Enrollment Guide Arthur J. Gallagher & Co. · 1/1/2017 · Arthur J. Gallagher & Co. PPO+HSA 1&2 and PPO+HCA 01/01/2017. Nearly one in every three Americans has a Blue Cross and

Enrollment GuideArthur J. Gallagher & Co.PPO+HSA 1&2 and PPO+HCA01/01/2017

Nearly one in every three Americans has a Blue Cross and Blue Shield product.

ExperiencePreventive care is essential to maintaining a healthier life, and no one understands this better than Blue Cross and Blue Shield of Illinois (BCBSIL). For more than 75 years, BCBSIL has provided quality health care benefits and services to its members and communities. BCBSIL provides members with programs and support to create customized wellness action plans, make smarter health care choices and help manage their health care.

Become Educated BCBSIL offers access to convenient online tools and resources to help you plan and manage your health care. BCBSIL health care plans include flexible options with the right combination of benefits, choice of providers and access to a wide variety of educational resources. Whether you are trying to improve your health or reach the next level of wellness, BCBSIL is here to help.

Take time to explore what Blue Cross and Blue Shield of Illinois has to offer. The coverage options, tools and resources can help you on your journey to wellness.

In this GuideThe following pages include a description of the medical plan and other features and services available to you. In some cases, your employer may be offering you more than one medical plan to choose from. Think carefully about how you and your family will use these benefits. Before you make a decision, consider the services that are covered, provider network, potential out-of-pocket costs and other options.

If you have questions, your employer can provide additional information or direct you to other resources for assistance.

The Choicefor Nearly 1 in 3 Americans

Blue Cross and Blue Shield of Illinois is a leader in health care benefits.

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The PPO plan offers a wide range of benefits and the flexibility to choose any doctor or hospital when you need care. The plan includes an annual deductible that you must satisfy before your benefits begin. Qualified medical expenses are applied toward your deductible.

PPO NetworkAccess to the large network of contracting providers is one of the many reasons to select the PPO plan. The network includes hospitals, physicians, therapists, behavioral health professionals and alternative care practitioners.

You and your covered dependents can receive care from any licensed doctor, hospital or other provider. However, when you use a contracting network provider, you will pay less out of pocket, you won’t have to file any claims and you will receive the highest level of benefits. If you use a doctor outside

the network, you’ll still be covered, but your out-of-pocket costs may be significantly higher.

To find a contracting doctor or hospital, just go to bcbsil.com/ajg and use Provider Finder® , or call the toll-free Customer Service number on the back of your ID card: 800-203-3765.

Georgia residents: Be sure to select your home state when using Provider Finder.

The PPO Plan

*Coverage levels vary by health plan, so refer to your plan documents for details.

Medical CareYour benefits may include coverage for*:

• physician office visits

• breast cancer screenings

• cervical cancer screenings

• inpatient hospital services

• muscle manipulation services

• outpatient hospital services

• physical, speech and occupational therapies

• outpatient surgery and diagnostic tests

• infertility treatment

• maternity care

• behavioral health and substance abuse

• hospital emergency medical and accident treatment

With the PPO plan, you can choose any doctor whenever you need care.

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Why Choose PPO + HSA 1 & 2?PPO + HSA is a consumer-directed health care plan (CDHP) that helps you achieve your health and financial goals. It combines a qualified high-deductible health plan with a health savings account (HSA) where you decide to either pay for qualified medical expenses with tax-free dollars or leave the funds untouched to work as a savings vehicle.

Deposits to the account can be made by you, your employer or anyone else. With it you have:

• Affordability – Use health savings account funds to help meet your annual deductible, or leave them untouched to grow as savings.

• Tax Savings – Health savings account funds that are used for qualified medical expenses are tax-exempt.

• Portability – Your health savings account belongs to you, unused funds can rollover at the end of the year, or you can take the money with you if you change health plans or your job, or if you retire.

• Control – You decide how, when and where your health care dollars are spent. The savvier a consumer you are, the more you extend how far your health savings account will take you.

• Freedom and Choice – Choose any doctor whenever you need care, but choosing a network doctor means getting care at the highest level of benefits.

There’s more to this plan:

• Preventive care and wellness visits – Adults and children are covered at 100 percent when you use network providers*. You don’t need to meet the deductible to enjoy these benefits.

• Online decision tools – Personalize how you manage your health care and your health care spending. Log in to Blue Access for MembersSM (BAM), a safe, secure website at bcbsil.com to:

– Manage your benefits

– Search for a network provider

– Estimate the cost of a procedure or treatment

– Find health and wellness information and resources

– Ask health care professionals for help with your concerns through 24/7 Nurseline

Network InformationUse Provider Finder® at bcbsil.com/ajg to see if your doctor is in the network or to search for another network provider. You may also call the toll-free Customer Service number on the back of your ID card: 800-203-3765.


PPO + HSA 1 & 2

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Under IRS regulations, anyone enrolling in this health plan should be aware that any adult can contribute to a health savings account (HSA) if he/she:

• Has coverage under an HSA-qualified high deductible health plan (HDHP)

• Has no other first-dollar medical coverage (other types of insurance such as specific injury insurance or accident, disability, dental care, vision care, or long term care insurance are permitted)

• Is not enrolled in Medicare

• Cannot be claimed as a dependent on someone else’s tax return

There are other regulations regarding contributions and distributions. If you are enrolling in a plan that includes ahealth savings account, you should first seek professional tax counsel to determine if your individual situation permits use of an HSA. If you have a flexible spending account (FSA), or a health care account (HCA), check with your employer to confirm that you are eligible for an HSA. Both the FSA and HCA are considered a limited purpose account that can only be used for certain expenses.

**The relationship between Blue Cross and Blue Shield of Illinois and HSA Bank is that of independent contractors. HSA Bank is a separate company that is solely responsible for administration of the health savings account associated with the PPO + HSA plan. Please note that the HSA is a separate account established by the member in accordance with an agreement with an independent third-party bank over whom Blue Cross and Blue Shield of Illinois has no relationship or contractual agreement.

Special Notice about HSAs

Health Savings Account AdministrationYour health savings account is administered by a separate custodian — not Blue Cross and Blue Shield of Illinois.

HSA Bank® administers the health savings account. BCBSIL will process the claim and determine your liability for the qualified medical expense, if any**. If you have a balance, the amount will be listed on your Explanation of Benefits statement and you may use the debit card or your own personal funds to pay any balance due to the provider**.

* The provider should first submit your claim for processing so that you receive benefits at the Blue Cross and Blue Shield of Illinois negotiated rate. You may then use the debit card or checks to pay any balance due to the provider.

† In these examples, in-network preventive care is covered at 100%. Not all groups cover preventive care. Ask your employer for details.

†† Funds must be available in your health savings account before you can use them to pay for medical services. Ask your employer when funds will be deposited to your account (each pay period, quarterly, annually, etc).

BlueEdge HSA ExampleHow It Works

Ben and AileenBen and Aileen and their two children have HSA family coverage through Aileen’s employer. The plan is paired with a health savings account that includes a debit card from HSA Bank*. At the beginning of the year, Ben and Aileen put $3,000 into their health savings account (the contribution cannot exceed the maximum determined annually by the IRS).

Year One Year Two– Aileen’s health savings account annual

contribution = $3,000

– Aileen’s annual family deductible = $3,000

Ben and Aileen had physicals and preventive care lab tests†. • $580 was paid by the preventive care benefit.

Both children had annual physicals and routine immunizations. • $320 was paid by the preventive care benefit.

Ben tore a ligament in his knee that required surgery. • Charges of $675 for the emergency room visit were

paid with the health savings account debit card, which counts toward the deductible††.

• Surgery charges were $6,000. Ben paid $2,325 with the debit card. With this, the $3,000 family deductible had been satisfied and health plan benefits began. Of the remaining $3,675, the health plan paid 80 percent ($2,940) and Ben paid his 20 percent coinsurance ($735).

