutes of the City Council. by the City Council on July 22, 2010 TOM MARTIN, MAYOR TTEST: Secretary ';APPROVED AS TO CONTENT: eisa Hutcheson, Human Resources Director ♦ "nn /1X rTTI A (1 'T/l Tnn w T. �CG - Q: CCDOCS RES Early Retiree Reinsurance Program Application 7.22 2010. doe Resolution No. 2010-RO326 OMB Approval 0938-1087 ERRP Early Retiree Reinsurance Program Application S��vrC�s U.S. Department of Health and Human Services According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1087. The time required to complete this information collection for this application is estimated to average 35 hours, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the Information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. HHS Form # CMS -10321 OMB Approval 0938-1087 Please note that if any information in this Application changes or if the sponsor discovers that any information is incorrect, the sponsor is required to promptly report the change or inaccuracy. Send, using the U.S. Postal Servicea hardcopy of the signed original ERRP Application (i.e. not a photocopy) and Attachments (if any) to: HHS ERRP Application Center 4700 Corridor Place Suite D Beltsville, MD 20705 HHS Form #CMS -10321 J( Page 2 OMB Approval 0938-1087 An asterisk * identifies a required field. PART I: Plan Sponsor and Key Personnel Information 1) *Organization's Name (Must correspond with the information associated with the Federal Employer Tax Identification Number (EIN): City of Lubbock 2) *Type of Organization (Check the one category that best describes your organization): M Government Q Union ❑ Religious ❑ Commercial ❑ Non-profit 3) *Organization's Employer Identification Number (EIN): 75 _600059 4) *Organization's Telephone Number: 806-775-3000 ext, 5) Organization's FAX Number: 806.775.3965 ext. 6) *Organization's Address (must be the address associated with the EIN provided above): * Street Line 1: 1625 13th Street Street Line 2: *City: Lubbock *State: Texas *Zip Code: 79401 7) Organization's Website Address: www.ci.lubbock.tx.us B. Authorized Representative Information 1) *First Name: Lee Middle Initial: A *Last Name: Dumbauld 2) *Job Title: City Manager 3) Date of Birth: Do not respond to this item now. To comply with the Application Instructions, you must provide this at a later date if and when the application is approved. 4) Social Security Number: Do not respond to this item now. To comply with the Application Instructions, you must provide this at a later date if and when the application is approved. 5) *Email Address: Idumbauld 6) *Telephone Number: 806.775.2016 ext 7) FAX Number: 806.775.3965 ext, 8) *Employer Name: City of Lubbock HHS Form #CMS -10321 K ryfLl.l'i.l Page 3 9) * Authorized Representative Business Address: * Street Line 1: 1625 13th Street Street Line 2: *City: Lubbock *State: Texas *Zip Code: 79401 C. Account Manager Information 1) *First Name: Terri *Last Name: Smith 2) *Job Title: Benefits/Wellness Coordinator OMB Approval 0938-1087 Middle Initial: L 3) Date of Birth: Do not respond to this item now. To comply with the Application Instructions, you must provide this at a later date if and when the application is approved. 4) Social Security Number: Do not respond to this item now. To comply with the Application Instructions, you must provide this at a later date if and when the application is approved. 5) *Email Address: tlsmith@mylubbock.us 6) *Telephone Number: 806-775-2317 ext, 7) FAX Number: 806-776-3965 ext. 8) *Employer Name: City of Lubbock 9) *Account Manager Business Address: * Street Line 1: 1625 13th Street Street Line 2: *City: Lubbock *State: Texas *Zip Code: 79401 v / HHS Form #CMS -10321 Page 4 OMB Approval 0938-1087 PART II: Plan Information A. Plan Information 1) *Plan Name: City of Lubbock Employee Benefit Plan 2) *Plan Year Cycle: Start Month/Day: 01 / 01 End Month/Day: 12 / 31 B. Benefit Option(s) Provided Under This Plan (If the plan has more than one benefit option for which you intend to seek program reimbursement, please include the information below for each benefit option, on a separate copy of the Attachment below.) 