MEDICAL

Buy-Up Plan Option

For 2011, Valassis will be renaming the Buy-Up plan to the Traditional PPO Plan. For information on this plan, click here. The below information regarding the BCBS Buy-Up plan will be valid until 12/31/10.

Under the Buy-Up Plan, you may choose to receive your care from network providers or from providers of your choice, outside the network. Generally, by choosing care from a network provider you will pay less than if you receive care from a non-network provider.

The Blue Cross Buy-Up Plan features a network of doctors, hospitals and other medical care providers who have agreed to accept negotiated rates for the care they deliver. If you use a network provider, you receive the higher, in-network level of benefits. You are also eligible for out-of-network benefits if you choose to use a provider that does not belong to the network. Each time you need care, you may choose to use a network provider and be eligible for the higher benefit level, or you may go out of network for your care.

When you enroll in the Buy-Up Plan, you will have online access to a Provider Directory that lists network doctors and hospitals in your area. You may also log on to www.bcbs.com and click on "Find a Doctor or Hospital", select "Guest", select the "PPO Plan" to find an up-to-date listing of the providers near you. If you have questions, call Blue Cross at 866-262-1180 for English and Spanish speaking staff will help you find a network doctor in your area. For maximum plan benefits, you should select doctors and health care providers who participate as in-network providers. If you use a network provider when you get medical care, you can save money because:

• The benefit level is greater.
• The network provider generally charges less (based on negotiated fees).

Since rates are negotiated, usual and customary limits do not apply. (If you see a non-network provider, plan benefits are limited to usual and customary charges in your geographic area, as determined by Blue Cross.)

In-network providers must meet certification standards for quality, accessibility and costs. In addition, they are monitored by network managers on an ongoing basis for quality assurance, patient satisfaction and clinical and office management standards.

Note: When you use non-network providers, you receive a lower level of benefits.

Covered Expenses Under the Buy-Up Plan
Here are some of the medical procedures that are covered under the Buy-Up Plan. For a more detailed look at what’s covered, see a comparison of what’s covered under all your medical plan options for 2010. For details on the pharmacy (prescription drug) benefit, see Prescription Drug Coverage.

Hospitalization and Surgery
You are covered for referred inpatient and outpatient hospital care for medical conditions. This coverage includes x-rays, laboratory testing, diagnostic services and medications required during your hospital stay. Your hospital benefits cover an unlimited number of days when medically necessary. Certain services (e.g., nonemergency inpatient hospital care) require precertification by Blue Cross.

Emergency Medical Care
If you need emergency care, you’re covered anytime, anywhere in the world. Be sure to call your provider as soon as possible after emergency treatment to report the emergency and coordinate proper follow-up care.

Expenses Not Covered
Services and supplies that are generally not covered include, but are not limited to:

• Care and services available at no cost to you in a veteran's, marine or other federal hospital or any hospital maintained by any state or governmental agency
• Medically necessary services received on an inpatient basis that can be provided safely in an outpatient or office location
• Custodial care, rest therapy and care in nursing or rest home facilities
• Dental surgery other than for the removal of impacted teeth or multiple extractions when the patient must be hospitalized for the surgery because a concurrent medical condition, such as a heart condition, exists
• Treatment of temporomandibular Joint Syndrome (TMJ) and related jaw-joint problems by any method
• Any medical care, hospitalization or service provided before the effective date of coverage or after the coverage termination date
• Routine hospital outpatient care requiring repeated visits for the treatment of chronic conditions such as diabetes
• Hospitalization principally for observation, diagnostic evaluation, physical therapy, X-ray or lab tests, reduction of weight by diet control (with or without medication), basal metabolism tests or electrocardiography
• Items for the personal comfort or convenience of the patient
• Psychiatric services after determination that the patient's condition will not respond to treatment
• Psychological tests for vocational guidance or counseling
• Routine premarital or pre-employment exams
• Services and supplies that are not medically necessary according to accepted standards of medical practice
• Services provided through a medical clinic or similar facility provided or maintained by an employer
• Treatment of occupational injury or disease that the employer is obligated to furnish or otherwise fund
• Care and services received under another certificate offered by BCBS
• Care and services payable by government-sponsored health care programs, such as Medicare or TRICARE, for which a member is eligible. These services are not payable even if you have not signed up to receive the benefits provided by such programs
• Cosmetic surgery solely for improving appearance, except as specified in the certificate
• Treatment of a condition caused by military action or war, declared or undeclared
• Services, care, devices or supplies considered experimental or investigative
• Services for which a charge is not customarily made; services for which the patient is not obligated to pay
• Dialysis services after 30 months of end stage renal disease treatment
• Services that are not included in your employer's coverage documents
• Charges from a nonparticipating provider that are in excess of the BCBS approved amount
• Charges for hospital room accommodations over and above the hospital's regular charges covered by your medical benefits
• Transportation and travel except as specified in this handbook
• Eyeglasses or contact lenses and vision examinations for prescribing or fitting them (except for Aphakic patients) or for soft contact lenses or sclera shells intended for use in the treatment of diseases or injury or as specified following cataract surgery (may be covered under an additional freestanding program)
• Professional fees for injections given by anyone other than a physician
• Injections for cosmetic purposes
• Charges for examination required by school, camp, licensing or for any other regulatory purpose
• Charges for services rendered during an office visit by anyone other than a physician
• Therapy or hospital admission for weight control
• Therapy for smoking cessation
• Testing more frequently than necessary
• Dental care and dental appliances except those as specified in the certificate (may be covered under an additional freestanding program)
• Reversal of sterilization procedures
• Specified Oncology Clinical Trials
• Bariatric surgery
• Infertility testing and/or treatment procedures
• Radial Keratomy, LASIK, PRK
• Wigs except with a chemotherapy diagnosis

For Information on the Blue Cross Health Choice Savings Plan

For Information on the Blue Cross Basic Plan

For Information on the Cigna CT HMO Plan

	Traditional PPO Plan Health Choice Savings Plan Health Savings Account Plan Comparison Chart Rate Sheet

Summary Plan Description
The legal summary of this benefit will be included in the 2011 Benefits Handbook.