Blue Cross and Blue Shield of Illinois (BCBSIL) is offering the Fitness Program as the newest value-added health and wellness option. The Fitness Program is an exclusive membership program that offers unlimited access to a nationwide network of fitness centers for a low monthly membership fee.

• Group Markets: As a new feature of Blue Care Connection®, the Fitness Program is now available to all group plan members (age 18 and older) who have Blue Care Connection. There is no additional cost to the employer or to the member’s premium for taking advantage of the Fitness Program.
• Individual Markets: The Fitness Program is available to all members (age 18 and older) with Individual Markets health care benefit plans, both Under 65 and Over 65.2 There is no additional premium cost to the member for the Fitness Program. (Under 65 Individual Members in the BCBSIL High Risk Pool may also participate in the program. Over 65 members with Part D coverage only are not eligible for this program.) Promotional postcards were mailed to individual members ages 18-55 and Over 55 at the end of 2009.

The Fitness Program offers:

• A one-time $29 enrollment fee and $29 monthly dues
• No long-term contracts with a flexible month-to-month membership
• Access to a nationwide network of popular fitness clubs, such as Bally’s Total Fitness, 24-Hour Fitness and participating YMCAs
• The option to work out close to home or work, near friends and family, or while traveling
• Easy online registration process through Blue Access® for Members
• Automatic direct billing through a major credit card or bank account
• Online fitness center location search, account management and customer service features
• Group Markets members and Individual Markets Under 65 members earn Blue PointsSM for joining the program and working out. [Note: Blue Points do not apply to Illinois Comprehensive Health Insurance Plan (ICHIP) members and Over 65 Medicare Supplement (Individual) members.]
• Tracking to earn Blue Points without self reporting. Fitness center visits are tracked via the membership card.

Enrolling is quick and easy. Members will be able to log in to their Blue Access® for Members account, click the My Health tab to find the Fitness Program button and use that link to search for participating locations and to complete their enrollment. Or, members can enroll by calling Customer Service at 888-762-BLUE (2583). The Fitness Program is available to members in addition to other fitness discounts available through the BlueExtras program.

Tags: BCBSIL Fitness Program, BCBSIL Wellness Discounts, BCBSIL Wellness Program, Blue Cross and Blue Shield of Illinois Gym Discounts, Blue Cross Blue Shield of Illinois

From the Chicago Tribune

Moody’s Investors Service has downgraded the debt and financial-strength ratings of the parent of Chicago-based Blue Cross and Blue Shield of Illinois.

Moody’s Investors Service this week said Health Care Service Corp., the nation’s fourth-largest health insurance company, has been hampered by higher than expected medical costs driven by increased unemployment and layoffs that reduced membership in its plans. Those issues have hampered earnings growth, Moody’s said.

“The pressures on medical trend and membership growth are expected to continue during 2010, which will make it difficult for (Health Care Service Corp.) to regain earnings traction,” said Moody’s Senior Vice President Steve Zaharuk. “We expect (Health Care Service) to produce after-tax margins in the 2 percent to 3 percent range over 2010, and to continue to manage earnings at that level going forward.”

The Moody’s report offers a glimpse into the finances of Health Care Service, which is a private mutual insurance company owned by policyholders and does not release quarterly financial reports to the public. In contrast, its publicly-traded and investor-owned rivals in the health insurance industry file and issue regular quarterly reports.

Health Care Service has 12.5 million health plan members. It operates Blue Cross and Blue Shield health plans in Illinois, Texas, Oklahoma and New Mexico.

Health Care Service ratings on its $400 million in debt dropped one notch to A2 from A1, the fifth-highest on Moody’s scale of 21 ratings. Meanwhile, the insurer’s financial strength rating dropped to A1 from Aa3, the fourth-highest on Moody’s scale.

Moody’s said an upgrade of the insurer’s rating is “unlikely” in the near term given the uncertainties of the economy and the coming impact of health care reform.

“(Health Care Service) remains one of the strongest health insurers financially and maintains the highest debt rating in the industry,” the company said in a statement. “Like other health insurers, we have been affected by the economic climate and increased utilization. Because of careful and prudent management, HCSC maintains a strong balance sheet and continues to meet all of its policyholder obligations.”

The ratings are still high and keep Health Care Service’s debt at investment grade. Net earnings for the first nine months of 2009 were $423 million on total revenues of $14.8 billion, Moody’s said.

Tags: Blue Cross and Blue Shield of Illinois Financial Rating, Blue Cross Blue Shield of Illinois 2010 Financial Performance, Moody's BCBSIL, Moody's Blue Cross Blue Shield of Illinois

For many years now many of my health insurance clients in Illinois have been asking for a dental insurance plan with Blue Cross Blue Shield of Illinois. Up until now, BCBSIL did not have dental insurance for families or individuals – just on the group insurance side. If someone purchased a BCBSIL individual or family health insurance policy, they would have to look else were for dental coverage. In the past, we would have recommended a stand alone dental plan with Aetna or a Vital Savings plan from Aetna.

