DOES MY PLAN HAVE A MAXIMUM BENEFIT?
The max benefit over your lifetime on your BCBS plan is $5,000,000.
WHEN IS PRECERTIFICATION NECESSARY?
Precertification is necessary for inpatient hospital, mental health and chemical dependency, and durable medical equipment. To precertify you will need to call the number on the back of your BCBS card.
HOW LONG CAN MY DEPENDENT CHILDREN STAY ON THE PLAN?
Dependents can stay on your BCBS plan to age 23 whether they are a student or not.
IS WELLNESS COVERED?
Yes, you have a $200 per year (January to December) wellness benefit. This is a per person benefit. When you go in for a physical or annual female exam BCBS will pay 100% of the charges up to $200. This is the only preventative or wellness benefit, if you exceed the $200 BCBS will not cover or pay additional charges. If you need additional testing done that is medically necessary make sure your doctor is coding it as diagnostic (medically necessary), then the normal benefit structure will apply.
Mammograms and well child visits do not apply to the $200 maximum benefit due to the state laws.
HOW DOES THE MAIL ORDER DRUG PROGRAM WORK?
If your plan includes prescription drug co-pay you also have access to the mail order drug program. If you are taking maintenance drugs (anything you take every day) you can use the mail order drug program. This is a wonderful cost saving benefit! If you go to the pharmacy to pick up your maintenance drugs you will end up paying 12 co-payments for 12 months of your drug. By using the mail order program you will get 3 months of your drug for 2 co-payments, so you will get 4 months of your drug free over the year. The only way to get this benefit is by using the mail order program. A mail order form is available under the “forms” tab, you simply need to mail in this form with a 90 day prescription for your drug and within about 5 days you will receive 90 days of your drug in the mail and pay only 2 co-payments. Your deductible will apply if it has not been met.
WHAT ABOUT WHEN I AM TRAVELING?
BCBS has a program called Blue Card. This allows you to travel all over the United States and still be in network. If you use BCBS participating doctors in the state you are in it is viewed as in network. International travel is also covered.
WHAT IF I USE A NON MEMBER DOCTOR?
If you choose to use a non BCBS participating doctor you are still covered. Your deductible will apply (you only receive first dollar benefits with participating doctors). If the doctor charges over the usual and customary rate you will be responsible for this amount; participating doctors write off any amount over the usual and customary rate.
WHERE CAN I GET A LIST OF THE MEMBER DOCTORS?
Click here to go to the Blue Cross Website and search for doctors by specialty, name or area.
Next Page »