You should keep these points in mind when using the benefits provided by the Plan:
- Pre-approval is required for elective or non-emergency hospitalization or elective Inpatient surgery. You must call the Blue Cross Blue Shield Medical Service Advisory (MSA) at least one business day before you go into the Hospital, or within two business days of the date of an emergency admission. You must pay an additional $250 copayment if you do not call the MSA. See the back of your medical ID card for instructions. You are encouraged, but not required, to contact the MSA for maternity admissions. Pre-admission authorization is not a guarantee that all services and charges will be paid for by the Fund. Your benefits are still subject to all terms and conditions of the Plan.
- If you and your spouse become divorced or legally separated, you or your spouse must notify the Fund Office. Your spouse is not eligible for coverage under the Plan as your Dependent as of the date of your divorce or legal separation. Your spouse may be eligible for continuing coverage for 36 months after the divorce or legal separation under COBRA. However to be eligible for that COBRA coverage, you or your spouse must notify the Fund Office within 60 days of the divorce or legal separation. See COBRA Continuation Coverage or contact the Fund Office if you have any questions about continuing coverage under COBRA.
- If your Child loses Dependent status under the Plan because your Child no longer meets the Plan’s definition of Dependent, you, your spouse, or your Dependent Child must notify the Fund Office within 60 days of the loss of status in order to be eligible for COBRA Continuation Coverage. See COBRA Continuation Coverage or contact the Fund Office if you have any questions about continuing coverage under COBRA.
- Certain routine diagnostic tests are covered by the Wellness Benefit. Other tests may be covered if you receive pre-approval by the Fund Office. See Wellness Expense Benefit for more details about the tests that are covered under the Wellness Benefit.
- This Plan coordinates its healthcare benefits (but not prescription drug benefits) with the benefits of any other Plan under which you and your Dependents are covered. If you and/or your Dependents are covered under another plan, you must report all other coverage directly to the Fund Office.
- Call the Fund Office at 1-708-449-7373 or Blue Cross Blue Shield at 1-800-810-BLUE, or visit the Blue Cross Blue Shield of Illinois website at www.bcbsil.com to find out if a particular provider is a Plan/PPO contracted provider – before you use their services.
- The fact that your Physician may prescribe, order, recommend or approve a particular service or supply does not make it Medically Necessary or make the expense a covered charge under the Plan. See Covered Expenses for more detailed information about covered medical expenses.
- Eligibility and benefit coverage are limited to and controlled by the terms of this written Plan Document. Fund Office employees, employers, union representatives, individual Trustees and individuals or entities other than the Board of Trustees acting in accordance with the Trust Agreement are not authorized or empowered to make representations, certify or guarantee coverage or interpret or change the terms of the Plan. You cannot rely upon their statements or actions to establish eligibility or benefit coverage. The Plan Document is the only instrument on which you can rely. If you would like to confirm eligibility or coverage you must file an official claim for benefits pursuant to the Plan’s claim filing procedures set forth in Filing Claims Other than Major Medical Claims.