2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(h). Wellness and Other Special Features
Section 5(h). Wellness and Other Special Features
Care Management Programs
If you have a rare or chronic disease or have complex healthcare needs, the Service Benefit Plan offers two types of Care Management Programs that provide assistance with the coordination of your care, provide member education and clinical support.
If you have a rare or chronic disease or have complex healthcare needs, the Service Benefit Plan offers two types of Care Management Programs that provide assistance with the coordination of your care, provide member education and clinical support.
- Case Management provides members who have acute or chronic complex healthcare needs with the services and assistance of a licensed health care professional with a nationally recognized case management certification. Case managers may be a registered nurse, licensed social worker, or other licensed healthcare professional practicing within the scope of their license, who may work with you and your providers to assess your health care needs, coordinate needed care and available resources, evaluate the outcomes of your care, and support and monitor the progress of the member’s treatment plan and healthcare needs. Some members may receive guidance and clinical support for an acute healthcare need while others may benefit from a short term case management enrollment. Enrollment in case management requires your consent. Members in case management are asked to provide verbal consent prior to enrollment in case management and must provide written consent for case management.
Note: Benefits for care provided by residential treatment centers require written consent and participation in Case Management prior to admission; please see pages 79, 89 and 109 for additional information.
- Disease Management supports members who have diabetes, asthma, chronic obstructive pulmonary disease (COPD), coronary artery disease, or congestive heart failure by helping them adopt effective self-care habits to improve the self-management of their condition. If you have been diagnosed with any of these conditions, we may send you information about the programs available to you in your area.
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care |
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management |
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wellness |
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rare |
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chronic |
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diseases |
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complex |
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healthcare |
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education |
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acute |
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nationally |
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recognized |
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certification |
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social |
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worker |
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nurse |
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license |
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residential |
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treatment |
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centers |
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disease |
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diabetes |
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asthma |
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obstructive |
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pulmonary |
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congestive |
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heart |
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failure |
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self-management |
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enrollment |
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eligible |
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eligibility |