1a) *Benefit Option Name: Pre 65 Retirees Medical 1b) *Unique Benefit Option Identifier: 010097 1c) *Benefit Option Type: Self -Funded❑✓ Insured ❑ Both ❑ 1d) *Benefit Administrator Company Name: Blue Cross Blue Shield of Texas T, t/ ^i 1HHS Form #CMS -10321 .t Page 5 OMB Approval 0938-1087 C. *Programs and Procedures for Chronic and High -Cost Conditions A sponsor cannot participate in the Early Retiree Reinsurance Program unless, as of the date of its application for the program is submitted, its employment -based plan has in place programs and procedures that have generated or have the potential to generate cost savings with respect to plan participants with chronic and high cost conditions. The program regulations define "chronic and high cost condition" as a condition for which $15,000 or more in health benefit claims are likely to be incurred during a plan year by one plan participant. Please identify the chronic and high cost conditions for which the employment -based plan has such programs and procedures in place, and summarize those programs and procedures, including how it was determined that the identified conditions satisfy the $15,000 threshold. If necessary to provide a complete response, the sponsor may submit additional pages as an attachment to the application. Please reference such attachment in this space. Our group health plan has several different programs and procedures currently in place to generate cost - savings with respect to participants with chronic and high-cost conditions that have been identified as likely to result in $15,000 or more in health benefit claims by a plan participant during a plan year. We work through Blue Cross Blue Shield of Texas to administer these cost -savings programs. Through this agreement, participants have the opportunity to access the Blue Care Connection suite of programs that are focused on a range of high-cost and chronic conditions designed to reduce related claims costs. Blue Care connection provides patient -focused services to help members improve their health care outcomes and manage their health care costs. BCBSTX has identified specific conditions, actual claims costs and predictive modeling across claims experience for their entire book of business, claims incurred and paid for pharmacy, lab, medical and hospital services as well as other ad hoc data to identify conditions that have a higher likelihood of resulting in claims in excess of $15,000 for any one of our plan participants. On the basis of the predictive modeling, separate programs and procedures are in place to address specific types of chronic and high-cost conditions including: 1. The Blue Care Connection Case Management Program, which focuses on rare and high impact conditions, such as end of life, catastrophic care, HIV/HCV, oncology, auto -immune disorders, transplants and other high- cost conditions. 2. This program, which focuses on five potentially high-cost conditions are are identified in medical literature as being the most prevalent chronic conditions that are potentially controllable and that if not well-managed, will result in increased claims costs. The conditions are: asthma; diabetes; coronary artery disease; congestive heart failure; chronic obstructive pulmonary disease. We have attached additional information from Blue Cross Blue Shield of Texas. The City of Lubbock and BCBS work in partnership to educate our members regarding the above referenced and the attached. In addition to working with BCBSTX, the City of Lubbock provides its active employees and retirees access to a free clinic. The City of Lubbock pays a monthly fee to a local physician's group and allows covered employees and their covered dependents to utilize the clinic without having a co -pay due. We feel this encourages active employees and retirees and their dependents to see a physician before a condition becomes chronic or high -costs. However, many of our employee/retirees with chronic conditions utilize the physicians at the clinic as their primary care doctors. The clinic offers wellness services as well as HRAs (Health Risk Assessment) and the City pays for the cost of the HRA. January 1, 2008, the City of Lubbock reduced our generic co -pay to $5.00 for a 30 day supply and $12.50 for a 90 day supply. This reduction in the generic co -pay has allowed our employees/retirees the ability to continue taking medications for chronic conditions rather than go without. Also at this time, the City began paying for prescription smoking cessation products. xC I"" Page 6 HHS Form #CMS -10321 = J Y �I• ''IfLI'.I:HI OMB Approval 0938-1087 PART II: Plan Information A. Plan Information 1) *Plan Name: City of Lubbock Employee Benefit Plan 2) *Plan Year Cycle: Start Month/Day: 01 / 01 End Month/Day: 12 / 31 B. Benefit Option(s) Provided Under This Plan (If the plan has more than one benefit option for which you intend to seek program reimbursement, please include the information below for each benefit option, on a separate copy of the Attachment below.) 