Aileen saw a dermatologist and had several moles removed. • Charges were $1,200. The health plan paid 80

percent ($960), and Aileen paid her 20 percent coinsurance ($240).

All of the health savings account money was spent so there was no amount to roll over to next year.

– Ben and Aileen decide to contribute $3,000 once again to their health savings account at the beginning of the year.

Ben and Aileen had physicals and preventive care lab tests. • $525 was paid by the preventive care benefit.

Both children had annual physicals. • $275 was paid by the preventive care benefit.

Aileen saw her dermatologist for a follow-up visit. • She paid for the $175 visit with the HSA debit

card, which also counted toward the deductible.

Ben participated in a smoking cessation program. • The program cost $450 and he paid for it with the

debit card from the health savings account. This expense did not count toward the deductible.

At the end of year two, $2,375 remains in the health savings account and this rolls over to the next year.

* The provider should first submit your claim for processing so that you receive benefits at the Blue Cross and Blue Shield of Illinois negotiated rate. You may then use the debit card or checks to pay any balance due to the provider.

† In these examples, in-network preventive care is covered at 100%. Not all groups cover preventive care. Ask your employer for details.

†† Funds must be available in your health savings account before you can use them to pay for medical services. Ask your employer when funds will be deposited to your account (each pay period, quarterly, annually, etc).

Sam has HSA coverage through his employer. His plan is paired with a health savings account. HSA Bank issues Sam a debit card that can be used to pay for eligible health care expenses that aren’t covered by the health plan*.

Year One Year Two– Sam’s health savings account annual

contribution = $1,500 (Sam contributes $750 and his employer contributes $750. The combined contribution cannot exceed the maximum determined annually by the IRS.)

– Sam’s annual deductible = $1,500

Sam had a physical and preventive care lab tests†. • $225 was paid by the preventive care benefit.

He injured his back and saw a specialist in the network. • Charges totaled $315, which Sam paid with his

health savings account debit card††. This amount was also applied to the deductible.

He had six physical therapy visits for his back with a physical therapist who is part of the network. • Each therapy session cost $175, for a total of

$1,050. Sam paid with his debit card and the total was applied to his deductible.

Sam broke his leg. • Total charges were $3,000. Sam paid $135 from

his debit card, which satisfied the annual $1,500 deductible, leaving $2,865. Health plan benefits paid 80 percent ($2,292) and Sam paid his 20 percent coinsurance ($573).

Sam used all the funds in his health savings account.

– Sam and his employer each contributed $750 to his health savings account for a total of $1,500.

– The annual deductible is $1,500.

He had an annual physical and several preventive care lab tests. • $280 was paid by the preventive care benefit.

He had an eye exam and purchased a year’s supply ofcontact lenses. • Total charges were $320, which Sam paid with his

debit card. Charges for the routine eye exam do not count toward the deductible.

At the end of the year, Sam changed health plans. His health savings account is completely portable, so he kept the unspent funds to be used tax free for qualified medical expenses.

What is a health savings account?If you have a qualified high-deductible health plan (HDHP), you can

establish a tax-exempt health savings account with your own funds,

those from your employer or both. You can use these funds to pay

for qualified medical care services. Qualified expenses also count

toward your annual deductible. Balances roll over from year to year

and the account is portable, which means it stays with you if you

change benefit plans, jobs or if you retire.

How can I decide if BlueEdge HSA is right for me?Comparing covered benefits, network providers, the cost of coverage

and other out-of-pocket expenses are important when choosing a

health plan. For more information on HSAs, visit the U.S. Treasury’s

website at treasury.gov.

Who is eligible to open an HSA account?Only eligible individuals may open an HSA account. To qualify for

an HSA, you:

• Must be enrolled in an HSA-compatible HDHP as of the first day

of the month;

• May not have other health coverage that is not an HSA-compatible

HDHP, including Medicare coverage; certain exceptions apply;

• May not be claimed as a dependent on another person’s tax return.

How is the HSA account funded?IRS rules for contributions include, but are not limited to the following:

Any person (an employer, a family member or any other person) may

make contributions to an HSA on behalf of an eligible individual.

Is there a specific health plan design for HSAs?Yes. HSA law and IRS guidance have focused on four elements of the

HDHP plan design:

• The deductible

• The out-of-pocket maximum

• Preventive care

• The requirement that the overall benefit design provide

“significant benefits” at all times to those covered by the HDHP

Health reimbursement arrangements (HRAs) and health savings accounts (HSAs), including products under our BlueEdge product portfolio have tax and legal ramifications. Blue Cross and Blue Shield of Illinois does not provide legal or tax advice, and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on, for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You may seek advice based on your particular circumstances from an independent tax advisor regarding the tax consequences of specific health insurance plans or products.

Frequently Asked QuestionsAbout BlueEdge HSA

PPO + HCA PlansPPO + HCA combines a PPO plan with a health care account (HCA) to help cover the health care expenses you pay out of pocket, such as the deductible. Based on your plan, copayments and coinsurance may also be paid from the health care account (refer to your plan documents for specific coverage details).

This plan has four important components:

• Preventive care and wellness visits for adults and children are covered when you use network providers*. You don’t need to meet the deductible to enjoy these benefits.

• Health plan benefits begin after you meet the deductible. You have the freedom to choose any doctor whenever you need care, but choosing a contracting network doctor will get you the highest level of benefits.

• Health care account (HCA) funds from your employer are used to pay for your first covered health care expenses. Money spent from the HCA counts toward your annual deductible.

• Online decision tools can help increase your awareness and knowledge of health issues as well as help you manage your health care and your health care spending.

Network InformationUse the Provider Finder® at bcbsil.com/ajg to see if your doctor is in the network or to search for another network provider. You may also call Customer Service toll-free at 800-203-3765 for provider information.

Deductible

You have a deductible to meet each calendar year before your health plan benefits begin. This is also called your “self-pay corridor.” The deductible amount, which is based on your particular benefit plan, is shared between you and your employer’s health care account contribution. Use HCA funds to pay the first part of the deductible each year and then you are responsible for the remainder of the deductible to satisfy the balance. PPO-eligible benefits—such as physician office visits, outpatient surgery and diagnostic testing—are applied toward your deductible.


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* In this example, in-network preventive care is covered at 100%. Not all groups cover preventive care at this level. Ask your employer for details.

**This is an example and your plan design may differ. Check with your employer to determine if your funds roll over.

BlueEdge HCA ExampleHow It Works

Johnhas PPO + HCA individual coverage. His plan includes a $500 health care account funded by his employer, which covers the first dollars spent on his heath care. Many of John’s preventive care services will be covered at 100 percent – with nothing deducted from the health care account – when he receives care in-network.

Year One Year Two– John’s health care account from his

employer = $500

– John’s annual deductible = $1,000

John had a physical and preventive care lab tests.

• $200 was paid by the preventive care benefit (nothing deducted from the HCA)*.

He saw an asthma specialist and received several tests.

• Charges of $175 were paid from the health care account and applied toward the annual deductible.

John had appendectomy surgery.

• Total charges were $6,000. The $325 remaining in the health care account was applied to the charges and also toward the deductible. John paid $500, which satisfied the annual deductible, leaving a balance of $5,175. John’s health care plan paid 80 percent ($4,140) of the charges and he was responsible for 20 percent coinsurance ($1,035).

At year-end there is a zero balance in the health care account, so nothing rolls over**.

– John’s employer funds his health care account with $500. The annual deductible is $1,000.

John had his annual physical and several lab tests.

• $200 was paid by the preventive care benefit (not from the HCA).

He saw his asthma specialist.

• Charges of $250 were paid by the health care account and applied to the deductible.

John had no other medical expenses during the year.

At year-end, the $250 balance in the health care account rolls over and is added to his employer’s $500 contribution. John begins year three with $750 in his health care account.

* In this example, in-network preventive care is covered at 100%. Not all groups cover preventive care at this level. Ask your employer for details.

