What does my insurance cover bcbs

Before you get care, check to see what your plan covers and if you need a referral or prior authorization (permission from Horizon BCBSNJ before you get certain treatments or services).

Understanding Your Benefits

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You can also call the Member Services number on the back of your member ID card to use the automated interactive voice response system which is available any time, any day, or you can speak with a Member Services Representative during business hours.

Glossary of health insurance words
Confused by all the health insurance words and abbreviations? Don’t worry. Our detailed glossary explains the health insurance terms you need to know to understand your benefits and coverage.

Watch our videos that explain copayments, coinsurance and deductibles.

We know your health is important to you.

At Blue Cross and Blue Shield of Illinois (BCBSIL), we have a variety of plans to meet your health care needs.

Below are the most common types of health insurance coverage offered. If you are considering maternity coverage, dental services or prescription drug coverage, check out the plan details for different types of health insurance and specific plans to make sure you get the coverage you need.

Individual Health Insurance For You and Your Family

Individual and family coverage is also known as major medical or comprehensive coverage. When you think of health insurance, this is likely the first type of health insurance you think of. It covers a wide range of services. This type of health insurance coverage:

• Lasts a year or longer
• Usually can be renewed
• Meets the requirements set by the Affordable Care Act and includes:
  • Emergency services, hospitalization, and preventive care
  • Maternity, newborn and pediatric care
  • Mental health care & substance abuse treatment
  • Laboratory services, prescription drugs, and disease management
  • Rehabilitative services and devices

If you enroll in Individual health insurance and family coverage, you may be able to get help paying for it with a premium tax credit or cost-sharing assistance. Learn more about getting financial help to lower your monthly bill.

Need more information about individual health insurance and family coverage? Attend an event and see us in person.

Group Health Insurance Plan

If you get your health plan through your job, this is called a group health insurance plan. It's also known as group coverage or a group plan.

Dental

Dental insurance plans provide coverage for part of the dental costs for you and your family. This type of health insurance:

• Can cover a wide range of dental services or just basic, routine care.
• Can be bought as part of your Blue Cross and Blue Shield of Illinois (BCBSIL) individual and family health plan or separately, as a stand-alone dental plan.
• Is required for children age 18 or younger under the Affordable Care Act.

Medicare

Medicare is a type of health insurance coverage for people age 65 or older, or people under 65 with certain disabilities or illnesses.

You can add to your Original Medicare Part A (hospital) and Part B (medical) to help strengthen your health insurance safety net:

• Part C – Medicare Advantage Plans can be seen as all-in-one coverage, some with built-in prescription drug coverage
• Part D – Prescription drug coverage that pays for approved drugs
• Medicare Supplement Insurance Plans – May help pay for health care costs not covered by Original Medicare

Need more information? Attend an event and see us in person.

Medicaid and Children's Health Insurance Plan (CHIP)

Medicaid and CHIP are types of low or no-cost health insurance through the government. Your eligibility is based on your household size and income and determined by the government. You can apply any time of year.

Whether you're looking for insurance for yourself or your entire family, Blue Cross and Blue Shield of Texas (BCBSTX) offers a variety of family and individual health insurance coverage options.

Individual Health Insurance For Yourself and Family

We offer a variety of individual health insurance plans, also known as major medical or comprehensive coverage. These plans cover a large range of services and meet the following requirements:

• Usually can be renewed.
• Last a year or longer.
• Include the following services, as required under the Affordable Care Act:
  • Maternity, newborn and pediatric care
  • Emergency services, hospitalization and preventive care
  • Laboratory services, prescription drugs and disease management
  • Mental health care and substance abuse treatment
  • Rehabilitative services and devices

You may qualify for help paying for your Individual and Family plan. Learn about getting financial help.

If you get your health plan through your job, this is called a group health insurance plan. It's also known as group coverage or a group plan.

Dental

Dental insurance plans can cover everything from basic care to a wide range of dental services. Dental coverage can be purchased as part of your Blue Cross and Blue Shield of Texas family and individual health insurance plan or as a standalone dental plan. As part of the Affordable Care Act, some Individual and Family plans include dental coverage for children up to age 21.

