Welcome to Blue Cross Medicare Advantage

Our goal is to help you manage your health. We’ll call to welcome you to the plan. We’d like to know if you have questions about your benefits or if you have other special needs that need immediate attention. During your welcome call:

✔ We’ll make sure you received your member ID card and instructions on how to access your Evidence of Coverage (EOC). Please review the EOC as it lets you know how to get your medical care and prescription drugs covered through our plan.

✔ We’ll ask you a few questions from a voluntary health questionnaire. The questions are easy to answer and will help us understand your needs. Based on your answers, we may reach out to you about your health to help you better manage it. We might suggest an in-home assessment with one of our care management professionals.

✔ We’ll help you schedule an Annual Wellness Exam.

If your phone has caller ID, you may not recognize that BCBSIL is calling you. Remember we’ll be calling, so be sure to answer.

We’d like to have your email address to send you communications about health plan benefits and programs throughout the year. We never share your email address outside the plan. You can always opt out or ask us to stop sending you emails.

You will receive an Annual Notice of Change in October. This notice outlines any expected premium/benefit changes for next year. These changes will go into effect January 1 of the following calendar year. Review this document carefully.

An Explanation of Benefits is a statement that shows details of your medical and pharmacy expenses and how your benefits were applied to cover those expenses. You will receive an EOB whenever a medical or pharmacy claim has been processed. This statement is not a bill. It simply details what you have paid and indicates the level of benefits you’ve used. Review these statements to be sure they are correct. If you think there are errors, please contact us. If you think you are the victim of fraud, report it immediately.

Blue Cross Medicare Advantage plans cover a broad range of prescription drugs. The formulary may be different from what you’re used to, and it is always available to view online. Share the formulary with your doctor and talk about the drugs you take now. You may find you can save money by choosing generic drugs. Ask if this is an option for you.

In Medicare Advantage plans, prescription drugs are placed into tiers. The costs for drugs in each tier are different. Tier 1 drugs will cost less than Tier 5 drugs. The tiers are:

• Tier 1 — Preferred Generic Drugs
• Tier 2 — Generic Drugs
• Tier 3 — Preferred Brand Drugs
• Tier 4 — Non-Preferred Drugs
• Tier 5 — Specialty Drugs

Please read the formulary for more information about these rules and exceptions, or visit the Prior Authorization/Utilization Management page for more information. 

Blue Cross and Blue Shield of Illinois uses clinical guideline criteria to make sure you get the health care you need. As a member, you can access the guidelines we use to make these coverage decisions. Learn more about accessing these guidelines.

To get the most from your benefits, you will use providers in our network. Your current doctors may be in the network. The network includes local primary care providers and a wide range of specialists. If you have an HMO plan, you must choose a primary care provider (PCP). In some cases, you may need care from a provider who is out of network, which may cost you more. If your current provider is not in the network, we can help you find a new one. Search for a provider.

Certain high-cost medical services that have more cost-effective alternatives need prior authorization from the plan before your provider can proceed. Our plans follow government guidelines in this area to make sure you receive the most appropriate, cost-effective care available.