1a) *Benefit Option Name: Pre 65 Retirees RX 1b) *Unique Benefit Option Identifier: 3010 1c) *Benefit Option Type: Self-Funded[Z] Insured ❑ Both ❑ 1d) *Benefit Administrator Company Name: MaxorPlus 1, i` / HHS Form #CMS -10321 ply 'Ilyl.l.l.l Page 5 OMB Approval 0938-1087 D. *Estimated Amount of Early Retiree Reinsurance Program Reimbursements Please estimate the projected amount of proceeds you expect to receive under the Early Retiree Reinsurance Program for the plan identified in this application, for each of the first two plan year cycles identified in this application. If you wish, you may provide a range of expected program proceeds that includes: (1) a low-end estimate of expected program proceeds, (2) an estimate that represents your most likely amount of program proceeds, and (3) a high-end estimate of expected program proceeds. For purposes of this estimate only, please assume for each of those plan year cycles that there will be sufficient program funds to cover all claims submitted by the Plan Sponsor that comply with program requirements. If necessary to provide a complete response, the sponsor may submit additional pages as an attachment to the application. Please reference such attachment in this space. Since Medical and RX will be combined, our estimates are based on combined claims. 0-$696,200 1 -$1,008,900 2 - $1,085,600 r�r HHS Form #CMS -10321 1 'r'fy�A:NI Page 7 OMB Approval 0938-1087 E. *Intended Use of Early Retiree Reinsurance Program Reimbursements 1) Please summarize how your organization will use the reimbursement under the Early Retiree Reinsurance Program to reduce health benefit or health benefit premium costs for the sponsor of the employment -based plan (i.e., to offset increases in such costs); or reduce, or offset increases in, premium contributions, copayments, deductibles, coinsurance, or other out-of-pocket costs (or combination of these) for plan participants; or reduce a combination of any of these costs (whether offsetting increases in sponsor costs or reducing, or offsetting increases in, plan participants' costs). If necessary to provide a complete response, the sponsor may submit additional pages as an attachment to the application. Please reference such attachment in this space. The City of Lubbock will utilize the reimbursement to continue to pay for the clinic, HRAs and any additional associated costs to continue to provide this free service to all employees, retirees and their dependents. Additionally, we anticipate waiving the office co -pay if an employee, retiree or dependent is referred to a specialist by the clinic. Wellness: No deductible for colonoscopy co -pays for diabetes related prescriptions, specifically, test strips reimbursement will help offset anticipated increase in claims by dependents covered to age 26. It will allow City to keep plan costs low and not pass along to participants. Page 8 HHS Form #CMS -10321 - OMB Approval 0938-1087 E. *Intended Use of Early Retiree Reinsurance Program Reimbursements (continued) 2) If a sponsor decides to apply the reimbursement for its own use, it may only use the reimbursement to offset increases in its health benefit premium costs, if an insured plan, or its health benefit costs, if it is self-funded. If any amount of the reimbursement is used to offset increases in health benefit premium or health benefit costs of your organization (as opposed to offsetting increases to, or reducing, plan participants' costs), please summarize how program funds, as a result of being used by your organization for such purposes, will relieve your organization of using its own funds to subsidize such increases, thereby allowing your organization to instead use its own funds to maintain its level of financial contribution to the employment -based plan. (in other words, please explain how your organization will continue to maintain the level of support for this plan, and if it applies the reimbursement for its own use, will use the program reimbursement to pay for increases in health benefit premium costs or health benefit costs, as applicable). if necessary to provide a complete response, the sponsor may submit additional pages as an attachment to the application. Please reference such attachment in this space. Help offset increased plan costs by eliminating limits which in turn would normally fall back on plan participants. v HHS Form #CMS -10321 ^�LI.I 1.1 Page 9 OMB Approval 0938-1087 PART III: Banking Information for Electronic Funds Transfer I 1) *Bank Name: Wells Fargo, N.A. 2) *Bank Address: * Street Line 1: Street Line 2: _ *City: Lubbock *State: Texas *Zip Code: 7940 1500 Broadway 3) *Account Number: 4000047951 4) *Name of Organization Associated with Account: City of Lubbock Master Account 5) *Account type: (Checking or Savings Account) Checking 6) *Bank Routing Number: 121000248 7) *Bank Contact Name: *First Name: Raine *Last Name: Young 8) *Email address: raine.l.young@wellsfargo.com 9) *Telephone Number: 806.767.7473 ext HHS Form #CMS -10321 z 1 1% Middle Initial: L Page 10 OMB Approval 0938-1087 PART IV. Plan Sponsor Agreement 1. Compliance: In order to receive program reimbursement(s), Plan Sponsor agrees to comply with all of the terms and conditions of Section 1102 of the Patient Protection Act (P.L. 111-148) and 45 C.F.R .Part 149 and in other guidance issued by the Secretary of the U.S. Department of Health & Human Services (the Secretary), including, but not limited to, the conditions for submission of data for obtaining reimbursement and the record retention requirements. 