Loyola BCBS PPO FAQs
On January 1, 2014, a key component of the health reform law went into effect: Everyone in the U.S. (with a few exceptions) is required to have health insurance.
- For more information, please visit http://www.luc.edu/hr/health/ and select “Health Care Reform.”
Loyola Advantage PPO
- While you have other options to purchase health insurance, Loyola offers you coverage that satisfies all the health reform requirements. Subsequently, you will not qualify for any federal assistance to purchase an individual or family policy on the open market. Loyola's single option medical provider is Blue Cross Blue Shield Illinois (PPO) and the medical insurance plan is called The Loyola Advantage BCBSIL PPO Medical Plan.
- The medical plan is a Preferred Provider Organization (PPO), a network of doctors, hospitals and other health care providers who agree to provide services at discounted rates.
- BlueCross BlueShield manages the medical plan and they are the claims administrator.
Loyola Advantage PPO Benefits
- The Loyola Advantage BCBSIL PPO Plan has a significant advantage over other medical plans because we offer affordable health care through our home hospitals ((Loyola University Health System and Gottlieb Hospital).
- Most routine preventive care from In-Network doctors is covered at 100%.
- After you meet the annual deductible, the plan then pays a percentage of the cost and you pay the remainder — your coinsurance. You pay a smaller percentage if you use a home hospital or a PPO network provider. A co-pay applies for the emergency room visits and hospital admissions.
- There are no pre-existing conditions on the health plan.
- Separate deductibles, coinsurance and out-of-pocket maximums apply to prescription drug expenses.
See the Health Plan Summary table on pages 12-13 of the Benefits Booklet for additional details.
Your plan covers emergency medical care for the initial treatment of a sudden and unexpected medical condition which has such severe life-threatening symptoms that the absence of immediate emergency medical attention could result in serious or permanent medical consequences. It also covers emergency accident care and related diagnostic services when initiated within 72 hours of the accidental injury.
All emergency room visits (including at a home hospital) are subject to a $150 per-visit copay.
Below are common preventive care services that the Loyola Advantage PPO Plan covers at 100% when you receive these services from a participating provider.
- When you see your doctor for a preventive care visit, be sure to specify that your visit is for preventive care or wellness, as covered under the plan.
- If your doctor discusses other preventive care or wellness services not listed below, be sure to ask if the service is covered at no additional cost.
|Breastfeeding support, supplies and counseling||Pap Smear*||
Health Counseling for Sexually Transmitted Infections
|Colonoscopy*||Physical Exam*||Health Education/Counseling Services|
|Obesity Screening and Counseling||Prostate Test*||Screening and Counseling for Domestic Violence|
|*Routine exams are covered as preventive care services, however diagnostic exams will go towards your annual deductible.|
When You Need Health Care Outside the U.S.
Always carry your BlueCross BlueShield identification card. Check with BCBSIL before leaving the U.S. because your health care benefits may be different outside the U.S.
If you need emergency medical care, go to the nearest hospital. If you are admitted, call the BlueCard Worldwide Service Center at (800) 810-BLUE (2583) or call collect at 1.804.673.1177.
If you need non-emergency inpatient medical care, you must call the BlueCard Worldwide Service Center.
- The Service Center will facilitate hospitalization at a BlueCard Worldwide hospital or make an appointment with a doctor.
- It is important that you call the BlueCard Worldwide Service Center in order to obtain cash-less access for inpatient care except for your usual out-of-pocket expenses (e.g., deductible, coinsurance).
- The Service Center is staffed with multilingual representatives and is available 24-hours-a-day, seven days-a-week.
Call BCBSIL for pre-certification or prior authorization, if necessary. Refer to the phone number on the back of your ID card.
CVS Caremark will manage your prescription benefits just like your health insurance company manages your medical benefits. Outpatient prescriptions (mail order and specialty) must be filled through CVS Caremark. Retail pharmacy prescriptions can be filled at CVS, Walgreens, Target, Walmart, and many more participating pharmacies. You will receive a separate prescription drug ID card from CVS Caremark. For complete information on Prescription Drug Coverage, please see the Benefits Booklet, located in the Resources section (upper right).
FOR PRESCRIPTIONS YOU WILL BE FILLING ON OR AFTER JANUARY 1, 2018:
Register online at www.Caremark.com, select "register now" and you do not need your subscriber ID number to register.
- Locate pharmacies (60,000+)
- Check plan coverage
- Print a temporary card or request new/additional card(s)
- Set up access for family members.
- Set up shipping/billing/payment info
- Check medication costs
- A complete list of what drugs are excluded
How can I get a new or additional ID card? You can print a temporary card or request a new one online at www.Caremark.com or call customer service at 888.202.1654. If you do not have your card, you can use the following information to obtain a prescription: Reference RX BIN#: 004336 & GROUP#: RX0804
Call and speak with CVS Caremark customer service: 888.202.1654
- For Specialty Medications, visit https://www.cvsspecialty.com/wps/portal/specialty/patients/registration or call 800.237.2767
*SPECIAL NOTE ABOUT PRESCRIPTIONS FOR CONTRACEPTIVES: In order to obtain these prescriptions, you will need to obtain and utilize a separate RX bin # and ID #, along with a SEPARATE ID card from CVS Caremark. The RX BIN # is: 004336 and the Group # is: RX3923. Contact 1-888-924-8738 to enroll in the Contraceptives Coverage and receive your separate ID card.
MDLIVE provides you with an opportunity to access a doctor from your home, office, or on the go.
- Board Certified doctors can visit with you either by phone or secure video* to help treat any non-emergency medical conditions.
- MDLIVE doctors can diagnose your symptoms, prescribe medication, and send prescriptions to your pharmacy of choice.
What is the cost for this service?
- Registration is free (Sign up in advance of using the service).
- The cost of the virtual visit is $44 and is paid via credit card at time of call.
How do I contact MDLIVE?
You can access MDLIVE a number of different ways:
- Log on to the website: MDLIVE.com/LUC;
- Download the MDLIVE App from the App Store, Google Play or Windows Store;
- or call 1-800-770-4622.
*Video consultations are available during the hours of 6:00AM - 8:00PM CST (7 days a week).
- Annual Deductible – The amount you have to pay each year before the plan starts paying a portion of expenses. Most covered expenses count toward the annual deductible. Prescription drugs (which have a separate deductible) do not count toward health plan deductibles. All family members’ expenses that count toward a health plan deductible accumulate together in the aggregate to satisfy the annual family deductible; however, one person will not pay more than $500 for the deductible.
- Annual Out-of-Pocket Maximum – Total amount you pay out of pocket each calendar year before the plan pays 100 percent of covered expenses for the rest of the calendar year. Expenses paid to satisfy the annual deductible count toward the annual out-of-pocket maximum. Most covered expenses count toward the out-of-pocket maximum, except prescription drugs (which have a separate out-of pocket maximum).
- Coinsurance – A percentage of a claim you pay after you meet the annual deductible.
- Copayment (copay) – A fixed dollar amount you pay for emergency room visits and hospital admissions.
- Home Hospital – Loyola University Health System or Gottlieb Hospital.
- PPO (Preferred Provider Organization) – A network of doctors, hospitals and other health care givers. The Loyola Advantage PPO Plan uses the BlueCross BlueShield network.