The Lake County Medical Society offers enrollment in health and/or dental insurance plans, to newly elected members who are actively at work. The plans are underwritten by Blue Cross Blue Shield of Illinois and we have enjoyed a mutually beneficial relationship for over 50 years. The LCMS Administrative Policy is quite specific about how and when members may join the plan, and it explains the general administrative policies of the group plans. Please call 847-482-0222 for a copy of the LCMS Administrative Policy. Other forms and important Notices are posted on this page of our web site. Our subscribers are encouraged to visit the web site frequently. Dental Forms
It's Easy to Find What You Need @bcbsil.com/members
Blue Access for members:
Besides information about doctors, hospitals and regular news and updates, you can access your own claims and see the Explanation of Benefits online before you receive them in the mail. You can even stop the paper clutter and just view your claims online. Your medical (and dental) visits and claims are posted before they hit the mail box. Check in frequently to see when claims have been paid, to whom and in what amount. Sign up for a user name and password now and visit any time, from any place.
And — you can go to MyRxHealth.com for entry to the Prime Therapeutics site, where you can track your prescriptions ordered for mail delivery to your home or another address. This service is for 90-day prescriptions of maintenance medications. Typically, you pay the pharmacy cost for a 60-day supply and you receive a 90-day supply. Once your prescription is registered, you can order renewals by phone, online, or by mail. You can reference your prescriptions and view your out of pocket costs. View your prescriptions as far back as the previous year. Initial prescriptions need to be mailed in. We will be happy to provide the form you need. (More than one prescription can be sent in one envelope.)
• Go to www.bcbsil.com
• Log in to Blue Access for members
• Click on Learn more about your pharmacy benefits in the Quick Links box on the right to go to your Rx Drugs home page.
• Click on Prime Therapeutics in the Prescription Drug Benefits and Services box on the left. This will take you to MyRxHealth.com, the member site of our pharmacy benefits manager.
• From there you can register with a username and password. Notices and Forms Available to Download:
Seniors, need help? You can contact the Illinois Senior Health Insurance Program ("SHIP") at 1-800-548-9034. The staff can answer a wide range of questions.
National Number for Social Security, 1-800-772-1213
Local Social Security office, 1-888-321-2587
Social Security
1930 N. Lewis Avenue
Waukegan, IL 60087
To find out if Medicare covers a service you need, visit www.medicare.gov, and select
"Find Out What Medicare Covers" or call 1-800-MEDICARE (1-800-633-4227).
The Medicare Coordination of Benefits Office can be reached at 1-800-999-1118. That is the number to call if you find you have Medicare and other insurance and you are posted incorrectly.
See the following additional information / articles on this page:
• New Illinois Insurance Continuation Law
• Notices and Updates for Our Members
• Medicare Insurance Information
• Insurance Claim Forms
• Your Health Care Benefit Booklets
• Your Dental Care Benefit Booklets
• General Notice of Special Enrollment Rights & Preexisting Condition Exclusion
• Appeal Procedure
• COBRA General Notice
• News from Blue Cross Blue Shield of Illinois, Rx Over-the-Counter Coupon Program
• Insurance Policyholder Information About Continuation Coverage
• Health Insurance Plan Information Benefits for Reconstructive Surgery and Mammograms
• Important Notice About Your Prescription Drug Coverage and Medicare
Illinois Civil Union Act, Effective June 1, 2011
Fact Sheet
Special 30-day Open Enrollment until July 1, 2011
Call us at 847-482-0222 for information.
Timely notices, updates and changes to our master policy will be posted on this web site. Subscribers should check frequently.
For members who are enrolled in our group plan, depending on the size of the employer group, some participating practices are subject to COBRA (offering at least 18 months of continuation), and others are subject to Illinois Continuation laws (12 months of continuation).
Blue Cross Blue Shield of Illinois has already implemented the extension of family coverage to covered dependents until they reach age 26. They are covered until the last day of the month during which they turn 26. Then, they have the option to enroll for 24 additional months as individual policy holders if they need the coverage. We will continue to notify you about any health care regulatory or other changes, which seem to come more and more frequently. As always, our enrollees are welcome to call or email with any questions about our group plan.
COBRA Reminder Notice
We remind employers who use our group plan that all employers subject to COBRA (those with 20 or more employees) are required to provide COBRA notices and election forms to covered employees upon termination of employment. This is an employer responsibility. We survey our participating employer groups annually with respect to employer group size, and you are required to respond. If you have questions, please call us.
If you are an employer subject to COBRA, remember to provide that all-important COBRA Notice and Election form to terminating employees and their covered spouses. Retain the signed election form in your files to prove that you offered continuation coverage, when applicable. Ideally, you will send the COBRA Notice and Election form to the home address so that the spouse sees it, as he or she has the independent right to retain coverage, even if the terminating employee does not.
