https://connect.bcbsil.com/my-coverage-explained/en-USTelligent Community 12https://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/what-is-3d-mammographyTue, 29 Sep 2026 11:35:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:2c1f706c-74af-42e2-84ff-d7537a511140BCBSIL Connect TeamWomen have choices when it comes to breast cancer screenings. A standard mammogram every one or two years is the recommended best practice for early detection. It can detect breast cancer up to three years before it can be felt. Since their introduction, standard mammograms, also called screening mammograms, have helped save countless lives. By using X-rays, they create two-dimensional images of the breast to spot tissue that may be cancerous. Still, over the past decade, there have been advances in mammogram technology. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer more accurately than standard mammograms. Here’s a deeper dive into the potential benefits and risks of a 3D mammogram. How Do 3D Mammograms Differ From Standard Ones? Standard 2D mammograms take two pictures of the breast. Side-to-side and top-to-bottom images are made. To capture them, the breast is pulled away from the body, compressed and held between two glass plates. This allows the whole breast to be seen. One of its drawbacks is breast tissue can overlap during this process. Healthy tissue may appear suspicious and cancerous tissue can be masked. For this reason, 2D mammograms can sometimes produce inaccurate findings. In contrast, 3D mammograms use CT (computed tomography) scans. The scans take detailed X-ray images from many angles. Combined, the X-rays create a three-dimensional picture of each breast. Tissue doesn’t overlap. As a result, 3D mammograms help doctors spot cancers more easily with fewer false alarms. This is especially important for women who have dense breast tissue. Having fewer false alarms reduces unnecessary stress and worry. It also lowers the need for retesting. What Are the Risks and Limitations of 3D Mammograms? CT-scan technology exposes patients to more radiation than X-rays. Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. Still, the overall benefit of 2D and 3D breast cancer screening outweighs any potential risks linked to radiation exposure. While research shows 3D mammograms are more effective in detecting tumors, both 2D and 3D mammography are currently recognized as equally acceptable screening methods. Are 3D Mammograms Covered? 3D mammograms may be covered by your health plan. Before your screening, the provider you choose should be able to give you a breakdown of what you may have to pay if anything. You can also check your coverage by logging into your health plan account online or calling the number on your member ID card. How Often Should I Get a Mammogram? The U.S. Preventive Services Task Force recommends that women with average breast cancer risk, between the ages of 40 and 74, get a mammogram at least every two years. If you have a higher risk of breast cancer, talk to your doctor about screening, no matter your age. Breast cancer risk factors include: Personal history of breast cancer Family history of breast cancer Gene mutations such as BRCA1 and BRCA2 Radiation treatments to the breast or chest area Check with your doctor if you have questions about mammograms or other breast cancer screenings. Sources: Mammograms , National Cancer Institute, 2025; Diagnostic Mammogram , National Breast Cancer Foundation, 2026; 3D Mammography (Digital Breast Tomosynthesis) , Breastcancer.org, 2026; 3D Mammograms , Mayo Clinic, 2024; Breast Cancer: Screening U.S. Preventive Services Task Force, 2024; 2D vs 3D Mammograms: Understanding the Difference , American Cancer Society, 2025Benefits and CoveragePreventive CareMammogramWomen’s HealthBreast CancerBreast Cancer Preventionhttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/appeals-decisionsMon, 28 Sep 2026 13:35:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:e3b0675b-8a3c-4f09-8663-85377b4e6d2bBCBSIL Connect TeamInternal Appeals Blue Cross and Blue Shield of Illinois has an internal claims and appeals process that allows you to appeal decisions about paying claims, eligibility for coverage or ending coverage. Please check “adverse benefit determination” in your benefit booklet for instructions or call the customer service number on your member ID card. External Appeals If your internal appeal is denied, in some cases you may request an external review. External review is an option for denials for services that were not medically necessary or were clinically unproven. As a BCBSIL HMO member, you may have these types of denials examined by external, independent reviewers. The independent review organization is not associated with your health plan. There is no charge for requesting the review. We will send you information reminding you that independent, external review of coverage is available every year. We mail the information to members who do not have fax, email or internet access. Call the customer service number on your member ID card if you have questions about the external review process. Find Tools and Resources Log in to your member our secure member account for a personalized search experience based on your health plan and network. Learn more about your benefits and gain access to member services. Get coverage details, access resources and tools, and more. You can also find doctors in your network, get an ID card, and sign up for text or email notifications, tips and reminders.AppealsBenefits and CoverageExternal Reviewhttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/deals-blue365Mon, 28 Sep 2026 11:36:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:b23f6a76-e912-4cd1-8522-b9c5c85f1089BCBSIL Connect TeamDo your shopping lists never end? Are you a champion bargain hunter? Then Blue365 ® is perfect for you. Blue365 is a discount service that saves you money on a variety of everyday needs and healthy lifestyle aids. How Does It Work? Any member of a participating Blue Cross and Blue Shield plan is eligible for Blue365. With Blue365, you can browse available discounts that are updated regularly. Discounts fall into six categories: Apparel and footwear Fitness Hearing and vision Home and family Nutrition Personal care Here are some examples of what kind of deals you can find. Do you or your family need new athletic clothes to keep you warm while you’re on the move? Does anyone need new sneakers? Blue365 has savings from brands like allbirds and Skechers ® . Extra screen time for school or work can mean you or your family members might need eyewear. Do you have a loved one who could use dental services or a hearing test? You may find savings for glasses or contacts, dental services, or hearing aids. Has anyone been hinting they might like a wearable health or fitness monitor this year for a holiday gift? Choose devices from brands like Google FitBit ® , Garmin ® or Oura. Would you or someone you know get peace of mind with a remote medical monitoring system for infants or seniors? Blue365 savings may make this technology work with your budget. Even when bigger ticket needs or wishes come up — weight loss programs, gym memberships or online courses — Blue365 may have just what you need. How to Get Started Create a free account at blue365deals.com . Be sure to have your member ID card handy for this. Click All Deals on the top left of the screen. Or search in one of the categories. When you see the discount you want, click on Details . Sign up to get weekly deals sent directly to your email. Tips for Using Blue365 Like most sales, Blue365 deals come and go. If you see something you like, take advantage of the deal you find while it’s still available. You can search for the most recently added deals or deals that may be expiring soon using the search filter. There’s no limit to the number of deals you may use at any time. Feel free to try as many as you’d like! And you aren’t obligated to use any of the discounts if none of them appeal to you. Remember that Blue365 is not extra insurance coverage, and it is not a health plan. It’s a way to save money on health and wellness items and is an extra perk to your health coverage. Blue365 is a discount program only for Blue Cross and Blue Shield of Illinois members. This is NOT insurance. Discounts are only given through vendors that take part in this program. BCBSIL does not guarantee or make any claims or recommendations about the program’s services or products. BCBSIL reserves the right to stop or change this program at any time without notice. The relationship between the Blue365 vendors and BCBSIL is that of independent contractors. BCBSIL makes no endorsement, representations or warranties regarding any products or services they offer.Benefits and CoverageBlue365DiscountsDealshttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/medical-tests-preventive-vs-diagnosticMon, 28 Sep 2026 09:57:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:5e38756a-ab8c-4bd9-9905-e7ec9edb524dBCBSIL Connect TeamWhen