The open enrollment period to add dependents to an existing Blue Cross® and Blue Shield® of Illinois (BCBSIL) individual policy is coming to an end on March 31, 2010. During this period there are no medical questions and the policy is guaranteed issue. The 12 month pre-existing condition waiting period is still applicable.

In order to qualify for the open enrollment period, the existing policy must have been in force prior to June 1, 2009. The open enrollment applies to all dependents under age 26 (and eligible military veterans under age 30), including children and/or spouses.

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Tags: BCBS Individual Policy Open Enrollment for Dependents Deadline, BCBSIL Open Enrollment, Blue Cross and Blue Shield of Illinois Add Dependent to Age 26 Deadline, Blue Cross Blue Shield of Illinois dependent additon

The acquisition of Lake Forest Hospital by Northwestern Memorial Health System was formally announced on Jan. 29, 2010. For the time being, the Northwestern Memorial Healthcare System parent company will have two separate subsidiaries: Northwestern Memorial Hospital and Northwestern Lake Forest Hospital.

At this time, each hospital will maintain separate agreements with Blue Cross and Blue Shield of Illinois (BCBSIL) and there is no plan to renegotiate agreements with BCBSIL. Lake Forest Hospital will remain in the provider network for the remainder of its contract with BCBSIL.

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Tags: Lake Forest Hospital BCBSIL PPO Network, Northwestern Acquires Lake Forest Hospital

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.

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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.

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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.

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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

UniCare announced yesterday that they will no longer be participating in the individual and group health insurance market in Illinois effective January 1, 2010. UniCare has collaborated with Blue Cross® and Blue Shield® of Illinois (BCBSIL) to ensure their group customers are provided the best opportunity to continue health insurance without the need to shop for new coverage.

As part of this transition, all existing UniCare groups will have the opportunity to transition to BCBSIL and receive:

* Guaranteed replacement coverage
* Guaranteed acceptance
* No waiting periods
* No underwriting

On October 30, 2009, a priority mailing will be distributed to the existing UniCare groups, which includes an Offer Acceptance and Initial Premium Forms. There is no guarantee that UniCare members will get medical coverage at the same price after the transition. Customers will have until Dec. 1 to decide whether to accept the Blue Cross coverage — a proposition that worries some UniCare subscribers.

If you or any one you know has UniCare please have them contact us.

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Tags: Unicare Illinois, Unicare Illinois Cancellation, Unicare Illinois Policy Cancellations, Unicare Leaving Illinois Market, Unicare Members Blue Cross and Blue Shield of Illinois Transition, Unicare Transfer to BCBSIL

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 becomes effective for benefit plans beginning on or after one year from the date the legislation was signed into law (October 3, 2008). All plans and products, including self-funded (ASO) groups – with the exception of ERISA-exempt groups – are affected and will be required to comply with the new law.*

While the law originally exempted the small group 2-50 market segment, Blue Cross and Blue Shield of Illinois has decided to implement Mental Health Parity for this 2-50 segment for all products. As a result, the provisions of the law apply to new contracts and renewals on or after October 3, 2009.

The Act does not require coverage of mental health or substance abuse benefits. However, the law does require that if benefits are offered for mental health and substance use disorders, they must have the same treatment and financial levels as the predominant medical and surgical benefits provided in the benefit plan. Equity of coverage applies to all treatment limitations – including frequency of treatment, number of visits, days of coverage or other similar limits – to ensure that treatment limitations applicable to mental health and substance abuse disorder benefits are not more restrictive or less generous than the limits applied to medical and surgical benefits.

For ERISA-Exempt Groups
ERISA-exempt groups subject to the Public Health Service Act (PHSA) are also subject to Mental Health Parity unless they seek an exemption under the PHSA. If they have not sought an exemption from the PHSA, then the law applies. The group must provide the annual opt-out by mailing a request to the Centers for Medicare & Medicaid Services (CMS) prior to the beginning of each plan year. Unless these groups are annually opting out of the HIPAA Mental Health Parity or don’t offer mental health coverage, they are required to meet the parity standards. If groups have not received an exemption, then they can still opt out under the rules for the Mental Health Parity Cost Exemption Amendments, which require the plan to implement mental health parity/substance abuse benefits for at least the first six months the law is in effect.