Benefit Highlights - July 1, 2011
It is not possible for benefit booklets to describe the coverage for every health condition that might occur. We urge members to contact the number on the back of your ID card for information about coverage for particular conditions. Insurance regulations can change throughout any given year and our plan rules change from time to time, between the preparation of benefit booklets. Watch for our periodic paper newsletters, mailed to home addresses for reminders about plan benefits and rules. Keep us informed if your home address should change.
If you or your Physician disagree with the determination of the MSA prior
to or while receiving services, you may appeal that decision by contacting
the MSA or the Claim Administrator's Medical Director.
In some instances, the resolution of the appeal process will not be
completed until your admission or service has occurred and/or your assigned
length of stay/service has elapsed. If you disagree with a decision after claim
processing has taken place or upon receipt of the notification letter from
the MSA, you may appeal that decision by having your Physician call the contact person
indicated in the notification letter or by submitting a written request to:
Medical Director
Health Care Service Corporation
P. O. Box A3957
Chicago, Illinois 60601
You must exercise the right to this appeal as a precondition to taking any
action against the Claim Administrator, either at law or in equity.
Once you have requested this review, you may submit additional information
and comments on your Claim to the Claim Administrator as long as you do so
within 30 days of the date you asked for a review. Also, during this 30 day
period, you may review any pertinent documents held by the Claim
Administrator, if you request an appointment in writing.
Within 30 days of receiving your request for review, the Claim
Administrator will send you its decision on the Claim. In unusual
situations, an additional 15 days may be needed for the review and you will be notified of this during
the first 30 day period.
COBRA General Notice (from the Blue Cross Blue Shield of Illinois Web site)
Employers are required to provide this notice when covered employees or their dependent spouses first become covered by a group health plan subject to COBRA.
In an effort to assist employer groups, HCSC has incorporated this notice into the Certificates of Coverage and Benefit Booklet. Although HCSC has taken this extra step, it is the employer group's responsibility to make this notice available to each covered employee and to the employee's spouse (if covered under the plan) not later than the earlier of:
Either 90 days from the date on which the covered employee or spouse first becomes covered under the plan; or
If later, the date on which the plan first becomes subject to the continuation coverage requirements; or
The date on which the administrator is required to furnish an election notice to the employee or to his or her spouse or dependent.
The Lake County Medical Society cannot serve as your COBRA Administrator, but we can recommend some professional COBRA administrators to our members.
You may have heard about Medicare's prescription drug coverage, and wondered how it would affect you. LCMS has determined that your prescription drug coverage with BCBS is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay.
Since January 1, 2006, prescription drug coverage has been available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans will provide at least a standard level of coverage set by Medicare. Some plans might also offer more coverage for a higher monthly premium.
Because your existing coverage with the LCMS group plan is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare coverage. Subject to reevaluation annually.
People with Medicare have the option of enrolling in Medicare Part-D, the prescription drug plan. However, those who have existing prescription drug coverage that, on average, is as good as Medicare coverage, can choose to join a Medicare prescription drug plan later. Anually, you will have the opportunity to enroll in a Medicare prescription drug plan between November 15th through December 31st.
If you do decide to enroll in a Medicare prescription drug plan and drop your LCMS group plan with prescription drug coverage, be aware that you may not be able to get this coverage back.
If you drop your coverage with LCMS and enroll in a Medicare prescription drug plan, you may not be able to get this coverage back later. You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area.
In addition, your current coverage pays for other health expenses, in addition to prescription drugs, and you will still be eligible to receive all of you current health and prescription drug benefits if you choose to enroll in a Medicare prescription drug plan.
You should also know that if you drop or lose your coverage with LCMS and don't enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more to enroll in Medicare prescription drug coverage later. If after May 15, 2006, you go 63 days or longer without prescription drug coverage that's at least as good as Medicare's prescription drug coverage; your monthly premium will go up at least 1% per month for every month after May 15, 2006 that you did not have that coverage. For example, if you go nineteen months without coverage, your premium will always be at least 19% higher than what most other people pay. You'll have to pay this higher premium as long as you have Medicare coverage. In addition, you may have to wait until next November to enroll.
For more information about this notice or your current prescription drug coverage...
Contact our office for further information at 847-482-0222, or call Blue Cross Blue Shield of Illinois. You may receive this notice at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage changes. You also may request a copy.
For more information about your options under
Medicare prescription drug coverage...
More detailed information about Medicare plans that offer prescription drug coverage are available in the medicare handbooks printed each year. You will get a copy of the handbook in the mail from Medicare if you are enrolled. You may also be contacted directly by Medicare prescription drug plans. You can also get more information about Medicare prescription drug plans from these places:
• Call your State Health Insurance Assistance Program (see your copy of the Medicare and You handbook for their telephone number)
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare, which offer prescription drug coverage after May 15, 2006, you may need to give a copy of this notice when you join to show that you are not required to pay a higher premium amount.
Name of Entity/Sender: Lake County Medical Society
Contact - Position/Office: Jane Stein, Executive Director
Address: 810 S. Waukegan Rd., Suite 104, Lake Forest IL 60045
Phone Number: 847-482-0222
Fax Number: 847-574-0445
Email: lakedocs@aol.com