Jennifer and Billhave PPO + HCA family coverage through Bill’s employer. Their son, Daniel, is born during the first year of coverage. The employer funds Bill’s health care account with $1,000 at the beginning of the year. Any covered family member can use these funds for eligible health care services. Well child care and certain adult care services are covered in full when care is received by network providers.

Year One Year Two– Bill’s health care account from his

employer = $1,000

– Bill’s annual family deductible = $2,000 (limit per individual = $1,000)

Jennifer and Bill had physicals and preventive care lab tests.

• $790 was paid by the preventive care benefit (nothing was deducted from the HCA)*.

Jennifer had several prenatal office visits.

• $320 was paid from the HCA and applied to the deductible.

She gave birth during the summer.

• Maternity charges totaled $9,600. The remaining $680 was deducted from the HCA and applied to the deductible (Jennifer’s $1,000 deductible was met). From the remaining balance of $8,920, 80 percent ($7,136) was paid by the health care plan and 20 percent coinsurance ($1,784) was paid by Bill and Jennifer.

Bill visited a dermatologist.

• He paid the $200 charges, which were also applied to the deductible.

Daniel had a well baby check up and immunizations.

• $750 was paid by the preventive care benefit.

He was also treated for an ear infection.

• Bill and Jennifer paid $280, which was applied to the deductible.

At the end of year one, there was a zero balance in the HCA, so there was no amount to roll over to next year.

– Bill’s employer again funds the family health care account with $1,000.

– The annual deductible is $2,000

Bill and Jennifer had physicals and preventive care lab tests and Jennifer had a mammogram. Daniel received well baby care and immunizations.

• Total charges of $1,380 were covered by the preventive care benefit with nothing deducted from the HCA and no cost to the family,

Bill saw his dermatologist for a follow-up visit.

• $210 for the office visit was deducted from the HCA and applied to the deductible.

Daniel saw his pediatrician for a cold and ear infection.

• Charges of $400 were paid from the HCA and applied to the deductible.

At the end of year two, the HCA balance is $390. This amount rolls over and is added to Bill’s employer’s annual contribution. The family’s health care account at the beginning of year three is $1,390.

What is a health care account?A health care account is a fund established for you by your employer to help you meet the plan’s annual deductible. You can use the HCA funds to pay for your first health care expenses and to help you meet the deductible. You are responsible for paying the remaining deductible balance.

What happens to the health care account balance if I leave the plan?If you change medical plans or jobs, or if you retire, any unspent balance returns to your employer, unless you elect to continue coverage under COBRA.

Does the health care account fund balance carry over if I don’t spend the money during the year?In most cases, any unspent funds will roll over to the next year and be added to your employer’s contribution. Check your plan documents for details.

How are claims paid from the health care account? When you use a contracting network provider, your claims will be filed automatically with Blue Cross and Blue Shield of Illinois. Any amount deducted from your HCA will be shown on your explanation of benefits along with the remaining balance.

Health reimbursement arrangements (HRAs) and health savings accounts (HSAs), including products under our BlueEdge product portfolio, have tax and legal ramifications. Blue Cross and Blue Shield of Illinois does not provide legal or tax advice, and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on, for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You may seek advice based on your particular circumstances from an independent tax advisor regarding the tax consequences of specific health insurance plans or products.

Frequently Asked QuestionsAbout PPO + HCA

Preventive CareYour coverage may include preventive care benefits for children and adults, including physical exams, diagnostic tests and immunizations. Check your group plan for the specific coverage.

Emergency CareIf you, as a prudent layperson (with an average knowledge of health and medicine) need to go to the emergency room of any hospital, your care will be covered subject to your plan’s deductible and any applicable copayments or coinsurance. In an emergency, you should seek care from an emergency room or other similar facility. Call 911 or other community emergency resources to obtain assistance in life-threatening situations. Your group plan may require that you, a family member or friend contact BCBSIL if you are admitted to the hospital. Non-emergency use of the ER is not covered.

You have nationwide access to contracting providers in networks linked through the BlueCard® program when you or your covered dependents live, work or travel anywhere in the country. The national network includes more than 85 percent of all physicians and hospitals in the country. Be sure to use a BlueCard network provider to receive the highest level of benefits.

With the BlueCard program, there are two ways to locate contracting doctors and hospitals:

•Visit the Web site at www.bcbsil.com/ajg to find provider names andlocations using the Provider Finder. Maps and driving directions are alsoavailable. Georgia residents please use the Georgia Residents link under'Find a Doctor.'

• Call the toll-free customer service number on the back of your IDcard.

Other Benefits for non-HMO plans

Your health care benefit plan travels with you wherever you go –

across the country or around the world.

National Coverage

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Reconstructive Surgery Following MastectomyFederal and State of Illinois legislation require group health plans and health insurers to provide coverage for reconstructive surgery following a mastectomy. Specifically, these laws state that health plans that cover mastectomies must also provide coverage in a manner determined in consultation with the attending physician and patient for reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of

physical complications for all stages of mastectomy, including lymphedemas.

Your coverage may also include benefits for baseline and annual mammograms. Check your group plan documents for details.

Illinois Dependent Eligibility Mandate Under new, Federal law, your dependents are eligible for health and/or dental coverage up to the dependent limiting age and may not be denied coverage due to marital, student or employment status before age 26. Check with your employer for additional details regarding eligibility requirements. In addition, eligible military personnel may not be denied coverage before age 30 under Illinois law. If you elect BlueChoice Select coverage, your dependents must live within the defined service area.

This Illinois law applies to all individual plans and insured group medical and/or dental plans, as well as self-insured municipalities, counties and schools. The law does not apply to self-funded national account groups or local non-municipal self-funded groups. If you have questions about this law, contact your benefits administrator.

When you travel outside the United States and need medical assistance services, call 800-810-BLUE (800-810-2583) or call collect to 804-673-1177 for information. Blue Cross and Blue Shield has contracts with doctors and hospitals in more than 200 countries. An assistance coordinator, in conjunction with a medical professional, can arrange your doctor’s appointment or hospitalization, if necessary.

Providers that participate in the BlueCard Worldwide® program, in most cases, will not require you to pay up front for inpatient care. You are responsible for the out-of-pocket expenses such as a deductible, copayment, coinsurance and non-covered services. The doctor or hospital should submit your claim.

You also have coverage at non-contracting hospitals, but you will have to pay the doctor or hospital for care at the time of service, then submit an international claim form with original bills. Call the toll-free customer service number on your ID card for the address to send the claim. You can get a claim form from your employer, customer service or online at www.bcbsil.com/ajg.

International Coverage

Doctor, Retail Clinic, Urgent Care or ER?

Quick reference guide for PPO network treatment resources Sometimes it’s easy to know when you should go to an emergency room (ER), such as when you have severe chest pain or unstoppable bleeding. At other times, it’s less clear. Where do you go when you have an ear infection, or are generally not feeling well? The emergency room is always an option, but it can be an expensive one. You have choices for receiving in-network care that work with your schedule and give you access to the kind of care you need. Know when to use each for non-emergency treatment. Non-emergency use of the ER is not covered.

Visit bcbsil.com/ajg for more information or to find a provider.

If you need emergency care, call 911 or seek help from any doctor or hospital immediately.

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Care Option Hours Your Relative Cost * Description

Doctor’s Office Office hours vary Usually lower out-of-pocket cost to you than urgent care

Your doctor’s office is generally the best place to go for non-emergency care such as health exams, colds, flu, sore throats and minor injuries.

Retail Health Clinic

Similar to retail store hours

Usually lower out-of-pocket cost to you than urgent care

Walk-in clinics are often located in stores and pharmacies to provide convenient, low-cost treatment for minor medical problems like: ear infections, athlete’s foot, bronchitis and some vaccinations.

Urgent Care Provider

Generally include evenings, weekends and holidays

Usually lower cost than an ER visit

Urgent care centers can provide care when your doctor is not available and you don’t have a true emergency, but need immediate care. For example, they can treat sprained ankles, fevers, and minor cuts and injuries.

