Medicare-Eligible Retiree Plans - 2020 The Boeing Company - Blue Cross and Blue Shield ...
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The Boeing Company
This is a Member
Boeing Well Being Partner Information Guide
2020
Medicare-Eligible Retiree Plans
www.bcbsil.com/boeing 888-802-8776
Contents
Welcome to Blue Cross and Blue Shield of Illinois..................................................................... 2
Frequently Asked Questions.......................................................................................................... 5
Using Your Online Resources......................................................................................................... 7
Blue Cross Blue Shield Global® Core............................................................................................ 9
Blue Distinction® Specialty Care.................................................................................................. 11
Filing a Claim................................................................................................................................... 13
Understanding Your Explanation of Benefits Statement....................................................... 15
Health Insurance Fraud................................................................................................................ 17
Fitness Program............................................................................................................................. 19
Behavioral Health.......................................................................................................................... 20
24/7 Nurseline................................................................................................................................ 21
Other Boeing Benefits.................................................................................................................. 22
Express Scripts® Prescription Benefit Services........................................................................ 23
Davis VisionSM................................................................................................................................. 24
Important Information................................................................................................................. 25
Contact Information At a Glance..................................................................................Back Cover
www.bcbsil.com/boeing
1 888-802-8776
Welcome to Blue Cross and Blue Shield of Illinois
Preventive care may help you have a healthier life, and Blue Cross and Blue Shield of Illinois (BCBSIL)
understands this. For more than 80 years, BCBSIL has provided health care benefits and services to
the members and communities we serve. Through these covered services plans, BCBSIL provides
members with access to programs and support to help them become knowledgeable health care
consumers, make smart health care choices and manage their well-being.
This information guide is for Boeing Medicare Retiree members enrolled in a plan administered
by BCBSIL:
• Traditional and Basic Indemnity plans • 80/20 Traditional Medical Plan Indemnity
• Catastrophic plan • 80/20 HSM plan
• 90/10 Indemnity plan • 80/20 Indemnity plan
www.bcbsil.com/boeing
2 888-802-8776We Are Here to Help
BCBSIL knows that the choices you make
every day can affect your health now and in If You Have Questions
the future. We have a wide variety of tools
For details on your medical coverage, including
and resources to help you plan and manage deductibles, copayments, coinsurance and covered
your health care. services, call Boeing Member Services. Health Advocates
If you have questions, call Boeing Member Services at can answer questions about your medical benefits.
888-802-8776. A Health Advocate is available Monday You can also go to www.bcbsil.com/boeing, which is
through Friday from 5 a.m. to 5 p.m. PT (8 a.m. to 8 p.m. your source for benefits information and tools. There,
ET and 7 a.m. to 7 p.m. CT). Whether you are trying to you can register for Blue Access for MembersSM, a
improve your health or reach the next level of wellness, secure member portal, where you can find answers to
BCBSIL is here to help. your questions, send a secure email directly to Member
Services or chat live with them.
How to Use This Guide
Please take a few minutes to review this guide, which Please note: This booklet is meant to be a summary of administrative
is intended to help you learn more about your BCBSIL services only. Benefits and coverage levels vary by plan option and are
explained in more detail in the applicable summary plan descriptions,
benefits, such as how to find a physician, contact insurance contracts and other formal plan documents. In the event
of a conflict between this booklet and the formal plan documents, the
dedicated clinicians, submit a claim and understand your plan documents will govern.
explanation of benefits (EOB) statements. * Not all plans include vision care.
For most plans, Boeing contracts with different service
representatives for pharmacy and vision care.* An
overview of benefits is provided for people enrolled in
those services.
www.bcbsil.com/boeing
3 888-802-8776Watch for Your ID Cards.
Member ID cards will arrive by mail for subscribers who
elect a new plan in 2020. For those who choose to stay
in their current plan for 2020, you will continue to
use your current ID card. If you need a temporary or
additional ID card or need to request a replacement
card, go online to www.bcbsil.com/boeing or call
Boeing Member Services. You can access a digital ID card
on Blue Access for Members. Remember to show
your ID card to each provider you see so he or
she can update your records and help ensure
that your claims are paid in a timely manner.
www.bcbsil.com/boeing
4 888-802-8776Frequently Asked Questions
What is BCBSIL? What type of information will Provider Finder
BCBSIL provides health care coverage to more than give me?
8.1 million members. We started in the height of the Great Searching for a network doctor is now easier than ever
Depression in 1936 in Chicago and grew out of a shared with the enhanced Provider Finder tool. Members can
interest to protect individuals and families. now compare providers on a single page, view and sort
Today, we remain member-owned. We answer to our providers by quality, cost and accessibility. Members can
members. Our company is the fourth-largest health also estimate costs for over 1,600 procedures and tests.
insurer in the U.S. Provider and facility profiles are also available, which
include information about a provider’s specialty and areas
How do I find a physician or hospital? of expertise as well as detailed member reviews and an
Keep in mind that Medicare is primary and your Boeing overall quality rating.
plan provides secondary coverage to Medicare. Your plan
does not include a network requirement, but you may Do I need to select a primary care physician or
wish to confirm with your provider that he or she accepts obtain a referral to see a specialist?
