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Blackfoot Fire & Police Employee Benefits Book Effective: October 1, 2020 ---PAGE BREAK--- Contact Information III-A Benefits: (208) 938-8199 Fax: (208) 575-6423 iii-a.org PO Box 190477 Boise, ID 83719 III-A Staff III-A staff is available 24/7, including all holidays, to assist our members, answer benefit questions and help with any issues that arise. If you have a question that is not an immediate benefit issue, please contact the appropriate staff member below: Executive Director Amy Manning (208) 317-2814 [EMAIL REDACTED] • Annual reports • New agency rate proposal Benefits Manager Lisa Fritz (208) 938-8199 or (208) 850-0545 [EMAIL REDACTED] • Member benefits • Prescription drug issues • Claims/EOB questions • Prior authorizations Health Coach & Data Analyst Megan Smith (208) 860-1979 [EMAIL REDACTED] • Health coaching • Onsite wellness clinics & programs Operations Manager Susan Lasuen (208) 869-3572 [EMAIL REDACTED] • COBRA administration • III-A internal claims payments Like us on Facebook! @IIIATrust Blue Cross of Idaho (986) 224-4152 or (833) 623-7993 bcidaho.com • ID cards • Help finding an in-network provider • Deductible reports ProAct Rx (877) 635-9545 Mail Order Pharmacy: (866) 287-9885 proactrx.com • ID cards • Formularies look up ---PAGE BREAK--- Board of Trustees Rick Watkins, Chairman City of Fruitland Dan Hammond, Vice-Chairman City of American Falls Grant Gager, Secretary City of Ketchum Gary Aldous Power County Highway District Ruth Bailes Minidoka Irrigation District Tyler Lewis Eagle Fire Traci Malvich City of McCall Suzanne McNeel City of Blackfoot Danielle Painter City of New Plymouth Patty Parkinson City of St. Anthony Jacob Qualls City of New Meadows Pat Riley Northern Lakes Fire Lori Yarbrough City of Athol Dear Member, We are excited to have you as part of the III-A family! The III-A team is dedicated to helping you with your benefits and wellness. Please do not hesitate to reach out to us at any time. Members of the III-A enjoy several enhanced benefits. Each year, the Trustees review new benefit options and, after careful consideration, choose which enhancements are added to the plans. List of the new 2020-21 benefits that will be effective October 1, 2020: Physical Therapy: • Increase physical therapy benefit to 30 visits per benefit period on all III-A standard plans Vasectomy: • Cover initial Vasectomy procedures at 100% (including consultation, procedure, and post semen analysis) Allergy Serum: • Allergy serum is a $20 copay (and $5 for injections) Hearing Protection Benefit: • Cover protective hearing devices for all subscribers up to $150 every five benefit periods (administered internally) Diabetic Test Strips Benefit: • Cover diabetic test strips at 100% for diabetic members on all III-A plans Zero-Dollar Pediatric Copay: • Medical and behavioral health visits for members under age 18 will be covered at 100% with a $0 copay This booklet will help explain the benefits available to you as a member of the III-A. We look forward to assisting you! Sincerely, Amy, Lisa, Susan, and Megan ---PAGE BREAK--- III-A Internally Administered Benefits **Please contact III-A Benefits Manager with any questions on III-A Internal Benefits MEDICAL TELEHEALTH: This is a no-cost Medical Telehealth program for all III-A members that is replacing MDLive. Hours of Operation: 24 hours a day, 7 days a week Dustin Reno, NP – Pocatello Wellness Clinic Phone: (208) 203-0783 or Velma Seabolt, NP – Wellness Associates Phone: (208) 271-4460 *You may call either Provider. Please leave a message if you receive the answering service and you will receive a call back within 2 hours If you leave a message do not call the other provider, you will receive a call back. COVID-19 testing is available if deemed medically necessary. HEALTH COACHING: Personalized health coaching is available to all members covered on a III-A medical plan. 1-on-1 coaching is available over the phone, or via email. Areas of focus include: Nutrition, Physical activity & exercise, Stress management, Sleep, Weight loss/maintenance, Diabetes prevention, Blood pressure and/or cholesterol management, and Tobacco cessation. Please contact III-A Health Coach, Megan Smith at [EMAIL REDACTED] or [PHONE REDACTED] to get enrolled or learn more information on this program. ACUPUNCTURE: 100 Acupuncture visits (up to $80 per visit), per