2. Reimbursement -Related and Other Representations Made by Designees: Plan Sponsor may be given the opportunity to identify one or more Designees (i.e., individuals the Sponsor will authorize to perform certain functions on behalf of the Sponsor related to the Early Retiree Reinsurance Program, such as individual(s) who will be involved in making program reimbursement requests). Plan Sponsor certifies that all individuals that will be identified as Designees will have first been given authority by the Plan Sponsor to perform those respective functions on behalf of the Plan Sponsor. Plan Sponsor understands that it is bound by any representations such individuals make with respect to the Sponsor's involvement in the Early Retiree Reinsurance Program, including but not limited to the Sponsor's reimbursement under, the program. 3. Written Agreement: Plan Sponsor certifies that, prior to submitting a Reimbursement Request, it has executed a written agreement with its health insurance issuer or employment -based plan regarding disclosure of information, data, documents, and records to HHS, and the issuer or plan agrees to disclose to HHS, on behalf of the Plan Sponsor, at a time and in a manner specified by the HHS Secretary in guidance, the information, data, documents, and records necessary for the Plan Sponsor to comply with the requirements of the Early Retiree Reinsurance Program, as specified in 45 C.F.R. 149.35. 4. Use of Records: Plan Sponsor understands and agrees that the Secretary may use data and information collected under the Early Retiree Reinsurance Program only for the purposes of, and to the extent necessary in, carrying out Section 1102 of the Patient Protection Act (P.L.111-148) and 45 C.F.R. Part 149 including, but not limited to, determining reimbursements and reimbursement - related oversight and program integrity activities, or as otherwise allowed by law. Nothing in this section limits the U.S. Department of Health & Human Services' Office of the Inspector General's authority to fulfill the Inspector General's responsibilities in accordance with applicable Federal law. 5. Obtaining Federal Funds: Plan Sponsor acknowledges that the information furnished in its Plan Sponsor application is being provided to obtain Federal funds. Plan Sponsor certifies that it requires all subcontractors, including plan administrators, to acknowledge that information provided in connection with a subcontract is used for purposes of obtaining Federal funds. Plan Sponsor acknowledges that reimbursement of program funds is conditioned on the submission of accurate information. Plan Sponsor agrees that it will not knowingly present or cause to be presented a false or fraudulent claim. Plan Sponsor acknowledges that any excess reimbursement made to the Plan Sponsor under the Early Retiree Reinsurance Program, or any debt that arises from such excess reimbursement, may be recovered by the Secretary. Plan Sponsor will promptly update any changes to the information submitted in its Plan Sponsor application. If Plan Sponsor becomes aware that information in this application is not (or is no longer) true, accurate and mal M\'l1Y\. i T\ ! 1! w HHS Form #CMS -10321 =K �1. w!'1y1:[III Page 11 OMB Approval 0938-1087 Page 12 HHS Form #CMS -10321 a Y complete, Plan Sponsor agrees to notify the Secretary promptly of this fact. 6. Data Security: Plan Sponsor agrees to establish and implement proper safeguards against unauthorized use and disclosure of the data exchanged under this Plan Sponsor application. Plan Sponsor recognizes that the use and disclosure of protected health information (PHI) is governed by the Health Insurance Portability and Accountability Act (HIPAA) and accompanying regulations. Plan Sponsor certifies that its employment -based plan(s) has established and implemented appropriate safeguards in compliance with 45 C.F.R. Parts 160 and 164 (H1PAA administrative simplification, privacy and security rule) in order to prevent unauthorized use or disclosure of such information. Sponsor also agrees