For PPO Business
Beginning October 3, 2009 for new and existing groups upon renewal, Serious Mental Illness, non-serious mental health, and/or substance abuse will not be specifically mentioned on PPO highlight sheets. Instead, it will be noted that all mental health conditions must be treated the same or better than other medical conditions under the office visit and inpatient hospital services sections. The standard office visit benefit copayment, coinsurance, and/or deductible will also apply to mental health and substance abuse services. Inpatient hospital services will include benefits for mental health and substance abuse, eliminating any previous inpatient/outpatient day limitations.

For HMO Business
Beginning October 3, 2009 for new and renewing groups, the description of the HMO benefits will be changed to remove any and all reference to mental health or Serious Mental Illness. Also, reference to inpatient days and outpatient visits associated with mental health are being eliminated.

*An amendment was made to the Act which allows plans maintained pursuant to one or more collective bargaining agreements (CBA) to wait until the later of (i) the date on which the CBA relating to the plan terminates (determined without regard to any extension agreed to after the enactment of the Wellstone Act) or (ii) January 1, 2010, to comply with the Wellstone Act. The original bill stated that compliance must be achieved by January 1, 2009.

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Tags: 2009 Blue Cross and Blue Shield of Illinois Mental Health Parity Notification, 2009 Mental Health Parity Act - BlueCross BlueShield of Illinois Groups, BCBSIL Mental Health Parity Changes, Blue Cross and Blue Shield of Illinois Mental Health Parity Act, Mental Health, Mental Health Parity Act Illinois, Mental Health Parity Act Legislation, Mental Health Parity and Addiction Equity Act, Mental Health Parity and Addiction Equity Act Effective Dates, The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008

Because Blue Cross and Blue Shield of Illinois (BCBSIL) believes an educated consumer will make better health care decisions, they have announced an enhancement to our Hospital Comparison Tool. Named Care Comparison, this new component of the hospital transparency tool allows members to make informed decisions when choosing a hospital or facility for common medical procedures and related services.

Launched on September 10, 2009, the Care Comparison tool provides Blue claims-based cost information for 35 of the most commonly performed elective medical procedures. This easy-to-use tool allows members to review and compare total treatment costs, both professional and facility combined, for procedures performed at designated facilities in the independently contracted provider network. Included are specified area hospitals, ambulatory surgery centers and free-standing radiology centers, including inpatient and outpatient services. Members can also compare cost difference between area facilities by ZIP code.

With the addition of the Care Comparison tool to our existing Hospital Comparison tool, which provides measures of quality for 161 inpatient procedures, customers and members now have access at their fingertips to information comparing hospitals as well as common medical tests and the facilities used to perform them.

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Pending Illinois Department of Insurance approval, Blue Cross and Blue Shield of Illinois is planning to introduce the BlueCare Dental PPO plan to members with individual and family health plans.

The BlueCare Dental PPO product will be offered as a rider to members that have a major medical individual health insurance plan. It will not be offered with the SelecTEMP® (short-term medical) product.

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Tags: BCBSIL Individual Dental, Blue Cross Blue Shield of Illinois Dental Plans

The following Independent Practice Associations will no longer participate in the Blue Cross and Blue Shield of Illinois HMO Illinois and Blue Advantage HMO networks, effective Dec. 31, 2009:

• Ravenswood Medical (062) and satellite: Ravenswood Medical Group at Cicero (153)
• Antillas Family Medical Center LTD (072) and satellites: West Care Medical Center (230), Lakeside Medical Center (339), Graceway Medical Center LTD (341), Allport Medical Group (411), Bazell Medical Center (412), Antillas South (452)
• Partners in Health (373)
• Perfect Managed Care LLC (460) and satellite: Perfect Managed Care, Lincoln Park (461)

The following Independent Practice Associations will be leaving the Blue Cross and Blue Shield of Illinois Blue Advantage HMO network effective December 31, 2009:

• Midwest Physicians Group / Bridgeport Family Center (152) and satellites: Midwest Physicians Group/Bourbonnais (205), Midwest Physicians Group/Crestwood (214), Midwest Physicians Group/Marquette (337), Midwest Physicians Group/Beverly (309), Midwest Physicians Group/Olympia Fields (234), Midwest Physician Group/Orland Park (261)

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Tags: Blue Advantage Illinois, Blue Cross and Blue Shield of Illinois HMO network, HMO IIllinois network