calendar year for each member covered under a III-A medical plan. Acupuncturist must be state licensed, and not “certified”. • Direct-Pay Acupuncturist (Best Option): By choosing to see a “III-A Direct-Pay” Acupuncturist, no upfront payment is required, and the provider will invoice the III-A directly. The list of Direct-Pay Acupuncturists is on our website: iii-a.org o Any amount charged over $80 is the patient’s responsibility to pay. • Blue Cross In-Network Acupuncturist: Provider will submit claims on your behalf and will bill you for any amount over $80 per visit. Use the “Provider Search” tool on the bcidaho.com website to locate a list of In- Network Acupuncturists. • Blue Cross Out-of-Network Acupuncturist: The provider typically collects payment at the time of service. You will need to submit a claim form to Blue Cross for reimbursement. Claims forms are available on bcidaho.com. ---PAGE BREAK--- HEARING-AIDS: 100% coverage for all members covered under the III-A medical plan, up to $3,000 every other calendar year. Payment options: • Reimbursement to the member upon submission of a detailed receipt showing payment and an internal claim form • Payment to the Hearing-Aid provider upon submission of an invoice and an internal claim form Please visit iii-a.org and download the “Internal Claim Form”. Submit the completed form, along with an invoice or receipt, via fax: (208) 575-6423, scan and email to: [EMAIL REDACTED] or mail to PO Box 190477 Boise, ID 83719 HEARING PROTECTION DEVICES: Protective hearing devices are covered for all members up to $150, every five calendar years. Payment options: • Reimbursement to the member upon submission of a detailed receipt showing payment and an internal claim form • Payment to the provider upon submission of an invoice and an internal claim form Please visit iii-a.org and download the “Internal Claim Form”. Submit the completed form, along with a paid receipt, via fax: (208) 575-6423, scan and email to: [EMAIL REDACTED] or mail to PO Box 190477 Boise, ID 83719 AIR AMBULANCE: III-A covers medically necessary air ambulance transports. III-A members: Claim will be submitted and processed through Blue Cross of Idaho. III-A will pay the member’s remaining balance upon receipt of the member’s Explanation of Benefits (EOB). Dependents NOT enrolled in the III-A Plan: Claim will be processed through dependents medical insurance and III- A will reimburse the remaining balance upon receipt of the Explanation of Benefits (EOB). Eligible dependents without any insurance coverage: III-A will pay a maximum of $2,000 of the medically necessary air ambulance claim upon receipt of air ambulance invoice. Please visit iii-a.org and download the “Internal Claim Form”. Submit the completed form, along with an invoice or EOB, via fax: (208) 575-6423, scan and email to: [EMAIL REDACTED] or mail to PO Box 190477 Boise, ID 83719 CASE MANAGEMENT: This is a voluntary program through Blue Cross of Idaho at no cost to III-A members. Case Managers are specially trained registered nurses and licensed social workers that bring skill, experience, and compassion to help with physical or behavioral health issues. Case Managers work in collaboration with your healthcare providers to coordinate care for optimal health outcomes. They provide extra guidance, advocacy and support to any member who has encountered a serious health situation, medical trauma, or illness. Please contact III-A Benefits Manager to get enrolled or learn more information on this program. ---PAGE BREAK--- Preferred BluePPO This information is for comparison purposes only and not a complete description of benefits. All descriptions of coverage are subject to the provisions of the corresponding Plan, which contains all the terms and conditions of coverage. Certain services not specifically noted may be excluded. Please refer to the Plan issued for a complete description of benefits, exclusions limitations and conditions of coverage. If there is a difference between this comparison and its corresponding Plan, the Plan will control. This comparison is subject to annual update and may not reflect the information contained in the corresponding Plan. III-A City of Blackfoot Fire District 2020 PPO Plan HLS Revised 6.2020 Summary of Benefits III-A First Responder Medical Plan - Blackfoot Fire District Effective Date: October 1, 2020 Preferred Blue Large In-Network Out-of-Network Benefit