This is the eighth in a series in which Penn State Employee Benefits staff explain key concepts, terms and processes to help faculty and staff better understand and use their health benefits.
For a direct link to the Highmark Blue Shield website, and additional resources on the benefits open enrollment period – Nov. 2 through Nov. 20 – visit the 2016 Benefits Open Enrollment microsite at http://openenrollment.psu.edu
Several recent Understanding Your Benefits articles have reviewed the importance of reviewing personal medical claims and expenditures in order to help determine which health plan to choose during the annual Benefits Open Enrollment period. While doing so may seem like a logical first step in the health care plan selection process, the task of locating a comprehensive list of medical claims and their associated costs can seem daunting, often requiring hours of sifting through files of medical bills and “Explanation of Benefits” forms. Likewise, employees who want to know the balance of their Health Savings Account (HSA) or Flexible Spending Account (FSA), may become frustrated because they do not know how to access this information.
Fortunately, the Highmark Blue Shield website serves as a “one-stop shop” for Penn State employees to view all medical provider costs, health care claims and spending account balances which are related to their health care plan. The website has recently undergone a facelift and now contains streamlined, user-friendly pages designed to help employees navigate them with ease and quickly obtain the information they want. The site may be accessed through a variety of electronic devices, including smartphones.
An employee who would like to access his or her medical information through the Highmark website will first need to create a user ID and password for the site using their Highmark member ID from their Highmark insurance card.
Once the employee logs into the site, the member home page will display basic information about the member’s information, such as Member ID, plan type, deductible, co-pays (if applicable) and the total out-of-pocket maximum for that person.
One of the most useful features of the home page is a link to the individual’s medical claims. Clicking on the “Review Claims” link displays that person’s most recent claims, arranged by date of service. Each entry includes the provider’s name, date of service, claim number and the cost to the plan member. The “See More” section embedded within each claim displays the provider’s charge for the service, the member discounted rate (sometimes referred to as the “allowed amount”), the amount the health plan paid on the member’s behalf, and the total amount owed by the plan member. “Download Claim Details” provides a PDF document of the same information which may be saved elsewhere or printed. If the employee would like to view more than just the most recent claims, a link at the bottom of the page, “View all Claims,” will display all of that individual’s claims.
In addition, if an employee has already paid a claim, he or she may mark that claim as “Already Paid,” or in the event that the employee would like Highmark to pay a provider directly for a particular claim, he or she may select the “Pay Claim” button. By paying claims this way there is no need for the person to contact the provider to pay the claim with a Highmark HSA or FSA debit card; and in the case of an employee with an FSA, there is no need to submit a receipt to substantiate the payment.
The Claims Page also provides information about how a person’s plan is progressing over the course of the year, with an outline of how much of the annual deductible has been satisfied and how much has been contributed toward the out-of-pocket maximum.
While the Claims Page provides detailed information about an individual’s health care costs, a return to the home page will connect that person with a link that enables him or her to view HSA or FSA spending account details. The “Spending Account” link will display the account details such as the employee’s monthly contribution to the account and the available balance in the account. By selecting “Transaction History,” a person can see each transaction by date and amount, and view the remaining balance after the transaction was made. The “Spending Claims” option provides the person with a view of each claim that was paid for by using funds from the account. Finally, by selecting “Covered Expenses”, an individual may view the list services and charges that qualify for reimbursement under an FSA or HSA.
The home page also contains links to other useful tools. At the bottom of the page, the “Find a Physician” tool assists plan members in locating all kinds of providers: physicians, laboratories, hospitals and pharmacies. The “Prescription Services” link displays several options within a new browser, including a list of the plan member’s recent prescription medications, as well as the opportunity to obtain more information about a specific medication. The link also contains a feature that allows an individual to obtain the price for a particular medication and compare it with the price of other forms of the same medicine.
Also on the home page, the care cost estimator is useful for a plan member who is anticipating a medical test or procedure. The estimator allows that person to search for providers and pricing for particular medical services within a specified geographic region. The estimator outlines total costs and estimates out-of-pocket costs for that member based on his or her spending summary up until that point in time.
Employees who wish to learn about how their health care dollars are being spent or who wish to become savvy health care consumers will find assistance through the Highmark Blue Shield website. Once an employee becomes accustomed to using the site, it will become second-nature to access valuable medical claims and spending information on a regular basis.