Are you considering applying to BCBSIL?

If you are considering on applying for health insurance coverage with Blue Cross and Blue Shield of Illinois (BCBSIL), this is what you need to know...

1. BCBSIL has a 12 month waiting period for pre-existing medical conditions; which are conditions that were consulted, diagnosed or treated (current prescriptions other than contraceptives) within the 12 months prior to application  the waiting period will be waived if you have had 12 months of credible coverage with any Blue Cross and Blue Shield carrier, without a gap in coverage greater than 63 days
2. BCBSIL is the strictest when it comes to placing condition specific exclusion riders
3. If you are currently seeking therapy/counseling you will not be offered coverage
4. Maternity coverage is a optional benefit at additional monthly premium that has a 12 month waiting period before maternity benefits are covered
5. The earliest effective date is 14 days from the time application is received or at your request past the 14 day period
6. BCBSIL will debit your initial monthly premium prior to approval to receive a refund if coverage is declined

For further information on BCBSIL plans please contact The Shoppe.

Thanks,

Jordan

Prescription Drug Coverage Options

Understanding how carriers cover outpatient prescription drugs can be confusing and will be much  different coverage if you are used to employer benefits.

Carriers all have different prescription benefits, with one common element; the network of providers (pharmacies).  All plans are a Preferred Provider Organization (PPO), providing you access (no referral required) to pharmacies that are contracted with your insurance carrier.  What does it mean for a pharmacy to have a contract with your insurance carrier???  Well, it means that your pharmacy has a set fee that they can bill a carriers member for prescriptions, known as the "contracted rate", which can range between 2-70% below retail cost for someone without insurance.  The final amount owed, known as the "allowable amount" is what the member is responsible to pay .  Every pharmacy will have a different "allowable amount"


If you currently take prescription medication other than contraceptives, carriers such as Blue Cross and Blue Shield of Illinois (BCBSIL), Celtic and Aetna, will not cover for the first 12 months.  These 3 carriers have a 12 month waiting period for pre-existing medical conditions, and BCBSIL only waives if current coverage is BCBS without a break in coverage greater than 63 days, and Aetna will waive no matter the carrier as long as there is not a break in coverage greater than 63 days.  All other carriers will increase premiums to cover medications or exclude coverage on medications as the cost more than the premium being collected.


Blue Cross and Blue Shield of Illinois (BCBSIL) offers 2 options, with the 1st option requiring a $500 deductible or lower on a specific plan design. With this option, the member pays a $10 copay for generics and cost shares on the "allowable amount" on Preferred and Brand Name prescription drugs...to not spend more than $100 on each prescription fill.  The amount that the member pays does not apply to the plan.  The 2nd option, which is available on all deductibles above $500 has the member paying the "allowable amount" toward the plan deductible.

All other carriers when not choosing a HSA plan design provide the member with a immediate $10 or $15 copay for generic drugs (level 1), to then have the member pay the "allowable amount" on Preferred (level 2) and Brand Name (level 3) drugs towards a separate $500 deductible before receiving a specific copay amount per drug level...none of which applies to the plan deductible.  Depending on the carrier, prescription drug deductibles can increase upwards to $1,000 or you can pay additional premium to lower down to $150 or $200.

To be honest...if you currently are taking prescription medications, it would be best to pay the "allowable amount" and chip away at the plan deductible...lowering your overall calendar year financial exposure to covered expenses.

For further information on benefits, please contact the shoppe.

-The Shoppe

Why work with The Health Insurance Shoppe?

So...are you in the market for health insurance coverage?  If so, you have come to the right place.

At The Health Insurance Shoppe we solely market health insurance plans, whether it be individual, family, small group or Medicare.  Instead of working with each health insurance carrier separately, you can contact the shoppe and search products between 6 major Illinois health insurance carriers, all with one point of contact.

Best of all, out service is free!


Individual and Family Coverage


When searching for a private individual or family plan of coverage, each carrier is not for everyone.  Some carriers have 12 month waiting periods for pre-exisitng medical conditions, while some carriers will cover current treatment (medications) and in return, increase your quoted premium to cover risk.  All carriers but one have the ability to exclude coverage on specific medical conditions.  If one carrier is going to place a exclusion of coverage..chances are you can go to another carrier who will not exclude, but will either increase premiums to cover risk or apply a separate condition specific deductible.  For those that receive current treatment, you will not find this information online, nor will the carrier tell you until you submit application with the first months premium.  With over 15 years of experience in the Illinois market, The Health Insurance Shoppe can take the guess work away and place in the most appropriate plan.


Small Group


Are you a small business employer interested in finding out the costs for group health insurance coverage?  Well, the facts are pretty simple...

• employer is required to pay at least 50% of the employee only coverage rate
• minimum of 2 eligible employees for enrollment with at least 75% eligible employee participation
• 50% employer cost share is a tax deductible to business
• if total # of employees is 25 or lower the employer is eligible to receive up to a 35% dollar-for-dollar tax credit on their share of the premium when average annual salaries are between $25,000-$50,000/year.

At the shoppe, you receive quotes from 4 top Illinois carriers and a breakdown of your options.  If the costs are not attainable, we will then ask the question of "what can be affordable?", and then illustrate a way to provide a employee health benefits package that does not involve a plan of health insurance, rather a means to cover employees medical expenses or individual plan premiums...up to a define amount per employee, per year.

Medicare

Have you ever listened to a radio ad or seen a TV commercial for Medicare products that asks for a beneficiary to stop on by?  The answer is NO, as all ads and marketing have the beneficiary call or click to learn more information, and are then bombarded with a bunch of reading material that most of the time does not make sense to the beneficiary.   When you see advertisement for a FREE medicare plan, it is best to make sure you know all the restrictions to the plan you are going to apply for.

Medicare can be quite easy to understand if explained right, and at the shoppe, you can walk-in a sit down face-to-face with a professional to have your questions answered and then enroll in a plan that best meets your needs.  

The bottom line is that there is nothing to lose in contacting the shoppe to be of service.

For more information on plans of coverage please call or complete our inquiry form on the website.

Cheers!

-The Shoppe