Serving Our Members in 2019
A Message from Our President
August 09, 2019
At Blue Cross and Blue Shield of Illinois, we know that health care coverage means more than just having access to health insurance. We also know that health care can be complicated and difficult to navigate on your own. Buying health insurance and going to a doctor or hospital — even with insurance — can cause financial strain for many households.
That’s why our commitment to the people of Illinois extends to investing in solutions that will lead to a long-term, affordable path for the future of your health. Our members have already begun to see progress through some of our investments and initiatives in our state:
- We’re working with local doctors and other health care partners to influence the price we pay for care and make sure our members get effective and appropriate services in the right settings.
- Social determinants, or other factors outside the health care system can play a big role in someone’s cost of care. We teamed up with MATTER, a Chicago-based health care tech incubator, to host our first Health Equity Challenge. The challenge helped us in finding creative solutions to help members overcome environmental, social, cultural and/or economic barriers to health care.
- We will continue collaborating with our long-standing network of community partners to help provide our members with access to transportation and healthy food. This includes piloting a nutritional food delivery service, foodQ, within 25 Chicago ZIP codes determined to be food deserts.
- Across the state, we’re strengthening our partnerships with local organizations to tackle some of the most pressing public health issues facing our communities, including access to behavioral health services, interventions for urban violence and the link between health and stable housing.
- Last April, we opened the Blue Door Neighborhood CenterSM, our first-ever neighborhood-based site - offering. Chicagoans in the Pullman neighborhood the opportunity to access in-person services, such as educational workshops with a focus on nutrition, diabetes, asthma, heart disease and behavioral health; care coordination; and wellness classes. Next summer, we will open another local site in the Morgan Park neighborhood, bringing 550 jobs to the area. Named "Chicago South", this multifunctional neighborhood space will serve both members and the local community and help tackle societal factors such as joblessness, that keep people from being their best selves.
I encourage you to visit our Newsroom to learn more and keep up with the latest updates and progress we’re making that could impact you and your family. We look forward to introducing new member-centered programs, forging deeper partnerships with our communities and care providers and, as always, standing with our members in sickness and in health.
President, Blue Cross and Blue Shield of Illinois
BCBSIL Meets Affordable Care Act's (ACA) 2018 Medical Loss Ratio (MLR) Standards
Aug. 05, 2019
What Is the ACA’s MLR?
In general, the ACA’s MLR is the percentage of insurance premium dollars that a health insurer spends on health care services and expenses reported as activities to improve health care quality.
The ACA set MLR standards for health insurers. The MLR standard for the large group market is 85%. The MLR standard for individual and small group markets is 80%.
If an insurer's MLR doesn't meet or exceed the ACA's MLR standard in a certain market segment of a state, the insurer may provide MLR rebates in that market.
2018 MLR Update
Blue Cross and Blue Shield of Illinois (BCBSIL) met or exceeded the ACA's MLR standards in the individual, small group and large group markets of Illinois in 2018. As a result, no MLR rebates will be provided in Illinois for 2018.
We're proud of our track record of managing costs, collaborating with providers and other health care professionals, and business innovations.
Changes to 2019 Prescription Drug Coverage
Feb. 14, 2019
If you have a Blue Cross and Blue Shield of Illinois (BCBSIL) plan, there may be changes to your 2019 prescription drug coverage, because of new state laws. These laws do not apply to all plans. The benefit limitations and any applicable coinsurance, copayments and deductibles continue to apply.
PA 100-1057 Stage 4 Cancer Drug Coverage Applies to policies amended, delivered, issued or renewed after Jan. 1, 2019 Health care plans that cover the treatment of stage 4 advanced, metastatic cancer cannot limit or exclude coverage for a drug by requiring the member to first fail to successfully respond to a different drug. This assumes that the use of the drug is consistent with appropriate treatment practices and is supported by peer-reviewed medical literature. BCBSIL drug plans already meet the requirements of this law, so no changes were needed.
PA 100-1024 Mental and Emotional Disorder Coverage and Parity Requirements Applies to policies amended, delivered, issued, or renewed on or after Jan. 1, 2019 Substance abuse disorder drugs (FDA-approved drugs that treat opioid drug and alcohol abuse and help to quit tobacco use) that are covered by your plan may be in the lowest cost tier of your drug plan (either generic or brand, depending on the drug). Substance abuse disorder drugs include those with such active ingredients as buprenorphine-naloxone, methadone, naltrexone, disulfiram, acamprosate, bupropion (smoking deterrent), varenicline and nicotine replacement therapy.
PA 100-1052 Formulary Change: Continuity of Coverage Effective Aug. 24, 2018; applicable to Fully Insured HMO policies on or after Jan. 1, 2019 A health care plan cannot remove a drug from its formulary (drug list), or negatively change its preferred or cost-tier sharing during a plan year unless specific guidelines are met. BCBSIL Fully Insured HMO plans will not remove a drug or negatively change the drug lists more than once annually, unless required by health and safety concerns or FDA changes.
PA 100-0804 15-month Prescription Limitation Applies to prescriptions on or after Jan 1, 2019 A prescription may be valid for up to 15 months for non-controlled substances from the date initially issued.
Health Coverage Remains in Place for Blue Cross Blue Shield Federal Employee Program® (FEP®)
Jan. 09, 2019
Health care coverage for members of the Blue Cross Blue Shield Federal Employee Program (FEP) remains in place and active during the government shutdown. Eligible FEP members can also contact Blue Cross and Blue Shield of Illinois if they have a Qualifying Life Event, such as the birth of a baby that allows them to change their coverage or add eligible individuals to their policy.
We remain committed to the health and wellbeing of our members and want them to know that they will continue to have full access to their health care coverage during this time.
Transition to Wellbeing Management for Many Employer Groups
Jan. 01, 2019
On Jan. 1, six million employer group customers will transition to Wellbeing Management. This new program replaces Blue Care Connection®, our previous health management and wellness offering. Wellbeing Management is a new holistic approach to health and wellbeing using integrated, multidisciplinary teams to help manage a member’s care comprehensively throughout their health journey.
The program also provides expanded digital solutions for members to become more engaged in their health. By focusing on whole person health, Wellbeing Management provides us with a better understanding of our members, so we can help connect them with the quality, affordable health care they need. For questions or to learn more, contact your customer advocate at the number on the back of your health insurance card.
Quarterly Drug List Updates for Employer Groups
Jan. 01, 2019
Each quarter, the Blue Cross and Blue Shield of Illinois prescription drug lists for our employer group customers are reviewed and updated. Drugs can be added or removed from the lists due to pharmaceutical industry changes and to make sure the medications on the drug list are safe, effective and affordable.
It’s important to note that generic equivalents are available for most medications excluded from a drug list. Members should discuss any medication concerns with their doctor or pharmacist.
First quarter changes for most non-regulated employer group plans go into effect on Jan. 1, 2019. Affected members were sent a letter detailing the updates.
Changes and effective dates may depend on group funding type (fully insured/self-funded), plan renewals and the specific prescription drug list the group has selected.