MEDICAL CLAIM TIPS
Since we are part of the Blue Cross
Blue Shield (BC-BS) PPO network, you have the option of using
a BC-BS PPO physician or hospital and receiving a discounted fee.
If you do not have a BC-BS of IL PPO physician, check out the Blue
Cross Blue Shield Web Site to find a physician in your area.
After selecting a provider you need to present your BC-BS/Express
Scripts ID card
at the physician’s office or the hospital.
Do not pay any fees at the time of the visit at any PPO
provider.
Also, be sure to present your card at every visit.
If for some reason you
do not have a BC-BS ID card, please contact the Welfare Fund office.
Your plan requires pre-certification
for all inpatient hospital admissions.
Contact Medical Cost Management at 1(800)367-9938 before any
scheduled hospital admission. For
emergency hospital admissions, contact Medical Cost Management by the
first working day following a weekend emergency admission or within 48
hours of a weekday emergency admission.
In addition, your plan requires that you obtain a second surgical
opinion for the surgical procedures listed in the schedule of
benefit in your plan booklet.
Medical Cost Management should also be contacted regarding second
surgical opinions.
You will need to submit a
Medical/Dental/Vision
claim form for the family, once a year.
In addition, you will need to submit a medical claim form for each
accident or if there is other insurance coverage. You can request a
claim form directly from our website or call us at (630)734-0074.
Please note: If a family member has other insurance coverage, we
will need the primary carriers explanation of
expense and benefits for each charge submitted.
We appreciate your consideration in providing all
the information necessary to process your claim so that we can provide
timely claim servicing.
DENTAL CLAIMS
Your
dental benefits are paid thru the Welfare Fund office. Providers and members should send all dental bills to the
Welfare Fund office for servicing. Your dental policy does not include any
PPO providers.
VISION CLAIMS
You
have the choice of using a BC-BS PPO provider or a non-PPO
provider for your vision care. Utilizing
a PPO provider could provide a discount on charges incurred when using
your BC-BS/Express Scripts ID card. All non-PPO
claims should be sent to the Welfare Fund office for servicing.
DISABILITY TIPS
When
you are disabled from work due to a non-work related illness or injury, a
disability claim form should be requested from the Fund office and
completed. Benefits would begin on the first day of your disability when
due to an injury. In the case
of an illness, benefits begin on the 8th day of your
disability.
In
the case or a work-related injury or illness, please forward copies of
your workman’s compensation pay stubs to the Welfare Fund office to
receive eligibility credit to be applied towards continued eligibility
under the Welfare Plan.
A maximum of 26 weeks (1040 hours) can be applied to continued
eligibility.
PRESCRIPTION TIPS
You have the
option of using your BC-BS/ Express Scripts prescription card (ID) at any participating pharmacy to
obtain a discounted cost. If
you use your ID card the bill will be electronically submitted to the
Welfare Fund office for servicing. If
you do not use your ID card, please send the original prescription receipt
to the Welfare Fund office for servicing.
You may also visit the EXPRESS
SCRIPTS Web Site.
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