Understanding Your Blue Cross Blue Shield of Illinois Coverage: 5 Things Every CCSD #59 Employee Needs to

Know

1. How do I stay within the PPO Network?

• It is YOUR responsibility to stay within the PPO network.

• How do I know if my provider participates in the PPO network?

• Go online at www.BCBSIL.com using the “Find a doctor” link. Or-

• Call the toll-free number on the back of your Medical ID card.

• Talk with your provider and ask the correct questions.

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“Do you take BlueCross?”

“Are you a participating BlueCross BlueShield PPO Provider?”

The BCBS IL Network is important!

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Benefits are always better when you receive services within the BCBS IL PPO network.•Better Co-Insurance (either 90% or 80% in network, depending on which plan you are enrolled in)•Lower Out-of-Pocket Maximums

Why are benefits better?•BlueCross negotiates with doctors and hospitals. If they come to an agreement/contract, the providers agree to provide services at lower costs and greater discounts. In return, the providers see greater utilization due to BlueCross’ large membership base.

These lower costs and greater discounts are passed on to the member with better benefits and lower out of pocket expenses!

If you are an HMO Member, your network is either the the Blue Advantage HMO Network or the HMO of Illinois network. remember, all care has to be directed by your Primary Care Physician.

In-NetworkProvider

90%Or 80%

In-NetworkProvider

90%Or 80%

Out of NetworkProvider

70% or 60%

Out of NetworkProvider

70% or 60%

DeductibleDeductibleDeductibleDeductible

Blue Distinction Centers

Blue Distinction® CentersComplicated surgeries – and their results – can vary significantly from one hospital to another. You need the facts so you can make smart decisions about where to go for your specialty medical care. Blue Distinction is a special, quality-based designation given to certain hospitals nationwide that deliver proven results for quality care and treatment. More than 1,600 Blue Distinction hospitals and treatment centers are available nationwide for these types of specialty care:

Cardiac CareComplex and Rare CancersSpine SurgeryKnee and Hip ReplacementsBariatric SurgeryTransplants

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2. BCBS IL Has Tools for your Reference

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Your Life is Mobile…

•ID Card. Instant digital membership

•Coverage. Benefits and eligibility

•Claims. By patient, date or status

•Health and Wellness.My Care ProfileBlue ExtrasSM discountsObesityNutrition and FitnessMetabolic SyndromeDiabetes CareMaternity Care

•User Profile. Manage profile settings

Secure Site – Log-in required

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Use the Integrated Provider Finder tool to:Find a network primary care physician, specialist or hospital

Make an appointment to consult with a provider

View Patient Feedback or Add your Review for a Provider

View Quality, certifications and recognitions for doctors

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Integrated Provider Finder

Integrated Provider Finder

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Schedule Appointments Online

BCBS IL Customer Service

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Service that Takes You Out of the Middle

Service that Takes You Out of the Middle

Your benefit plan requires that you contact the Preauthorization number one day prior to hospitalization or within two days of an admission for emergency or maternity care. Failure to preauthorize may reduce your benefits.

For questions regarding benefits, membership and claims please call the Customer Service number and select the appropriate prompt.

Medical Providers: Please file all medical claims with your local Blue Cross and Blue Shield Plan.

Your benefit plan requires that you contact the Preauthorization number one day prior to hospitalization or within two days of an admission for emergency or maternity care. Failure to preauthorize may reduce your benefits.

For questions regarding benefits, membership and claims please call the Customer Service number and select the appropriate prompt.

Medical Providers: Please file all medical claims with your local Blue Cross and Blue Shield Plan.

Customer Service 1-800-xxx-xxxx BlueCard Access 1-800-xxx-xxxx Preauthorization (MH/CD) 1-800-xxx-xxxx Provider Locator 1-800-xxx-xxxx 24/7 Nurseline 1-800-xxx-xxxx

Members: If a provider does not file a claim on your behalf, please contact Customer Service.

BlueCross BlueShield of Illinois, an independent licensee of the BlueCross BlueShield Association, provides administrative claims payment services only and does not assume any financial risk or obligation with respect to claims.

Customer Service 1-800-xxx-xxxx BlueCard Access 1-800-xxx-xxxx Preauthorization (MH/CD) 1-800-xxx-xxxx Provider Locator 1-800-xxx-xxxx 24/7 Nurseline 1-800-xxx-xxxx

Members: If a provider does not file a claim on your behalf, please contact Customer Service.