Period* Deductible (Individual/Family) $3,000 / $6,000 Cost Sharing You pay 20% of the allowed amount You pay 40% of the allowed amount Individual Out-of-Pocket Limit (See Plan for services that do not apply to the limit.) (Includes applicable Deductible, Cost Sharing and Copayments) $3,500 $5,000 Family Out-of-Pocket Limit (See Plan for services that do not apply to the limit.) (Includes applicable Deductible, Cost Sharing and Copayments) $7,000 $10,000 Copayment (Applies to In-Network only. Other services rendered during an Office Visit will be subject to Deductible and Cost Sharing.) You pay a $20 Copayment Not applicable COVERED SERVICES By choosing a Noncontracting Provider you may be responsible for the difference between what Blue Cross allows and what the Noncontracting Provider charges. This is called balance-billing. Some services may require Prior Authorization. In-Network Out-of-Network What you pay Acupuncture (Only for a licensed acupuncturist) (Limited to 100 visits combined In- and Out-of-Network per member, per Benefit Period) No charge up to $80 of the allowed amount per day No charge up to $80 of the billed charge per day Advanced Imaging Services (Outpatient services only) (Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), Computed Tomography Scan (CT Scan), Positron Emission Tomography (PET), Nuclear Cardiology) Deductible and Cost Sharing Deductible and Cost Sharing Allergy Injections • Administration Only • Allergy Serum $5 Copayment (if this is the only service provided during the visit) $20 Copayment Ambulance Transportation Services Deductible and Cost Sharing Breastfeeding Support and Supply Services (Limited to one breast pump purchase per Benefit Period, per Participant) No charge Cardiac Rehabilitation Therapy Services – Outpatient (Limited to 36 visits combined per Participant, per Benefit Period) Deductible and Cost Sharing Chiropractic Care Additional services, such as laboratory, x-ray, and other Diagnostic Services are not included in the Office Visit. (Limited to 24 visits combined per Participant, per Benefit Period) Copayment Deductible and Cost Sharing 50% Cost Sharing after Deductible Colonoscopies and Sigmoidoscopies (Preventive and Diagnostic) No charge Deductible and Cost Sharing Dental Services Related to Accidental Injury Deductible and Cost Sharing Diabetes Self-Management Education Services (Only for accredited Providers approved by BCI.) Copayment Medical ---PAGE BREAK--- Preferred BluePPO This information is for comparison purposes only and not a complete description of benefits. All descriptions of coverage are subject to the provisions of the corresponding Plan, which contains all the terms and conditions of coverage. Certain services not specifically noted may be excluded. Please refer to the Plan issued for a complete description of benefits, exclusions limitations and conditions of coverage. If there is a difference between this comparison and its corresponding Plan, the Plan will control. This comparison is subject to annual update and may not reflect the information contained in the corresponding Plan. III-A City of Blackfoot Fire District 2020 PPO Plan HLS Revised 6.2020 COVERED SERVICES By choosing a Noncontracting Provider you may be responsible for the difference between what Blue Cross allows and what the Noncontracting Provider charges. This is called balance-billing. Some services may require Prior Authorization In-Network Out-of-Network What you pay Diagnostic Services Deductible and Cost Sharing Deductible and Cost Sharing Durable Medical Equipment, Orthotic Devices and Prosthetic Appliances (Includes wigs required due to a medical condition up to a limit of $300 combined per Participant, per Benefit Period.) Emergency Services – Facility Services (Copayment waived if admitted) (Additional services, such as laboratory, x-ray, and other Diagnostic Services are subject to applicable Deductible, Cost Sharing and/or Copayment.) (BCI will provide In-Network benefits for treatment of Emergency Medical Conditions. Participant may be balance- billed for these services.) $100 Copayment for hospital Outpatient emergency room visit, then Deductible and Cost Sharing $100 Copayment for hospital Outpatient emergency room visit, then Deductible and Cost Sharing Emergency Services – Professional Services (BCI will provide In-Network benefits for treatment of Emergency Medical Conditions. Participant