that if it participates in the administration of the plan(s), then it has also established and implemented appropriate safeguards in regard to PHI. Any and all Plan Sponsor personnel interacting with PHI shall be advised of: (1) the confidential nature of the information; (2) safeguards required to protect the information; and (3) the administrative, civil and criminal penalties for noncompliance contained in applicable Federal laws. 7. Depository Information: Plan Sponsor hereby authorizes the Secretary to initiate reimbursement, credit entries and other adjustments, including offsets and requests for reimbursement, in accordance with the provisions of Section 1102 of the Patient Protection Act (P.L. 111-148) and 45 C.F.R Part 149 and applicable provisions of 45 C.F.R. Part 30, to the account at the financial institution (hereinafter the "Depository") indicated under the Electronic Funds Transfer (EFT) section of the Plan Sponsor application. Plan Sponsor agrees to immediately pay back any excess reimbursement or debt upon notification from the Secretary of the excess reimbursement or debt. Plan Sponsor agrees to promptly update any changes in its Depository information. 8. Policies and Procedures to Detect Fraud, Waste and Abuse. The Plan Sponsor attests that, as of the date this Application is submitted, has in place policies and procedures to detect and reduce fraud, waste, and abuse related to the Early Retiree Reinsurance Program. The Plan Sponsor will produce the policies and procedures, and necessary information, records and data, upon request by the Secretary, to substantiate existence of the policies and procedures and their effectiveness, as specified in 45 C.F.R. Part 149. 9. Change of Ownership: The Plan Sponsor shall provide written notice to the Secretary at least 60 days prior to a change in ownership, as defined in 45 C.F.R, 149.700. When a change of ownership results in a transfer of the liability for health benefits costs, this Plan Sponsor Agreement is automatically assigned to the new owner, who shall be subject to the terms and conditions of this Plan Sponsor Agreement. Signature of Plan Sponsor Authorized Representative 1, the undersigned Authorized Representative of Plan Sponsor, declare that I have legal authority to sign and bind the Plan Sponsor to the terms of this Plan Sponsor Agreement, and I have or will provide evidence of such authority. l declare that I have examined this Plan Sponsor Application and Plan Sponsor Agreement. My signature legally and financially binds the Plan Sponsor to the statutes, regulations, and other guidance applicable to the Early Retiree Reinsurance Program including, but not limited to Section 1102 of the Patient Protection Act (P.L.111-148) and 45 C.F.R. Part 149 and applicable provisions of 45 C.F.R. Part 30 and all other applicable statutes and regulations. l certify that the information contained in this Plan Sponsor Application and Plan Sponsor Agreement is true, accurate and complete to the best of my knowledge and belief, and I authorize the Secretary to verify this information. I understand that, because program Page 12 HHS Form #CMS -10321 a Y OMB Approval 0938-1087 reimbursement will be made from Federal funds, any false statements, documents, or concealment of a material fact is subject to prosecution under applicable Federal and/or State law. *Signature: v� APPROW,D AS TO CONTENT: c 1/ l Q;e:isa utcheson, Human Resources Director Page 13 HHS Form #CMS -10321 ;! J s, OMB Approval 0938-1087 Attachment: Additional Benefit Options (Complete this form for each unique benefit option not already specified above in Part II.B) 1a) *Benefit Option Name: City of Lubbock Employee Benefit Plan 1b) *Unique Benefit Option Identifier: 3010 lc) *Benefit Option Type: Self -Funded✓© Insured F—] Both O 1d) *Benefit Administrator Company Name: MaxorPlus Page 14 HHS Form #CMS -10321 'IJy1.1:1.1 Resolution No. 2010-R0326 V 9 BlueCross BlueShield of Texas Below are the average costs for an inpatient admission and ER visit for members with different combinations of these conditions based on a study of projected claims costs for 2010. Asthma Chronic Obstructive Pulmonary $141208 $1256 Disease(COPD) $19,620 $1,638 Congestive Heart Failure (CHF) $22,855 $11868 CoronaryArtery Disease (CAD) $23,126 $2,178 Diabetes $18,042 $1,604 Diabetes and CAD $23,610 $2,077 Asthma and Diabetes $16,762 $1,557 CAD or COPD and one more Chronic Condition (excl CAD & Diabetes)___$24,403 $1,876 CHF and Diabetes or Asthma $23,582 $1,753 AEy 3 Chronic Conditions $23,940 $1,921 Any 4 Chronic Conditions $26,088 $2,011 In addition, the same claims history and predictive modeling processes are used to