Medicare reimbursement. You are not required to select a primary care physician or
The Provider Finder® tool helps you locate doctors and obtain a referral to see a specialist. However, an ongoing
other health care providers that meet criteria you set. relationship with a primary care physician can help you
You can view the most current list of providers online manage your health and address any concerns you have.
by visiting www.bcbsil.com/boeing. Click Menu, You can use Provider Finder from your computer or
select Find a Doctor or Hospital and then choose mobile phone web browser to search for primary care
Provider Finder. physicians for you and your covered family members in
specialties, such as internal medicine and family practice.
Will I receive a provider directory?
Provider directories are not printed because they are
updated frequently. You may view the current list of
providers online by visiting www.bcbsil.com/boeing.
Click Menu, select Find a Doctor or Hospital and then
choose Provider Finder.
How can I get more information about
my health care coverage through BCBSIL?
Please visit www.bcbsil.com/boeing for additional
information about your health care coverage, or call
Boeing Member Services.
www.bcbsil.com/boeing
5 888-802-8776Frequently Asked Questions
Where can I get a summary of my benefits? How do I submit a claim?
You may view your plan benefits online by visiting If you use a Medicare provider, the provider will submit
www.bcbsil.com/boeing. Click Menu, select claims directly to Medicare and then to BCBSIL. Be sure
Coverage and Plans and then choose Medical to show your new ID card to each provider you see. If you
Benefits. You can also call Member Services or view need to file a claim yourself, you must fill out and submit a
your plan benefits via Boeing Worklife. claim following the instructions on page 13.
When will I receive ID cards? How and when can I call BCBSIL Member Services?
Member ID cards will arrive by mail for subscribers who You can reach Member Services at 888-802-8776 from
elect a new plan in 2020. Please be sure to show your new 5 a.m. to 5 p.m. PT (8 a.m. to 8 p.m. ET and 7 a.m. to
ID card to each provider you see so he or she can update 7 p.m. CT). Health Advocates are available to explain
their billing systems with your new information. Show your your benefits, answer questions about claims or assist
member ID card when seeking behavioral health services. with many other matters. Call Boeing Member Services
Digital ID cards are also available on Blue Access for or visit www.bcbsil.com/boeing and log in to Blue
Members. Text* BCBSILAPP to 33633 to use the Access for Members to use Live Chat. You can also
BCBSIL App. find other helpful plan information online at any time.
Why do the ID cards have only the subscriber’s name Can I email questions directly to BCBSIL?
and not all family members’ names? Yes. Once you register for Blue Access for Members, the
The member ID cards display only the subscriber secure member portal at www.bcbsil.com/boeing, you
(employee or retiree) name. The cards are to be used can send a secure email directly to Member Services.
for all eligible family members even though their
names are not printed on the card. If you need an
additional card, you can request one by contacting
Boeing Member Services.
If you have other questions about
BCBSIL, call Boeing Member Services
at 888-802-8776.
Health Advocates are available Monday
through Friday from 5 a.m. to 5 p.m. PT
(8 a.m. to 8 p.m. ET and 7 a.m. to 7 p.m. CT).
*Message and data rates apply. Terms, conditions and privacy policy
are at bcbsil.com/mobile/text-messaging.
www.bcbsil.com/boeing
6 888-802-8776Using Your Online Resources
BCBSIL Provides Tools and Resources to BCBSIL App
Help You Manage Your Health and Benefits You can access your health coverage and wellness
Once you receive your new member ID card, you can information conveniently and securely via your mobile
register for Blue Access for Members and use this device anytime, anywhere. You can even access your ID
secure website to manage your benefits and health. Go card information.
to www.bcbsil.com/boeing click Member Log In and Text* BCBSILAPP to 33633 to get the BCBSIL App that
follow the steps to register. lets you use Blue Access for Members while you’re on
the go.
Manage Your Benefits
Once you register and log in, Blue Access for Members Provider Finder
allows you to: You can also use Provider Finder to locate doctors and
• Review your coverage. hospitals in your network. Filter the search results by
• Review who is covered under your plan. provider type, specialty, ZIP code, language and gender.
Plus, get door-to-door directions.
• Find and compare providers or facilities.
• Check the status of a claim. With Provider Finder, it’s easy to:
• Sign up to receive email notifications when a claim • Compare providers on a single page
is finalized. • View and sort providers by quality, cost and accessibility
• View and print your explanation of benefits statements • Estimate costs for over 1,600 procedures and tests
and opt out of receiving printed copies in the mail.
• Request a replacement or additional ID card and print a
temporary one.
*Message and data rates apply. Terms, conditions and privacy policy are at bcbsil.com/mobile/text-messaging.
www.bcbsil.com/boeing
7 888-802-8776Find What You Need with Blue Access for Members
8 9 10
1 2 3 4 5
6
7
1 My
Coverage: Review benefit details for you and the 6 Message Center: Receive notification of pending
family members who are covered under your plan. and finalized claims and other updates via secure
messaging.
