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:
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 pharm acy program. See the mail order brochure for more information.
To Initialize or to Refill a Prescription:
Option I: Use the PrimeMail Prescription Order Form
Option II: You can set up an account on My Prime Mail using the Member ID number on your BCBS ID card.
C. How to Submit Claims
All claims must be submitted by the provider, pharmacist or member to BlueCross BlueShield (BCBS) to apply to the deductible, coinsurance and out of pocket, or to receive the discounted drug price. Show the provider or pharmacist your BCBS ID card, and in most cases, the provider will submit the claim directly to BCBS on your behalf.
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.
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. Please contact the Benefits team for a Family Status Change Form if you need to make a mid-year change.
Maximum Employee Contributions
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 a full-time 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