Benefits FAQs

Medical

Prescription Drug

Dental

Vision

Health Savings Account

Flexible Spending Account

 

 

Medical

 


What if I have questions about my medical coverage?

Review your plan highlights on http://www.bcbsil.com/foundations. or within the Plan Description, or Call BCBSIL at 1-866-563-8366.

 

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Do I have access to a Nurseline?

Blue Cross Blue Shield does have a 24/7 Nurseline. The 24/7 Nurseline can help when you or a family member has a health problem or concern. The 24/7 Nurseline is staffed by registered nurses who are available 24 hours a day, 7 days a week. The Nurseline phone number is 1-800-299-0274.

 

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Is there medical coverage outside of the United States?

Yes - If you are outside the U.S. and need urgent or immediate care, call 800-810-BLUE (2583) or call collect to 804-673-1177.  Most BlueCard Worldwide contracting hospitals will submit your claim, but if you need a claim form contact customer service at the number on your ID card or download the BlueCard Worldwide medical claim form.

 

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What if I am enrolled in my employer plan and another plan?

Review the Coordination of Benefits Section under the Plan Descriptions.

 

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How does the family deductible work?

The Premium PPO plan has a $450 per individual/$900 per family annual deductible. The combination of deductible expenses for the entire family will not exceed $900.

The Standard PPO plan has a $1,000 per individual/$2,000 per family annual deductible. The combination of deductible expenses for the entire family will not exceed $2,000.

The Consumer Choice PPO plan has a $2,700 annual deductible for employee coverage or $5,450 annual deductible for all other tiers. One family member or a combination of family members can satisfy the family deductible and the full family deductible must be met before post-deductible benefits are paid. .

 

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Prescription Drug

 


When will I receive my ID card?

You will not receive a Caremark ID card. Your prescription information is included on your BlueCross BlueShield of Illinois ID card.

 

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What is the generic substitution policy?

Unless your physician indicates a prescription must be a brand drug (dispense as written), your prescription will be filled with a generic drug.  If you wish to purchase a brand “Preferred/Non-Preferred” drug when a generic is available, you will pay the generic copay plus the difference between the costs, unless your physician substantiates “dispense as written” when issuing your brand prescription.

 

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Why can’t the pharmacy fill my prescription?

If your pharmacy is not able to fill your prescription, ask the pharmacy to call Caremark at 1-800-565-5827 to confirm coverage.

 

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How does coverage with another prescription drug plan work?

There is no coordination of benefit provision under the plan. You will pay the full co-insurance under the plan even if you have other insurance.

 

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What about other prescription discount cards?

Other prescription discount cards cannot be applied toward the cost of a prescription under the plan. If you use a discount card, the amount paid will not be applied toward your medical deductible (Consumer Choice Plan only).

 

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How are prescription drugs covered in the Consumer Choice PPO Plan?

Your prescription costs are applied to your deductible. Contact BCBSIL to confirm your deductible amount.

 

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What if I have more questions?

  • Call CVS/Caremark at 1-800-565-5827.
  • Contact your local pharmacist or medical provider if you have any questions about your prescribed medications.

 

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Dental

 


How do I know what my dental services will cost?

Ask your dentist to submit a pre-treatment estimate to Delta Dental for specific plan coverage.

 

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How can I get another ID card If I lost mine?

Print out a card on www.DeltaDentalks.com.

 

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What do I do if I am having a problem with a dental claim?

Check with Delta Dental at 1-800-234-3375 or talk to your dental provider.

 

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How do you handle claims submitted by a non-participating dentist?

If you visit a non-participating dentist, you may be required to submit a claim form for the services rendered and possibly pay the entire amount up front. In all instances, when a non-participating dentist renders services, any payment made by Delta Dental will be made directly to you, the subscriber.

 

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Vision

 


When will I receive my ID card?

There is no ID card associated with the VSP benefit. Be sure to tell your eye care provider you have VSP.  Your provider will confirm your coverage with VSP.

 

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I'm having problems with a VSP payment/benefit.

Call VSP at 1-800-877-7195 or check with your VSP provider

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Health Savings Account

 


What happens if I contribute more than my maximum annual contribution to my HSA?

