How do I select my Primary Care Physician (PCP)?
When you first enroll, you select your PCP from your Blue Cross and Blue Shield of Illinois provider directory. A provider directory is included with your enrollment materials, or you can call Member Services to learn more about a particular PCP. You can search the online list of Doctors & Hospitals.
How do I change my PCP?
You can change your PCP by calling Member Services at (800) 516-1270. If you change your PCP, you will receive a new medical ID card.
Some doctors will occasionally be added to the network and some doctors will leave the network. If your PCP leaves the network, Blue Cross and Blue Shield of Illinois will notify you and ask you to select another PCP. Be sure to call Member Services with your new PCP selection prior to your first visit to your new PCP.
What happens if my PCP refers me to a specialist?
When your PCP refers you to a network specialist, you receive in-network benefits for covered services. Because you may choose at any time to seek care outside the network, your PCP’s referral to a network specialist notifies Blue Cross and Blue Shield of Illinois that your visit to the specialist has been authorized, and to pay your eligibility claims in-network. Without the referral, your claims will be paid out-of-network, even if the specialist or hospital is a network provider.
What do I do if I’m traveling and need medical care?
If you’re traveling and need urgent medical care when you’re away from home, call your PCP to discuss treatment. If your doctor recommends that you be treated where you are, your expenses will be paid at the in-network level provided they are otherwise covered by the Plan. If you can’t contact your PCP, get the treatment you think you need. If you call your PCP within 48 hours, you’ll receive in-network benefits for the covered services. However, because treatment was provided out-of-network, you’ll have to file a claim form.
What do I do if I have an eligible dependent child who attends school away from home?
If your eligible dependant child attends school away from home, select a PCP for your child in your home network. The PCP will provide and coordinate all care when your child is at home.
When your child is at school, non-preventive care is covered in-network without a referral from the PCP provided it is otherwise covered by the Plan. It is still a good idea to keep your child’s PCP informed of any care received while away at school, so the PCP has a complete medical history on your child. Preventive care is only covered if provided by your child’s PCP.
What do I do if I have dependent children or an eligible spouse who permanently lives outside the network area?
If you have dependant children or an eligible spouse who permanently lives outside your network area (non-resident dependents), their covered expenses will be paid as in-network benefits, even through services are provided out-of-network, provided they are otherwise covered by the Plan. In this situation, you’re responsible for ensuring that the services are medically necessary; non-medically necessary treatment is not covered. In addition, you’ll have to file claim forms to be reimbursed. You should not select a PCP for these non-resident dependents.
To designate your dependant children or eligible spouse as non-resident dependents, call the UPS Benefits Service Center at (800) 353-9877.
What do I do if I need emergency treatment?
In an emergency, seek medical care as quickly as possible at the nearest appropriate facility. Contact your PCP or primary doctor so he or she can coordinate your care.
An emergency is defined as a sudden and serious situation that happens unexpectedly and requires immediate medical attention.
Are transplants covered under my medical plan?
Transplants are covered as any other medical procedure.