2 Claims
Center: View and organize details such as
payments, dates of service, provider names, claims 7 Quick
Links: Go directly to some of the most
status and more. popular pages, such as replacement ID cards, manage
preferences, stop receiving paper statements and
3 My
Health: Make more informed health care
more.
decisions by reading about health and wellness topics
and researching specific conditions. 8 Settings:
Set up notifications and alerts to receive
updates via text messaging and email, review your
4 Doctors
& Hospitals: Use Provider Finder to locate
member information and change your secure
a network doctor, hospital or other health care
password at any time.
provider, and get driving directions.
9 Help:
Visit Health Care School to learn more about
5 Forms
& Documents: Use the form finder to get
using your health care benefits.
medical claim and other forms quickly and easily.
10 Contact
Us: Submit a question or connect to a
Health Advocate via Live Chat.
Please note: The information above is representative of the resources available through Blue Access for Members. However, the resources
available to you may vary, based on the particular plan you have enrolled in. Contact Boeing Member Services with any questions.
www.bcbsil.com/boeing
8 888-802-8776Blue Cross Blue Shield
Global Core
You’re Never Far from Health Care Services —
Even When You’re Far from Home
Like your passport, always carry your member ID card
with you when you travel or live abroad. Through the Blue
Cross Blue Shield Global Core program, you have access to
doctors, hospitals and other health services in nearly 200
countries and territories around the world.
How Blue Cross Blue Shield Global Core Works
To take advantage of the Blue Cross Blue Shield Global
Core program, review this information:
• Before you leave home, contact BCBSIL for coverage
details. Your coverage outside the United States may
be different.
• Always carry your member ID card.
• In an emergency, go directly to the nearest hospital.
• The Blue Cross Blue Shield Global Core Service
center is available 24 hours a day, seven days a
week toll free at 800-810-BLUE (2583) or by
calling collect at 804-673-1177.
Call the Service Center in these situations:
• You need to locate a doctor or hospital or need medical
services. An assistance coordinator, in conjunction with a medical
professional, will arrange a physician appointment or hospital stay.
• You need inpatient care. After calling the Service Center, you should
also call BCBSIL Customer Service for precertification or pre-approval.
You can find the telephone number on the back of your ID card. This
number is different than the Blue Cross Blue Shield Global Core Service
Center number shown here.
GeoBlue is the trade name of Worldwide Insurance
Services, LLC (Worldwide Services Insurance Agency,
LLC in California and New York), an independent
licensee of the Blue Cross and Blue Shield Association.
Blue Cross Blue Shield Global Core
GeoBlue is the administrator of coverage provided is there if you need medical care
under insurance policies issued by 4 Ever Life
International Limited, Bermuda, an independent outside the U.S.
licensee of the Blue Cross Blue Shield Association.
www.bcbsil.com/boeing
9 888-802-8776Blue Cross Blue Shield Global Core
Payment Information Claim Filing
• For participating Blue Cross Blue Shield • The hospital will file your claim if the Blue Cross
Global Core hospitals – Blue Shield Global Core Service Center arranged your
In most cases, you should not need to pay up front for hospital stay. You will need to pay the hospital for the
inpatient care at participating hospitals except for the usual out-of-pocket expenses.
usual out-of-pocket expenses (non-covered services,
• You must file the claim for outpatient and doctor care
deductibles, copayments and/or coinsurance). The or inpatient care not arranged through the Blue Cross
hospital should submit the claim on your behalf. Blue Shield Global Core Service Center. You will need to
• For doctors and/or non-participating hospitals – pay the health care provider and submit an international
You will need to pay up front for services. Then you claim form with the original bill(s).
can complete a Blue Cross Blue Shield Global Core
international claim form and send it with the bill(s) to the Claim Forms
Blue Cross Blue Shield Global Core Service Center at the International claim forms are available from BCBSIL, the
address on the form. You can also submit your claim Service Center or bcbsglobalcore.com.
online or through the Blue Cross Blue Shield Global Core
mobile app. The claim form is available from your
Remember to take this information with
Blue Cross Blue Shield company or online at
bcbsglobalcore.com. you when you travel or live outside the U.S.
Blue Cross Blue Shield Global
Core Service Center
Toll-free: 800-810-2583
Collect: 804-673-1177
www.bcbsil.com/boeing
10 888-802-8776Blue Distinction Nationwide Access
Specialty Care There are approximately 1,900 Blue Distinction
Choosing Quality Care for You and Centers nationwide. Use Provider Finder to find
one near you:
Your Family
With Blue Distinction® Centers, you have access to 1 Go
to www.bcbsil.com/boeing and click Menu.
designated specialty care facilities that have met national
measures for quality and cost-efficient care. When you use
2 Select
Find a Doctor or Hospital in the menu,
a Blue Distinction Center, you will receive the most from click Blue Distinction Centers and then choose
your benefits and know that the facility has a record of Find a Blue Distinction® Specialty Care Facility.
providing proven, effective specialty care.
3 You
may search for a specific area of specialty
Blue Distinction Centers are available for the following care or view a complete list of Blue Distinction
specialty health care services: Centers by state.
