SelectBlue High Option

SelectBlue, a point-of-service plan from Highmark Blue Cross Blue Shield, gives members a choice every time they receive medical care. They can allow their Primary Care Physician (PCP) or Blues On Call^SM to "coordinate" their care and receive a higher level of benefits coverage…or they can choose to receive care from an out of network provider and receive benefits at a lower level. Each member chooses a PCP from the SelectBlue provider network. Because SelectBlue uses the largest managed care network in western Pennsylvania, it's very likely that the hospitals and physicians your employees use now are part of this network.

The Select Blue High Option Plan allows members to visit their PCP and pay a $10 Co-Pay. Generic prescription drugs purchased at a Premier Pharmacy Network cost the member a $10 Co-Pay. The Co-Pay for brand name drugs is $20. If a generic drug is available and the member or physician requests a brand name drug, the member is responsible for the $20 Co-Pay plus the difference in cost between the brand and generic drugs.

SelectBlue also includes these important features for maximum member convenience:

• Female members can receive gynecological or maternity care - at the higher level of benefits - from the network Ob/Gyn or nurse midwife of their choice, at any time, without a PCP referral.
• Mental health/substance abuse care is available at the higher level of benefits without a PCP referral. The member or PCP simply calls the Highmark Behavioral Health Unit for an evaluation to determine the type of care, therapy or counseling needed.
• Prior approval is not required for emergency care services.
• The Blues On Call^SM health decision support line is available to members 24 hours a day, seven days a week. Members can call this toll-free phone number to speak with a registered nurse for answers to health care questions, specialty referrals for coverage at the maximum level of benefits, and help making informed health care decisions.
• Prescription drugs are covered when received at any pharmacy in the Premier Gold III Pharmacy Network or through the convenient mail order service.

Good News for Highmark POS Members! Effective July 1, 2004 members will no longer need to get a referral from their Primary Care Physicians (PCPs) for their specialty care to be covered at the higher level of benefits. Instead, members can go directly to the network specialist of their choice! If members decide to receive care from an out-of-network provider, they will be covered for eligible services at the lower level of benefits coverage. Members will still need to select a primary care physician to provide certain routine care services, including adult routine physicals, pediatric routine physicals and pediatric immunizations. And in many cases it will still make sense for a PCP to coordinate care with a specialist. But in these cases members will not be required to obtain a referral.

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Care is considered coordinated (in-network) when it is performed or referred by your PCP, or referred through the Blues On Call^SM Health Information and Support Line. Exceptions apply for emergency room, Ob/Gyn, and mental health and substance abuse services. If you choose to obtain medical care through another provider, in most cases, this care will be considered self-referred care. Network specialists may continue to provide follow-up care and refer for diagnostic services for a 60-day time period. Below are specific benefit levels.

Wish to have a printable version of this benefit grid? A simple click will open a pdf version...SelectBlue High Option

The benefit summary outlines the principal features of the program. It should not be considered the contract of benefits and provisions. Please refer to your member handbook for a complete description of benefits or contact us for a further explanation.

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To locate a participating provider, please click on the link below.

• SelectBlue

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To determine premium rates, Highmark Blue Cross Blue Shield uses a demographic rating method based on the following factors: business location, the number of eligible employees enrolling, the average age of all covered employees, and industry classification. Please contact the Council's Employee Benefits Group to determine your specific rates.

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Highmark Blue Cross Blue Shield® is an independent licensee of the Blue Cross and Blue Shield Association serving businesses and residents in western Pennsylvania.

Highmark® is a registered service mark of Highmark Inc.

Blue Cross and Blue Shield® and the cross and shield symbols are registered service marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

Blues on Call^SM is a service mark of the Blue Cross and Blue Shield Association.

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This information is not intended for use without professional advice. While we have attempted to make this site as accurate as possible, it is only a summary. For more information, see our disclaimer.

Last updated on:  Tuesday, November 15, 2005  Page: 

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