Emergency Room (ER)

24 hours, seven days a week

Highest out-of-pocket cost to you

For medical emergencies, call 911 or your local emergency services first.

* The relative costs described here are for network providers. Your costs for out-of-network providers may be significantly higher.

Prescription Drug Card ProgramYour benefits include prescription drug coverage through BCBSIL. You have access to a national network of contracting pharmacies, which includes most national chain as well as independent pharmacies across the country. When you visit a contracting pharmacy and show your BCBSIL card, the claim is processed immediately at the time of purchase based on your medical plan deductible, coinsurance and out-of-pocket limitations. You are only responsible for your share of the discounted price of the medication.

Mail ServiceYou can receive up to a 90-day supply of maintenance medication delivered directly to you. Mail service claims are processed based on your medical plan deductible, coinsurance and out-of-pocket limitations, and you are only responsible for your share of the discounted price of the medication. You can print registration and order forms, request prescription refills and see the status of orders you’ve placed, as well as learn more about generic drugs and more when you visit bcbsil.com/ajg and log in to Blue Access for MembersSM.

Prescription Drugs

The prescription drug mail service can help you save money on your maintenance medications.

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Your prescription drug coverage through Blue Cross and Blue Shield of Illinois (BCBSIL) offers many options, resources and advantages:o Cost savings: Using generic drugs, when right for you, can help you save money. If you are taking or are prescribed

a brand drug, visit bcbsil.com/ajg to find out if generic options are available.

o Convenience: A broad pharmacy network allows you to choose a contracting retail pharmacy close to you.

o Time savings: Through mail service, you can have long-term (maintenance) medications delivered directly to you.

o Safety programs: BCBSIL has programs that help identify potential safety concerns.

Prescription Drug Information ...Whenever You Want ItOnline Tools

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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To get started, just follow these steps:

1 Go to bcbsil.com/ajg.

2 Log in to Blue Accessfor MembersSM.

3 Click Prescription Drugs inthe Quick Links box on the right. This will take you to MyPrime.com, the member site of BCBSIL’s pharmacy benefit manager. From there, you can...

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1 Find MedicineSee if your medicines are covered, get pricing and learn about ways to save, including available generic options. You also can check for drug interactions or find information about potential side effects.

2 Prescription History View your detailed prescription history and out-of-pocket costs. See claims as far back as the previous calendar year.

3 Find Pharmacies Use the pharmacy locator tool to find a contracting pharmacy near you. You can search by ZIP code, pharmacy name, city and state, or find 24-hour pharmacies.

4 More Resources: Get tips on usingMyPrime.com and MyPrimeMail.com, get forms and other helpful information.

Go to bcbsil.com/ajg o Log in to Blue Access for Members o Click Prescription Drugs in the Quick Links

box.

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Prime Therapeutics LLC is an independent pharmacy benefit management company. PrimeMail is a home delivery pharmacy service operated by Prime Therapeutics. Blue Cross and Blue Shield of Illinois (BCBSIL) contracts with Prime Therapeutics to provide pharmacy benefit management and home delivery pharmacy services. In addition, contracting pharmacies are contracted through Prime Therapeutics. The relationship between BCBSIL and contracting pharmacies is that of independent contractors. BCBSIL, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

PrimeMail is a registered trademark of Prime Therapeutics LLC. MyPrime.com and MyPrimeMail.com are online resources offered by Prime Therapeutics.

Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

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

When you use PrimeMail®, a convenient home delivery option, you can have your long-term prescriptions delivered right to you. Visit myprimemail.com to print an order form, refill a prescription and check the status of an order.

MyPrime.com is also Mobile Friendly!

MyPrime.comAt MyPrime.com you will find a variety of tools that can help you learn more about your medicines, estimate prescription drug costs and help you better communicate with your doctor about your prescription drug options.

Use MyPrime.com to:

o Find out if a drug is on your plan’s drug list, also known as a formulary.

o See a list of generic options for a brand drug and learn more about generic drugs.Using generic drugs can often save you money.

o Calculate your estimated cost for a 30-day or 90-day supply of a covered drug.

Q&A Prescription Drug ListWhat is a prescription drug list (formulary)?The Blue Cross and Blue Shield of Illinois (BCBSIL)drug list (also known as a formulary), which your prescription drug benefit plan is based on, is a regularly updated list of preferred drugs selected based on the recommendations of a committee comprised of individuals from throughout the country who hold a medical or pharmacy degree. U.S. Food and Drug Administration (FDA)-approved drugs are chosen based their safety, cost and how well they work.The drug list includes all generic drugs and a select group of brand drugs.

Why should I use the drug list?Your copayment/coinsurance amount for covered preferred brand drugs is usually lower than for non-preferred brand drugs. You have benefits for most covered medicines that are not on the drug list, but you may pay more out of pocket. The drug list is a reference for your doctor when prescribing medicines. But it is solely up to you and your doctor to decide the medicine that is best for you.

What are the advantages of using generic drugs?Generics are recognized as safe and effective medicines. Generics often cost less than a brand medicine. A generic can usually be substituted for a brand drug if it has the same active ingredients, the same strength and dosage form and produces the same results. Talk to your doctor or pharmacist to find out if a generic drug is available and right for you.

How do I know if a drug is on the drug list and what my cost will be?Bcbsil.com/ajg lists some commonly prescribed generic and preferred brand medicines. If a drug you are looking for is not on the list, call the number on the back of your ID card. Your prescription drug benefit plan and whether the drug is on the drug list will determine the amount you may pay out of pocket. To find out what you will pay, visit bcbsil.com/ajg or call the number on the back of your ID card.

What are dispensing limits?Based on FDA-approved dosage regimens and manufacturer’s research, certain drugs have dispensing limits. This means that these drugs have a limit on how much medicine can be filled per prescription or in a given time span. For example, coverage for the osteoporosis drug Actonel® (risedronate) is limited to 30 tablets per 30 days because the FDA-approved labeling states that the recommended dose is one 5 mg oral tablet taken daily.

What if I have questions? Call the number on the back of your ID card, 24 hours a day/7 days a week, or visit bcbsil.com/ajg.

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Save when you use Generic DrugsTalk to Your Doctor and PharmacistYour doctor uses clinical knowledge and judgment to prescribe drugs that meet your needs. The next time your doctor writesyou a prescription, consider asking if a generic is available and right for you. When purchasing a prescription, you can tell thepharmacist that you would like the generic equivalent, if available, unless your doctor indicates otherwise.

Frequently Asked QuestionsAre generic drugs as safe as brand drugs? Generic drugs are reviewed and approved by the U.S. Food and DrugAdministration (FDA), just as brand drugs are. According to the FDA, compared to a brand drug, a generic equivalent:

• is chemically the same

• works the same in the body

• meets the same standards set by the FDA

• is as safe and effective.

Why do generic drugs cost less? Generic drugs tend to cost less than the equivalent brand drug because the companies thatmake them do not have to recover the costs of research and development. On average, generic drugs cost 30 to 80 percent lessthan their brand counterparts.* Please keep in mind, however, that your out-of-pocket expense will be determined by yourparticular benefit plan.

Is there a generic drug available for my condition? Most likely. Sixty-three percent of all prescriptions dispensed in the UnitedStates are filled with generic drugs.**

A Good ChoiceYour doctor will determine the appropriate medication for you. Consider asking if a generic equivalent is available for yourprescription. Remember, you get a drug with the same active ingredients at the same dosage as the brand drug – usually at alower cost.

Below are some of the most commonly prescribed brand drugs and their generic equivalents. Ask your physician to approvethe generic equivalent whenever possible by writing the generic name on the prescription.

