Frequently Asked Questions

No, but in order to receive the highest level of benefits, members should use PPO network doctors and hospitals whenever possible. Members can seek treatment from non-PPO doctors and hospitals; however, benefits will be at the non-PPO benefit level and will be subject to usual and customary allowed amounts. Additionally, doctors and hospitals who are not contracted are allowed to balance bill you for fees that exceed usual and customary amounts.

You can search the online list of doctors and hospitals for information on contracting doctors and hospitals. With it, you can search for PPO doctors and hospitals in your area, or search for a specific doctor by name. You can also print out your search results in a customized report.

If you are unable to locate a network doctor or hospital in your area using our online Provider Finder^® tool, please call Customer Service and a representative can assist you in your search. Your Customer Service number is listed on the back of your ID card.

You can also nominate a doctor for inclusion into the contracting network.

If you do not find the doctor you are looking for you can nominate a doctor for inclusion into the contracting network.

For associates enrolling for the first time, you may be eligible to temporarily continue treatment with that doctor and receive the in-network benefit level. If you believe that you have a situation which may qualify for this special handling, contact Customer Service by calling the number on the back of your card.

In order to qualify for this transitional benefit, you must contact BCBSIL prior to the start of the new plan year (by December 31, 2010).

Examples of medical condition that may meet the guidelines:

• Pregnancy (if confirmed prior to January 1, 2011)
• Patients whose hospitalization continues beyond December 31, 2010
• Terminal illness where life expectancy is less than six months
• Chemotherapy/Radiation therapy
• Physical therapy,

Examples of medical conditions that would not meet the guidelines:

• Routine care (immunizations, physicals)
• Chronic conditions which are stabilized (asthma, diabetes)
• Minor illness (flu, sprains)
• Elective surgery

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 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.

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.

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.

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.

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 dependent children or eligible spouse as non-resident dependents, call the UPS Benefits Service Center at 800-353-9877.

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.

Transplants are covered as any other medical procedure.

As a member of the medical plan you do not need to pre-notify for routine care from your doctor, such as when you seek care in your doctor's office. However, you do need to pre-notify any inpatient hospital care and certain outpatient hospital procedures. In addition, all infertility services must be pre-notified. If you have further questions about pre-notifying for care, please contact Customer Service by calling the number on the back of your ID card.

To pre-notify an inpatient hospital admission, call the number on the back of your ID card and asked to be connected with Utilization Management. The Utilization Management department is staffed with knowledgeable professionals who will help you determine may be the most appropriate and cost-effective way to meet your health care needs and maximize available benefits.

A medical emergency is generally defined as a medical condition that has symptoms of an injury or illness serious enough to make you, as a prudent layperson with an average knowledge of health and medicine, believe that any delay in seeking care may result in significant impairment or death. If you are in a situation in which you need emergency medical care, go directly to the nearest hospital, immediate care center or doctor.

If you lose your ID card you can print a temporary card and request new cards through your secure Blue Access^® for Members account. You can also order a new card by calling 800-516-1270.

UPS medical plan participants with "member only" coverage are sent one identification (ID) card. Participants with "member-plus-one" or "family coverage" receive two ID cards. If additional cards are needed, you can obtain them by contacting the Group Medical Customer Service Unit using the number on the back of your card. Members can also request additional ID cards by visiting Blue Access for Members.