Medical Benefits

As a Blue Cross Community Health PlansSM member, you are covered for medical care, prescription drugs and more. Your plan also offers extra services called Value-Added Benefits. VABs cover more than just your standard Illinois Medicaid benefits. They are designed to help keep you and your family healthy. 

  • BCCHP Medical Plan Benefits

    What Is Covered?

    The table below contains just some of the services covered by your BCCHP plan. Some of these services may require a prior authorization (getting an “okay” from BCCHP).

    For a more in-depth list of what is covered and what requires prior authorization, check your Certificate of Coverage.

    TYPE OF CARE COPAY BENEFIT LIMIT/EXCLUSIONS REQUIRES PRIOR AUTHORIZATION?*

    Annual Adult Well Exams

    $0

    Well exam must be done by your Primary Care Provider (PCP) or Women’s Health Care Provider (WHCP)

    No

    Behavioral Health Services

    $0

    Some services include:

    • Alcohol or drug treatments
    • Care during a hospital stay
    • Outpatient behavioral health services
    • Mobile Crisis Response services

    Yes, under certain circumstances.

    Chiropractic Services

    $0

    Limited to spinal manipulation for subluxation of the spine. 

    No

    Dental Services

    $0

    Services include:

    • Routine Exams
    • Cleanings
    • Fillings
    • Root canals
    • Dentures
    • Extractions

    Yes, under certain circumstances, a Prior Authorization is required for non-covered benefits.

    Emergency and Urgent Care Services

    $0

     

    No

    Family Planning Services and Supplies

    $0

    Services include:

    • Doctor visit
    • Birth Control
    • Family Planning and Education

    Services that are not included:

    • Fertility treatments
    • Surgery to reverse sterilization

    No

    Home Health Care Services

    $0

    Services include:

    • Home health aide services
    • Speech therapy
    • Physical therapy visits

    Yes

    Hospital Emergency Room Visits

    $0

    Go to the nearest hospital in an emergency.

    No

    Hospital Inpatient Services and Ambulatory Services

    $0

     

    Yes

    Laboratory and X-ray Services

    $0

    Services include:

    • All medically necessary lab services
    • Cancer tests
    • X-ray services

    Yes, these services must be ordered by your PCP.

    Non-emergency Transportation Services

    $0

    Services include transportation to:

    • A doctor's appointment
    • An appointment with another health care provider
    • BCCHP sponsored events

    You are not required to obtain a prior authorization for standard non-emergency transportation services.

    Vision Services

    $0

    Services include:

    • One (1) eye exam every 12 months per member
    • Eyeglasses:
      • Every two (2) years for member age 21 and older
      • Replaced "as needed" for members under 21
      • Additional reimbursement toward a pair of upgraded eyeglass frames
    • Contact lenses when medically necessary

    Yes

    *Services must be medically necessary. Some services need approval from your health plan before you get treated. This approval is called "prior authorization." Your doctor should know which services need approval and can help with the details.

    Some limits apply to general dentistry.

    What Is Not Covered?

    Some services that are not covered include:

    • Cosmetic surgery or treatment that are not medically necessary
    • Procedures that are still being tested or experimental
    • Care from a non-licensed provider
    • Drugs and supplies without a prescription
    • Acupuncture
    • Services in an emergency room for health issues that are not emergencies

     

  • Health Plan Benefits for Immigrant Adults and Seniors

    What Is Covered?

    Medical Care:

    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


    Prescriptions:

    • 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


    Copays:

    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:

    Benefit What You Pay Notes
    Nonemergency Inpatient Hospitalizations $250 copay per stay An Inpatient Hospitalization is an overnight stay in the hospital
    Ambulatory Surgical Centers and Outpatient Services: Up to 10% of the Medicaid payment. The amount you can be charged will vary depending on the service. Your provider can tell you the amount you will be charged prior to providing the service. 10% of the allowed amount Ambulatory Surgical Centers are facilities where surgeries that do not require a hospital stay are performed.


    Prior Authorization:

    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

Find a Provider

Use our Provider Finder® to search for doctors and other providers.

Member Resources

For plan details, check the Blue Print SM Member Handbooks for:
BCCHP 
MLTSS
HBIA/HBIS

Need Help?

1-877-860-2837
(TTY/TDD: 711)
The call is free.