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

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.

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.

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.

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.

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)

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

Blue Cross and Blue Shield of Illinois (BCBSIL) has acquired DenteMax by Dental Network of America (DNoA), a wholly owned dental subsidiary of Health Care Service Corporation (HCSC), which operates Blue Cross Plans in Illinois, New Mexico, Oklahoma and Texas. As a result, the DNoA Preferred Network in Illinois will be increased by more than 500 dentist access points on August 1, 2009.

DenteMax was previously a wholly owned subsidiary of Blue Cross and Blue Shield of Michigan. The acquisition brings the two strategically focused companies under one umbrella. DenteMax has one of the nation’s largest independent dental PPO networks in excess of 91,000 dentist access points, serving more than 5 million members nationwide. In addition, DenteMax leases its network to approximately 200 benefit payers. DNoA is known primarily for the exceptional customer service and third party administrator services they provide to more than 2.6 million Blue Cross and Blue Shield members in Illinois, New Mexico, Oklahoma and Texas.

Tags: 2009 BlueCare Dental Network Acquisition, BCBSIL Dental Network, Blue Cross and Blue Shield of Illinois Dental, BlueCare Dental Network, BlueCross Blue Shield of Illinois Dental Network Expansion

For existing Blue Cross and Blue Shield of Illinois individual plan members who were members prior to June 1, 2009, the open enrollment window to enroll dependents under age 26 (and eligible military veterans under age 30) will take place from January 1, 2010 through March 31, 2010. Please note that beginning in November 2008, BCBSIL stopped removing dependents from coverage who would have otherwise aged out.

This pertains to the new law in Illinois that allows young persons under age 26 to join their parents have health insurance policy as a dependent as long as they are not married until their 26th birthday. This also applies to young persons under the age of 30 whose mom or dad served in the military as long as the young person lives in Illinois and is unmarried.

To obtain Blue Cross and Blue Shield of Illinois individual plans and quotes, visit the BCBSIL website.

Tags: 2009 Illinois dependent age limitation, BCBSIL individual plans for dependents, Blue Cross and Blue Shield of Illinois under 26, Blue Cross Blue Shield of Illinois - dependent law change, Illinois dependent age change, Illinois health insurance dependent law change

In May 2009, Blue Cross and Blue Shield of Illinois informed their Springfield Medicare Select members that St. John’s Hospital had elected to discontinue its status as a Medicare Select contracting network hospital effective June 17, 2009. BCBSIL has announced that St. John’s Hospital has reconsidered and will remain a Medicare Select contracting network hospital. There will be no disruption of services provided or benefits covered under the Medicare Select plan at St. John’s Hospital. A letter containing this updated information was mailed to BCBSIL Medicare Select members in Springfield on June 19, 2009.

If you are a Medicare Select client that requested a plan change as a result of the May 2009 notification and would like to reinstate your previous Medicare Supplement insurance plan, you can call BCBSIL (800) 624-1723 and a customer service representative will assist in reinstating your former plan and will make sure that you are credited for any increase in premium they may have paid to change plans.

Tags: Medicare Select Network, St. John's Hospital Blue Cross Blue Sheild of Illinois, St. John's Hospital Medicare Select

Blue Cross® and Blue Shield®of Illinois (BCBSIL) has removed the following Illinois residential requirement: “50% or more of the enrolled employees must reside in IL or the bordering states. The restriction still applies to group with 2-50 employees. BCBSIL is very competitive in this market and still uses a gatekeeper form, that means no individual underwriting on most groups.

In the past, this rule may have effectively removed BCBSIL as an option for many companies. If you are a group that has been affected by this rule in the past and would like get a Blue Cross and Blue Shield of Illinois group quote, please email us at info@ilhealthagents.com with the subject BCBSIL group quote or contact us.

Tags: Blue Cross Blue Shield of Illinois group health insurance, Blue Cross Blue Shield of Illinois Group Quotes