Blue Distinction® Centers for Bariatric Surgery
Postoperative, follow-up and patient education Note: Designation as Blue Distinction Centers means these
facilities’ overall experience and aggregate data met objective
Blue Distinction Centers for Cardiac Care
®
criteria established in collaboration with expert clinicians’ and leading
Cardiac care, cardiac rehabilitation, cardiac catheterization professional organizations’ recommendations. Individual outcomes
may vary. To find out which services are covered under your policy
and cardiac surgery at any facilities, please call your local Blue Cross and Blue Shield
Plan. Call your provider before making an appointment, to verify
Blue Distinction® Centers for Knee and the most current information on their Network participation status.
Neither Blue Cross and Blue Shield Association nor any of its
Hip Replacement licensees are responsible for any damages, losses, or non-covered
Knee and hip replacement surgeries and services charges that may result from receiving care from a provider
designated as a Blue Distinction Center.
Blue Distinction® Centers for Cellular
Immunotherapy
Treatments for immune system diseases; chimeric antigen
receptor T (CAR-T) cell therapies
Blue Distinction® Centers for Gene Therapy
(coming in 2020)
Gene therapies for inherited disorders, including ocular
disorders
Blue Distinction® Centers for Spine Surgery
Spine surgery services, including discectomy, fusion and
decompression procedures
Blue Distinction® Centers for Transplants
Transplant and support services
The goal of Blue Distinction Centers is to help you find
consistent specialty care, while encouraging health care
professionals to improve the overall quality and delivery
of care nationwide.
www.bcbsil.com/boeing
11 888-802-8776www.bcbsil.com/boeing
12 888-802-8776Filing a Claim
Guidelines to Help Ensure Your Claims Are • lace where service was received (hospital, office
P
Submitted Quickly or clinic)
• Diagnosis of illness or injury; if an injury, give the date
Provider-Submitted Claims
it happened
Most physicians, hospitals and other providers will file a • Description of service received
claim directly with Medicare. Show your member ID card
to providers when checking in to confirm that they will file • Date of each treatment or surgical procedure
claims directly to BCBSIL after Medicare has paid. • Charge for each treatment or surgical procedure
Member-Submitted Claims • Itemized bills for ambulance service should include:
If you need to file a claim yourself, you will need to fill out • Date(s) when service was used
and submit a form to Medicare. You may call 888-802-8776 • Base rate and mileage
for assistance, or you may download a form online:
• Place where patient was picked up and driven to
1 Go to www.bcbsil.com/boeing and click Menu. • If patient was transferred from one location to
2 Click Forms. another, a letter from the attending physician giving
the reason for the transfer must be attached to the bill
3
Click Medical Claim Form and print the form
and instructions. • Itemized bills for rental of durable medical equipment
should include:
Then, fill out the form completely, attach a copy of the
original itemized bill and mail to the address shown on the • A statement from the attending physician that’s
claim form. attached to the bill and states why the equipment was
necessary
Tips for Submitting Claims
• An estimate of how long the equipment will be used
Help us avoid unnecessary delays by answering all
and the purchase price of the equipment; if for long-
questions completely and accurately and including original
term use, remember that rental is paid only up to the
itemized bills that contain the information we need to
purchase price of the equipment
process claims.
• If your claim is submitted through Medicare first, BCBSIL • Please remember to attach original bills to the claim
form. We recommend that you make copies of each
will process your benefits covered by Boeing.
bill for your personal records. The original bills will not
• Show the instructions accompanying the claim form to be returned.
the persons providing your care and ask them to provide
bills that follow the instructions.
• Itemized bills for medical treatment or surgery
should include:
• Provider’s name, address and phone number
• Provider’s tax identification number
• ull name of patient (not just name of person to whom
F
bill is addressed)
www.bcbsil.com/boeing
13 888-802-8776Filing a Claim
Claim Form
to Pay Insured/Subscriber
P.O. Box 805107 • Chicago, Illinois 60680-4112
Each item on this form needs to be completed.
Instructions for completion are listed on the reverse side.
Please print or type.
Insured/Subscriber Name (Last, First, Middle Initial) Group Number Insured/Subscriber Identification Number (from ID card)
Mailing Address Patient’s Full Name (Last, First, Middle)
1 City and State ZIP Code 2 Patient’s Sex Patient’s Date of Birth Month Day Year
__________ /__________ /_____________
Insured Employed? Date of Retirement:
Month Day Year Patient’s Relationship to Insured
£ Yes £ No £ Retired __________ /__________ /_____________ £ Self £ Spouse £ Child £ Other (explain) _______________________________________
Type of treatment received: Month Day Year
Check only one type and attach itemized statements. Please use £ Injury — Date of accident: __________ /__________ /_____________
a separate claim form for each different type of treatment.
3 £ Illness — Date of first symptom: __________ /__________ /_____________
Please note: Preventive care includes immunizations, routine
well baby care, routine physical examinations, vision and £ Pregnancy — Date of conception: __________ /__________ /_____________
hearing exams. £ Preventive — Date of service: __________ /__________ /_____________
Describe: Diagnosis, symptoms of illness or injury or explain preventive or routine care received.
