How Often Is Your Bluecard Doctor And Hospital Finder Updated
Each one of our Blue Cross and Blue Shield independent licensees collect and provide information for our PPO finder via different timetables and methods. While we make every effort to keep the Provider Finder “up-to-date,” it is always best to confirm any provider information you select from this utility with your local Blue Cross and Blue Shield representatives.
Do You Need Supplementary Health Or Dental Insurance
If you are young and healthy, you might not need to buy supplementary health or dental coverage. It depends to an extent on what you are covered for under OHIP, a group plan or a parents group plan. For example, starting in January 2018, OHIP provides prescription drug coverage to youth 24 and under who are not covered by private benefits. Those children and youth are able to get more than 4,400 prescription medicines for free by showing their health card and prescription. Coverage is automatic, with no up-front costs. Read the news release to find out more. Check what you are covered for, take a look at your individual situation, and make a decision on whether what you have now is sufficient.
South Carolina State Health/dental/vision Plans
For State of South Carolina: employees, retirees, and local government entities covered under these plans.
- Health Claims and Benefits: 803-736-1576 in Columbia, or toll-free 800-868-2520
- Dental Claims and Benefits: 803-264-7323 in Columbia, or toll-free 888-214-6230
- Pharmacy Claims and Benefits: 855-612-3128
- Routine Vision Claims and Benefits: 877-735-9314
- Address Changes and Premiums: 888-260-9430
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What Ohip Covers And What It Doesnt
Before you can decide whether or not you need supplementary health and dental insurance, you should have an idea about the kinds of services OHIP does and doesnt pay for. The basic expenses covered by OHIP include:
- Visits to doctors
For a full list visit What OHIP Covers.
What OHIP doesnt typically cover:
- Prescription drugs/medicines provided outside of hospitals such as antibiotics, painkillers, and some cancer drugs
- Specified elective medical services such as chiropractors or massage therapists
- Semi-private or private hospital rooms
- Some medical exams, tests and vaccinations
How To Protect Yourself From Healthcare Fraud
Although healthcare fraud is committed by a very small minority within the healthcare system, no one can assume it won’t happen to them. We encourage you to take these steps to avoid becoming a victim of healthcare fraud:
- After care, review your statement to verify accuracy.
- Ask your doctor to explain the reason for services.
- Report any discrepancies to your health insurance plan or payer.
- Beware of “free” medical services, as illicit entities use this lure to obtain information.
- Safeguard your insurance member ID card.
- Report instances where co-payments or deductibles are waived.
- Dont give your insurance number to marketers or solicitors.
- Never sign a blank insurance form.
If you suspect, experience or witness healthcare fraud, you should report the information to your local Blue Cross Blue Shield company by calling the number on the back of your member identification card. If you are not a BCBS member you can or call the report fraud hotline 1-877-327-BLUE . If you are a federal employee or retiree, you can report potential healthcare fraud by calling 1-800-337-8440.
The report fraud hotline cannot address medical benefit questions, individual payment disputes, expiration of benefits or other administrative concerns.
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What Is Blueprint Portal
Blueprint Portal is a members-only website that will help you understand and manage your health plan so youre able to find quality, patient-focused healthcare at the best possible price.
- Review claims history
- Check deductible and out-of-pocket totals
- View and order replacement ID cards
- Find a doctor or hospital
- Estimate treatment costs
- Review a recent doctor visit
How Can I Find Out Information About Coverage That Is Supplemental To Medicare
There are lots of Medicare choices, including Medicare+Choice, medical savings accounts and private fee-for-service plans. For plans available to you, use our Medicare guide. You can also view a listing of Blue Cross and Blue Shield companies who participate in Medicare Advantage and Prescription Drug choices. Contact your local BlueCross and Blue Shield representative for details regarding claims or coverage. Not sure which Blue company you belong to? You can find out by typing your home or work ZIP code in our Plan Finder.
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Healthcare Fraud Prevention And Reporting
Healthcare fraud hurts everyone. In addition to higher premiums and increased out-of-pocket costs, healthcare fraud compromises health and safety, which can result in harm to patients, and undermines the public’s confidence in the healthcare system.
As part of our mission to improve and protect the healthcare system, the Blue Cross Blue Shield Association leads a national effort to prevent and respond to healthcare fraud that impacts members. The Blue Cross Blue Shield companies partner with state and federal agencies, as well as advocacy organizations, to report, investigate and reduce the incidence of healthcare fraud.
I Am A Member But I Do Not See Where I Can Log In On This Website Where Do I Find Access To My Member Benefits Coverage Etc
Bcbs.com is the Blue Cross and Blue Shield Association website. The Blue Cross and Blue Shield Association does not have access to member information. We regulate the brand and licenses to all 36 Blue Cross and Blue Shield local companies.
To access specific information about your coverage, EOBs, prescriptions, paying a bill, or any other questions related to your individual or group health insurance, please contact the customer service number on the back of your member card. You can also find your local BCBS company on BCBS.com.
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What Is Supplementary Health And Dental Insurance
If you live in Ontario, you are probably covered under the government-funded Ontario Health Insurance Plan . When you are approved for OHIP, youll get an Ontario health card which enables you to go to a doctor, clinic, hospital or emergency room, and receive medical attention, tests and surgeries at no cost to you.