*The National Association of Chain Drug Stores**IMS Health

Brand Name Generic NameAltace ramiprilAmaryl glimepirideAmbien zolpidemAtivan lorazepam Calan SR verapamil SR Cardizem diltiazem ERCelexa citalopramCoumadin warfarinDiabeta glyburideDilantin phenytoinEffexor venlafaxineFlonase fluticasoneFosamax alendronateGlucophage metformin Glucotrol glipizideHytrin terazosinImitrex sumatriptanLasix furosemideLopid gemfibrozil

Brand Name Generic NameMevacor lovastatinMicronase glyburideNorvasc amlodipinePaxil paroxetinePepcid famotidinePravachol pravastatinPrilosec omeprazolePrinivil lisinoprilProcardia nifedipineProcardia XL nifedipine XL Proventil albuterolProzac fluoxetineRetin-A tretinoinRisperdal risperidoneSonata zaleplon Synthroid levothyroxineTimoptic timolol

Brand Name Generic NameToprol XL metoprolol

ext-releaseTylenol acetaminophen

with codeine w/codeineUltram tramadolVasotec enalaprilVentolin albuterolWellbutrin bupropionWellbutrin XL bupropion

ext-release Xanax alprazolamYasmin drospirenone/ethinyl

estradiol; branded generic called Ocella

Zantac ranitidineZestril lisinoprilZocor simvastatinZoloft sertralineZovirax acyclovir

As always, you should discuss with your physician questions or concerns about any drugs you are taking. Your doctor candetermine whether a generic drug is appropriate for you.

Common Brand Drugs and Their Generic Equivalents

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Specialty drugs are often prescribed to treat chronic, complex health problems, such as multiple sclerosis, hepatitis C and rheumatoid arthritis. These drugs are typically received by injection, but may be topical or taken by mouth.

Specialty drugs frequently call for careful adherence to a treatment plan and have special handling or storage needs and may not be stocked by retail pharmacies.

Some specialty drugs must be given by a health care professional, while others are approved by the U.S. Food and Drug Administration (FDA) for self-administration. Medications that call for administration by a professional are often covered under your medical benefi t. Your doctor will order these medications. Coverage for self-administered specialty drugs is usually provided through your pharmacy benefi t. Your doctor should write or call in a prescription for self-administered specialty drugs to be fi lled by a specialty pharmacy.

Your plan requires that you get specialty drugs through Prime Specialty Pharmacy to receive the highest level of benefi ts. If you choose to use a pharmacy outside Prime Specialty Pharmacy, your benefi ts may be reduced or your medication may not be covered.

Examples of Self-administered Specialty MedicationsThe chart below shows some conditions self-administered specialty drugs may be used to treat, along with sample medications. This list is not all-inclusive and may change from time to time. Visit bcbsil.com/ajg to see the up-to-date list of specialty drugs.

Specialty Medications

Blue Cross and Blue Shield of Illinois (BCBSIL) has arranged for Prime Therapeutics Specialty Pharmacy* to support members who need specialty medication and help them manage their therapy.

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Condition Sample Drugs**

Osteoporosis Forteo

Cancer (oral) Gleevec, Nexavar, Sprycel,Sutent, Tykerb

Growth Hormones Genotropin, Humatrope,Norditropin, Omnitrope,Tev-Tropin

Hepatitis C Copegus, Infergen, Intron-A,Pegasys, Peg-Intron

Multiple Sclerosis Avonex, Betaseron,Copaxone, Rebif

Rheumatoid Arthritis/Psoriasis

Enbrel, Humira, Kineret

Support in Managing Your Condition: Prime Specialty PharmacyThrough Prime Specialty Pharmacy, you can have your covered, self-administered specialty drugs delivered straight to you, or to your doctor’s office. When you get your specialty drugs through Prime Specialty Pharmacy, you get support in managing your therapy – at no additional charge – including:

o Convenient delivery of drugs to you or your doctor’s office

o Information about your particular condition and aboutmanaging potential medication side effects

o Syringes, sharps containers and other supplies with each

shipment for self-injectable drugs

o 24/7/365 customer service phone access

Ordering Through Prime Specialty PharmacyTo start using Prime Specialty Pharmacy, call 877-627-MEDS (6337). If you currently use a self-administered specialty drug, you can have your existing prescription transferred to Prime Specialty Pharmacy.

If you have a new prescription, Prime Specialty Pharmacy can give you more information about submitting the prescription or having your doctor do so. Your doctor may also order office-administered specialty drugs through Prime Specialty Pharmacy.

Certain coverage exclusions and limitations may apply, based on your health plan. Check your benefit materials for details, or call the number on the back of your ID card with questions.

Call Prime Specialty Pharmacy at 877-627-MEDS (6337) to order. Have your ID card and the following information ready:o Name, address, phone number

o Name of medication

o For existing prescriptions, your current pharmacy’s nameand phone number, and the prescription number

o Doctor’s name, phone and fax numbers

Receiving Specialty MedicationsSince many specialty drugs have unique shipping or handling needs, shipments will be arranged with you through Prime Specialty Pharmacy. Medications are shipped in plain, secure, tamper-resistant packaging.

Before your scheduled refill date, you may be contacted to:

o Confirm your drugs, dose and the delivery location

o Check any prescription changes your doctor may haveordered

o Discuss any side effects you may be having

If you need support, you can reach Prime Specialty Pharmacy at 877-627-MEDS (6337).

*Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) isa wholly owned subsidiary of Prime Therapeutics LLC, a pharmacy benefit management company. Blue Cross and Blue Shield of Illinois contracts with Prime Therapeutics to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. Blue Cross and Blue Shield of Illinois, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

**Third-party brand names are the property of their respective owners.

BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

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PrimeMail, the mail-service pharmacy trusted by your health plan, delivers your long-term (or maintenance) medicines right where you want them. No driving to the pharmacy. No waiting in line for your prescriptions to be filled.

Extended Supply NetworkThe Prime Therapeutics extended supply network (ESN) of retail pharmacies lets members fill a 90-day supply of long-term, or maintenance, medicine at a retail pharmacy. Long-term medicines are taken for chronic conditions such as diabetes and high blood pressure.

Keep in mind that some medications have dispensing limits and may not be covered for a 90-day supply at one time. When filling a prescription through the ESN, it will follow the mail order benefit level for a 90-day supply.

Savings • PrimeMail delivers up to a 90-day supply of

long-term medicines. This can reduce what you pay out-of-pocket, and includes free standard shipping.

Convenience • Prescriptions are delivered to the address of

your choice, within the U.S.

• You can order from the comfort of your home – either online, over the phone or through the mail. Or, you can have your doctor fax or e-prescribe your order.

• You can receive up to a 90-day supply of long-term medicine at a time.

• You can ask for refills online or over the phone.

• Plain-labeled packaging protects your privacy.

Service • You can receive notification by email or phone –

your choice – when your prescription is received and when your orders are sent.

• Member service agents are available 24/7.

• Licensed, U.S.-based pharmacists are available seven days a week.

• Choose to receive refill reminder notifications by phone or email.

• Standard delivery is included at no additional cost.

• PrimeMail pharmacies are located in the U.S.

PrimeMail® Delivers

PrimeMail is a mail-order pharmacy service operated by Prime Therapeutics LLC, a pharmacy benefit management company. Blue Cross and Blue Shield of Illinois (BCBSIL) contracts with Prime Therapeutics to provide pharmacy benefit management and mail-order pharmacy services. BCBSIL, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

PrimeMail is a registered trademark of Prime Therapeutics LLC.

Existing PrescriptionsYou can request that PrimeMail contact your doctor to transition your prescription.

• Visit bcbsil.com/ajg and log into Blue Access for MembersSM (BAM). Click on My Coverage tab, Prescription Drugs on the left and then Prime Therapeutics in the center.

• Click Go to MyPrimeMail.com. Select Transition Prescriptions from Retail to PrimeMail and fill out the online form. Or, call PrimeMail at 877-357-7463.

• Medicines take about 8 days to deliver after PrimeMail receives approval from your doctor.

New PrescriptionsMail your prescription or have your doctor fax or e-prescribe.

• Ask your doctor for a prescription for a 90-day supply of each of your long-term medicines. Or, ask your doctor to fax or e-prescribe your order to PrimeMail. If you need to start your medicine right away, request a prescription for a one-month supply to fill at a local retail pharmacy.