_________________________________________________________________________________________________________________________________________________________________________
4
_________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________
5 Was illness or injury work connected? £ Yes £ No Name and address of employer
______________________________________________________________________________________________
6 If injury, was a motor vehicle involved? £ Yes £ No ______________________________________________________________________________________________
Is patient covered under any other health benefits plan (besides Medicaid, Medicare or CHAMPUS)? £ Yes £ No
Insurance Co. _____________________________________________________________________ Month Day Year
Address __________________________________________________________________________ Effective date of coverage ___________ /___________ /______________
7 Employer _________________________________________________________________________ Sex of Insured £ Male £ Female
Insured name ____________________________________________________________________ Date of birth of insured ___________ /___________ /______________
Policy # ___________________________________________________________________________ Relationship to patient _________________________________________________________
If the other coverage is primary, attach the other insurance company’s Explanation of Benefits.
Medicare — Is the patient: Month Day Year
a) Entitled to benefits under Medicare insurance (Part A)? £ Yes £ No Effective ___________ /___________ /______________
b) Entitled to benefits under Medicare insurance (Part B)? £ Yes £ No Effective ___________ /___________ /______________
8
c) Entitled to benefits under Medicare due to a disability? £ Yes £ No Effective ___________ /___________ /______________
Patient’s Medicare Identification Number. (From Medicare ID card) ___________________________________________________________________________________________________
I certify the above is complete and correct and that I am claiming benefits only for charges incurred by the patient named above.
Authorization is hereby given to any Hospital, Physician, Dentist, Provider, Insurance Carrier or other entity to give Blue Cross and
Blue Shield of Illinois, upon request, any medical information which the Plans in their judgment deem necessary to the adjudication of this
claim. Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to
9
fines and confinement in state prison.
Signature of Insured Date Daytime telephone number
Total amount for ALL covered services and supplies received. $
10
Itemized Bill(s) for covered services and supplies must be attached. (See Instructions on reverse side.)
228934.1015
www.bcbsil.com/boeing
14 888-802-8776Understanding Your EOB
An explanation of benefits (EOB) statement What You Can Find
is a notification form provided to members 1 Account name (member’s company or organization)
when a health care benefits claim is 2 Date claim was finalized
processed by BCBSIL. The EOB displays the
3 Toll-free number to call for additional information
expenses submitted by the provider and
shows how the claim was processed. 4 Member’s name and mailing address
5 Messages
The EOB has four sections:
6 Member’s name
• Claim Information includes the member and patient
name, the member’s group and ID numbers and the 7 Employer and/or group identification number*
claim number. 8 Identification number that appears on the ID card*
• Summary highlights the financial information — the 9 Claim number*
amount billed, the total benefits approved and the
amount you may owe the provider. 10 Person who received the services*
• Service Information identifies the health care 11 Provider
name (top line) and description of
provider, dates of service and charges. service (below)
• Coverage Information shows what was paid to whom, 12 Beginning and ending service dates
what discounts and deductions apply and what part of
13 Amount billed by the provider for each service
the total expense was not covered.
14 Portion
of the billed amount not covered by the plan
The EOB may include additional information: (a footnote will explain the reason)
• Amounts Not Covered will show provider discounts, 15 Amount covered by the plan*
or what benefit limitations or exclusions apply.
16 Total charges included on this claim
• Out-of-Pocket Expenses will show an amount when a
claim applies toward your deductible or counts toward 17 Plan
reductions subtracted from billed amount, such
your out-of-pocket expenses. as PPO allowances
• Appeals explains your rights regarding review of claim 18 Deductible
and copayment or coinsurance amounts;
denials. can also display applicable penalties
• Fraud Hotline is a toll-free number to call if you think and/or reductions for failure to pre-authorize
you are being charged for services you did not receive 19 Payment
amounts approved for benefits
or if you suspect any fraudulent activity.
20 Amount the member may be responsible for paying
21 Total benefits approved for provider
22 Summary
box, including the total billed by the
provider for the services, the benefits approved
and paid by BCBSIL, and the remainder you may
owe (see also 13, 19 and 20)
* Please provide this information when contacting us about a claim.
www.bcbsil.com/boeing
15 888-802-8776Understanding Your EOB
Your EOBs Are Available Online!
1
Go to www.bcbsil.com/boeing
2 and sign up for Blue Access
for Members. You’ll get quick,
convenient and confidential
ANTHONY DOE 3
4
100 BLUEBIRD LANE access to your claim information
CHICAGO, IL 60601-7332 and history.
5 Check here for BCBSIL messages.
To support our commitment to
eco-friendly business practices,
6 you can choose to opt out of
7
receiving EOBs by mail.
8
9
10 This saves resources and offers
you additional confidentiality. Just
go to www.bcbsil.com/boeing,
11 12 13 14 15
log in to Blue Access for Members,
click Settings at the top and select
16
Preferences.
17
18
19
20
21
22
If you have questions about an EOB, call Boeing Member Services.
www.bcbsil.com/boeing
16 888-802-8776Health Insurance Fraud: What You Should Know
Don’t Be a Victim
Identifying Fraud
Commonly identified schemes involving providers include:
• Misrepresenting services
Intentionally billing procedures under different names
or codes to obtain coverage for services that aren’t
included in a member’s plan.