your doctor orders a test for you, it’s important to know what type of test is ordered. There are two types, preventive and diagnostic. Knowing the difference between these two types of tests will help you better understand your treatment plan. It will also help you understand how your health plan will pay for it. What’s the Difference? A screening test is often part of preventive care. Preventive screenings are routine tests ordered when there is no reason to suspect a problem. They are usually done at certain ages or timeframes depending on what they are for. The goal of these screenings is to check your health status and keep you healthy. In some cases, follow-up tests ordered by your doctor after the initial screening may also be considered preventive. A diagnostic test is ordered when there are signs or symptoms of a possible problem that were not found during a routine preventive screening. These tests take a closer look to see if disease is present. They are used to confirm or rule out a cause of the symptoms. Screening tests, such as Pap smears, colonoscopies and mammograms, are often less invasive than diagnostic tests, such as a biopsy. But some types of tests may have both preventive and diagnostic versions . For example, colonoscopies and breast cancer screenings have both preventive screening and diagnostic versions. A colonoscopy is often done as a preventive measure to detect any early signs of colon or rectal cancer. But a colonoscopy can also be a diagnostic test if it’s done because a problem is suspected. Similarly, a screening mammogram is usually performed regularly as a preventive measure. Preventive screening is used to detect breast cancer early, often before a lump can be felt. Your doctor may request additional tests as part of your preventive screening. Sometimes, your doctor may order breast cancer screening tests when there are signs of a problem that were not found during your routine screening tests. That may be considered a diagnostic test. A few things can affect whether a test is considered preventive or diagnostic. If you’re not sure what kind of test you’re having, ask your doctor. Test Type and Your Cost Share Many health plans cover most preventive health care services with no out-of-pocket costs.* This coverage applies when you go to your primary care provider or medical group (for HMOs) or a doctor or medical center in your plan’s network (for non-HMO plans). That means you pay no copay or coinsurance even if you haven’t met your deductible. You can find details about the preventive services your plan covers in your benefit materials. A diagnostic test is considered medical care, not preventive care. You may have out-of-pocket costs for these types of tests. The costs depend on what your doctor orders and if there are other requirements for that kind of test. For example, some states have laws that require certain tests to be covered without cost. Get the Details on Your Costs To avoid unexpected out-of-pocket costs, here are some questions to ask your care team: What type of test or procedure will be ordered? Is it covered by my health plan? Is the provider in-network? Will any other providers be involved in the tests or procedures? Are they also in-network? Is the facility in-network? Are there any other related services or fees that may affect my costs? To make sure a provider or facility is in your plan’s network, log in to your online member account a nd go to Find Care . Depending on your plan, you may also be able to estimate the out-of-pocket costs for your tests or treatments. Knowledge is power. Know what type of test you’ll receive. This is the best way to be prepared to ask questions and not be surprised by unplanned costs. *Preventive services at no cost applies only to members enrolled in non-grandfathered health plans. You may have to pay all or part of the cost of preventive care if your health plan is grandfathered. To find out if your plan is grandfathered or non-grandfathered, call the customer service number on your member ID card. Sources: Screening and Diagnostic Tests: Know the Difference , Labcorp; Preventive vs. diagnostic care: What to know and why it matters , UCLA Health, 2022; Diagnostic Mammogram , National Breast Cancer Foundation, 2026Benefits and CoverageMedical CareUnderstanding InsurancePreventive Carehttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/cancer-screening-preventive-diagnosticMon, 28 Sep 2026 09:28:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:8e649e29-59ea-44f5-8e23-0db48e287ef8BCBSIL Connect TeamGetting screened for colon cancer is an important way to protect your health. Colon cancer is the fourth leading cause of cancer death in the U.S. But colon cancer can be successfully treated when it is found and treated early. Until it grows or spreads, colon cancer usually has no symptoms. So screening is vital for early detection. Talk to your doctor about which type of screening test is best for you. There are several options. Some are simple in-home tests. Others, like a colonoscopy, are done by a doctor. Colon cancer used to be a disease that mainly affected people over 45, but studies show it’s becoming more common in younger people. Catching it early gives people of all ages a better chance at successful treatment. If you’re between the ages of 45 and 75, talk to your doctor about routine colorectal cancer screening. If a history of colon cancer runs in your family, speak up. You may need earlier testing. Learn more about screening tests from the Centers for Disease Control and Prevention . Getting the care you need to protect your health is important. It’s also important to ask questions before your test so you understand exactly what you’re getting and what it costs. Preventive and Diagnostic Tests Asking questions up front can help you understand the type of test your doctor orders and how your health plan will pay for it. And as with other health visits, going to an in-network provider can save you money. It’s important to know that there are both screening and diagnostic versions of many tests. For example, colonoscopies have both types of tests. Preventive A screening version is considered preventive care. Preventive screenings are routine tests ordered when there is no reason to suspect a problem. They are generally done at certain ages and intervals, like every two years. Many health plans cover most preventive health care services with no out-of-pocket costs when you go to your primary care provider or medical group (for HMOs) or a doctor or medical center in your plan’s network (non-HMO plans).* That means you pay no copay or coinsurance even if you haven’t met your deductible. You can find complete details of the preventive services your plan covers at no cost to you in your benefit book. Diagnostic If a person has symptoms or signs of a problem that were not found during a preventive screening, a diagnostic test will be ordered. Diagnostic tests take a closer look to see if disease is present. A diagnostic test may be ordered if anything unusual shows up on a preventive screening test. A diagnostic test is considered medical care, not preventive care. You may have out-of-pocket costs for diagnostic tests. For a colonoscopy, how much you may have to pay is based on what is ordered by your doctor and other factors. Preventive screening test: This is a routine colonoscopy for people who have no symptoms to suggest a problem. Diagnostic test: This testing is for people who have signs of a problem that were not found during a preventive screening. These may include anemia, gastrointestinal bleeding or blood detected by a stool test. You may have out-of-pocket costs for a diagnostic colonoscopy. The costs depend on what your doctor orders and whether there are other requirements for the kind of test you’re getting. For example, some states have laws that require certain tests to be covered without cost. Get the Details on Your Costs To avoid unexpected out-of-pocket costs, ask your doctor what type of test is being ordered and what the estimated cost (if any) will be. Give the person who books your appointment the specific information from your health plan ID card. Make sure that the provider who will do the procedure is in-network. And ask if there are other providers who will be involved. Additional providers may perform related services like anesthesia or blood tests. Make sure all of the providers involved are in your plan’s network. Ask what facility you’ll be using and if it is in your plan’s network. And there may be additional costs for related services, such as bowel prep medicines, pathology tests and facility fees. Ask if you will have any related services that will affect your cost. To make sure a provider or facility is in your plan’s network, log in to your member account and go to Find Care. *Preventive services at no cost applies only to members enrolled in non-grandfathered health plans. You may have to pay all or part of the cost of preventive care if your health plan is grandfathered. To find out if your plan is grandfathered or non-grandfathered, call the customer service number on your member ID card. Sources: Screening for Colorectal Cancer , Centers for Disease Control and Prevention, 2026; Colorectal Cancer Statistics , CDC, 2026; Colorectal Cancer , American Cancer SocietyColorectal Cancer Screening OptionsBenefits and CoverageColon HealthMedical CarePreventive CareCancerhttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/fitness-program-waived-enrollmentTue, 01 Sep 2026 08:17:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:61b030e2-3efb-4bc8-b718-4e20fab2caafBCBSIL Connect TeamWell onTarget and the Fitness Program are not available to all members. Check your online account information or ask your benefits administrator to see if you have these benefits. If you’re looking to stay in shape, or get back in shape, now is a good time to join the fitness program. The $19 enrollment fee will be waived for eligible new members who sign up now through Oct. 31, 2026.