The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 • Reasonable and necessary expenses for lodging for the patient (while not hospitalized) and lodging only for one companion. Expenses are reimbursed at a per diem rate of up to $50 for one person or up to $100 for two people. • Travel and lodging expenses are available only if the patient resides more than 50 miles from the designated bariatric facility. • If the patient is a covered dependent minor child, the transportation expenses of two companions will be covered and lodging expenses will be reimbursed up to the $100 per diem rate. There is a combined overall lifetime maximum of $1,500 paid by the Program per covered person for all transportation and lodging expenses incurred by the patient and companion(s) and reimbursed under this Program in connection with the surgery. Note: The deductible must be met by members enrolled in the Early Retiree Medical option before these expenses can be reimbursed by the Program. Cardiac Care The Blue Distinction Centers for Cardiac Care ® is available for members 18 and older for health care options administered by BCBS. This national network includes facilities that have demonstrated their commitment to quality care, resulting in better overall outcomes for cardiac patients. Blue Distinction Centers for Cardiac Care ® provide a full range of cardiac care services, including inpatient cardiac care, cardiac rehabilitation, cardiac catheterization and cardiac surgery (including coronary artery bypass graft surgery).** You are not required to use facilities in the Blue Distinction Centers for Cardiac Care ® network regardless of whether it’s an emergency situation or not. Benefits for lodging and travel are not available when using these types of centers. You may view a listing of designated centers at www.bluecrossmn.com/usb. Once you locate a designated center, you need to confirm the designated center is participating in your applicable network. To do this, choose your applicable network from the drop down menu under “Network” and search for the designated center to make sure it displays. You may also get information by calling BCBS customer service (see the “Important Resources” section in this SPD). ** At the discretion of the local BCBS Plan and under a specified contingency process, a facility that provides the full range of cardiac services but does not provide on-site coronary artery bypass graft (CABG) surgery may be considered for Blue Distinction designation if it is part of a cooperative system with a qualifying facility that provides emergency backup CABG for percutaneous coronary intervention (PCI) and meets contingency criteria. Blue Distinction Centers for Cardiac Care without on-site CABG will be differentiated from full-service Blue Distinction Centers for Cardiac Care in program listings. Complex and Rare Cancers The Blue Distinction Centers for Complex and Rare Cancers® is available to members 18 and older for health care options administered by BCBS. This national network includes facilities that were evaluated on patient assessment, treatment planning, complex inpatient care and major surgical treatments for adults; all delivered by teams with distinguished expertise and subspecialty training for complex and rare cancers. The program focuses on the following 13 cancers: • Bladder cancer 84
Retiree Health Care SPD Effective January 1, 2012 • Brain cancer – primary • Esophageal cancer • Gastric cancer • Liver cancer – primary • Pancreatic cancer • Rectal cancer • Acute leukemia (inpatient, non-surgical) • Bone cancer – primary • Head and neck cancers • Ocular melanoma • Soft tissue sarcoma • Thyroid cancer – medullary or anaplastic You are not required to use facilities in the Blue Distinction Centers for Complex and Rare Cancers ® network. Benefits for lodging, and travel are not available when using these types of centers. You may view a listing of designated centers at www.bluecrossmn.com/usb. Once you locate a designated center, you need to confirm the designated center is participating in your applicable network. To do this, choose your applicable network from the drop down menu under “Network” and search for the designated center to make sure it displays. You may also get information by calling BCBS customer service (see the “Important Resources” section of this SPD). Emergency Care Before the need arises, be prepared for the possibility of an emergency. • Find out about your doctor’s or clinic’s procedures for care needed after regular clinic hours. • Write down the telephone numbers of the clinic’s after-hours service and the nearest hospital. Your phone book should also list telephone numbers to call in case of an emergency. Keep this information in an accessible location in case an emergency arises. • Share this information and the BCBS phone number on your ID card with family members so they can call if you are unable to do so. • In the event of an emergency — you should go to the nearest emergency facility, even if it is an out-of-network or a non-participating facility. • Remember, you or a covered family member must call BCBS within 48 hours of hospitalization due to an emergency. Follow-up care for emergency services (for example, suture removal) is a non-emergency service and must be provided by a PPO provider (for the Early Retiree Medical option), or a BCBS "participating provider" (for the Comprehensive option) in order to be covered at the highest level. Knee and Hip Replacements In order to receive the highest level of benefits, use of a Blue Distinction Center for Knee and Hip Replacements SM is required for members age 18 and older for Health Care plans administered by BCBS. This national network includes facilities that demonstrate an expertise in quality care, resulting in better overall outcomes for patients, by meeting objective clinical 85
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The eligibility and enrollment rules for the U

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