• Upcoding
Deliberately charging for more complex or more
expensive services than those actually provided.
• Non-rendered and/or “free” services
Some providers intentionally bill for tests or services
never provided. This can also mean that the provider
offered “free” services to bill the insurance company for
services not performed or needed.
• Kickbacks, bribes or rebates
Referring patients to a provider or facility where the
referring provider has a financial interest.
Commonly identified member schemes include:
• Identity swapping
Allowing an uninsured individual to use your
insurance card.
• Identity theft
Using false identification to gain employment and the
health insurance benefits that come with it.
• Non-eligible members
Adding someone to a policy who is not eligible
or failing to remove someone when that person Fraud Affects Everyone.
becomes ineligible.
Fraud may cost the health care industry
• Prescription medicine and abuse diversion
Controlled substances can be obtained through (public and private payers) more than
deception or dishonesty for personal use or sale “on $200 billion each year. This fraud may
the street.” Prescription medications can be obtained
through doctor shopping, visiting several emergency cause you to face rising premiums,
rooms or stealing doctors’ prescription pads. increased copayments and deductibles
and the elimination of certain benefits.
www.bcbsil.com/boeing
17 888-802-8776Health Insurance Fraud: What You Should Know
BCBSIL Offers Tips for Fighting Fraud Preventing Health Care Fraud
• Know your own benefits and scope of coverage. BCBSIL created the Special Investigations Department
(SID) to fight fraud and help lower health care costs. The
• Review all EOB statements. Make sure the exams,
procedures and tests billed were the ones you actually staff includes individuals with medical, insurance and
had with the provider who treated you. law enforcement backgrounds as well as data analysts
experienced in detecting fraudulent billing schemes. The
• Understand your responsibility to pay deductibles SID aggressively investigates allegations of fraud and refers
and copayments, and what you can and cannot be appropriate cases for criminal prosecution.
balance-billed (an amount your provider may bill you) for
once your claim has been processed. Fraud Isn’t Fair — Help Us Fight It
• Guard your health insurance card and personal Reducing health care fraud is a collaborative effort
insurance information. Notify BCBSIL immediately if between BCBSIL, its providers and its members. Additional
your card or insurance information is lost or stolen. information — including a “fighting fraud checklist” — is
available through the SID website at www.bcbsil.com/sid.
• Sign and date only one claim form per office visit.
We also encourage you to report any suspected
• Never lend your member ID card to another person.
incidence of fraud by calling our Health Care Fraud
• Don’t give out insurance or personal information Hotline, completing a form online or sending us a note in
if services are offered as “free.” Be sure you understand the mail. Suspicions of fraud can be reported to the SID
what is “free” and what you or your insurance company anonymously.
will be charged for.
3 Ways to Report Fraud to BCBSIL
• Ask your doctors exactly what tests or procedures
they want you to have and why they are necessary The SID is here to help you. You can contact the SID
before you have them. in any of the following ways:
• Be sure any referrals you receive from your 1 800-543-0867
network provider are to other network doctors The toll-free Health Care Fraud Hotline operates
or facilities. 24 hours a day, seven days a week. You can remain
If you’re not sure, ask. anonymous or provide information if you want to be
• Monitor your prescription use at contacted by a member of the SID.
www.bcbsil.com/boeing or your Pharmacy 2 www.bcbsil.com/sid/reporting
Benefit Manager. Make sure the medications billed This website address links to an online fraud-reporting
to your insurance are accurate. form that you can complete and send to the SID
electronically.
3 U.S.
Mail
You can write the SID at:
Blue Cross and Blue Shield of Illinois
Special Investigations Department
300 E. Randolph Street
Chicago, Illinois 60601
www.bcbsil.com/boeing
18 888-802-8776Fitness Program
Make Your Fitness Program Membership Work for You!
Fitness can be easy, fun and affordable. Available exclusively to
members and their covered dependents (age 18 and older), the
Fitness Program provides:
• Flexible membership, no long-term contract required. The Fitness
Program offers a flexible option to get in shape and stay active. Choose
from a nationwide network of fitness centers that can work with your
lifestyle, whether you are at home or on the road. Membership is
month to month with no long-term contract.*
• Unlimited access to a nationwide network of more than 10,000
participating fitness centers.
• Online fitness location search functionality and view your visits
online.
• Easy online enrollment; automatic monthly payment withdrawal.
• Access to discounts through a nationwide network of 40,000 health
and well-being providers, such as acupuncturists, massage therapists
and personal trainers.
Are You Ready for Fitness?
Enroll today online by logging in to Blue Access for Members at www.bcbsil.com/boeing. Click Fitness Program under
“Quick Links” and follow the steps. Prefer to sign up by phone? Call 888-762-BLUE (2583) toll-free, Monday through Friday,
5 a.m. to 5 p.m. PT (6 a.m. to 6 p.m. ET and 7 a.m. to 7 p.m. CT).
It’s Easy to Sign Up
1 Go
to www.bcbsil.com/boeing and log in to Blue Access for Members.
2 Under
Quick Links, choose Fitness Program. On this page, you can enroll, search for fitness centers near you by
ZIP code and learn more about the program.