* Join today and get access to a nationwide network of participating facilities so you can work out whether traveling, at home or at work. You can also choose digital options like online fitness videos and live classes. Enjoy All the Fitness Program Benefits The Fitness Program offers flexible plan options ranging from $19 to $239 a month. You can select a plan option that best suits your lifestyle. You’ll have access to all locations available in the plan you choose, as well as locations in any of the lower-priced plan options. Digital fitness options are also included in all plans at no cost. The Digital Only plan is $10 per month. Choose from thousands of digital fitness videos and live classes. More Fitness Program Features Real-time check-in and activity reporting information is provided through the Well onTarget Fitness Program mobile app and Well onTarget portal. Get Complementary and Alternative Medicine (CAM) discounts through Choices by Whole Health Living.** Save money through a nationwide network of 40,000 health and well-being providers such as acupuncturists, massage therapists and personal trainers. To take advantage of these discounts, register at wholehealthliving.com . Go online to find fitness locations and track visits. Get the Well onTarget Fitness Program Mobile App You can use the Well onTarget Fitness Program app to: Have real-time check-in and activity reporting Explore nearby locations in the Fitness Program network Get easy access to your Fitness Program membership card Download the Well onTarget Fitness Program app free of charge from the Apple and Android app stores. Search for “Well onTarget Fitness Program.” Join Now To get the waived fee, use coupon code OCT26FP when you enroll. To enroll, log in to your Blue Cross and Blue Shield of Illinois member account, go to the My Health drop-down menu and select Wellness . Then scroll down to Fitness Program . You can decide on the plan that best meets your needs and select the fitness location that is best for you. Remember to enter the coupon code OCT26FP during enrollment before Oct. 31 to get the waived fee. You can also enroll by calling 888-762-BLUE (2583) Monday through Friday, between 7 a.m. and 7 p.m. CT (6 a.m. and 6 p.m. MT). *After Oct. 31, 2026, regular enrollment fees will apply to all new memberships. This offer can’t be combined with any other promotional offers. **Choices by WholeHealth Living benefits are not offered in Oklahoma and Montana. The waived enrollment promotion is only available to members with the Fitness Program. Individuals must be 18 years old to purchase a membership. Dependents 16 to 17 years old can join but must be accompanied to the location by a parent/guardian who is also a Fitness Program member. Check your preferred location to see their membership age policy. Underage dependents can log in and join through the primary member’s account as an “additional member.” Member agrees to comply with all applicable federal, state and local laws, including making all disclosures and paying all taxes with respect to their receipt of any reward. The Fitness Program is provided by Tivity Health TM , an independent contractor that administers the Prime Network of fitness locations. The Prime Network is made up of independently owned and operated fitness locations. No endorsements, representations or warranties are made regarding third-party vendors and the products and services offered by them.Benefits and CoverageFitness ProgramExerciseWell onTargethttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/reconstructive-surgery-mastectomyThu, 27 Aug 2026 19:43:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:ef3354d0-7fcc-4a7d-900b-6bd3610c1179BCBSIL Connect TeamIt’s normal to be anxious if you find out you need to have a mastectomy. A mastectomy is the removal of one or both breasts. This procedure is most often performed to treat breast cancer. If you are facing this surgery, take some comfort in knowing that federal and state laws require health insurance companies to cover reconstructive surgery afterward. Blue Cross and Blue Shield of Illinois provides coverage for: Recreating the breast that was removed Breast implants Surgery on the other breast for an even appearance Treatment of possible side effects of mastectomy, including lymphedema (fluid buildup that leads to swelling) These procedures must be provided by a licensed physician and meet other requirements. Your plan may also cover annual mammograms. Want to find out more? Just call us at the customer service number on your member ID card.Benefits and CoverageEmployer CoverageUnderstanding Breast Cancer Treatment OptionsWomen’s HealthBreast Cancerhttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/what-is-an-hmoThu, 27 Aug 2026 18:48:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:85301aa5-ba70-433b-9756-f2c3facd55feBCBSIL Connect TeamAn HMO — or health maintenance organization — can help keep your costs lower and more predictable compared to other types of plans. With one medical group to coordinate your care, an HMO health plan is easy to use. An HMO health plan offers: Monthly premiums, copays and deductibles that are often lower than other types of plans. Access to certain doctors, hospitals, clinics, pharmacies, labs, and other care and service providers in your HMO network, to help control how much you pay for health care. A primary care provider (PCP) you see for annual physicals, preventive screenings, common illness or injuries, and other routine care. A referral from your PCP is required for most other types of care, like seeing a specialist, to be covered by your plan. It's Personal An HMO health plan offers personalized care. Your care is coordinated by one medical group that knows you — your health history, current issues, medicines, lifestyle and how your family health history may affect your health. Get Started When you first sign up for an HMO health plan, you choose, or are assigned, a medical group or independent practice association. Each person on your plan can pick a PCP. A PCP most often focuses on general internal medicine, family medicine or obstetrics/gynecology (OB/GYN). Older adults can choose a geriatric doctor. Children can have a pediatrician. If you're a member, you can find your PCP or your medical group listed on your member ID card. Your Health Partner As the primary member of your care team, your PCP plays a big role in helping you stay healthy. Here are some tips to help you make the most of your PCP: If you're a new patient, see your PCP right away. When you make your first appointment, let the doctor's office know you're a new patient. Going to your new patient appointment right away will help avoid delays in getting an appointment when you’re sick or need a referral. Get a referral. If you need to see a specialist, your PCP will refer you to one. Make sure the specialist or behavioral health care provider is in your network. Women don't need a referral to see an in-network OB/GYN. You’ll need a referral to visit a hospital for non-emergency services. To find a provider or hospital in your network, log in to your account and go to Find Care . Call your PCP when you need care. Your PCP should be your first stop when you need care. For common illness and injury, like a cold, flu, minor cuts or burns, they will fit you into their schedule or refer you to another doctor or clinic. In some cases, they may have you go an urgent care clinic or a hospital. For emergencies. If your illness or injury is life-threatening, call 911 or go to the nearest emergency room. You don't have to stay in-network or get a referral. Just let your PCP know that you had an emergency as soon as you can. They’ll follow your treatment and manage your follow-up care. You Have Choices Finding a provider you feel comfortable with is important. You can change your PCP, medical group or independent practice association to another in-network provider at any time. The only exceptions are when you are hospitalized or in the second or third trimester of pregnancy. To change doctors within