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Part III: Using the Consumer Driven Health Plan (CDHP)

A. How to Find an In-Network Provider

Even though the BlueEdge CDHP Plan allows participants to use any provider, if you use network providers, claims expenses are applied to a much lower deductible. In addition, eligible preventive care benefits are covered at 100% with no deductible and no limit on an in-network basis. 

Steps to find a network provider:

  • Go to www.bcbsil.com;
  • Select "Find a Doctor" from the items at the bottom of the page;

Once you identify a doctor in the network, you should contact him or her to ensure he or she is taking new patients.

B. How to Use the Mail Order Pharmacy for Maintenance Medications

If you are on a maintenance medication, you can save a significant amount of money by using the mail-order pharmacy program.  See the mail order brochure for more information.

To Initialize or to Refill a Prescription:

Option I: Use the mail order application available on the BlueCross BlueShield (BCBS) website.

Option II: Use www.myprime.com/MyRx/MyPrime/#ViewHomeEvent/MyPrimeMail/. You can set up an account on the site using the Member ID number on your BCBS ID card.

  • Make your selection on the Prime Mail tab.
  • To order a new prescription, click on "Order a new prescription". 
  • To refill a prescription, click on "Refill a previous prescription". 

C. How to Submit Claims

All claims must be submitted by the provider or member to BlueCross BlueShield (BCBS) to apply to the deductible, coinsurance and out of pocket.  Show the provider your BCBC ID card, and in most cases, the provider will submit the claim directly to BCBS on your behalf.

If you receive your prescriptions from a retail pharmacy,be sure to show the pharmacist your BCBS ID card in order to receive the discounted drug price and ensure the claim will be properly applied to your deductible.

Note: Once you set up a Health Savings Account, you will receive a debit card in the mail for use with your account.

Note: Only qualified expenses on or after the date that the Health Savings Account is established are eligible for reimbursement on a tax-advantaged basis.

For Mail-order instructions, log into www.bcbsil.com and go to the "My Coverage" tab.  You will find a link to the prescription program and claim forms.

Important:

  • Keep copies of all receipts.  These will be needed in the event of an IRS audit to verify that HSA funds were used for qualified medical expenses and are therefore not taxable.
  • See Section VB for information regarding the type of expenses that can be paid with your Health Savings Account.

D. How to Make Mid-year Changes if Necessary

Changes can be made to your medical plan coverage if you experience a qualifying family status change (such as adding a spouse or new child) as defined in the Health Plan Summary Plan Description found on the DePaul University HR website.

Maximum Employee Contributions

  • The new maximum employee contribution allowed in the event of a plan coverage level change will be the annual contribution amount allowed based on the new level of coverage.  Employees who coverage level is decreasing should ensure they do not exceed the annual maximum allowed by the IRS.
  • Employee HSA contribution changes are entered on-line as described above in Part IID.

Employer Contribution Changes in the Event of a Change of Coverage Level

If an employee switches from Employee-only to [Employee plus Spouse, Employee plus Children or Family Coverage] then DePaul will make a pro-rated additional employer contribution.  For instance, if an employee began the year with single coverage and hence received a $500 contribution in January and switched to family coverage effective July 1st, then an additional contribution will be made.  The additional amount in this example would be the difference between the family contribution made on January 1st and the employee-only  contribution ($1,000 - $500 = $500) divided by 12 month ($500/12 = $41.67) and multiplied by the number of months the employee will be in the family coverage level for the year ($41.67 * 6 = $250).   In this case the additional employer contribution would be $250.

Conversely, DePaul will not attempt to have employer contributions returned from employees who received a family contribution for the full year on January 1st, and then switched from family coverage (or employee plus spouse, or employee plus child) to single coverage during the year.  Employees who participate in the HSA are responsible for monitoring all contributions to his or her HSA account and ensuring that the Statutory Maximum Annual Contribution as stipulated by IRS guidelines is not exceeded.  If it is, the employee is responsible for taking corrective distributions and reporting the excess to the IRS.

Employees who Terminate before the End of the Calendar Year

  • DePaul does not attempt to have employer contributions returned for employees who leave the plan before the end of the year, yet already received the entire employer contribution. For example, if an employee who had family coverage received a $1,000 employer contribution for the year on January 1st, terminated on June 30th, then DePaul does not attempt to recover the $500 of the contribution already made for the second half of the year.
  • If there are excess contributions to your Health Savings Account for any reason, including your termination of employment resulting in you not being covered by a High Deductible Health Plan as defined by the IRS, DePaul will not report this on your W2.  You, the CDHP member, are responsible for reporting all excess contributions to the IRS and taking corrective distributions.


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