If you contribute more than the maximum annual contribution to your HSA, you may withdraw the excess without penalty until the deadline (including extensions) for filing your tax return for the tax year for which the excess contribution was made. After that time, the funds are subject to both income taxes and an excise tax.

 

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What health care expenses does my HSA cover?

Your HSA funds can be used tax free to pay for out-of-pocket qualified medical expenses, even if the expenses are not covered by your HDHP. This includes expenses incurred by your spouse or qualified tax dependents.

There are hundreds of qualified medical expenses, including:

  • Over-the-counter medications for which you have a prescription from your doctor;

  • Dental visits;

  • Orthodontics;

  • Glasses

All of these expenses may be paid for with distributions from your HSA, free from federal income tax or state income tax (for most states).

Refer to IRS Publication 502 for a more complete list of qualified medical expenses.

 

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What happens to my HSA if I quit my job or otherwise leave my employer?

Your HSA is portable. This means that you can take your HSA with you when you leave and continue to use the funds and any earnings you have accumulated. If you are covered by a qualified HDHP you can continue to make tax-free contributions to your HSA

Distributions from your HSA that are used exclusively to pay for qualified expenses for you, your spouse or your dependents are excludable from your gross income. Your HSA funds can be used for qualified expenses even if you are not currently eligible to contribute to your HSA.

 

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What happens to the money in my HSA after I reach age 65?

At age 65 and older, you may continue to use your HSA funds to pay for qualified medical expenses; for instance, you may use your HSA to pay certain insurance premiums, such as Medicare Parts A and B, Medicare HMO, or your share of retiree medical coverage offered by a former employer. Funds cannot be used tax-free to purchase Medigap or Medicare supplemental policies.

If you use your funds for qualified medical expenses, the distributions from your account remain tax-free, i.e., free from federal income taxes or state income tax (for most states). If you use the monies for non-qualified expenses, the distribution becomes taxable, but due to your age, exempt from the 20% penalty.

Once you are enrolled in Medicare, you are no longer eligible to contribute to your HSA. If you reach age 65 or become disabled, you may still contribute to your HSA if you have not enrolled in Medicare.

 

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Can I roll over or transfer funds from my HSA to my IRA?

No. You can only roll your HSA funds into another HSA.

 

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What is the difference between health care flexible spending accounts (FSAs) and HSAs?

Both HSAs and FSAs allow you to pay for qualified medical expenses with pre-tax dollars. One key difference, however, is that HSA balances can roll over from year to year, while FSA money left unspent at the end of the year is forfeited. (Use it or Lose it)

 

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Is there a daily limit on my HSA debit card?

Yes, $2500

 

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Flexible Spending Account

 


How much can I contribute to my Healthcare FSA?

Health FSA contributions are limited to $2,600 annually.

 

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Why do I have to substantiate my claims under the Healthcare FSA?

Under IRS regulations all claims being paid with Healthcare FSA funds have to be substantiated to prove that the services were actually for a qualified health related services. Learn more about what is required to substantiate your card transactions during the plan year.

 

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How does a Limited Purpose FSA work?

This pre-tax feature allows you to save up to the IRS limit in your Health Savings Account while contributing up to $2,600 (pre-tax) per calendar year for non-medical reimbursable expenses such as dental or vision charges not covered under a group plan. You must be enrolled in the Consumer Choice (HDHP) to be eligible to have a Limited Purpose FSA.

 

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How much can I contribute to my Limited Purpose FSA?

Limited Purpose FSA contributions are limited to $2,600.

 

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What health care expenses does my Limited Purpose FSA cover?

Qualified expenses eligible for reimbursement with a Limited Purpose Health FSA include:

  • Dental and vision deductibles and copayments not covered by insurance

  • Eyeglasses and contact lenses

  • Your portion of orthodontia expenses

  • Certain over-the-counter drugs and supplies such as contact lens solution

 

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Why do I have to substantiate my claims under the Limited Purpose FSA?

Under IRS regulations all claims being paid with Healthcare FSA funds have to be substantiated to prove that the services were actually for a qualified health related services. Learn more about what is required to substantiate your card transactions during the plan year.

 

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