the same medical group: Log in to your account online and go to Find Care to find providers in your network. Then call the group or association on your member ID card and ask to change your PCP to the new network doctor you've chosen. To change to a different medical group : Online Log in to your account. Choose the “Change MG” link. Follow the instructions. By phone Call the customer service number on your member ID card. Having one health care expert coordinate all your health care helps keep your costs and health on track. Year after year, health plans help improve member health and lower their total cost of care because health issues are handled before they get serious. In most cases, your HMO health plan won't cover your costs if you go to a provider who isn’t in your network. Your health plan contracts with network providers who offer a service at a set price. Because out-of-network providers don't have a contract with us, we can't control how much they charge you. To avoid getting big bills, make sure you stay in your network. Be Informed No matter which type of plan you have, review it carefully. Know what's covered and where you can go for care before you need it. Understanding how your plan works may save you time and money.Benefits and CoverageUsing Health InsuranceBlue Access for MembersProvider FinderHMOhttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/pharmacy-benefit-vs-medical-benefitThu, 30 Jul 2026 13:50:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:d56b5d6e-9c1a-40f2-bb8b-534927d51aa2BCBSIL Connect TeamIt’s no secret that prescription drugs can be pricey. One of the best ways to save on the drugs you are prescribed is to make sure you understand how your health plan benefits work. A good place to start is to answer this question: Is my prescription drug a pharmacy or medical benefit? In most cases, a prescription drug is covered under your pharmacy benefit . There are times, though, when a prescription drug is considered a medical benefit . Here is a breakdown to help you understand which is which. Drugs That Fall Under Your Pharmacy Benefit Think about the common medicines you pick up at your local drugstore or have delivered to your home. Drugs that help keep your blood pressure or cholesterol in check. The cream your dermatologist gave you for that itchy rash. Antibiotics for a sinus infection. Or insulin to manage your diabetes. These are just a few examples of prescription medicines you may take that may be part of your pharmacy benefit. Drugs That Are a Medical Benefit Sometimes, medicines must be given by a care provider in a health care setting. Birth control implants are one example. So are chemotherapy infusions for cancer, immunotherapy for complex and chronic diseases, and treatment for substance abuse. These types of medicines usually require patients to be monitored by a medical professional during their treatment. Your medical benefit may cover the costs of these drugs and their administration. Some Drugs Can Be Both Vaccines given as part of preventive health care can be either a pharmacy benefit or a medical benefit. A flu shot is the most common example. Did you go to your local retail pharmacy for your flu shot? Or did your primary care provider give you a flu shot during your annual wellness check? The benefit category for the vaccine depends on your health plan and where you got it. Of course, understanding the details of your Blue Cross and Blue Shield of Illinois plan is one of the best ways to get the most out of your pharmacy benefit. Here are some things you can do: Check Your Plan’s Drug List The list is exactly what the name suggests — a list of prescription drugs covered by your health care plan. The list is organized into different levels of coverage called member payment tiers. Some plans may have up to six tiers. Each tier has its own cost. The lower the tier, the lower your out-of-pocket costs will be for the drug. Generic drugs are usually found in the lower tier. Name brand drugs and specialty drugs are often in higher tiers. You may pay more for a brand name drug if you choose the brand name drug when a generic equivalent is available. Talk with your doctor and pharmacist about all your medicines. Always check to see if they are covered under your health care plan. For any name-brand drug, ask if there are generics or lower-cost options you can take. If your drug isn’t covered on your drug list, ask if there are other covered drugs or treatments that meet your needs. To check coverage of drugs on your drug list, log in to your member account online or through the BCBSIL App . Click on the Pharmacy tab to search a medication and get all the details you need. Be In-the-Know About In-Network Pharmacies BCBSIL works with a broad network of pharmacies. When you use an in-network pharmacy, your out-of-pocket costs are often less. You may also be able to get up to a 90-day supply of covered drugs you use regularly . Understand Special Requirements and Limits Sometimes, you may need to meet certain criteria before your prescription drug coverage is approved. Members who use a specialty and complex care drug to treat a complicated, long-term or rare condition may need to follow specialty pharmacy program guidelines. Some drugs may have limits on how much medicine can be dispensed per prescription or in a given time span. Your doctor may need to get prior authorization before your drug is covered. You might need to use step therapy , which means you must try a more cost-effective drug first before moving to another higher cost drug. To review your pharmacy benefits, you can: Log in to your online member account or the BCBSIL App to see in-network pharmacies, get cost and coverage information, check refills and more. Call BCBSIL customer service at the number on your member ID card. Prime Therapeutics LLC is a separate company contracted by Blue Cross and Blue Shield of Illinois to provide pharmacy solutions. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.Benefits and CoveragePrescriptionsPharmacy BenefitsPharmacyDrug ListGeneric DrugsIn-Networkhttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/make-most-of-plan-year-endThu, 30 Jul 2026 10:06:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:d7d53c35-d6e4-4d2f-b158-4694c21d45fbBCBSIL Connect TeamIf you’re the kind of person who needs a deadline to get things done, there may be a big one just around the corner. If your health plan year is ending soon, it’s a good time to review your health benefits. Doing so could be a boost to your overall health — and could even save you money. That’s because you might have benefits you want to use before the end of the plan year. It pays to check it out and make a few appointments. Deductibles Looking at your health benefits now may save you money. If your plan has a deductible and you’ve met it, you might want to schedule care your doctor has been recommending now, rather than waiting until your next plan year. A deductible is the amount you pay for health care services each plan year before your health plan starts to pay. For example, if you have a $1,500 deductible, you pay the first $1,500 of the services you need. Once you’ve met your deductible, you usually pay only a copay and/or coinsurance for covered services. Coinsurance is when your plan pays a large percentage of the cost of care and you pay the rest. For example, if your coinsurance is 20 percent, you’ll pay 20 percent of the costs when you need care. Your health plan pays the other 80 percent. Since your deductible resets each plan year, it’s a good idea to keep an eye on the figures. If you’ve met your deductible for the year or are close to meeting it, you may want to squeeze in some needed tests or procedures before your plan year ends to lower your out-of-pocket costs. If you have had a lot of medical expenses this year, you may have also met your out-of-pocket maximum. If that’s the case, you may not have to pay anything for in-network services covered by your plan. So you'll save even more on treatment you’ve been putting off. If you wait until your new plan year starts for the same treatment, your deductible and your out-of-pocket maximum will have reset. That means you will have to pay more out of pocket for the very same care. High Finance The end of your plan year is also a good time to review your financial paperwork. Members with employer-sponsored plans may have a Flexible Spending Account balance that needs to be used before the end of the plan year. A Flexible Spending Account, or FSA, is an employer-sponsored option that lets you set aside a part of your earnings before taxes for qualified medical expenses. Qualified expenses include doctor’s visits and products such as contact lenses and prescription glasses. Using an FSA may save you money. But pay attention to the calendar. FSA money is often a “use-it-or-lose-it” benefit. Sometimes FSA money will roll to the next plan year, but check with your benefits department to make sure. For both employer-sponsored and individual plans, a Health