3 Click
Search Locations, then search and select the fitness location that is best for you.
4 Verify
your personal information and method of payment. Print or download your Fitness Program membership ID
card. You may also request to receive the ID card in the mail.
5 Visit
a facility today! Remember, you can visit any participating fitness center after you sign up.
Make new friends, take a class and try something new! Join the Fitness Program today.
* The one-time enrollment fee and monthly membership fee for the Fitness Program are both subject to applicable taxes.
The Fitness Program is provided by Tivity HealthTM, an independent contractor that administers the Prime Network of fitness centers.
The Prime Network is made up of independently owned and managed fitness centers.
www.bcbsil.com/boeing
19 888-802-8776Behavioral Health
Feeling Worried? Sad? Anxious? Member communications and information from the program are not
meant to replace the advice of health care professionals. Members are
With help, you can start to feel better. encouraged to seek the advice of their doctors or behavioral health
specialist to discuss their health care needs. Decisions regarding course
Most people have times when they don’t feel their best. But and place of treatment remain with the member and his or her health
care providers.
when negative feelings get in the way of normal activities or
last a long time, you may need extra support.
The good news is there are many treatments and support
systems available. With help, you can learn to help control
your symptoms and live a full life.
Your health care plan includes behavioral health benefits so
you and your covered family members can get the support
you may need for issues such as:
• Alcohol and substance use disorder
• Anxiety and panic disorders
• Attention deficit disorders
• Autism spectrum disorder
• Bipolar disorder
• Depression
• Eating disorders
• Schizophrenia and other mental health conditions
Need More Help?
To find a behavioral health provider in your area, go to
www.bcbsil.com/boeing or call Boeing Member
Services. Behavioral health professionals on the Boeing Care
Management Team at BCBSIL can assist you in getting help.
Most people know someone who is dealing
with a behavioral health issue. Seeking
help is a sign of strength and a first step in
getting better.
www.bcbsil.com/boeing
20 888-802-877624/7 Nurseline
Around-the-Clock,
Toll-Free Support
Health happens — good or bad, 24 hours a You can also call the 24/7 Nurseline whenever you or
day, seven days a week. That is why we have your covered family members need answers to health
registered nurses waiting to talk to you questions about:
whenever you call our 24/7 Nurseline at • Asthma, back pain or a chronic health issue
800-765-7298. • Dizziness or severe headaches
Our nurses can answer your health questions and try to • Cuts or burns
help you decide whether you should go to the emergency • A grandchild’s high fever or nonstop crying
room or urgent care center or make an appointment with
your doctor. • And much more
Plus, when you call, you can access an audio library of
more than 1,000 health topics – with more than 500 topics
available in Spanish.
Note: For medical emergencies, call 911 or your local emergency services first. 24/7 Nurseline is not a substitute for a doctor’s care.
Talk to your doctor about any health questions or concerns.
www.bcbsil.com/boeing
21 888-802-8776Other Boeing Benefits
In addition to the medical coverage provided through BCBSIL, you may
also receive coverage for specialized services through vendors with
whom Boeing has contracted, as described in this section. Specific
offerings may depend on employment status, union agreements and
other factors.
The benefits described in this section are not administered by BCBSIL.
The vendors mentioned are independent companies that do not provide
BCBSIL products or services. These vendors are solely responsible for
the products and services described.
www.bcbsil.com/boeing
22 888-802-8776Express Scripts, Inc.
Prescription Benefit
Services
Unless you are enrolled in a Catastrophic Express Scripts Specialist Pharmacists
medical plan, your prescription drug If you or your family members take medications to treat
benefit is administered by Express Scripts. certain long-term conditions, you can take advantage of
They provide personalized care designed the personalized care and expertise of Express Scripts
to help improve and maintain your and Specialist Pharmacists. They’re available by phone
your family’s health while helping you 24 hours a day, seven days a week to work with you and
your physician to help ensure that your medications work
save on the medications you take every
safely together and work well for you. These pharmacists
day. have specialized training in the medications used to treat
Convenient Mail-Order Service and More specific ongoing conditions, such as high cholesterol,
high blood pressure, depression, diabetes, asthma,
Express Scripts offers you convenience, safety and
osteoporosis and cancer. To contact an Express Scripts
savings through the Express Scripts mail-order
Specialist Pharmacist, call 877-505-3224.
pharmacy. With the Express Scripts mail-order
pharmacy, you can get up to a 90-day supply of
Contact Express Scripts
medications you take to treat an ongoing condition
(e.g., high blood pressure or high cholesterol) delivered To start taking advantage of everything your Express
to you for just one copayment. Take advantage of the Scripts prescription drug benefit offers, call Medicare
Express Scripts mail-order pharmacy and get: Member Services toll-free at 877-505-3224. Or visit
www.express-scripts.com.
• Phone access to pharmacists who can talk to you
about your prescriptions 24 hours a day, seven days Catastrophic Plan
a week.
Members enrolled in the Catastrophic plan should contact
• Easy refills online, over the phone or by mail. BCBSIL directly at 888-802-8776 to learn how to submit
• Peace of mind in knowing that your prescriptions are pharmacy claims or how your pharmacy benefit works.
undergoing safety and advanced quality checks to
help prevent harmful drug interactions. For short-
term prescriptions, such as antibiotics, continue using
a participating retail pharmacy.