But OHIP only partially covers or doesnt cover some medical services like prescription drugs and vision care, and it does not cover dental care. To pay for medical needs and dental care that OHIP doesnt cover, you may want to consider purchasing supplementary health insurance also known as extended health insurance, or private health insurance, and supplementary dental insurance.
You might have supplementary health and dental insurance through your employer, known as group insurance, or you may decide to buy your own policies, known as individual insurance. Supplementary health and dental insurance is a way to get the medical services you need, at an affordable price. To find out more about the different types of supplementary health and dental insurance, visit Types of Supplementary Health and Dental Insurance.
Were As Close As Your Wallet
Healthcare benefit programs issued or administered by Capital Blue Cross and/or its subsidiaries, Capital Advantage Insurance Company®, Capital Advantage Assurance Company® and Keystone Health Plan® Central. Independent licensees of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. Communications issued by Capital Blue Cross in its capacity as administrator of programs and provider relations for all companies.
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What Is Healthcare Fraud
Healthcare fraud is a federal crime under most criminal codes, consisting of intentional deceit for the purpose of illicit gains. Healthcare abuse is similar activity or behavior where knowing intent to obtain an unlawful gain cannot be established. Some examples of healthcare fraud and abuse include:
- Phantom claims for services or supplies that were never provided
- Using someone elses medical insurance information to obtain services or supplies
- Falsifying signatures or medical records to support misrepresented services or supplies
- Unbundling services from a group to unlawfully increase medical payment
- Misrepresenting the location where services or supplies are provided
- Rendering medical care without a license
- Duplicate claim submissions
What Is A Ppo
A Preferred Provider Organization is an arrangement designed to supply health care services at a discounted cost by providing incentives for members to use designated health providers , but which also provides coverage for services rendered by health care providers who are not part of the PPO network.
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How Does It Work
Supplementary health and dental insurance policies are contracts between you and an insurance company. You agree to pay a yearly or monthly fee called a premium, and the company agrees to pay the benefits which are covered under your policy. Your policy will outline what is included and what is not.
Here are some common features of supplementary health and dental insurance:
- Most policies do not cover 100 per cent of your medical expenses. You may have to pay some of the medical expenses you and your dependants incur. This is known as the deductible. Each policy is structured differently and you might have family deductibles or per service deductibles .
- Some plans have a co-insurance feature in addition to the deductible. That means you have to pay a percentage, or co-insure, the medical expenses on top of your deductible. It could be 10 per cent of the eligible medical expense, or higher, and it may depend on the type of medical service required.
- You may also have dollar or percentage limits, or maximums placed on the amount of benefits that you can receive. Maximums can apply to specific health benefits like eyeglasses or massage therapy sessions in a specified period typically a year, or during your lifetime.
What Is An Hmo
HMO stands for Health Maintenance Organization, a health care system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee.
For more insurance terms and definitions, please see our Glossary.
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Fields Marked With An Asterisk Are Required
Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration.
For Prescription Drug Questions:
- Hours: Monday – Thursday, 8 a.m. to 7 p.m., Friday 9 a.m. to 7 p.m. and Saturday, 9 a.m. to 1 p.m. EST
- Dont have your Member Card handy?
- Medicare Members: Call Hours: Monday – Friday 8 a.m. to 8 p.m.From Oct. 1 to Mar. 31, representatives are available seven days a week 8 a.m. to 8 p.m. EST
- Other Members: Call Hours: Monday – Thursday 8 a.m. to 7 p.m., Fridays 9 a.m. to 6 p.m.
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How Can I Get Information On Purchasing Health Insurance
for information on obtaining health insurance coverage for yourself, your family or a group. You may also find more information about insurance for individuals and families and Medicare.
The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.
Shopping For Health Insurance
If you need a new plan, we have the options you’re looking for. Contact us and find a plan that works for you.
Need help paying your bill? Find out how to make a payment.
For questions about ID cards, benefits, claims or other issues: Call the number on the back of your member ID card or 313-225-9000.
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How Much Supplementary Health Or Dental Insurance Do You Need
There are a wide variety of supplementary health and dental insurance plans, each with their own level of coverage, but the amount of health insurance you need is a highly personal decision. Only you can decide how much is right for you, but an insurance agent or company may be able to help you make those decisions. Visit the finding an insurance agent or company section of Working With an Insurance Agent or Company to find someone who can help you.
Factors to consider when deciding how much coverage you need include:
- How much can you afford to pay each month? Each year?
- Do you have any other supplementary health insurance through your employer, a parents group plan or a spouse/partner?
- Do you require prescription drugs on an ongoing basis?
- Are you willing to share a hospital room, or do you prefer a private room?
- Do you wear glasses or contact lenses?
- Do you receive medical services from professionals such as chiropractors or massage therapists?
- Can you afford to pay out of pocket for ambulance fees?
- Do you have a chronic illness that requires more extensive medical services than OHIP provides?
- Do you have a pre-existing medical condition? Some supplementary health insurance plans do not cover this. Be sure to shop around to find an insurer who might.
Supplementary Health and Dental Insurance | 101: Getting Started 4