may be balance-billed for these services.) Deductible and Cost sharing Deductible and Cost Sharing Hearing and Hearing Aid Exams Copayment Home Health Skilled Nursing Deductible and Cost Sharing Deductible and Cost Sharing Home Intravenous Therapy 80% Cost Sharing after Deductible Hospice Services No charge Deductible and Cost Sharing Hospital Services (Inpatient and Outpatient services at a licensed general hospital or ambulatory surgical facility.) Deductible and Cost Sharing Mammograms (Preventive and Diagnostic) No charge Maternity Services and/or Involuntary Complications of Pregnancy Deductible and Cost Sharing Morbid Obesity (Includes the surgical treatment of morbid obesity, complications resulting from the surgical treatment of morbid obesity or for reversals or revisions of surgery for morbid obesity when required to correct an immediately life-threatening condition. Lifetime maximum benefit of $20,000 combined per Participant.) Deductible and Cost Sharing Outpatient Habilitation Physical Therapy Services (Limited to 40 visits combined per Participant, per Benefit Period.) Copayment Outpatient Habilitation Therapy Services (Includes speech and occupational therapies. Limited to 40 visits combined per Participant, per Benefit Period.) Deductible and Cost Sharing Outpatient Rehabilitation Physical Therapy Services (Limited to 40 visits combined per Participant, per Benefit Period.) Copayment Outpatient Rehabilitation Therapy Services (Includes speech and occupational therapies. Limited to 40 visits combined per Participant, per Benefit Period.) Deductible and Cost Sharing Physician Office Visit (Other services rendered during a Physician Office Visit will be subject to Deductible and Cost Sharing.) Copayment Post-Mastectomy/Lumpectomy Reconstructive Surgery Deductible and Cost Sharing Pediatric Physician Office Visit (For Participants under the age of eighteen No charge Prescribed Contraceptive Services (Includes diaphragms, intrauterine devices (IUDs), implantables, injections, tubal ligation and vasectomy.) PSA Tests and Pap Smears ---PAGE BREAK--- Preferred BluePPO This information is for comparison purposes only and not a complete description of benefits. All descriptions of coverage are subject to the provisions of the corresponding Plan, which contains all the terms and conditions of coverage. Certain services not specifically noted may be excluded. Please refer to the Plan issued for a complete description of benefits, exclusions limitations and conditions of coverage. If there is a difference between this comparison and its corresponding Plan, the Plan will control. This comparison is subject to annual update and may not reflect the information contained in the corresponding Plan. III-A City of Blackfoot Fire District 2020 PPO Plan HLS Revised 6.2020 COVERED SERVICES By choosing a Noncontracting Provider you may be responsible for the difference between what Blue Cross allows and what the Noncontracting Provider charges. This is called balance-billing. Some services may require Prior Authorization In-Network Out-of-Network What you pay Services – Inpatient (Facility and Professional Services) Deductible and Cost Sharing Deductible and Cost Sharing Services – Outpatient Services Copayment Pediatric Outpatient Services (For Participants under the age of eighteen No charge Facility and other Professional Services Deductible and Cost Sharing Outpatient Applied Behavioral Analysis (as part of an approved treatment plan) Copayment Rehabilitation or Habilitation Services Deductible and Cost Sharing Skilled Nursing Facility (Limited to 30 days combined per Participant, per Benefit Period.) Sleep Study Services Surgical/Medical (Professional Services) Therapy Services (Including chemotherapy, growth hormone therapy, radiation and renal dialysis.) Transplant Services Preventive Care Benefits (See Plan for specifically listed preventive care services.) No charge for services specifically listed For services not specifically listed Deductible and Cost Sharing Immunizations (See Plan for specifically listed immunizations.) No charge for listed immunizations Treatment for Autism Spectrum Disorder (Services identified as part of the approved treatment plan) Covered the same as any other illness, depending on the services rendered, see appropriate Covered Services section. Visit limits do not apply to Treatments for Autism Spectrum Disorder, and