Savings Account is also money set aside to be used for qualified health care costs. But any money you don’t spend can be rolled to the next plan year. Find out more about flexible spending accounts and health savings accounts . Keep Smiling It’s nice to have a clean report from the dentist, no matter your age. If you think you might need to have some work done, now’s a good time to check it out. If you have a dental plan, double check your yearly maximums. If you expect to need fillings, crowns or root canals, you might want to plan them in the current plan year to use your available funds. Some people have one procedure at the end of one plan year and the next at the beginning of the new plan year to break the treatment into two different plan years. It’s an efficient, cost-effective way to use your benefits. Check Your Benefits With Ease If you have questions, there’s one place to go — your member account. You can access your account any time via the online portal or our free BCBSIL App . Your member account lets you manage your health plan online. You can get easy access to whatever information you’re looking for. Stay organized and cut the time you spend looking for paperwork. One thing to check is your deductible amounts. That’s the amount you pay on some visits and treatments each year before your health plan starts to pay. You can see an overview of your deductible information on your Dashboard. You can find more details in the Coverage section. You can also get more plan details and a new printed or digital ID card. The Claims section shows your claims for the past 18 months. It’s also where you will find your claim statements or Explanation of Benefits (EOB). The statements will show the service supplied, what your plan covers, your financial responsibility and more. You can also sort claims by date, status, provider and claim type. While you’re logged in, you can change your contact preferences under My Account. You can also search for doctors and other providers in your network by selecting Find Care. Sources: Health Checkup , U.S. National Library of Medicine, 2024; Year-End Tips to Maximize Your Health Benefits , JDRF.org, 2022Benefits and CoveragePreventive CareBlue Access for MembersDeductiblesBAMSave MoneyHealth Care Costshttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/what-is-an-out-of-pocket-maximumThu, 30 Jul 2026 09:00:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:9177c39f-b769-4cfe-8a33-9c339ecb4e3dBCBSIL Connect TeamWe know health care terms can be confusing. One you’re sure to run across is “out-of-pocket maximum.” What does it mean? How does it affect you and your family? How does it influence your choice of health plan? You share the cost of your care with your health insurance company. You pay money to cover your deductible, copays and coinsurance (if coinsurance applies to your plan). But here’s some good news: There is a limit to how much you are required to pay. It’s called your out-of-pocket maximum (OOPM). And it is the most you’ll have to pay during a policy period – usually a year – for health care services. If you are a current BCBSIL member, you can see your plan’s OOPM on your member ID card and in your online member account . It’s different for every type of plan. Here are some things to keep in mind: Your OOPM limits how much you can be charged for your health care expenses. This limit protects you if serious and expensive medical issues come up. The government can change the OOPM each year. For 2027, the highest OOPM a plan can have is $12,000 for an individual and $24,000 for families. But some plans will have a lower OOPM. Remember, if you go out of your health plan's network for services, those expenses may not count toward your OOPM, and you could have to pay more. Take this scenario for example: Joe’s plan has a $9,200 out-of-pocket maximum. That is the most Joe will pay this year out of his own pocket for covered medical expenses. Joe only pays for the medical care he uses. If he’s healthy, he may only pay for a few doctor visits and prescriptions. But if he has an accident or major illness, that accident or illness could mean costly hospital bills. But Joe has health insurance and stays in network. So he won’t have to pay more than $9,200 for covered expenses this year, even if his care costs more. Read more about a deductible vs out of pocket maximum. Before you choose a health insurance plan, it’s important to first consider a plan’s provider network. To see which providers are in a plan’s network, you can search online . If you already have a health insurance plan, log in to your account and click Find Care to find a provider in your plan's network.Medical BillsOut-of-pocket CostsInsurance BasicsProvider FinderHow Health Insurance WorksHealth Care Costshttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/coordination-of-benefitsTue, 28 Jul 2026 09:02:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:70c2673d-2c08-4768-ae94-569d81d1a199BCBSIL Connect TeamWhen you need care and are on two different health insurance plans, your insurers will coordinate your benefits (COB). This helps you get maximum coverage when you need it. If you’re covered by two different health plans, your provider may file the claim with both plans. The health insurers will decide which plan covers certain expenses on the claim. This is called Coordination of Benefits. If there are times when your primary plan doesn’t cover the whole claim, the secondary plan may cover them all or pay a certain amount. It depends on the COB rules. How It Works Coordination of benefits may be needed if: You are on your employer's health plan and on the plan your spouse has with their employer. You buy your own health plan, but you are also on your spouse's group plan. You and your spouse have individual policies and are listed as dependents on both. You have dependent children covered under both your and your spouse's health plan. A custody agreement requires one parent to cover the children, but both parents choose to include them on their coverage. If you have Medicare and another plan, coordination of benefits is always used. Medicare may be the primary or secondary payor. It depends on the Medicare coordination of benefits. Let your insurer know up front if you have Medicare. It will save you and your doctor time when filing claims. Why Coordination of Benefits? Coordination of benefits helps: Avoid duplicate payments so the two plans don’t pay more than the total amount of the claim Make sure the proper payments are made by each plan Reduce the cost of insurance premiums You may get a form in the mail, an email or a call from your insurer to set up the coordination of benefits. You may also want to document any other coverage you have when your plan renews each year. Even if you don’t have other coverage, you'll need to let your insurer know. Sometimes claims are held until coordination of benefits is confirmed. A provider won’t be paid until primary and secondary coverage is confirmed. Want To Know More? If you have more than one health plan, check out the section of your benefit materials called Coordination of Benefits to learn how it works. For more information, call the customer service number listed on your health plan's member ID card. Source: Coordination of Benefits , ehealthinsurance.com, 2023; Coordination of Benefits , Centers for Medicare & Medicaid Services, 2026; How Medicare works with other insurance , medicare.govBenefits and CoverageUnderstanding InsuranceCustomer ServiceMedical Claimshttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/reasons-claim-deniedThu, 16 Jul 2026 15:21:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:ef2a091d-4067-4942-a2ca-32b352fb7c0eBCBSIL Connect TeamBelieve it or not, there are only a handful of reasons that may lead to a health care service not getting approved or a claim not being paid. They fall into these five buckets. The claim has errors. Minor data errors are the most common culprit for claim denials. Sometimes, a provider may code the submission wrong, leave information out, misspell your name or have your birth date wrong. Your explanation of benefits (EOB) will give you clues, so check it first. If you find an error, ask your provider to correct the information and submit your claim again. You used a provider who isn’t in your health plan’s network. Some plans only cover care if you use providers and facilities in your plan’s network. If you go out of network, your plan may not cover any of the costs. Other plans may only cover some of the out-of-network costs, and you have to pay the difference. Your care needed approval ahead of time. Some procedures, like CT scans, MRIs and certain surgeries, usually require prior authorization. If a claim isn’t covered because it wasn’t authorized in advance, talk to the provider who ordered it. Your provider may be able to submit patient records that show you needed the service. You get care that isn’t covered. Your health plan may not provide that benefit. For example, your plan may not cover