What Is Covered?
This new medical program offers a full benefit package. The program may cover up to 3 months of health care prior to when you enroll. Services provided and billed by a hospital may be subject to co-pays. Services provided by a primary care provider (PCP) are not subject to co-pays. Some of what your plan covers includes:
- Primary care visits
- Care at a Federally Qualified Health Center (FQHC)
- Vaccinations at a pharmacy or doctor’s office
- Prescription drugs
- Dental services
- Vision services
- Transportation services
- BCCHP uses a Preferred Drug List (PDL)
- The PDL is provided by the Illinois Department of Healthcare and Family Services (HFS)
- BCCHP must follow the HFS provided PDL. This is to help your doctor choose which drugs to give you.
- Covered drugs on the PDL have a $0 copay if filled at in-network pharmacies
- Certain drugs on this list need approval or have limits based on medical necessity
- Learn more about drug coverage
Your plan includes copayments (copays). Copays are fixed amounts you pay for a covered health care service. You usually pay a copay when you get the service. The amount you can be charged will vary depending on the service and the provider. No co-payment or cost sharing can be charged for an emergency service needed to evaluate or stabilize an Emergency Medical Condition. An Emergency Medical Condition is a condition with symptoms that are severe and painful enough that a reasonable person would think they are life-threatening and need immediate medical care. Things like a severe asthma attack, symptoms of a heart attack, or a car accident with serious injuries, are just some examples.
Copays can only be charged for these services:
Some services need approval from your BCCHP health plan. This approval is called "prior authorization." You will need this before you get treated. If the service is not approved, then the costs will not be covered (paid) by BCCHP. You do not need to contact us for prior authorization. Your doctor should know if a service needs approval and can help with the details. Work with your doctor to submit a prior authorization.
Both BCCHP and your doctor will agree which services are medically necessary. “Medically necessary” refers to services that:
- Protect life
- Keep you from getting seriously ill or disabled
- Find out what’s wrong so you can get treated for a disease, illness or injury
- Help you do things like eating, dressing, and bathing
We won’t pay for services for out-of-network providers without prior authorization. You can work with an out-of-network provider to get the approval before you get treatment.
You do not need a prior authorization for:
- Primary care
- In-network specialist care
- Family planning
- Women’s Health Care Providers (WHCP)
- Emergency care
Primary Care Provider (PCP):
Your PCP is your personal doctor who will give you most of your care. They may also send you to other providers if you need special care. With BCCHP you can pick your PCP. Please call your PCP to schedule an initial health exam within 30 days of joining. During the first exam, the PCP will learn about your health care needs.
Do you need help to find a PCP or change your current PCP? Call Member Services at 1-877-860-2837. The call is toll free. You can also use the Provider Finder.
What Is Not Covered?
Some services that are not covered include:
- Home and Community Based Waiver services
- Transplant services (these are limited to kidney transplants and inpatient stem cell transplants)
- Long-Term Care facility services