• To print a PrimeMail New Prescription Order Form, go to bcbsil.com/member/rx_drug_choices.html. From there, select your plan coverage and scroll down to the Mail Service Program section. Or, call PrimeMail at 877-357-7463.

• Mail your prescription, completed order form and payment to PrimeMail.

• Medicines take about 8 days to deliver after PrimeMail receives and verifies your order.

Refills Are Easy Refill dates are shown on each prescription label. You can choose to have PrimeMail remind you by phone or email when a refill is due. Choose the reminder option that best suits you.

Online Visit bcbsil.com/ajg to refill a prescription or renew an expired prescription. Log into BAM and click on My Coverage tab, Prescription Drugs on the left and then Prime Therapeutics in the center. Then click Go to MyPrimeMail.com. Select Refill to choose the medicine you would like to refill.

Over the Phone Call the PrimeMail automated refill system at 877-357-7463.

Through the Mail Complete and mail the Refill Prescription Order Form sent with your order. Remember to allow time for your refill order to be received and processed.

Questions? To learn more, visit bcbsil.com/ajg.

Getting Started with PrimeMail

Treatment decisions are always between you and your doctor.

Blue Cross and Blue Shield of Illinois is working to find ways to manage the rising cost of prescription drugs. Your benefit plan uses tools, such as prior authorization, that can help control costs for everyone.

What is prior authorization?The prior authorization program encourages safe and cost-effective medication use. The program applies to certain high-cost drugs that have the potential for misuse. Before medications included in the prior authorization program can be covered under your benefit plan, your doctor will need to get approval through Blue Cross and Blue Shield of Illinois.

If you are already taking or are prescribed a drug that is part of the prior authorization program, your doctor can submit a prior authorization request form so your prescription can be considered for coverage. Your doctor can find prior authorization forms on the provider website at bcbsil.com/ajg. Doctors may also call 800-285-9426 with questions, or to get a form.

How does the program work?If the prior authorization request is approved:You will pay the appropriate amount based on your prescription drug benefit when you fill your prescription.

If the prior authorization request is not approved:The medication will not be covered under your prescription drug benefit. You can still purchase the medication, but you will be responsible for the full cost. Or, you can talk to your doctor to find out if another drug might be right for you. Remember, treatment decisions are always between you and your doctor. As always, the appeal rights provided by your benefit plan are available to you.

Why are only certain drugs included in the program?The program’s goal is to promote safe, cost-effective medication use. Therefore, the prior authorization program includes drugs that are not only high-cost but sometimes are misused. Growth hormone is one example. These drug products are meant to treat growth hormone deficiency and other medical conditions. However, growth hormone is sometimes misused by body builders to increase muscle mass and by other people for anti-aging effects.

Prior Authorization Program

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The prior authorization program encourages safe and cost-effective medication use.

Drug Categories Which May Be Included in the Prior Authorization Program*

Androgens/Anabolic Steroids

Antibiotics (e.g., doxycycline/minocycline)

Antifungal Agents

Erectile Dysfunction

Fentanyl (oral/nasal)

Narcolepsy

Opioid Dependence


Tools such as prior authorization encourage safe and cost-effective medication use, and help manage the rising cost of prescription drugs – for everyone.

* Categories may be added or removed and the program may change from time to time.

What should I do if I take a drug that is part of the program?If you are already taking a medication that is included in the prior authorization program after the program becomes part of your prescription drug benefit: your doctor will need to submit a prior authorization request for your prescription before you can continue to receive coverage for the drug.

If your doctor writes you a new prescription for a medication included in the program: your doctor will need to submit a prior authorization request before the drug can be covered under your benefit plan.

What medications are included in the prior authorization program?The box above right shows examples of drug categories which may be included in the prior authorization program. To see a sample list of drugs in these categories, go to bcbsil.com/member/rx_drug_choices.html. From there, select your plan coverage and scroll down to the Prior Authorization/Step Therapy Program section. Your doctor can also find more information on the provider website at bcbsil.com/ajg. If you have questions about the prior authorization program, or to find out if a particular drug is included in the program, call the number on the back of your ID card.

Work with your doctor to determine which medication options are best for you.

Blue Cross and Blue Shield of Illinois is working to find ways to manage the rising cost of prescription drugs. Your benefit plan uses tools, such as step therapy, that can help control costs for everyone.

What is step therapy?The step therapy program encourages safe and cost-effective medication use. Under this program, a “step” approach is required to receive coverage for certain high-cost medications. This means that to receive coverage you may need to first try a proven, cost-effective medication before using a more costly treatment, if needed. Remember, treatment decisions are always between you and your doctor.

Don’t more expensive drugs work better?Not necessarily. A higher cost does not automatically mean a drug is better. For example, a brand drug may have a less-expensive generic or brand alternative that might be an option for you. Generic and brand drugs must meet the same standards set by the U.S. Food and Drug Administration for safety and effectiveness. Work with your doctor to determine which medication options are best for you.

How does the program work?The step therapy program requires that you have a prescription history for a “first-line” medication before your benefit plan will cover a “second-line” drug.

• A first-line drug is recognized as safe and effective in treating a specific medical condition, as well as being cost-effective.

• A second-line drug is a less-preferred or sometimes more costly treatment option.

Step 1When possible, your doctor should prescribe a first-line medication appropriate for your condition.

Step 2If your doctor determines that a first-line drug is not appropriate for you or is not effective for you, your prescription drug benefit will cover a second-line drug when certain conditions are met.

Step Therapy Program

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The step therapy program encourages safe and cost-effective medication use.

Drug Categories Which May Be Included in the Step Therapy Program*

Cox-2/NSAID GI Protectant (pain management)

Depression

Diabetes (GLP-1 receptor agonists)

Glucose Test Strips

Lipid Management (cholesterol)

Proton Pump Inhibitors (gastroesophageal reflux disease)


Tools such as step therapy encourage safe and cost-effective medication use, and help manage the rising cost of prescription drugs – for everyone.

* Categories may be added or removed and the program may change from time to time.

What should I do if I take a drug that is part of the step therapy program?If you are already taking a medication that is part of the step therapy program: you may not be affected. Call the number on the back of your ID card to find out.

If you start taking a medication that is included in the step therapy program after the program becomes part of your prescription drug benefit: your doctor will need to write you a prescription for a first-line medication or submit a prior authorization request for the prescription before you can receive coverage for the drug. Your doctor can find prior authorization forms on the provider website at bcbsil.com/ajg. Doctors may also call 800-285-9426 with questions, or to get a form.

What medications are included in the step therapy program?The box above right shows examples of drug categories which may be included in the step therapy program. To see a sample list of drugs in these categories, go to bcbsil.com/member/rx_drug_choices.html. From there, select your plan coverage and scroll down to the Prior Authorization/Step Therapy Program section. Your doctor can also find more information on the provider website at bcbsil.com/ajg. If you have questions about the step therapy program, or to find out if a particular drug is included in the program, call the number on the back of your ID card.

You have a choice when choosing where to go for health care. Many times you can choose between more than one provider or facility and have the same procedure at a lower cost. Now you can speak to a BCBSIL Benefits Value Advisor2 who can help you get benefits information and find contracting, in-network providers for a number of health care services such as:

• CAT or CT scans

• MRIs

• Endoscopy procedures

• Colonoscopy procedures

• Back or spinal surgery

• Knee surgery

• Shoulder surgery

• Hip or joint replacement surgery

• Bariatric surgery

Benefits Value Advisors can also help you plan for your health care by:• Helping you better understand your benefits

• Giving you a cost estimate3 for health care services or procedures

• Scheduling a doctor or procedure appointment if you like

• Helping you get general health information about your condition

• Helping you with pre-certification

• Telling you about online educational tools

Benefits Value Advisors Help with Cost Comparison For example, if your doctor wants you to get an

MRI of your knee, you can call a Benefits Value

Advisor. The Advisor can tell you about several

in-network MRI providers and the estimated cost

for an MRI at each provider. This way, you will

have more information when choosing where to

go for your MRI. If you like, the Advisor can then

schedule the MRI for you with the provider you

choose, and help you with pre-certification.