related diagnoses. *The specified period of time during which charges for Covered Services must be incurred in order to accumulate toward annual benefit limits, Deductible amounts and Out-of-Pocket Limits. ---PAGE BREAK--- Highlights of Your Preventive Care Benefits Preventive care is when you see a doctor or have a screening when you do not have any signs of a medical problem. • You pay nothing; no coinsurance, copayment or deductible, for covered preventive care services when you visit in-network providers. • Preventive care benefits for services from out-of-network providers are subject to your out-of-network benefit. Please Note: Your provider must bill these services as preventive/wellness services. For complete descriptions of your policy and please contact the III-A Benefits Manager. Covered Preventive Care Services In-Network Out-of-Network Specifically Listed Services Annual adult physical examinations; Routine or scheduled well-baby and well-child examinations, including vision, hearing and developmental screenings; Dental fluoride application for participants age 5 and younger; Bone density; Chemistry panels; Cholesterol screening; Colorectal cancer screening (colonoscopy, sigmoidoscopy, fecal occult blood test); Complete Blood CouWatitis B virus screening; Sexually transmitted infections assessment; HIV assessment; Screening and assessment for interpersonal and domestic violence; Urinalysis (UA); Aortic aneurysm ultrasound; Alcohol misuse assessment; Breast cancer (BRCA) risk assessment and genetic counseling and testing for high-risk family history of breast or ovarian cancer; Newborn metabolic screening (PKU, Thyroxine, Sickle Cell); Health risk assessment for depression; Newborn hearing test; Lipid disorder screening; Smoking cessation counseling visit; Dietary counseling (limited to 3 visits per participant, per benefit period); Behavioral counseling for participants who are overweight or obese; Preventive lead screening; Lung cancer screening for participants age 55 and older; Hepatitis C virus infection screening; Gestational diabetes screening for pregnant women; Iron deficiency screening for pregnant women; Rh incompatibility screening for pregnant women; and Urine culture for pregnant women. You pay nothing of the allowed amount for specifically listed preventive care services per person, per benefit period. No copayment, deductible or coinsurance required. You pay costs subject to your out-of- network benefit. Women’s Preventive Health Services In-Network Out-of-Network Well Woman visits (for recommended age-appropriate preventive services); breastfeeding support, supplies and counseling. You pay nothing of the allowed amount for specifically listed preventive care services per person, per benefit period. No copayment, deductible or coinsurance required. You pay costs subject to your out-of- network benefit. Blue Cross of Idaho pays 100 percent for women’s preventive prescription drugs and devices as specifically listed on the Blue Cross of Idaho website, bcidaho.com; deductible does not apply. The day supply allowed shall not exceed a 90-day supply at one time, as applicable to the specific contraceptive drug or supply. Prescribed Contraceptive Services Includes diaphragms, intrauterine devices (IUDs), implantables, injections and tubal ligation Immunizations In-Network Out-of-Network Accellular Pertussis, Diphtheria, Hemophilus Influenza B, Hepatitis B, Influenza, Measles, Mumps, Pneumococcal (pneumonia), Poliomyelitis (polio), Rotavirus, Rubella, Tetanus, Varicella (Chicken Pox), Hepatitis A, Meningococcal, Human Papillomavirus (HPV) and Zoster. All Immunizations are limited to the extent recommended by the Advisory Committee on Immunization Practices and may be adjusted to coincide with federal government changes, updates, and revisions. Other immunizations not specifically listed may be covered when medically necessary and approved by the Blue Cross of Idaho Pharmacy & Therapeutics Committee. You pay nothing for specifically listed immunizations. No copayment, deductible or coinsurance required. ---PAGE BREAK--- III-A PROACT PRESCRIPTION DRUG BENEFIT Below is a sample copy of your ProAct Prescription Drug ID Card. This is what you will present to your pharmacy to process your prescription(s). IMPORTANT: Please make sure your medical provider(s) also receive a copy of your ProAct Prescription Drug ID card and understand that any prescription prior authorization requests must be submitted to ProAct, NOT Blue Cross of Idaho. Why ProAct? All Pharmacies across the U.S. are in-network, including Walgreens. 