2020 Benefit Updates

For Renewing Members

Renewing Medical Coverage

On Market plans purchased through the Federally- Facilitated Marketplace

Gold PPO 2150/10/20

  • Participating Provider annual deductible - $2,150 single/$4,300 family
  • Participating Provider annual maximum out of pocket limit - $8,150 single/$16,300 family
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - $45 copayment
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Silver PPO 6000/20/40

  • Participating Provider annual deductible - $6,000 single/$12,000 family
  • Participating Provider annual maximum out of pocket limit - $8,150 single/$16,300 family
  • PCP copayment - $40
  • Specialist copayment - $85
  • Urgent Care copayment - $100
  • Participating Provider coinsurance - 20%
  • 35% coinsurance after deductible for outpatient facility procedures for high tech imaging services
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - $85 copayment
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Silver PPO 6000/20/40 CSR73

  • Participating Provider annual deductible - $5,500 single/$11,000 family
  • Participating Provider annual maximum out of pocket limit - $6,500 single/$13,000 family
  • Participating Provider coinsurance - 15%
  • 25% coinsurance after deductible for outpatient facility procedures for high tech imaging services
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - $20 copayment
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Silver PPO 6000/20/40 CSR87

  • Participating Provider annual deductible - $1,500 single/$3,000 family
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - $10 copayment
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Silver PPO 6000/20/40 CSR94

  • Participating Provider annual deductible - $450 single/$900 family
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - $5 copayment
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Bronze PPO 8000/0/60

  • Participating Provider annual deductible - $8,000 single/$16,000 family
  • Participating Provider annual maximum out of pocket limit - $8,150 single/$16,300 family
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - $85 copayment
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Zero/Limited Plans

  • Coverage for biofeedback therapy for management of certain chronic pain conditions - Covered in full
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime.

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Off Market plans purchased directly through Capital BlueCross

Gold PPO 2150/10/20

  • Participating Provider annual deductible - $2,150 single/$4,300 family
  • Participating Provider annual maximum out of pocket limit - $8,150 single/$16,300 family
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - $45 copayment
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Silver PPO 5950/20/40

  • Participating Provider annual deductible - $5,950 single/$11,900 family
  • Participating Provider annual maximum out of pocket limit - $8,150 single/$16,300 family
  • PCP copayment - $40
  • Specialist copayment - $85
  • Urgent Care copayment - $100
  • Participating Provider coinsurance - 20%
  • 35% coinsurance after deductible for outpatient facility procedures for high tech imaging services
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - $85 copayment
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Silver PPO 6000/20/40

  • Participating Provider annual deductible - $6,000 single/$12,000 family
  • Participating Provider annual maximum out of pocket limit - $8,150 single/$16,300 family
  • PCP copayment - $40
  • Specialist copayment - $85
  • Urgent Care copayment - $100
  • Participating Provider coinsurance - 20%
  • 35% coinsurance after deductible for outpatient facility procedures for high tech imaging services
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - $85 copayment
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Bronze PPO 8000/0/60

  • Participating Provider annual deductible - $8,000 single/$16,000 family
  • Participating Provider annual maximum out of pocket limit - $8,150 single/$16,300 family
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - $85 copayment
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Bronze HMO 8000/0/60

  • Participating Provider annual deductible - $8,000 single/$16,000 family
  • Participating Provider annual maximum out of pocket limit - $8,150 single/$16,300 family
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - $85 copay
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Catastrophic PPO 8150/0/75

  • Participating Provider annual deductible - $8,150 single/$16,300 family
  • Participating Provider annual maximum out of pocket limit - $8,150 single/$16,300 family
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - no charge after deductible
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Catastrophic HMO 8150/0/75

  • Participating Provider annual deductible - $8,150 single/$16,300 family
  • Participating Provider annual maximum out of pocket limit - $8,150 single/$16,300 family
  • Coverage for biofeedback therapy for management of certain chronic pain conditions - no charge after deductible
  • Your prescription drug plan includes a new home delivery (mail order) pharmacy—AllianceRx Walgreens Prime

Visit the prescription drug benefits page to view the Value Formulary (list of drugs) and other important information for 2020.

