Sample PHS

A new view of your claims

Personal Health Statement keeps members "up to date".

At Arkansas Blue Cross and Blue Shield, we want the conversations we have with our members to be helpful, clear and complete, whether we’re talking by telephone, on our websites or in writing.

One of our most frequent member communications — the Explanation of Benefits (EOB) — is getting a new look and content, and, a new name. The EOB is the health-care benefit statement generated every time your doctor or hospital files a claim.

The EOB notifies you that we received a claim and how we handled that claim. Beginning in March, many Arkansas Blue Cross members will begin receiving a Personal Health Statement (PHS) in place of their EOB.

The PHS is more comprehensive than the EOB and designed to make claims processing easier to understand. The PHS also gives more information about health benefits.

"Health insurance is a complex industry with lots of moving parts and a language all its own," said Karen Raley, vice president of Communications and Product Development. "We want to simplify industry terms into everyday language, clearly explain claims, and help our members know exactly where they are with their out-of-pocket costs (deductibles, copayments, coinsurance and more)."

The new PHS is the result of feedback from member focus groups. "First and foremost, members told us they want to know ‘what do I owe?’" Raley said. "So we’ve put this information in red on the first page. We’ve also added a ‘Benefits at a Glance’ section, so members are reminded of their health benefits. Charts and graphs, hopefully, will make the information displayed easier to understand."

Members also asked for:

• A better description of the discounts they receive on their health-care services.
• Information on how to get in touch with us.
• A quick understanding of how much they owe and to whom.
• Help in understanding the benefits they have and how they work.

A Benefit Summary section shows members their personal health benefits and tracks where they are in meeting deductibles and out-of-pocket maximums.

Pharmacy information has been added, including generic medication recommendations. Another new feature on the PHS will be personal health messages and reminders to get health screenings.

Members still have the option to confidentially view their PHS electronically. To sign up for a notification email, members can go online and sign up through the My Blueprint member self-service center. Then, when a new PHS is generated, you will receive an email.

The new PHS will be issued two times a month instead of every time a claim is filed. If a member only has pharmacy claims during a month, the PHS will be issued quarterly.

The PHS was piloted with three groups in Arkansas to get member reaction to the new format and content.

"We love the new statements!" said Sharon Burdine, vice president and assistant director of Human Resources with Simmons First. "Our associates are finding the new Personal Health Statement is easy to understand. The statement shows several things that were not available before, such as prescriptions. The information shown is more descriptive of what our benefits are, of services received, what the health plan pays for and what the member’s portion is going to be. We’re seeing how the PHS also can serve as a backup for a flexible spending account (cafeteria plan) — all services are listed in case you lose a receipt or forget to include an expense to be filed."

"We think the new PHS will be a valuable tool for helping us become better consumers of health care," said Barb Gordon, benefits specialist with Northwest Arkansas Community College in Fayetteville. "The PHS gives employees a great snapshot of where they are at a given time and is backed up with all the details they need to be informed about their benefits. For employees who have spouses with other insurance coverage, the PHS is a great tool for coordination of benefits — it’s easy to see what has been paid to whom and what is owed. The discounts on health-care services are easier to see, and, wow, what a difference in cost! I don’t think many employees realized the true cost of prescription drugs until the new format. Once you become familiar with the new format, it is more understandable overall."

Ann Freeman, vice president of Benefits with First National Bank and Trust of Mountain Home, said, "Our employees are finding the new Personal Health Statement easier to read. The language is better and doesn’t sound so ‘insurance-y’ and the charts provide a good picture of where the employees are with their deductibles and out-of-pocket maximums."

The new PHS will be available to many Arkansas Blue Cross members beginning in the spring of 2010 and later in the year for Health Advantage. "We love to hear from our members," said Raley. "Feedback always is welcome on how the PHS can be improved."