weight-loss surgery. In that case, it doesn’t undergo medical review. If your plan doesn’t cover it, the procedure won’t be approved. This is called a coverage limit or contract exclusion. If you lost health plan coverage, your claim may not be covered. This may happen if you don’t pay your monthly premiums or run out of COBRA. The claim could also be denied for a medical reason. These types of denials may include: The services are not considered medically necessary. The right level of care wasn't provided given your condition. The treatment hasn’t been proven effective or is considered experimental for your condition. The claim went to the wrong insurance company. If you have a second health plan, like one from your employer and one from your spouse’s employer, the provider may have billed the wrong company. Or your care provider may have outdated information if you changed insurers. When you get your EOB, check to see if it is from the right health plan, then contact your provider. Sources: Reasons for Health Claim Denials and What You Should Do , VeryWellHealth, 2023; What to Do When Health Insurance Won’t Pay , Insurance.com, 2023; Appealing a Health Care Decision , HealthCare.govAppealsUnderstanding InsuranceMedical ClaimsExplanation of BenefitsHow Health Insurance WorksHealth Care Costshttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/claim-not-approvedThu, 16 Jul 2026 14:40:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:e313569a-ba0d-4922-87c5-c455e42b4a79BCBSIL Connect TeamNurse care manager Lenzy Mixon got a call from a member about a large bill he received for a stay at a skilled nursing facility. He checked with his doctor, who assured him the stay had been pre-approved by his health plan. His next call was to us. Mixon said she was sure it was a mistake, so she reached out to a utilization review nurse and a customer advocate. Together, they found the error that caused the claim to be denied, adjusted the records and sent it through again for payment. “He was relieved and happy hearing that the claim was being adjusted so quickly,” Mixon said. While not every claim denial is so easily fixed, there are times a claim doesn’t get approved for reasons other than the service not being covered by a member’s health plan. Do you know what to do if a claim isn’t approved? First, Ask Why If you have a claim that isn’t approved, you can look at the explanation of benefits (EOB) for the claim to find out why. An EOB is generated for your medical claims to help you track what your insurance is covering and what amount you may need to pay, such as a copay or coinsurance. If a claim is denied, the EOB will explain the reason for the denial. Find Out Your Next Steps Do they have the wrong birth date listed for you? Is the address your doctor listed different from what we have on file? If the claim wasn’t approved because of an information error, reversing the denial may be fairly quick and easy. Call customer service at the number on your member ID card. You can give the customer advocate the right information to correct your file. If your provider’s office made the mistake, you can call the billing office to get the information corrected. If the service isn’t preauthorized or is denied for payment for another reason, you may need to ask that the claim be reviewed. This is called appealing the decision. You can appeal by phone or by mail. You, your doctor or another person you’ve named to represent you can appeal. Understand the Appeals Process There is a multi-step process in place that can help you if you think a claim has been denied in error. It is outlined in an insert included with your EOB. It is also explained in your benefit information. I f our reviewer is going to deny a service as not medically necessary, your doctor will receive a notification. That notification will include the option to schedule a call with the reviewer. Your doctor can review the case over the phone with us to try to resolve the issue. If the issue is not resolved and the claim is denied, you can appeal. A standard appeal is an internal review of your claim. You’ll call or send a letter to ask that the claim be reviewed to see if something can be done to reverse the denial. If a claim is denied for a medical reason, a medical doctor will review the claim. If a standard appeal does not resolve the issue, you can request to have a second medical reviewer look at the request. This second level of appeal is done by an outside, independent review organization. Your EOB will explain what types of denials can be sent for external review. There is no cost to you for an external review. Get Started You’ll need to provide as much information as you can to support the claim. Maybe the claim reviewer didn’t have the films from your MRI that showed you needed the surgery your doctor requested. It may be that a referral was required, and the referral wasn’t documented. The need for more information is another reason that often leads to a claim not getting approved. Medical review will require more information. For example, you may need: A letter from your doctor explaining why the requested treatment should be approved Patient notes from your treating physician on other care you have had for your condition The results of other tests or procedures related to the request Current medical articles or study results that support the treatment’s effectiveness Your own letter explaining why you believe the treatment is needed Hang in There For things like wrong information, a quick correction can be made and the claim refiled for approval. But other reviews take time. A standard appeal takes about 30 days for review for getting care pre-approved. Other appeals may take up to 60 days. These timeframes start when you file the appeal, not from the time of your treatment or from when the claim wasn’t approved. You have 180 days to file an appeal from the date the claim wasn’t approved. An external review takes about 45 days. If you qualify for urgent review, the outside review organization will give you a decision within 72 hours. You have four months from the date of your internal review decision notice to file a request for external review. Check Your EOB You should always check your EOB to make sure your claim information is correct. Every EOB has instructions on what to do if a claim has been denied. You may get your EOB in the mail. If you are signed up for paperless communications, your EOB can be found in your online account. Sources: Engaging with Insurers: Appealing a Denial , Patient Advocate FoundationAppealsUnderstanding InsuranceMedical ClaimsExplanation of BenefitsHow Health Insurance WorksHealth Care Costshttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/in-network-health-careWed, 08 Jul 2026 15:10:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:726453ab-391b-44f0-94cc-734fe76345b4BCBSIL Connect TeamWhen you shop, you probably keep an eye on costs. You want to buy the things you need at a fair price. What about when you’re shopping for health care? Using providers in your health plan’s network can help you save money. A network includes hospitals, clinics, doctors, pharmacies and others who take part in your health plan. These network providers agree to work with your health plan. That helps keep your costs down. Providers who do not have a contract in place with your health plan are out-of-network . In-Network, Out-of-Network — What’s the Difference? By staying in your network, you can take advantage of discounted rates and avoid surprise charges. That’s because in-network health care providers and your health plan have agreed to a set price for each treatment or procedure in advance. A provider who is not in your plan's network can charge higher prices for the same care. You may also have to pay a higher copay or deductible for out-of-network care. In some cases, you may even have to pay the full cost. Before you go anywhere for care, make sure the provider or facility is in your health plan network. You’ll receive the same quality health care you should expect from any provider at the most affordable cost to you. Try these tips: Once you find a provider, check to see if they are in-network for your specific health plan. Simply asking if they take Blue Cross and Blue Shield insurance is not enough. Give them the information on your member ID card — including the full name of your plan — to make sure. If your primary care provider gives you a referral to another doctor, ask for one who is in your plan’s network. Then make sure that the new doctor is in your network. If you need surgery or other health services, check to make sure each facility where you will get care is in your network. It’s a good idea to see if each provider for the service or procedure is also in your network. But if you get care from an out-of-network provider while you’re at an in-network facility, you may be protected from unexpected costs, called balance billing or surprise billing. To find providers in your health plan’s network, log in to your account and select