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You must call a BVA prior to scheduling the following non-emergency services to receive full benefits: Outpatient CT Scan and Outpatient MRI. If you do not call a BVA before your procedure, your benefits will be reduced by $100. Call the toll-free Customer Service number on the back of your ID card to talk to a BVA.

Benefits Value AdvisorsSame Treatment. Lower Cost.1

1. Benefits Value Advisors offer cost estimates for various providers, facilities, and procedures. Lower pricing and cost savings are dependent on the provider or facility you choose.

2. Member communications and information from Benefits Value Advisors are not meant to replace the advice of health care professionals. Members are encouraged to seek the advice of their doctors to discuss their health care needs. Decisions regarding course and place of treatment remain with the member and his or her health care providers.

3. Cost estimates are just estimates. In addition to your usual deductibles, copayments and/or coinsurance, the actual cost of the services may vary based on a number of factors including the date of service, the actual procedure performed and what services were billed by the provider and your particular benefit plan. Coverage is subject to the limitations and exclusions of your plan.

Frequently Asked Questions

Q: Whom do I call with questions about my benef its?A: Call customer service at 800-203-3765

Q: How do I f ind a contracting network doctor or hospital? A: Go to www.bcbsil.com/ajg and use the Provider Finder® or call 800-203-3765

Q: What should I bring to my first appointment?A: Your first appointment is an opportunity to share information about your health with your new doctor, so bring as much

medical information as possible, including:

• Medical records and insurance card – If you are undergoing treatment when you change doctors, your medical recordsare especially important to your new doctor. Your BCBSIL member ID card provides information about copayments,billing and customer service phone numbers.

• Medications – Give your new doctor information on prescription and over-the-counter medications, including any herbalmedications you take. Be sure to include the name of the medication, the dosage, how often you take it and why.

• Special needs – Make a list of medical equipment and devices you use, including wheelchairs, oxygen, glucose monitorsand glucose strips. Be prepared to explain how you use them, not only to make sure you have the equipment you need,but also to avoid any disruption in your care.

Q: Are my medical records kept confidential?A: Yes. Blue Cross and Blue Shield of Illinois is committed to keeping specific member information confidential. Anyone

who may need to review your records is required to keep your information confidential. BCBSIL may need to review your medical record or claims data (for example, as part of an appeal that you request). If so, precautions are taken to keep your information confidential. In many cases, your identity will not be associated with this information.

• What is the doctor’s experience in treating patients with the same health problems I have?

• Where is the doctor’s office? Is there ample parking or is it close to public transportation?

• What are the regular office hours? Does the office have drop-in hours for urgent problems?

• How long should I expect to wait to see the doctor when I’m in the waiting room?

• Are routine lab tests and X-rays performed in the office, or will I have to go elsewhere?

• Which hospitals does the doctor use?

• If this is a group practice, will I always see my chosen doctor?

• How long does it usually take to get an appointment?

• How do I get in touch with the doctor after office hours?

• Can I get advice about routine medical problems over the phone or by e-mail?

• Does the office send reminders for routine preventive tests, like cholesterol checks?

Q: What questions should I ask when selecting a doctor?A: In addition to preliminary questions you’d ask a new doctor—such as “Are you accepting newpatients?”—the following questions will help you evaluate whether a doctor is right for you:

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Use BAM while you’re on the go. Register or log in by going to bcbsil.com/ajg from your mobile device Web browser for secure and convenient access.

It’s easy to get started

1. Go to bcbsil.com/ajg.

2. Click the Already a Member? tab. Then clickthe Register Now button in the BAM section.

3. Use the information on your BCBSIL ID cardto complete the registration process.

Log in to Blue Access for MembersSM (BAM)

Your Online Resource

Would you like to know when your medical claims are paid and the payment amounts? Do you need to confirm who in your family is included under your coverage? BAM, the secure member portal from Blue Cross and Blue Shield of Illinois (BCBSIL), can help. Get immediate online access to health and wellness information, and:

• Check the status of a claim and yourclaims history

• Confirm the family members who are coveredunder your plan

• View and print an Explanation of Benefits(EOB) statement for a claim

• Select an option to stop receiving EOBsby mail

• Set your preferences to receive notificationsfor claims status and wellness updatesthrough emails or text alerts.

• Locate a doctor or hospital in the network

• Request a new or replacement member IDcard or print a temporary member ID card

• Join My Blue Community®, a social networkfor BAM members

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Find what you need at Blue Access for MembersSM (BAM)

1 2 3 4 5

6 7

89 J

1. My Coverage: Reviewbenefit details for you and thefamily members covered underyour plan.

2. Claims Center: View and organize details such aspayments, dates of service,provider names, claims statusand more.

3. My Health: Make moreinformed health caredecisions by reading abouthealth and wellness topicsand researching specificconditions.

4. Doctors & Hospitals: UseProvider Finder® to locate anetwork doctor, hospital orother health care provider, andget driving directions.

5. Forms & Documents:Use the form finder to getclaim and other forms quicklyand easily.

6. Message Center: Learn aboutupdates to your benefit plan,and receive notification ofpending and finalized claimsvia secure messaging.

7. Quick Links: Go directlyto some of the most popularpages for information,such as medical coverage,replacement ID cards, managepreferences and more.

8. Settings: Set up notificationsand alerts to receive updatesvia text messaging andemail, review your memberinformation, and change yoursecure password at anytime.

9. Help: Look up definitions ofhealth insurance terms, getanswers to frequently askedquestions and find Health CareSchool articles and videos.

10. Contact Us: Submit aquestion and a CustomerService Advocate willrespond by phone or throughthe message center.

Blue Access Mobile brings convenient, secure access to your mobile phone.

Blue Access MobileSM

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From your mobile phone Web browser, you can:SM

coverage details, access or request identification (ID) cards, check claims status, manage

/ajg

There is no registration required to access the mobile site. However, BCBSIL members must enter their user name and password to log in to Blue Access for Members.

bcbsil.com/mobile

Provider Finder from Blue Cross and Blue Shield of Illinois (BCBSIL), is an innovative tool for helping you choose a provider, plus estimate and manage health care costs.

By logging in to Blue Access for MembersSM (BAM) you can use Provider Finder to:

• Find a network primary care physician, specialistor hospital.

• Filter search results by doctor, specialty, ZIP code,language and gender – even get directions fromGoogle MapsTM’.

• Make an appointment to consult with a provider in selectgeographic areas.

• Estimate the cost of hundreds of procedures, treatmentsand tests and help estimate your out-of-pocket expenses.

• Determine if a Blue Distinction® Center is an optionfor treatment.

• View patient feedback or add your review for a provider.

• View clinical quality ratings from Blue Cross and BlueShield as well as independent third parties.

• �Review�providers’�certifications� and recognitions.

It’s easy, immediate, secure – and available at bcbsil.com/ajg.

Provider Finder shares information that puts you in charge.

• Do you want to know more about the providers who take care of you or your family?• Do you need to know the estimated cost of a medical service and your estimated out-of-pocket share of the cost?• �Do�you�want�to��find�savings�by�comparing�costs?• How do you choose where to go for medical services?

A quick and easy way to make better health care decisions.

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Provider Finder for Georgia and all other states Choice. Costs. Access.

Provider Finder with Benefit Accumulator

Informed Choice. Cost Savings. More Options.

It’s easy to get started with Provider Finder by registering for BAM:

1. Go to bcbsil.com/ajg.

2. Click the Log In tab, and then click the RegisterNow link.

3. Use the information on your BCBSIL ID card tocomplete the process.

4. Then, log in to BAM. Provider Finder is locatedunder the Doctors & Hospitals tab.

Choose your provider and estimate the cost for hundreds of medical procedures.

Get assistance while you’re away from home.

