Your Journey To Better Health Starts Here

Understanding Your Plan

We want you to get the most from your new plan. In this section, you'll find resources to help you get started, maximize your benefits, use online tools, learn about claims and more.

Helpful Documents

Once enrolled in a Blue Cross Medicare Advantage plan with Blue Cross and Blue Shield of Illinois, you will have access to documents that provide information you may need understand and use your plan.

Annual Notice of Change (ANOC)

You will get your Annual Notice of Change in October. This document will tell you what changes will be made to your plan for the next year, starting January 1st. It will outline any expected premium or benefit changes.

Evidence of Coverage (EOC)

You will get your Evidence of Coverage in October. This document gives you a detailed description your plan benefits. It explains your rights and responsibilities, what is covered, what you pay as a member of the plan, and how to file a complaint if you are not satisfied with a decision or treatment.

Learn About Your Costs and Coverage

Coinsurance and Copays

• Understanding Costs: You may hear the terms "coinsurance" and "copay" while enrolled in a Blue Cross Medicare Advantage plan. Coinsurance is a percentage of the bill you pay. Copays are a set amount you pay at the time of service.

Quick Facts About Claims and More

• Claims Filing: Your provider and pharmacist will usually file any claims for services or prescriptions you received. Once the claim is filed, you will get a statement called the Explanation of Benefits (EOB) from us. How often you receive it depends on how often you get care or fill your prescriptions.
• What is an EOB? The EOB is a statement, not a bill. It simply details what you have paid and indicates the level of benefits you’ve used.
• How to use an EOB: Review these to be sure they are correct. If you think there are errors on your EOB statement, or you think you are the victim of fraud, please call customer service.

Is My Care Covered?

It’s easy to ask questions or voice concerns about Blue Cross Medicare Advantage coverage. If you have questions about what the plan covers, you can:

• Read the Evidence of Coverage (EOC): This important document is in the Welcome Kit you will receive in the mail after you enroll. The EOC explains what is covered, what you pay as a member of the plan, and how to file a complaint if you are not satisfied with a decision or treatment.
• Call Customer Service: After becoming a member, call the number listed on your member ID card to speak with a representative who can explain your plan benefits.

Prescription Drug Coverage

Drugs covered by Blue Cross Medicare Advantage plans are listed in formularies (drug lists). Each plan has its own drug list that includes generic and brand name drugs. The list also provides information about drug copays and limitations, such as prior authorization, quantity limit and step therapy.

Drug Formulary

You will have access to the Drug Formulary, which is a list of drugs that are covered, both as a document or online. You can share the formulary with your doctor to talk about your medication options. Drug lists can change, most often in the beginning of each year. Normally, any changes in the drug list are reflected in the list at the beginning of each year. To access your formulary online, use the drug finder tool.

Medication List

The Medication List is used to record your current medications along with directions, prescriber, and any knock allergies. Bring your Medication List when you go to the doctor, hospital, or emergency room and share it with your family or caregivers.