Find Care. Don’t Forget Pharmacies When you use a pharmacy that is in your network, you’ll save money. With some prescription drug plans, there can be another consideration. Along with in-network and out-of-network pharmacies, there may be a preferred pharmacy network in your plan benefits. If so, you’ll save the most money when you fill your prescriptions at preferred pharmacies. To find an in-network pharmacy, log in to your account and look under Pharmacy. On the Pharmacy page, search for retail or home delivery pharmacies. If you’ve been using a pharmacy that isn’t in-network, it’s easy to switch. You can take your prescription bottle/bag to the new in-network pharmacy. Or you can call the new pharmacy and ask them to contact your current pharmacy. You can also ask your health care provider to contact your new pharmacy. Make sure to ask your provider to send any new prescriptions to your network pharmacy. You may need to take your BCBSIL member ID card with you if it’s your first visit to the pharmacy or if you’ve changed health insurance plans. Plan in Advance Remember, whether it’s a doctor, clinic, hospital, therapist or other provider, you may pay less for care when you visit an in-network provider. That’s why it’s good to learn about your choices before you need care. It will help you be better prepared to take care of your health.Benefits and CoverageHealth Insurance NetworkUsing Health InsuranceIn-NetworkHealth Care Costshttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/utilization-managementWed, 08 Jul 2026 11:07:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:90688b15-351d-461a-941d-e4cd504dfc5cBCBSIL Connect TeamThis article is intended for HMO members enrolled in an employer health insurance plan. We know you may have questions about your medical condition and how best to coordinate your care. Having access to utilization management (UM) staff can help you better understand your options. UM is a tool that helps us make sure your care, services and benefits are right for you. UM decisions are based on medical need. Our staff can provide the following services when you want information about the UM process and the authorization of care. Staff are available at least eight hours a day during normal business hours for inbound collect or toll-free calls about UM issues. Staff can receive inbound telephone, email and fax communications about UM issues. Communications received after normal business hours are returned on the next business day. Those received after midnight on Monday through Thursday are responded to on the same business day. Staff give their names, titles and organization name when making or returning calls about UM matters. TDD/TTY services are used when a member has hearing or speech difficulties. For members who need language translation, the service is provided free of charge in the requested language through bilingual staff or an interpreter during business hours. (Language assistance doesn't apply when we are not making UM decisions about care, or if all services are automatically approved.) The more information you have about your medical care, the better you can manage your care. Using the resources available to you can help. If you have questions, call the customer service number on your member ID card.Benefits and CoverageEmployer CoverageManaged CareUtilization Managementhttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/virtual-visits-annual-examsWed, 08 Jul 2026 09:15:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:ed65aa7d-b524-4338-a313-3014c02e8b6aBCBSIL Connect TeamDoes your health plan offer telehealth visits with doctors in your plan’s network? Now's a good time to check. It may be just what you need to stay on top of your health. During the pandemic, more health care facilities turned to telehealth visits to help keep patients and staff safe. And telehealth visits remain a good option for things like: New health concerns Annual exams Routine check-ins on health issues When There’s a Problem Having stomach issues? A headache that won’t go away? A rash that concerns you? These are the types of issues you may see your primary care doctor about. To do so, you usually have to schedule a visit and go to the office. But a hands-on exam may not be necessary. Instead, the doctor may simply offer helpful medical advice, prescribe a medicine or send you for a test. This is the type of visit that can often be handled just as well with a telehealth visit. If your plan includes behavioral health care, a telehealth visit is also a good opportunity to talk to your doctor about depression, anxiety or other mental health issues. Annual Exams Some primary care doctors, pediatricians and women’s health providers may also choose to do annual exams using telehealth visits. These visits play a big role in catching small health problems before they become big ones. Doctors are finding that much of what they do in your yearly checkup can be done virtually: Review your health and family history Update a list of your current medicines Talk about your lifestyle Discuss tobacco and alcohol use, diet and sleep habits Other exams and tests can be scheduled separately. Blood tests, vision and hearing exams and imaging like mammograms are good examples. Your doctor can also send prescriptions directly to your pharmacy. As always, an annual exam is covered at no cost to you if you see a provider in your health plan’s network. Condition Check-ins Chronic health conditions like diabetes, asthma, heart disease and cancer need your attention every day. It’s vital that you keep your appointments, follow doctor’s instructions and let your care provider know if you have concerns. An added benefit of telehealth visits is that you don’t have to arrange travel or time off from work or school. How Telehealth Doctor Visits Work Depending on your health plan’s benefits, a telehealth visit with a doctor in your plan’s network may be covered. Signing up for a telehealth visit is easy: Make sure you have internet access and a smartphone, tablet or computer with a built-in or attached camera. Call your doctor’s office to ask about telehealth visits and schedule an appointment. Be sure to ask if the provider is in your health plan’s network. You may need to handle paperwork and any payment before the call, either online or by email. When it’s time for your appointment, follow the instructions from the doctor’s office on how to connect with your doctor. Virtual Visits, powered by MDLIVE ® Telehealth visits are covered under many Blue Cross and Blue Shield of Illinois health care plans. Some BCBSIL health plans also include access to Virtual Visits*, powered by MDLIVE ® . This service gives you access to board-certified doctors and licensed behavioral health therapists for many non-emergency health situations. Log in to your online account to see if you have the Virtual Visits benefit. Go to My Health then Find Care . If you see Virtual Care , click there to see your telehealth options. If you have Virtual Visits, you will see instructions for how to register and schedule an appointment. *MDLIVE is a separate company that operates and administers Virtual Visits for Blue Cross and Blue Shield of Illinois. MDLIVE is solely responsible for its operations and for those of its contracted providers. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without permission. Virtual Visits may be limited by plan. For providers licensed in New Mexico and the District of Columbia, Urgent Care service is limited to interactive online video; Behavioral Health service requires video for the initial visit but may use video or audio for follow-up visits, based on the provider’s clinical judgment. Behavioral Health is not available on all plans. MDLIVE ® is not available on Illinois HMO plans.Benefits and CoverageAnnual ExamTelehealthVirtual Visitshttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/hmo-planMon, 29 Jun 2026 23:17:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:293ee232-ad1f-4f3e-baac-36c51e8d885dBCBSIL Connect TeamOpen enrollment is a good time to take a fresh look at your health plan choices. One option you may see is a Blue Cross and Blue Shield of Illinois HMO plan. HMO plans offer high-value health benefits at the lowest total cost of care compared to other types of plans. HMO members may have savings every year over other health plans — including maternity and delivery care.