Important provider information on new wellness initiatives for federal employees under the Service Benefit Plan
Beginning Jan. 1, 2010, the Blue Cross and Blue Shield Service Benefit Plan began rewarding federal plan members when they complete either the adult Blue Health Assessment or a child’s body mass index (BMI) assessment. The intent of these programs is to encourage wellness and prevention and aim to remove barriers to care.
The member reward will be enhanced benefits. If an adult member completes the Blue Health Assessment (our Health Risk Assessment), the copayment for his/her subsequent annual physical examination or an individual preventive counseling visit will be waived. The member will receive a certificate that entitles them to a preventive visit at no charge and the member will be directed to present the certificate to the physician at the time of care. The member must complete the Blue Health Assessment and present a certificate of completion in order for the provider to waive the copayment for the visit.
The second incentive targets children who complete a BMI assessment. Once the BMI assessment is complete, the member will receive a certificate to present at the time of care. The copayments for up to four nutritional counseling visits will be waived. This incentive is limited to children ages 5 through 17 whose BMI falls in the 85th percentile or higher, according to standards established by the Centers for Disease Control and Prevention (CDC). Only those children who meet these requirements will be presented with a certificate. The member must complete the child BMI assessment and present a certificate of completion for the provider to waive the copayment for the visit.
The certificates for both programs will include the member’s name, contract ID number, effective date and expiration date. Following this article are copies of the certificates for your reference.
How does it affect my office?
The directions for providers can be found on the certificates, but we are also providing them here for your convenience.
- If a Service Benefit Plan member presents a certificate, please do not collect the copayment amount from the member at the time of the visit. The reimbursement from Blue Cross and BlueShield of Texas (BCBSTX) for these visits will include the payment of the copayment.
- If a member presents a certificate and an office visit copayment is collected in error for these types of visits, providers will be required to refund this amount to the member upon receiving payment from BCBSTX.
- To ensure correct reimbursement, the claim must be filed with the correct evaluation/management procedure code and diagnosis to reflect that the visit was primarily a routine/annual examination for adults, or the correct medical nutrition therapy/nutritional counseling codes and diagnosis to reflect that the visit was primarily a nutritional counseling visit for children.
- Providers may retain the certificate for their records; you need not submit it with the claim.
- The child certificate encompasses four visits, so providers are asked to sign and date the certificate when presented by the member in order for the member to track usage of visits.
- For questions about the certificate or the process, please contact BCBSTX.
Members will be told they do not have to pay copayments for these visits, so we want to ensure our members do not get charged copayment amounts for these visits. Please follow these important directions and do not charge a copayment when a member brings in a certificate. Reimbursement for this visit will be 100 percent of the plan allowance, including payment of the copayment amount.
What action do you need to take?
- Please ensure the entire office staff is aware of these programs and the process, especially those that normally collect member copayments and arrange appointments. If the patient is a Service Benefit Plan member, you may want to ask if they have a certificate to waive the copayment amount.
- Follow the directions on the certificate when a Service Benefit Plan member presents one to ensure a positive member experience with your office and the patient’s health coverage.
We hope these programs will encourage wellness and prevention. We appreciate your support of these programs that encourage good health practices for our Service Benefit Plan members.
About the BlueCross and BlueShield Service Benefit Plan
Local Blue Cross and Blue Shield Plans underwrite and administer the Blue Cross and Blue Shield Service Benefit Plan, the largest privately underwritten health insurance contract under the Federal Employee Health Benefits (FEHB) program. Sixty percent of all federal employees and retirees who receive their health care benefits through the government’s FEHB program are members of the Service Benefit Plan.