Medicare

Medicare is a government program designed to provide health insurance to people age 65 years or older, as well as people under 65 with certain disabilities or illnesses. When you sign up for Medicare through the government, you get Original Medicare Part A (hospital) and B (medical) coverage. But you can also purchase additional insurance through Medicare-approved insurance companies like BCBSTX, to strengthen your health insurance safety net. The additional insurance includes the following parts:

• Part C — Medicare Advantage Plans are considered all-in-one coverage, and some come with built-in prescription drug coverage.
• Part D — This part of Medicare includes prescription drug coverage that pays for approved drugs.
• Medicare Supplement Insurance Plans — These plans may assist with health care costs that aren't covered by Original Medicare.

Medicaid and Children's Health Insurance Program (CHIP)

Medicaid and CHIP are types of low or no-cost health insurance through the government. Your eligibility is based on your household size and income and determined by the government. You can apply any time of year. You can apply online and if you qualify for Medicaid or CHIP, the proper government office will contact you.

Please note: If you sign up for Medicaid or CHIP, you will not be able to use the premium tax credit or cost sharing discount. If you have Medicaid coverage now, you're considered covered under the health care law and don't have to buy a plan on the Marketplace.

Where do I file a claim for medical care received outside the United States?

If you are eligible for the Federal Employee Program (your member ID starts with the letter R immediately followed by numbers), your overseas claim form and instructions can be found here.

If you are eligible for the Blue Cross Blue Shield Global Core program, enter the first three letters or numbers of your member ID here to access your international claim form and instructions.

Otherwise, contact your Blue Cross and Blue Shield company for assistance.

Whom do I contact when I have billing questions, get claim forms or talk to if a claim has been rejected?

How often is your BlueCard Doctor and Hospital Finder updated?

Each one of our Blue Cross and Blue Shield independent licensees (our member companies) collect and provide information for our PPO finder via different timetables and methods. While we make every effort to keep the Provider Finder "up-to-date," it is always best to confirm any provider information you select from this utility with your local Blue Cross and Blue Shield representatives.

What is a Primary Care Physician (PCP)?

A physician or other medical professional who serves as a group member's first contact with a company's health care system. Also known as a primary care provider, personal care physician or personal care provider.

What is an HMO?

HMO stands for Health Maintenance Organization, a health care system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee.

For more insurance terms and definitions, please see our Glossary.

What is a PPO?

A Preferred Provider Organization (PPO) is an arrangement designed to supply health care services at a discounted cost by providing incentives for members to use designated health providers (who contract with the PPO at a discount), but which also provides coverage for services rendered by health care providers who are not part of the PPO network.

I was denied coverage, a claim, or received erroneous charged on my EOB, whom do I contact?

To access specific information about your coverage and claims related to your individual or group health insurance, please contact the customer service number on the back of your member card. Otherwise, you can find your local BCBS company online. BCBS.com does not maintain member information.

I am a member but I do not see where I can log in on this website. Where do I find access to my member benefits, coverage, etc?

Bcbs.com is the Blue Cross and Blue Shield Association website. The Blue Cross and Blue Shield Association does not have access to member information. We regulate the brand and licenses to all 36 Blue Cross and Blue Shield local companies.

To access specific information about your coverage, EOBs, prescriptions, paying a bill, or any other questions related to your individual or group health insurance, please contact the customer service number on the back of your member card. You can also find your local BCBS company on BCBS.com. 

How can I find out information about coverage that is supplemental to Medicare?

There are lots of Medicare choices, including Medicare+Choice, medical savings accounts and private fee-for-service plans. For plans available to you, use our Medicare guide. You can also view a listing of Blue Cross and Blue Shield companies who participate in Medicare Advantage and Prescription Drug choices. Contact your local BlueCross and Blue Shield representative for details regarding claims or coverage. Not sure which Blue company you belong to? You can find out by typing your home or work ZIP code in our Plan Finder.

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.