BlueCross BlueShield of Illinois, an independent licensee of the BlueCross BlueShield Association, provides administrative claims payment services only and does not assume any financial risk or obligation with respect to claims.

bcbsil.combcbsil.com

Call your BCBS customer service team for:• Claim questions or status• Medical benefit coverage

questions• Help with finding network

providers• Membership and eligibility • ID card requests• Help with navigating online tools• Health education and transfer

to other health programs

3. Know Your Preventive Guidelines and Wellness Tools

Certain services can be billed as preventive or diagnostic. Preventive services are covered 100% In-Network – make sure billed as preventive!

Covered preventive services performed specifically for preventive screening, with no known symptoms, illnesses, or history, are generally covered as Preventive Care, subject to age and gender guidelines, and health status.

Preventive services are usually covered when performed on a person who:• has not had the preventive screening done before• does not have symptoms or abnormalities• has had a screening done within the recommended age/gender guidelines with

the findings considered “normal” • has had previous diagnostic services with the results being “normal”• has a preventive service done that results in a therapeutic service done at the

same time, and as an integral part of the preventive service (e.g. polyp removal during a preventive colonoscopy), the therapeutic service would still be considered preventive service

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Adult Preventive Care Guidelines

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Children’s Preventive Care Guidelines

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BCBS IL Well onTarget

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Health & Wellness Interactive Tools and Resources

Well onTarget is designed to give you the support you need to make healthy choices. All while rewarding you for your hard work.

Well onTarget Member Wellness Portal

• Onmytime Self-Directed Courses• Health and Wellnes Library• Tools and Trackers• Onmyway Health Assessment• Life Points Program

Health & Wellness Interactive Tools and Resources

Symptom Checker

A resource for you designed to assess your medical

symptoms.

Articles & Tools Interactive tools to help educate

you on a topic of interest

Food & Exercise DiaryTool indicating calories consumed,

Calories burned &daily calorie budget.

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BCBS IL Wellness onTarget

BCBS IL Fitness Programs

The BCBS IL Fitness Program offers membership to a national network of leading national, regional and local fitness centers for one low monthly price of $25 and no contract.

There are more than 8,600 fitness centers in the Fitness Program Network.Chains Include;

• Snap Fitness• Anytime• 24 Hour Fitness• Gold’s Gym• Some YMCA’s 16 Buy-up option with BCC Enhanced or Custom

Life Points

Offerings that earn points

−Health Assessment −Self-directed courses

(5 courses)−Fitness Programs−Tracking

Life Points Redemption

−# of levels

−Amazon Like store

−Buy Ups are available

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Blue365

Davis VisionSM (877) 393-8844, TruVision (877) 882-2020Save on eyeglasses, as well as contact lenses, laser vision correction services, examinations and accessories. Find out more when you log in to BAM.

Jenny Craig® (877) JENNY70 (877-536-6970)Jenny Craig can help you reach your weight loss goals. You will get one-on-one support given by a trained weight loss expert.

Life Time® FitnessLife Time Fitness offers a total health fitness experience no matter your fitness level, interests, schedule or budget.

Procter & Gamble (P&G) Dental Products (877) 333-0121Get savings on dental packages containing the latest in Oral B® power toothbrushes and Crest® products.

TruHearing® (800) 687-4617Save on digital hearing aids through TruHearing. Get a hearing test at no extra charge when performed to fit a hearing aid.

Seattle Sutton’s Healthy Eating® (800) 442- DIET (800) 442-3438These freshly prepared, calorie-controlled meals are designed to help with weight loss and managing certain health problems.

4. Understand Your Prescription Drug Plan

Generic Drugs: These are drugs where the patient has expired and competing pharmaceutical manufactures can no produce and sell that formulary. These lower cost generics allow the plan to pass the savings onto you with a lower copay.

Brand Name Drugs: Brand name drugs are still within the patient. These drugs are heavily advertised and cost considerably more than generic alternatives.

A Formulary is a list created by your insurance carrier BlueCross BlueShield of Illinois. They will negotiate with drug companies for discounted rates. These drugs are put on a formulary list and some of the savings is passed to the consumer at a lower copay.

Non Formulary are brand name drugs that do not fall onto the formulary list. These drugs have the highest copayments.

A copy of the formulary list can be found on www.bcbsil.com

Save Money on Prescription Drugs

Save Money on Prescriptions- ask about lower cost/no cost drugs; ask for samples; shop different pharmacies for discount drug programs (www.walmart.com , www.target.com, www.meijer.com, www.costco.com, www.samsclub.com)

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Mail Order Prescriptions

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5. Read and Understand your Explanation of Benefits

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Sample Explanation of Benefits

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CCSD #59

Questions

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