identify other, pre -cursor conditions and co -morbidities that pose high risks for future chronic conditions and high claims costs in excess of $15,000. These include obesity and other lifestyle issues. Further, additional policies and procedures are in place to identify specific participants with high- cost or potentially high cost conditions that should be addressed under one of the available programs. These procedures identify participants both real-time, pre -claim, at the time of authorization for services (e.g., hospital admissions) and at the time of actual claims payment (for individual high -dollar claims, currently defined as $50,000 or more). Also, other potentially high-risk and/or high-cost participants are added to these programs as the result of outreach efforts such as personal health risk assessment and health management tools, data -mining, and physician education. Many chronic diseases are preventable and capable of being controlled if they are properly identified and managed. Below are preventive aspects of the Blue Care Connection program that may help members maintain overall health, manage chronic conditions and potentially reduce the need for high-cost care. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association GNU 131ueCross BlueShield of Texas Health Counseling Blue Care Connection offers participant health counseling for weight management, smoking cessation and metabolic syndrome lifestyle management programs, all of which are chronic conditions that, without intervention and lifestyle changes, will result in high claims costs. Members may register for the online program and/or the member -centric telephonic outreach program. Care and Condition Management Members with chronic conditions are identified through our predictive model search engine, which pulls pharmacy, labs, claims, utilization and other ad hoc data to identify m embers with high -dollar claims costs or chronic conditions. The predictive model search engine can also identify those members with high risk for future chronic conditions and high cl aims costs. These members also have the opportunity to participate in condition -specific health improvement measures that include prevention and patient education through m ultiple forms of outreach and activities. This approach identifies gaps in care and establishes lifestyle improvement goals. Chronic and high-cost conditions managed through this program include asthma, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, diabetes and other co -morbidities including, but not limited to depression, gastroesophageal reflux disease, hypertension, low back pain and migraine headaches. These members may be identified and outreached to by a licensed nurse or they may self enroll as well. Episodic and High -Risk Care/Utilization and Case Management Utilization review/case and medical management services identify and help high-risk members cope with complex care or catastrophic health events. This integrated approach identifies members requiring case management services and maximizes the benefits of these in-depth programs, which ensures care follow through, decreased emergency room utilization and avoidance of hospital readmissions Complex case management triggers may include: • A catastrophic event, such as traumatic brain injury; spinal cord injury, major burns, a need for long-term intensive rehabilitation, high-risk obstetrical/neonate care, transplant and/or related services • Typically any single claim greater than $50,000 per month and/or monthly claims reports identifying high-cost members based upon cumulative claims • Admission to long-term acute (transitional/sub-acute) care (LTAC) facilities • Air/ground ambulance transport of more than 50 miles • Private duty nursing services and/or extra -contractual agreements, requiring complex negotiations Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association ►,e V BlueCross 13lueShield of Texas • Inpatient rehabilitation not coordinated by utilization management • Social service intervention • Inpatient and/or outpatient pain control programs • Complex discharge planning and/or chronic condition needs Special Beginnings® Blue Care Connection provides a maternity program designed to help new mothers and their babies get off to a healthy start. Special Beginnings provides participants with education and support, pregnancy risk factor identification and ongoing communications and monitoring from early pregnancy to six weeks after delivery. Upon enrollment in Special Beginnings, participants receive The Simple Guide to Having a Baby. This book includes comprehensive information on a multitude of pregnancy and infant care