24/7 Customer Service (877) 635-9545 Your III-A Pharmacy Benefit Copays: Retail Pharmacy Per 30-day Supply Generic Drugs (Tier Copay up to $10 Brand Name Drugs (Tier Copay up to $25 Non-Preferred Drugs (Tier Copay up to $40 Contact: (877) 635-9545 Fax: (315) 287-7864 Web: ProActRx.com Email: [EMAIL REDACTED] Specialty Pharmacy 30-Day Supply Limit Requires a new/separate prescription to be submitted *Copays are same as Retail Contact: (888) 843-2040 Fax: (888) 842-3977 Email: [EMAIL REDACTED] Mail Order Pharmacy You receive a 90-day supply for the price of a 60-day supply Per 90-day Supply Requires a new/separate prescription to be submitted Generic Drugs (Tier Copay up to $20 Brand Name Drugs (Tier Copay up to $50 Non-Preferred Drugs (Tier Copay up to $80 Contact: (866) 287-9885 to set up home delivery & payment profile Fax: (315) 287-3330 Web: ProActRx.com Email: [EMAIL REDACTED] Visit ProActRx.com to register as a member and view your pharmacy claims. NEVER LEAVE THE PHARMACY WITHOUT YOUR PRESCRIBED MEDICATIONS If you encounter any issues, please contact the III-A Benefits Manager DIABETIC MEMBERS DexCom G6 Program - Members may purchase the DexCom G6 through ProAct via their local retail pharmacy or through ProAct mail order with a prescription from their provider. To purchase via Retail: You must present your prescription to the pharmacy, along with your ProAct ID card. Copays are as follows: Transmitter: $25 / Reader: $25 / Sensors: $25 for a 30-day supply (3 sensors per month) To purchase through the ProAct mail-order program (and receive a 90-day supply for the price of a 60-day supply) call: (866) 287-9885. ---PAGE BREAK--- This information is for comparison purposes only and not a complete description of benefits. All descriptions of coverage are subject to the provisions of the corresponding plan, which contains all the terms and conditions of coverage. Certain services not specifically noted may be excluded. Please refer to the plan issued for a complete description of benefits, exclusions limitations and conditions of coverage. If there is a difference between this comparison and its corresponding plan, the plan will control. This comparison is subject to annual update and may not reflect the information contained in the corresponding plan. 10.2020 III-A Master Standard PPO Dental Plans Revised 6.2020 Summary of Benefits– III-A Trust Standard Plan Dental PPO3 Effective October 1, 2020 Preferred Blue Dental PPO In-Network Out-of-Network Individual/Family Deductible (Deductible applies to In-Network basic, major services, and all Out-of-network services. The Family Deductible is satisfied after three Participants of the same family have met their Individual Deductible.) $50 / 3 Family Maximum Individual Benefit Period Maximum $2,000 Dental Maximum Carryover (You may carry over a portion of your unused dental benefits from one year to the next)* No Orthodontia Lifetime Maximum for Enrolled Eligible Dependent Children $1,000 Orthodontia Waiting Period None Preventive Services What you pay Oral Examinations One examination every six months. No charge By choosing an Out-of-Network provider 20% of the allowed amount** Fluoride Limited to one application per benefit period and limited to Participants who are under age twenty-six (26). Sealants Limited to permanent posterior unrestored dentition of Participants under age sixteen (16). Also limited to one time per tooth in any three consecutive Benefit Periods. X-rays, Bitewings Once per benefit period. X-rays, Complete Mouth Series or Panoramic x-ray One time in any five consecutive benefit periods. Prophylaxis (Cleaning) Once every six months. (Regardless of type) Basic Services What you pay Fillings Restorations involving multiple surfaces will be combined and paid according to the number of surfaces treated; same tooth surface restoration is covered once in a two year period. 