Pharmacy Changes

Pharmacy changes can be found here.

Prescription Drug Updates

2019 Selectively Closed Formulary

Please read this document in its entirety as it provides important information about the list of prescription drugs in the Selectively Closed Formulary for 2019.
Each year we review and update the Selectively Closed Formulary1 (list of drugs). As a result of our most recent review, changes for January 1, 2019 will include expanding the list of drugs needing prior authorization,* modifying quantity level limits* for certain drugs, and adding or removing drugs. Affected members and providers will be notified of the changes before they go into effect. Please visit capbluecross.com for a full listing of the 2019 Selectively Closed Formulary and other information about the prescription drug benefit.

What is changing

Some of the drug classes that have changes in the 2019 formulary include:2

  • Opioids (such as oxycodone or tramadol)
  • Muscle Relaxants (such as cyclobenzaprine or carisoprodol)
  • Topical Corticosteroids (such as betamethasone or clobetasol)

2This list does not represent all drug classes or all changes on the Selectively Closed Formulary. Please see the Selectively Closed Formulary at capbluecross.com to see the full list of drugs.

What should you do

We recommend taking the time to carefully review the 2019 Selectively Closed Formulary located on capbluecross.com to see if any drugs you currently take were changed. If a change applies to you, please contact your provider to discuss your care. To get a printed version of the formulary, call the number on the back of your member ID card. If you have any questions, please call CVS/caremarkTM member services at 800.585.5794.

Definitions of key terms in this document1

Formulary: A list of the most commonly prescribed drugs by therapeutic class.

Prior Authorization: This process helps ensure that certain drugs are prescribed appropriately and in keeping with Food and Drug Administration (FDA) guidelines. In-network providers are responsible for requesting prior authorization on your behalf. Medications requiring prior authorization will not be covered if authorization is not obtained before dispensing.

Quantity Level Limits: For certain drugs, the amount of the drugs covered by your plan during a certain time period is limited. This is to help promote use of selected medications and enhance patient safety.

Enrollment

Open Enrollment Timeline

Applications for coverage effective January 1, 2020 must be submitted November 1 – December 15, 2019.

Applications received after December 15, 2019 will fall into the Special Enrollment Period and must have a qualifying event to enroll.

Ready to Enroll or Make a Change

You can apply for medical with Rx included, dental or vision plans if you live in our service area.

Visit our Individual and Family Plans to get started.

Enrollment Details

Current member

If you’re a current member and you would like to keep your current plan, you do not need to take any action. We will re-enroll you in your current plan.

On Marketplace members

Visit healthcare.gov to review your Marketplace application for any changes, including any changes to your financial help.

New Member

If you are a new member, you’ll receive a declaration page after you enroll. The page provides the effective date of coverage, covered members and expected premium amounts.

ID Cards

Current medical members and new members will receive new ID cards in mid to late December.

Current stand-alone dental and vision members will not receive a new ID card for 2020.

Billing

Invoices for January enrollment will be generated on December 10, 2019.

Estimated Subsidies in Renewal Package (On Marketplace Members Only)

Reminder that the declaration page in your renewal packet may show you a premium different than your bill for 2020.

These estimates were based on your 2019 Advanced Premium Tax Credit (APTC) instead of your 2020 APTC. Your final 2020 premium may be higher or lower than the amount estimated in your renewal packet.

To confirm that your tax and income information is correct, please visit Healthcare.gov. Review your Exchange application on the Federally Facilitated Marketplace (FFM) to make sure the information is still current and accurate and to see if you qualify for more of less financial help than in 2019. Report changes in your expected income, changes to your household or individual members or changes in your healthcare (Medicare or Medicaid eligible)

Or call us at the number on the back of your member ID card to confirm your monthly premium.

Payment Options

  • Credit Card/eCheck- Make payments by logging into your secure member account or by calling 833.496.7321. Select a single payment or setup recurring payment options.
  • Check it Out- Members will receive a notice when Check It Out is processed. Payment will be deducted from the selected account on the first day of each month.
  • Paper Bill- Invoices are mailed to the address on the enrollment application.
  • Bill Payer- Payments can be made through a financial institution’s bill payer program.

Visit the Welcome page for more information about your plan.