Medical

image

Your medical coverage is provided by BlueCross BlueShield of Illinois.  Get information about your health benefits, find in-network providers, review past claims, and more using the secure member website: Blue Access for Members (BAM). Make sure to download the mobile app for easy access while on the go. 

Summary of Benefits and Coverage (SBCs):

 

To find a provider that is in-network, use the BCBSIL Provider Finder website. 

What to think about regarding plan options

  1. Provider availability - Will you be able to visit the doctors, hospitals and other facilities you want to
  2. Your costs - How much is going to come out of your paycheck every month? What about the whole year?
  3. Benefit payments - How much will you have to pay out of your pocket for your medical expenses?
  4. Medical services - Consider your health status and services you expect to use during the year. What has your experience been in the past years?

PPO 

In-network provider advantages: 

  • Receive the highest level of benefits and potentially pay less for care
  • Protection from billing over the allowed amounts (balance billing)
  • No claim forms (provider files claim)
  • No referrals required 
  • No requirement to select a PCP
  • Access to a national PPO network

Out-of-network provider drawbacks:

You do have coverage, but:

  • You pay a greater share of the costs
  • You may receive fewer benefits out-of-network
  • You may need to file your own claims
  • You may be billed for charges over the allowed amount (balance billing)

CDHP

Plan advantages:

  • Same network access as PPO
  • No referrals required
  • HSA contributions are tax-free
    • An HSA allows you to accumulate a balance of funds year over year 
  • Employee premium contributions typically lower than the PPO
  • Once deductible and out-of-pocket maximums are satisfied, all benefits including pharmacy will be paid at 100%

Plan disadvantages:

  • Higher deductible than a PPO
  • The deductible must be met before benefits are available for non-preventive services

HMOI Overview

  • Each covered employee and dependent(s) choose a Primary Care Physician (PCP) from participating Medical Groups/IPAS
    • Female members may also choose an OB-GYN (must have a referral arrangement with the member's PCP)
  • Your PCP will coordinate your covered health care services and provide specialist referrals when appropriate
  • Out-of-network coverage on the HMO plan is available in case of emergency
    • For urgent care you will need a referral from your PCP
  • You may change medical groups by calling BCBSIL customer service 
    • Changes can be made up until the last day of the month for an effective date of the first of the following month
      • For example: Make changes by January 31st for an effective date of February 1st 

 


Back