The new dental insurance plan is called Blue Care Dental PPO and is a solid dental plan.

Eligibility Requirements:

• You must enroll in a BCBSIL health plan in order to enroll in the dental plan (you have up to 31 days from the effective date of your policy to enroll). There is a window of time where current BCBSIL members can add the Dental plan starting on November 9th, 2009 and going until January of 2010.
• All members on that health plan must be enrolled in BlueCare Dental PPO, you can’t pick and choose family members who get dental.
• Once your dental plan is dropped for any reason, you cannot re-enroll unless you reapply for a new health insurance plan. As long as someone hasn’t had any major changes in their medical history, we usually recommend them to reapply every year or so to take advantage of new business rates.

One of the best benefits is that you’ll get dental coverage on day one – with no deductible required – for periodic checkups, cleanings x-rays and other preventive services. Most important, costs are typically reduced when you receive care from any of our participating network dentists. However, you also have the option to see any dentist not in the network, but your out-of-pocket costs may be higher.

There is a $50 dollar deductible per member per benefit period but this only applies to major services like Bridges, Crowns, Dentures, Endodontics (root canals), Oral Surgery and Periodontics (gum disease). For these services which they consider type III they do cover 50% of the Maximum Allowance after deductible. The maximum benefit per calendar year is $1,500.

Services like fillings and simple extractions don’t have a waiting period and they are covered 80% of maximum allowance without needing to pay a deductible. This is a very strong feature that you don’t see with many plans. For example a $100 cavity filling would only cost $20. Compared to the popular Aetna PPO plus dental plan, fillings were only covered at 50% and and there is a 6 month waiting period.

Monthly Premium for BlueCare Dental PPO

The pricing as an add on plan is very competitive especially for a family of 4 or more.

Zip codes 600 – 608

Member: $26.55
Member: + Spouse $53.10
Member: + Child(ren) $45.50
Family: $77.85

Zip codes 609 – 629

Member: $25.05
Member: + Spouse $50.10
Member: + Child(ren) $42.95
Family: $73.45

To run a quote or apply online, visit the BCBSIL quoting website. Please note that you must already have or apply for a new Blue Cross Blue Shield of Illinois health insurance policy in order to obtain a BCBSIL dental plan. You cannot get a standalone dental policy without applying for a health insurance plan.

Tags: BCBS IL dental, BCBS Illinois Individual Dental Insurance Plans, BCBSIL Individual Dental, Blue Cross Blue Shield of Illinois Individual Dental Plans, New Blue Cross Blue Shield of Illinois Individual and Family Dental Plans

Aetna has recently clarified their underwriting requirements when a doctor’s visit is needed in order to underwrite a new application. The doctor’s visit must be performed by a Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioner/Certified Registered Nurse Practitioner (NP/CRNP) or Physician Assistant (PA).

Aetna Online Application

Age/Timeline Requirements:

Newborn through age 17: The application must include a doctor’s visit within the past 3 years. If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required. The only exception to this policy would be a newborn, under 31 days old, or a newly adopted child who is being added to a policy without underwriting.

Age 18 through age 30: The application must include a doctor’s visit within the past 5 years. If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required. A physical must include height, weight, and a blood pressure reading.

Age 31 through age 49: The application must include a doctor’s visit within the past 5 years. If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required. A physical must include height, weight, a blood pressure reading and lab results for blood sugar and cholesterol.

Age 50 and older: The application must include a doctor’s visit within the past 2 years. If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required. A physical must include height, weight, a blood pressure reading, and lab results for blood sugar and cholesterol.

If the Underwriter determines (either through outreach to an applicant in a phone interview or by review of medical records) that the applicant has not had a doctor’s visit within the required time frames, the underwriter will close the application.

The underwriter will document what information is required to be considered for enrollment and a written letter will be sent to the applicant to advise that their application has been closed.

Example: A 50 year old applicant applies for coverage with no medical history. A telephone interview is conducted and at that time, the applicant confirms that he/she has not seen a physician in over 5 years.

At that time, the clinician performing the telephone interview will advise the applicant during the conversation that “To proceed with underwriting your application, the results of a current physical exam is required. This includes but is not limited to: height; weight; blood pressure; lab results for cholesterol and fasting blood sugar; and past medical history. Your application can be continued if you submit this documentation to the underwriting department within the next 30 days. You may fax this information to (866) 223-2041.” The applicant should identify on the fax that this is a “Request to reopen their application” and they should include their closed letter.

Tags: Aetna Doctor Visit Requirement, Aetna Individual and Family Underwritiing Guidelines, Aetna Individual Underwriting, Aetna Underwritng Requirements