Well-Child Care

Benefits currently provided under High Option for Children will be included in well-child care coverage starting January 1, 2007. There will be no additional premium for this coverage. Effective January 1, 2007, premiums will be reduced for those enrollees currently paying the additional premium for High Option. This expanded benefit will provide 100% coverage for well-newborn nursery care while the newborn is hospital-confined after birth. Well-newborn nursery care includes room, board, and other normal care provided for which a participating hospital or physician makes a charge.

Well-child physician office visits and certain diagnostic tests will also be covered at 100%. A list of the covered wellness/preventive services can be found at the Plan's web site, http://knowyourbenefits.dfa.state.ms.us or you can call BCBSMS at 1-800-709-7881 to request a copy.

Immunications are covered at 80%.

Please remember that these benefits will only be provided if a provider participating in the AHS State Network renders the services. All services provided under well-child care will be subject to the calendar year deductible.

Adult Wellness/Preventive Services

In 2007, the Plan will continue to provide first-dollar coverage up to $250 for certain adult wellness/preventive services. As an added benefit, it a participant over the age of 18 completes a Health Risk Assessment (HRA), he will be eligible for an additional $50 to be applied toward the cost of any wellness/preventive services. For more information regarding the HRA, see Motivating Mississippi Keys to Living Healthy.

The Plan will pay 100% of the allowable charge, up to the $250 maximum ($300 for those eligible participants that complete an HRA) for office visits and certain diagnostic tests. These services will not apply to the calendar year deductible. These benefits will only be provided when a provider participating in the AHS State Network renders services. Please remember that any unused benefit amounts do not carry over to the next year.

A list of the covered wellness/preventive tests can be found at the Plan's web site, http://knowyourbenefits.dfa.state.ms.us, or you can call BCBSMS at 1-800-709-7881 to request a copy.

Base Coverage

For Base Coverage to continue to qualify as a high deductible health plan under federal tax regulations, the calendar year deductibles will be as follows:

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Select Coverage

There will be no changes in deductibles for Select Coverage for 2007.

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Prescription Drug Program

Effective January 1, 2007, there will be changes to the co-payment amounts you pay for prescription drugs. Participants with Select Coverage must continue to satisfy a $50 prescription drug deductible before receiving benefits under the program. Participants with Base Coverage must satisfy the applicable deductible (medical and/or prescription drug) before receiving benefits under the program.

The following chart shows the new co-payment amounts for prescription drugs:

If there is a generic equivalent available for a prescription drug and you choose to purchase the brand name version at a retail pharmacy, you will be responsible for the generic co-payment in addition to the difference in the price between the generic and brand name drug.

*Based on the price of some high-cost generic drugs, a non-preferred brand co-payment (rather than the generic co-payment) may apply.

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Outpatient Certification

Effective January 1, 2007, UGI endoscopies/EGD's and colonoscopies will no longer require certification by Intracorp. The following outpatient tests will continue to require certification by IntraCorp prior to the services being performed:

• CAT Scan
• MRI Scan

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Other Services Requiring Certification

Effective January 1, 2007, benefits will be provided for the following services, subject to certification of medical necessity by Intracorp:

• Skilled Nursing Facility
• Long Term Acute Care Facility
• Hospice
• Wound Vacuum Assisted Closure

The 2007 Plan Document you should receive in December will include more information regarding coverage of these services.

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Motivating Mississippi Keys to Living Healthy

As a part of the State and School Employees Health Insurance Management Board's focus on improving the overall health of Plan participants, the Plan will have a wellness and health promotion services vendor effective January 1, 2007. This vendor will help to identify and encourage positive health practices designed to improve the overall wellness and health of the Plan's approximately 188,000 participants.

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Intracorp Changing Name to CareAllies

Beginning December 1, 2006, Intracorp, the company that provides the State and School Employees' Health Insurance Plan participants with medical case management and disease management services, will have a new name: CareAllies. There will be no changes to the services provided to Plan participants. CareAllies will continue to offer the same personalized support and tools to help you and your covered family members maximize your benefits under the Plan by helping manage serious and/or chronic health conditions, providing timely information and resources to help you become better informed about health concerns, and to assist you in making smart choices on how to lead a healthy lifestyle.

This site is maintained by Lisa Giger. Send questions and comments regarding this site to lgiger@deltastate.edu