Go to bcbsil.com/ajg and register or log in to BAM. You can stay connected to your claims activity, member ID card and coverage details – you can also receive prescription reminders and health tips via text messages.You can also call a BCBSIL Customer Service Advocate at the toll-free telephone number on the back of your member ID card for help in locating a provider.

Blue365 is just one more advantage of being a Blue Cross and Blue Shield of Illinois (BCBSIL) member.

With this program, you may save money on health and wellness products and services from top retailers

that are not covered by insurance. There are no claims to file and no referrals or pre-authorizations.

Once you sign up for Blue365 at blue365deals.com/BCBSIL, weekly “Featured Deals” will be emailed to you.

These deals offer special savings for a short period of time.

Below are some of the ongoing deals offered to Blue365 members.

Davis VisionSM | TruVision®

You may save on eyeglasses as well as contact lenses, exams and accessories. Davis Vision is made up of national and regional retail stores as well as local eye doctors. You may get possible savings on laser vision correction through the TLC/TruVision group.

TruHearing® | Beltone™

You may get possible savings on hearing tests, evaluations and hearing aids. Discounts may also be available for your immediate family members.

Procter & Gamble (P&G) Dental ProductsYou may get savings on dental packages with Oral B® power toothbrushes and Crest® products. Packages may include items such as an electric toothbrush, mouth rinse, teeth whiteners and floss.

Dental SolutionsSM You may get dental savings with Dental Solutions. You may receive a dental discount card that provides access to discounts of up to 50 percent at more than 61,000 dentists and more than 185,000 locations.*

Blue365®

Discounts to Make Health and Wellness More Affordable

21274.0415

See all the Blue365 deals and learn more at blue365deals.com/BCBSIL.

CORD:USE® | CorCell®

You can protect your family’s cord blood at a state-of-the-art laboratory using high-quality cord blood banking practices and technologies. Cord blood contains stem cells (like those in bone marrow) that have the ability to develop into additional cells and can be used to treat possible life-threatening diseases in the future. You may save on cord blood processing and storage fees.

Jenny Craig® | Seattle Sutton’s® | Nutrisystem®

You may reach your weight loss goals with savings from leading programs. You may save on healthy meals, membership fees (where applicable), nutritional products and services.

RetrofitSM

Receive 15 percent off Retrofit’s online, private weight loss coaching sessions. Retrofit includes the use of a wireless Fitbit® device and smart scale, one-on-one videoconferencing with a personal team of experts and unlimited online support. You will enjoy flexibility in scheduling and the ability to meet with coaches anywhere there is an Internet connection.

Reebok | SKECHERS®

Reebok, a trusted brand for more than 100 years, makes top athletic equipment for all people, from professional athletes to kids playing soccer. SKECHERS, an award-winning leader in the footwear industry, offers exclusive pricing on select Performance, Sport, Work and Corporate Casual styles. You will enjoy 20 percent off plus free shipping for your online orders.

Life Time Fitness®

Life Time Fitness offers total health fitness to fit your level, interests, schedule and budget. For new members, Life Time Fitness offers a $0 online signup fee.**

SeniorLink Care™

With SeniorLink Care, you may find support to help your aging family members or friends lead fulfilling and comfortable lives. From planning care to helping caregivers, SeniorLink Care assists older adults and their loved ones in finding the programs and services they may need most. You can save on a three- or 12-month membership.

Handstand KidsHandstand Kids brings the family together in the kitchen, spending more time cooking and eating healthy, delicious meals. The Handstand Kids Cookbook series features the languages and cuisines of Italy, Mexico, China and many other countries. Every book also introduces the language and culture of each country. You may save up to 25 percent on cooking accessories and Cookbook Kits.

The relationship between these vendors and Blue Cross and Blue Shield of Illinois (BCBSIL) is that of independent contractors. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by the above-mentioned vendors.

* Dental Solutions requires a $9.95 signup and $6 monthly fee.

** Proof of Blue Cross and Blue Shield of Illinois coverage is needed. The $0 enrollment fee offer is only for new Life Time Fitness members who enroll online at blue365deals.com/BCBSIL. A $35 administrative fee applies to all memberships. Monthly dues and taxes may also apply. Members’ prices, dues and fees may change at any time. Other rules may apply. Always check with the Life Time Fitness club in your area for the most up-to-date offer.

Blue365 is a discount program only for BCBSIL members. This is NOT insurance. Some of the services offered through this program may be covered under your health plan. Please check your benefit booklet or call the customer service number on the back of your ID card for specific benefit facts. Use of Blue365 does not change your monthly payment, nor do costs of the services or products count toward any maximums and/ or plan deductibles. Discounts are only given through vendors who take part in this program. BCBSIL does not guarantee or make any claims or recommendations about the program’s services or products. You may want to talk to your doctor before using these services and products. BCBSIL reserves the right to stop or change this program at any time without notice.

For more great deals or to learn more about Blue365, visit blue365deals.com/BCBSIL.

Sometimes managing your health requires more than doctor visits, lab tests and prescriptions. Blue Cross and Blue Shield of Illinois, a division of Health Care Service Corporation, offers the following resources through Blue Care Connection, a program to help you and your covered family members reach your health and wellness goals.

• Fitness Program – Take advantage of a discounted gym membership to a nationwidenetwork of fitness centers

• 24/7 Nurseline – Around the clock, toll-free accessto registered nurses for health information

• Utilization Management – You and your doctorcan obtain information about your benefitsand easily navigate the health care system tohelp you maximize your benefits for coveredservices

• CCEISM Care Coordination and EarlyIntervention – If you are in the hospital, a care management specialist may call to helpcoordinate special care you might need when you get home

• Condition Management – Blue Care® Advisors(registered nurses and other health careprofessionals) work with you and yourdoctor to provide education, coaching andmonitoring if you are at risk for or already havea chronic condition

• Health Education and Support – There are tutorials on more than 170 health topicsavailable online or by mobile device throughyour Blue Care Advisor. Many tutorials areavailable in Spanish as well

• Healthy Tips by Text – Receive securetext messages on such topics as diabetesprescription drug reminders, blood sugarreminders, coronary artery disease care management and diet tips, as well as exerciseand fitness tips

• Special Beginnings®’ – Maternity programoffering expectant mothers ongoing supportand education from prenatal to postpartumcare, including convenient online and mobile tools and educational materials

• Case Management – Case managers, registerednurses with specialized training and clinical experience, help you navigate complex medicalsituations and access the services you need

• Behavioral Health – Licensed behavioral healthprofessionals help you access services and offersupport with co-existing medical conditionsand disorders such as anxiety, depression, etc.

20491.0912 POD

Blue Care Connection®

Helping You Live a Healthier Life

* These resources can help you plan and manage your health, but they do not replace the care of a doctor. To get the most out of the Blue Care Connection program, discuss the health information you receive with your doctor.

Health concerns don’t always follow a 9-to-5 schedule. Fortunately, registered nurses are on call at (800) 299-0274 to answer your health questions, wherever you may be, 24 hours a day, seven days a week.

The 24/7 Nurseline’s registered nurses can understand your health concerns and give general health tips. Get trusted guidance on possible emergency care, urgent care, family care and more.

When should you call?The toll-free Nurseline can help you or a covered family member get answers to health problem questions, such as:

• Asthma, back pain or chronic health issues

• Dizziness or severe headaches

• High fever

• A baby’s nonstop crying

• Cuts or burns

• Sore throat

Plus, when you call, you can access an audio library of more than 1,000 health topics—from allergies to women’s health—with more than 600 topics available in Spanish.

24/7 Nurseline* – Around-the-Clock, Toll-Free Support

20750.0710

The 24/7 Nurseline can help you figure out if you should call your doctor, go to the ER or treat the problem yourself.

Get the information you need, just when you need it.

Note: For medical emergencies, call 911 or your local emergency services first. This program is not a substitute for a doctor’s care. Talk to your doctor about any health questions or concerns.

*The 24/7 Nurseline is not available to HMO members.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 90712.0914

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