20% of the allowed amount By choosing an Out-of-Network provider 30% of the allowed amount** Extractions Root Canal Therapy Periodontal Maintenance Once every six months. (Regardless of type) Scaling and Root planing Once per quadrant of the mouth every three benefit periods. Occlusal Guard One appliance every two benefit periods. Osseous Surgery Once per quadrant of the mouth every three years. Space Maintainers Limited to Participants who are under age sixteen (16). Benefits limited to deciduous teeth. Includes all adjustments made within six months of installation. Major Services Predetermination required on all major services What you pay Bridges, Inlays, Onlays, Crowns, Veneers, and Full or Partial Dentures Five year replacement. 50% of the allowed amount By choosing an Out-of-Network provider 60% of the allowed amount** Dental Implants Including the implant body, implant abutment and implant crown – benefits may be available up to the Maximum Allowance of a standard complete or partial denture, or bridge. Implant body and abutment- limited to once per tooth per lifetime. Implant crown –five year replacement. Orthodontia Services Covered What You Pay Orthodontia for enrolled eligible dependent children No Charge up to Lifetime Maximum The Preferred Provider Organization (PPO) dental program offers access to a large network of dental providers who have agreed to offer covered services at or below established maximum allowances, and, by choosing an in-network PPO provider, you maximize your dental benefit dollars. *See Group Master Plan for requirements of the Dental Maximum Carryover, if this is a selected benefit. **By choosing an Out-of-Network provider you pay your cost sharing, deductible, and any difference between what Blue Cross of Idaho allows and what the Out- of-Network provider charges. Dental ---PAGE BREAK--- Mental Health Resource Directory If this is an Emergency, please call 911 BPA HEALTH: For immediate crisis counseling assistance or ongoing counseling, contact BPA Health, your Employee Assistance Program (EAP): Call: # (800) 726-0003 Or visit: bpahealth.com/eap-home/ Employer Name/Login: III-A Toll Free Number/Password: [PHONE REDACTED] EAP is a benefit provided by III-A to help you successfully address work and personal problems that impact your life. They provide counseling services – either face-to-face, or virtual, with licensed mental health professionals. All III-A members receive 10 sessions per incident/per calendar year. Services are provided at no cost to employee and family and are strictly confidential. ***Call BPA to request an authorization prior to seeing a Provider. If you or someone you care about is in a crisis, seek help immediately: Call 911, visit a nearby emergency department or your health care provider’s office. Or call a toll-free, 24-hour hotline: Idaho Suicide Prevention Hotline: • Text or Call: (208) 398-4357 or dial 211 National Suicide Prevention Lifeline: • Call: (800) 273-TALK (8255) or TTY: (800) 799-4TTY (4889) • Text: HELLO to 741741 to talk to a trained counselor Safe Call Now: A 24/7 crisis line for public safety employees, emergency services personnel and their families to speak confidentially with officers, former law enforcement officers, public safety professionals and/or mental healthcare providers • Call: (206) 456-3020 III-A Blue Cross of Idaho Counseling Benefits: Outpatient Mental Health Services: Office visit copayment (same as medical). Additional testing or services may be subject to in or out of network deductible/out of pocket. Inpatient Mental Health Services: Subject to in or out of network deductible/out of pocket. Prior authorization is required. To find a Blue Cross of Idaho provider either visit online at www.bcidaho.com, or call the customer service phone number listed on the back of your ID card: (986) 224-4152 or (833) 623-7993 ---PAGE BREAK--- Employee Assistance Program (EAP) BPA Health: In addition to your 10 EAP counseling sessions per incident/per year (see Mental Health Resource page) for the entire family, our members also have access to the following services provided by BPA: • Legal/Financial Assistance: All members receive one annual free 30-minute session with a legal attorney on most issues. In most cases discounted rates are available if further legal representation is required. • Financial Guidance: Free telephonic consultation with a financial professional on common topics such as: Avoiding, responding to, and correcting identity theft. Budgeting, buying a home, managing credit. Easy access to vital legal and financial information. • Free Legal downloadable and customizable forms & online resources: Quicken Will Maker & Trust Budget worksheet Landlord/Tenant Checklist Additional articles are available