Serving Our Members in 2019

A Message from Our President

Jan. 15, 2019

As we begin a new year, I’d like to thank you for choosing Blue Cross and Blue Shield of Illinois (BCBSIL) and trusting us to provide health care coverage for you and your family in 2019.

Whether you get your insurance through your employer, the individual market, Medicare or Medicaid, we are prepared to serve you.

At BCBSIL we know new health care coverage means more than just having access to health insurance. We’re committed to making coverage and care more affordable, helping members navigate the complex health care system, and empowering whole-person health.

Buying health insurance and going to a doctor or hospital — even with insurance — can cause financial strain for many households. That’s why we’re finding new and innovative ways to address these costs and help our members attain their best health.

  • 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.
  • Like many in health care, we believe ZIP code is as important as genetic code in determining a person’s health. Social determinants, or factors outside the health care system can play a big role in a person’s cost of care. We will continue to build with our long-standing network of community partners to better support our members to assist in providing access to transportation and healthy food.
  • Through Affordability Cures Learn more about third-party links, we are focused on addressing the root causes of rising health care costs in Illinois and helping you and your family use your benefits.

In April, we will open the Blue Door Neighborhood Center, our first-ever neighborhood-based site. The Blue Door Neighborhood Center will offer Chicagoans 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. In the year ahead, 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.

Maurice Smith
President, Blue Cross and Blue Shield of Illinois

Recent Updates

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.

Employer Updates

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.

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