You can also save with generic drugs. FDA-approved
generics meet the same FDA quality standards as
brand-name drugs, yet they can cost much less. The
My Rx Choices® prescription savings program lets you
go online to www.express-scripts.com/boeing to Express Scripts is an independent company that is contracted
through Boeing. Express Scripts does not provide Blue Cross and
view potential savings opportunities. Print them out and
Blue Shield of Illinois products or services. Express Scripts is solely
share them with your physician. responsible for the products and services it offers.
www.bcbsil.com/boeing
23 888-802-8776Davis Vision
Please note: Vision benefits vary by plan and Boeing Worklife or call your Davis Vision Boeing
populations. Some retirees do not have vision Member Services line at 844-770-1500.
coverage. For more information regarding Non-Davis Vision Providers
available vision benefits, please contact If you choose to see a non-Davis Vision provider, you may
Boeing Member Services at 888-802-8776. need to file your own claim for reimbursement. Submit
Davis Vision provides personalized vision care for you and your claim(s) to Davis Vision within 12 months of the
your covered dependents. When you visit a doctor in Davis date of service.
Vision’s broad network, you receive discounts on glasses, • Log in at www.davisvision.com/boeing, select
contacts, exams and other products and services. You Access Benefits and Forms, choose the Out of
can still see other providers, but your costs may be lower Network Claim form and then follow the instructions.
when you visit a Davis Vision provider. Please note that not
all plans include vision coverage. • Reference Boeing as your employer in your
correspondence.
Davis Vision Providers If you don’t have internet access, you can send the
To find a Davis Vision provider, log in to following to Davis Vision:
www.davisvision.com/boeing or call 844-770-1500 • Itemized receipt listing services received
and we’ll help you find a provider who is right for you.
Davis Vision will issue you a separate ID card. When you • Name, address and phone number of the
non-Davis Vision provider
make your appointment, tell them you have Boeing Davis
Vision services. • Patient’s name, date of birth, address, phone number
and relationship to covered member
Check your coverage on www.davisvision.com/boeing
before you go so you have a clear idea of what’s covered. • Reference Boeing as your employer in your
Your vision care provider will submit claims for you. correspondence.
Benefits include: • Keep copies of the claims and send the originals to:
• Vision exam Davis Vision
Davis Vision providers do more than a quick eye check. Non-Network Claims
They take their time and look for eye problems and signs P.O. Box 1740
of other health conditions. Latham, NY 12110-1740
• Choice in eyewear Davis Vision is an independent company that is contracted through
Boeing. Davis Vision does not provide Blue Cross and Blue Shield of
You can choose from a wide selection of eyewear. Illinois products or services. Davis Vision is solely responsible for the
• Additional savings products and services it provides.
Get discounts on laser vision correction, contacts
and more.
If you do not have vision coverage, you may participate
in the Davis Vision Discount Program that provides
members with savings on eye examinations, frames,
spectacle lenses and contacts. To learn more, visit
the Boeing Employee and Retiree Discount page on
www.bcbsil.com/boeing
24 888-802-8776Important Information
Health care coverage is important for everyone.
We provide free communication aids and services for anyone with a disability or who needs language assistance.
We do not discriminate on the basis of race, color, national origin, sex, gender identity, age or disability.
To receive language or communication assistance free of charge, please call us at 855-710-6984.
If you believe we have failed to provide a service, or think we have discriminated in another way, contact us to file a grievance.
Office of Civil Rights Coordinator Phone: 855-664-7270 (voicemail)
300 E. Randolph St. TTY/TDD: 855-661-6965
35th Floor Fax: 855-661-6960
Chicago, Illinois 60601 Email: CivilRightsCoordinator@hcsc.net
You may file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at:
U.S. Dept. of Health & Human Services Phone: 800-368-1019
200 Independence Avenue SW TTY/TDD: 800-537-7697
Room 509F, HHH Building 1019 Complaint Portal: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Washington, DC 20201 Complaint Forms: http://www.hhs.gov/ocr/office/file/index.html
www.bcbsil.com/boeing
25 bcbsil.com 888-802-8776Important Information
bcbsil.com
www.bcbsil.com/boeing
26 888-802-8776Contact Information At a Glance
For information on benefits for Medicare-eligible or non-Medicare-eligible members, please contact
BCBSIL at 888-802-8776 or visit www.bcbsil.com/boeing.
Blue Cross and Blue Shield of Illinois
Boeing Member Services: 888-802-8776 (medical and behavioral health)
Blue Cross Blue Shield Global Core: 800-810-BLUE (2583)/804-673-1177 collect
Fraud Hotline: 800-543-0867
Fitness Program: 888-762-BLUE (2583)
24/7 Nurseline: 800-765-7298
Other Boeing Benefits
Davis Vision Care: 844-770-1500
Express Scripts Prescription Benefit Services: 877-505-3224
Boeing Service Center for Health and Insurance: 866-504-4256
www.bcbsil.com/boeing
Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association
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