on the BPA website to provide a range of assistance on various topics, such as: Work & Personal Relationships, Aging, Parenting, Medical and Mental Health Issues and more. Use the below username and password to review this information: Toll Free: (800) 726-0003 Website: bpahealth.com/eap-home/ Employer Name Login/Username: III-A Toll Free Number/Password: [PHONE REDACTED] Life Insurance Life, Accidental Death & Dismemberment (AD&D) Insurance: As of 10/1/2020, OneAmerica has replaced Unum as the III-A life insurance carrier. IMPORTANT: Fill out and submit your Beneficiary Designation form to your Employer. This form is available at iii-a.org (or the last pages of this booklet). ***Keep this form updated*** Eligibility: Active fulltime Employees and Elected Officials Benefit Amount: $20,000 Accelerated Death Benefit: 25%, 50%, or 75% of face value with remainder paid at time of death Portability: If you retire, reduce your hours to less than fulltime, or leave your Employer, you can take this coverage with you. Life Benefit Reduction: 50% at age 75 Other services included with this life insurance benefit: • Life Planning Financial & Legal Resources • Employee Assistance Program (3-visits at no cost per incident/per year) • Travel Assistance Program Please visit the OneAmerica website for more details: oneamerica.com ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- Preventive Schedule Make a Plan for Your Health *Your primary care provider (PCP) will help determine frequency. Depending on your health and personal risk factors, your preventive care schedule may differ from the standard recommendations. Talk with your Primary Care Provider (PCP) about a schedule that is best for you. If you have particular risk factors like a chronic disease, obesity, or a family history of a disease, your PCP may recommend additional screenings. ✔ CHECK WHEN COMPLETED FREQUENCY DATE SCHEDULED ❒ Annual Wellness Exam Every 12 months ❒Blood Pressure At least annually* ❒Cholesterol Every 5 years* ❒Body Mass Index Annually ❒Bone Mass Measurement Every 1-2 years ❒Breast Cancer Annually ❒Colon Cancer Ask my doctor ❒Diabetes Screening (A1C) At least annually* ❒Flu Vaccine Annually ❒Immunizations As needed* ❒Pneumonia Vaccine Once after age 65 ❒ Well Baby/Well Child Exam As recommended in Well Child Schedule ❒Well Woman Exam Annually ---PAGE BREAK--- Well Child Immunization and Visit Schedule Giving Your Kids a Healthy Start Getting your child vaccinated is one of the best steps you can take for a healthy start in life. Not too long ago, diseases like measles, whooping cough and polio affected thousands of children, sometimes leading to lifelong disability or even death. Now, vaccines can help prevent children from ever suffering from these diseases. Vaccines are administered during Well Child visits with your child’s healthcare provider. These visits include a complete physical exam, developmental milestones, immunization schedules and more. The American Academy of Pediatrics Bright Futures suggest the following schedule for Well Child visits unless otherwise suggested by your pediatrician. Age Activity Immunization/ Test 2 weeks Exam, Health Education None 2 months Exam, Health Education DTaP-Polio-Hib, Hepatitis B, Pneumococcal, Rotavirus 4 months Exam, Health Education DTaP-Polio-Hib, Hepatitis B (if birth dose not given), Pneumococcal, Rotavirus 6 months Exam, Health Education DTaP-Polio-Hib, Pneumococcal, Hepatitis B, Rotavirus 9 months Exam, Health Education None 12 months Exam, Health Education MMR, VZV, Hepatitis A, Anemia test, Lead test, TB test as needed 15 months Exam, Health Education DTaP-Polio-Hib, Pneumococcal 18 months Exam, Health Education Hepatitis A 24 months Exam, Health Education Lead test, TB test as needed 30 months Exam, Health Education None 3 years Exam, Health Education Blood Pressure (at each exam 3 years & older) 4 years Exam, Health Education MMR, VZV, DTaP, Polio 5 years Exam, School Readiness Vision and Hearing Screens (MMR, VZV, DTaP, Polio if not given at 4 year WCC) 6-10 years Exam, Health Education Physical Exam Yearly Catch-up Immunizations 11-18 years Annual Sports/Adolescent Exam Yearly Tdap, Meningococcal, HPV Catch-up Immunizations Anemia Test (menstruating females) Your Pediatrician will review immunizations on each visit for the needs of your child. www.completechildrenshealth.com/education-resources/immunization-schedule.php