* In a member satisfaction survey,** 91 percent of respondents said they were satisfied with the overall value of their BCBSIL HMO plan and the customer service they received. You might already have an HMO or a PPO. No matter where you’re starting, learning what an HMO plan offers can help you decide what’s right for you. Care Starts with Your Primary Care Provider With an HMO plan, you choose a medical group and a primary care provider. Your PCP is your first stop for most care. You see them for checkups, routine visits and when you don’t feel well. Your PCP gets to know you and your health history. They help you stay healthy and guide your care over time. If you need to see a specialist or have tests, your PCP helps set that up. Your PCP also helps coordinate your care so each provider you see has the information they need to provide the best care for you. Many people like having one doctor who helps manage their care and answer questions along the way. Using Doctors and Hospitals in Your Network HMO plans focus on care from providers and hospitals and other care facilities in the plan’s network. When you use in-network providers, your care is covered based on your plan benefits. In most cases, your HMO plan won’t cover costs if you go to a provider or facility that is not in your plan’s network. If you have a medical emergency, you can get care right away at the nearest hospital emergency room. There are also options to help you get urgent care while you’re traveling, whether it’s a short trip or a longer stay — like an extended work assignment or a student away at school. Preventive Care to Help You Stay Healthy Preventive care is a key part of an HMO plan. This includes annual checkups, vaccines, well-child visits and health screenings. These services help catch health issues early or even prevent them before they start. If you have a long-term condition, like asthma or diabetes, your care team helps you manage it. Your PCP works with you to keep your condition under control over time. A Large Illinois Provider Network An HMO plan includes access to hospitals, clinics, labs, pharmacies and thousands of PCPs and specialists across the state. You can choose a medical group and PCP that work best for you. An online member account makes it easy to search for doctors and hospitals. You can see locations, office hours, languages spoken and patient reviews to help you choose. Prescription Drug Coverage that Fits Your Life HMO plans include access to a wide pharmacy network. You can fill prescriptions at many local pharmacies. For long-term medicines, home delivery may also be an option. Your online account lets you check which drugs are covered by your plan, find pharmacy locations and manage refills anytime. Tools and Programs that Support You You can access your member account online or through the BCBSIL App . You can see your benefits, check claims, find doctors and use your digital ID card. Many plans also offer wellness programs, fitness options and health discounts. These programs are designed to support healthy habits and everyday wellbeing. An Option Worth a Look Everyone’s health needs are different. An HMO plan may be a good fit if you want lower costs and more coordinated care. As you review your plan choices, take time to learn more about an HMO plan and see how it could work for you and your family. Learn more about how an HMO works . *2023 blended HMO savings data **2023 and 2024 Commercial Member Satisfaction SurveyBenefits and CoverageUsing Health InsuranceHMOhttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/trouble-premium-paymentMon, 29 Jun 2026 16:49:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:b94c5885-8f40-4a09-a264-c611ffa674dcBCBSIL Connect TeamWe encourage members to make payments by electronic funds transfer and to set up monthly premium payments using Auto Bill Pay electronic funds transfers. When you’re first getting started, using electronic funds transfer helps us process your enrollment quickly. And throughout the plan year, auto payments help make sure your payments are on time without you having to worry about it. Using auto bill pay lowers your risk of losing coverage due to nonpayment of monthly premiums. Our member payment portal experience is designed for quick and easy use. But what can you do if you’re having trouble getting your payments set up? Here are a few common issues and tips that may help you fix them. If your payment set-up is not going through: Recheck for errors. Typos often happen with both number and letter entries. And autocorrect may sneak in an incorrect spelling before you copy and paste. Try a different payment method. Using a different credit card or bank account may help. Banking institutions can have system outages that keep your payment method from going through. And sometimes other electronic bills come through sooner or later than expected, keeping your payment set up from going through. If your payment is not appearing on your bank statement: Check the auto bill pay specifics: Double check the date of your first auto draft or the next date of the auto draft. Look to see where your payment is in the process during the end of the month draft (see status indicator). Remember that it can take up to 24 hours for the bank to show the draft in your account. If you’ve checked for these common issues and are still having trouble, call the number on your member ID card. A customer service representative will be happy to help you complete the process.Benefits and CoverageIndividual and Family CoveragePay Premium Paymentshttps://connect.bcbsil.com/my-coverage-explained/b/weblog/posts/preventive-or-medicalMon, 08 Jun 2026 21:44:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:5cc7856d-d6ce-472e-9254-a894926e58a0BCBSIL Connect TeamMany people may not know that there are two types of care you can receive when you go to the doctor — preventive care and medical care. The type of care is different, and your costs may be different, too. Medical Care vs. Preventive Care Think about how people use health care based on their needs. A person with a chronic disease may need to see a doctor or specialist often. Others may have occasional injuries or infections. Treatment of disease and injury is considered medical care. So What Is Preventive Care? Proper diet, exercise and healthy lifestyle can all help avoid certain health problems. Preventive care does the same thing. Preventive screenings can help catch problems early, before you notice symptoms. Yearly preventive exams and screenings may include: A physical exam Screenings for things like blood pressure and cholesterol levels Vaccines you need to prevent illness Mammogram screening Colon cancer screening Cervical cancer screening Diabetes screening Sometimes Preventive Care and Medical Care Cross Paths There are both "screening” and “diagnostic” versions of many tests , such as mammograms and colonoscopies. A screening version is considered preventive care. Preventive screenings are usually ordered at certain ages and at regular intervals when there is no reason to suspect a problem. If a person has symptoms or anything looks unusual on a screening test, then they may need a diagnostic test, which is considered medical care. Diagnostic tests take a closer look to see if disease is present. The technology for screening and diagnostic (medical) tests may be similar. But where and when you take them and who reads the results are different. The out-of-pocket costs may also be different. It’s a good idea to find out what your out-of-pocket costs will be before you schedule your appointment. Check with your doctor’s office to see which kind of test you’ll be getting. And check your benefits or call the customer service number on your member ID card to get the details about your coverage and costs for the test. Why Fix What Isn’t Broken? Even if you feel healthy, once a year you should get a preventive checkup from your doctor. Preventive care may help you avoid some health problems, or find health problems early, when your chances for treatment and cure are better. A preventive checkup is worth your time and effort because: It can catch disease early and may lead to better health outcomes and lower costs. Six in 10 American adults have a chronic disease. Four in 10 have four or more chronic diseases. These diseases are a leading cause of death and disability in the U.S. These conditions are preventable or treatable in many cases. Preventive screenings can find very early signs of a condition, when simple changes in diet and daily habits may reduce the risk or even reverse it. Our qualified* health plans cover most preventive health care services with no out-of-pocket costs when you go to your primary care provider or medical group (for some HMOs) or a doctor or medical center in your plan’s network (non-HMO plans). You pay no copay or coinsurance even if you haven’t met your deductible. You can find complete details of the preventive services your plan covers in your benefit book. To make sure a provider or facility is in your plan’s network, log in to your account online or through the BCBSIL App and go to Find Care. *Preventive services at no cost applies only to members enrolled in non-grandfathered health plans. You may have to pay all or part of the cost of preventive care if your health plan is grandfathered. To find out if your plan is grandfathered or non-grandfathered, call the customer service number on your member ID card. Sources: Chronic Disease , Centers for Disease Control and Prevention; Fast Facts: Health and Economic Costs of Chronic Diseases , CDC, 2025; About Chronic Diseases , CDC, 2026Benefits and CoverageMedical CarePreventive Care