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SMU Health and Wellness Plan
SMU, in partnership with BlueCross Blue Shield of Texas (BCBSTX), is committed to helping employees and their dependents achieve and maintain excellent health. The SMU Health and Wellness Plan offers a comprehensive approach that includes several medical options, Blue Care Connection, the Employee Assistance Program, and the Wellpower Wellness Program.
► PPO Medical Options
Administered by BlueCross BlueShield Of Texas
Group #: 090138
(877) 768-2005
SMU employees have a selection of BCBSTX PPOs (Preferred Provider Organization) from which to choose, each with different deductibles, out-of-pocket maximums and monthly/bi-weekly premiums. A PPO is a managed care arrangement involving physicians, hospitals and other health care providers who have contracted with an insurer or third party administrator to provide health care at reduced rates.
The PPOs available to SMU employees are self-insured by the University and administered by BCBSTX. You are not required to select a primary care physician and you do not need a referral to see a specialist. You have the option to receive care from in-network or out-of-network providers, or both, depending on your needs. Your options are:
- $500 Deductible PPO, $1,000 Deductible PPO, $2,000 Deductible PPO
- $2,500 Deductible PPO (High Deductible Health Plan with HSA)
You will find detailed information about how each option covers various health care services including physician office visits, hospital charges, x-rays, prescription drugs and much more in the Schedule of Coverage. You will also find helpful information in BCBSTX Frequently Asked Questions and the monthly and bi-weekly premium rates in the Rate Schedule.
If you have any questions about coverage for specific procedures or services, or about plan limitations and exclusions, please call BCBSTX at 877-768-2005
PPO Preventive Care Benefit
The SMU PPO options provide a $500 annual preventive care benefit for you and each of your enrolled dependents. This benefit, which is not subject to the annual deductible, covers routine physicals, screenings and immunizations. Please refer to SMU Preventive Care Guidelines for detailed information.
Important: Effective January 2008, the PPOs will cover mammograms, colonoscopies, and prostate screenings (administered by BCBSTX providers) at 100%. These expenses are not subject to the annual deductible and are covered over and above the annual $500 preventive benefit. Typically these screenings are covered in accordance with the BCBSTX Wellness Guidelines. However, if your physician feels that you should have one or more of these screenings at an earlier age or more frequently - primarily due to family medical history - they will still be covered at 100%.
PPO Prescription Drug Coverage
The prescription drug component of PPO coverage is administered by Prime Therapeutics. You will find detailed information on prescription drug coverage in the BCBSTX Summary Plan Description below. Once you enroll in a PPO option be sure to visit the Prime Therapeutics website. You will be asked to register and once you do you will have 24/7 access to your personal prescription information.
Davis Vision Care Program
This program is available under the PPO options through Davis Vision, Inc., a leading vision care organization. The program offers discounted fees for routine vision care services provided by Davis Vision providers. This program is not associated with the SMU Vision Plan administered by Compbenefits. Be sure to visit the Davis Vision website at www.davisvision.com for more information.
High Deductible Health Plan with Health Savings Account
Sometimes referred to as a "catastrophic" health plan, a High Deductible Health Plan typically has a lower premium and a higher deductible and out-of-pocket limit. In conjunction with an HDHP, a Health Savings Accounts (HSA) is a tax-advantaged savings account that offers a different way for individuals and families to pay for their health care. The BCBS of Texas $2500 Deductible PPO is the SMU HDHP. If you enroll in the $2500 Deductible PPO and the HSA, you cannot contribute to a Health Care Flexible Spending Account. Please review the Health Savings Account Brochure and Health Savings Account FAQs for more information. SMU's HSAs are administered by Mellon Bank
► Blue Care Connection
Sometimes managing your health requires more than doctor visits, lab tests and prescriptions. The BCBSTX Blue Care Connection is an umbrella of programs that provide outreach, educational resources and health advocacy services that can help you and your enrolled family members achieve a healthier life and prevent future medical complications. The services available through Blue Care Connection are confidential and available at no additional cost to you. Following are brief summaries of the various components of Blue Care Connection.
Blue Access For Members
Blue Access enables you to check the status of a specific claim or your claim history, sign-up to receive claim status email alerts, request a new or replacement BCBSTX ID card, locate a doctor or hospital in the network, and much more. You can use the Hospital Comparison Tool to find the outcome history of procedures previously performed at certain hospitals and the Treatment Cost Advisor to find the typical cost of a health care procedure.
Blue Care Advisors
Experienced RNs, Licensed Professional Counselors and Masters-level Social Workers that work with you and your physician to educate, facilitate and monitor your treatment program.
Personal Health Manager
Personal Health Manager is an online health and wellness resource to help you and your family adopt and manage healthy behaviors. You can use this tool to email health questions and receive personalized answers, and learn how to manage a chronic condition. You can also use the tool to plant nutritious meals, keep track of your personal health records, log your workouts and more.
24/7 Nurseline
Around the clock access through a toll-free number to experienced registered nurses who can help with your health care concerns is available through the BCBSTX Nurseline.
Special Beginnings®
The Special Beginnings maternity program offers on-going contact with obstetric nurses who can provide prenatal risk assessment education and can coordinate care with your physician. You will find more helpful information in the BCBSTX Suggested Prenatal Care Guidelines.
Health Improvement Program
Resources that can help participants who live with chronic health conditions like asthma, diabetes, heart disease and low back pain.
Care Management
Focuses on traditional elements of medial care management with targeted, confidential outreach if you are an “at risk” participant.
Case Management
Assists if you are a higher-risk participant coping with a complex or catastrophic condition.
Behavior Modification Obesity/Weight Management Program
Licensed Master-level Social Workers and Licensed Professional Counselors who promote wellness through a holistic approach of behavior coaching, clinical coaching, education and condition management.
Blue Compare Provider Tool
This online comparison tool provides information about the quality of physicians' care, as well as general affordability. Look for Blue Ribbon indicators that identify doctors who have the highest rating for performance and efficiency, when compared with care provide by other doctors.
To enroll in any Blue Care Connection program please call 1-866-412-8795.
► Employee Assistance Program
Managed by Magellan Health Services
(877) 704-5696
SMU's Employee Assistance Program (EAP) is a comprehensive and confidential program designed to help employees and their families manage issues related to health, marriage, work, stress, substance abuse and other personal issues. Be sure to visit the Magellan website for more information or call Magellan Health Services directly.
► Wellpower Wellness Program
Wellpower offers a wide array of opportunities that promote wellness in three key areas: Body, Mind and Spirit. The program features three levels of achievement: Bronze, Silver and Gold with many different ways to earn credits in the program. Members may participate in a variety of campus activities, complete health challenges, take an online health assessment, and learn about health issues via the website while earning credits along the way. The program is very flexible and is customizable to help meet your unique health goals.
Summary Plan Descriptions
BCBSTX PPO Summary Plan Description (PDF Document)
BCBSTX Prescription Drug Summary Plan Description (PDF Document)
BCBSTX Indemnity Summary Plan Description (PDF Document)
Health Savings Account Summary Plan Description (PDF Document)