related topics. In addition, participants have the opportunity to discuss their concerns and questions with an OB nurse between physician appointments. As part of the Special Beginnings program, expectant mothers receive follow-up throughout their pregnancy to: • Identify any risk factors that might adversely affect pregnancy • Determine progress in self-management techniques • Provide education on prenatal, postpartum and newborn care • Reinforce physician's treatment plan • Help manage high-risk conditions • Offer assistance on how to access other pregnancy -related resources Wellness and Prevention Blue Care Connection offers online interactive tools, services and programs to members that support healthy practices and outcomes through risk -reduction opportunities and improved self care. Many of these interactive tools, such as the online health risk assessment, can be tied to incentive programs (i.e., BluePointssm) to encourage members to participate in healthy activities. Available programs include: • Personal Health Manager Members who register with Blue Cross and Blue Shield of Texas' secure online website, Blue Access for Members, have access to the Personal Health Manager, an online resource and information tool that helps manage members health. In the Personal Health Manager, members and covered dependents can: • Set up a personal health record to track and manage health and communicate with physicians • Get answers to questions from experts through Ask a Nurse, Ask a Trainer, Ask a Dietitian and Ask a Life Coach Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association WV BlueCross BlueShield of Texas • Complete the Health Risk Assessment, research symptoms, investigate treatment options or prescription drugs and their side effects, learn about nutritious meal planning, as well as create and track fitness workouts while earning rewards • Participate in an online weight m anagement or tobacco cessation program • Access online content such as health and medication information, wellness tracking tools, videos and interactive tutorials • Receive wellness, condition -specific information and alerts for screening tests via secure messaging, as well as set up reminders for medical appointments and medication refills • Weight Management and Tobacco Cessation Blue Care Connection offers lifestyle management programs to covered members that can help participants lose weight or discontinue the use of tobacco. The program includes personalized telephone coaches who wil I work with members in setting goals and determining the best approach for to achieve success. In addition, for those who prefer a self -paced online program, members can use the Personal Health Manager to set goals, track your success, and get helpful hints. • 24/7 Nurseline Registered nurses offer health information by telephone, day or night, in English or Spanish. An audio library of health topics is also available. An important part of the program includes nurse guidance and support, which may include directing members to the appropriate level of care (i.e., emergency versus non -emergency care) that ultimately results in cost savings to the group health plan. The Nurseline also has a navigation and referral service that can explicitly screen for and refer members who would benefit from additional condition management and/or care management programs within the Blue Care Connection program. Upon identifying appropriate candidates, the Nurseline program can facilitate service referrals through an online system integrated with condition management and care management departments. • BlueExtras- Discounts on Health Related Products and Services Through the B IueExtras program, members can save money on health-related products and services that help support healthy lifestyles. Discount programs include eyewea r, hearing aids, complementary alternative medicine services and products, and most recently a Fitness Program. In 2010, Blue Care Connection began offering a national fitness network to promote and encourage wellness for members. This program offers a single health club membership card providing access to all facilities within the network at any time. Members pay a Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association OV BlueCross BlueShield of'rexas nominal membership fee to belong to the network. Health club visits are tracked via a dedicated swipe box. Members may earn Blue Points incentives for each visit. The focus on fitness is aimed at reducing high- cost claims and chronic conditions, such as weight management and diabetes that can be reversed or help remain stable. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association