Are there coverage differences between BCBS and UHC?
Yes. In the BCBS plan option, you will pay a copay when you see a physician. In addition, you won't have benefit coverage if you seek care outside of the BCBS PPO National Network or the BCBS Caterpillar NetWork.
What does BCBS Caterpillar NetWork mean?
Eligibility for participation in a Caterpillar NetWork service area is dependent on the residential zip code of the employee. You should utilize Caterpillar NetWork providers whenever possible but you can also utilize any BCBS National provider.
How will I know if I am in the BCBS Caterpillar NetWork plan option or the BCBS National plan option?
Your ID card will say "Caterpillar NetWork" on the front if you are included in the BCBS Caterpillar NetWork.
I am enrolled in the Blue Cross Blue Shield plan option and a Flexible Spending Account (FSA). How can I get reimbursed under the FSA guidelines for medical claims related to my copayments, coinsurance and deductible amounts?
The FSA claim forms can be found in the FSA section for both health care and dependent care claims. The claims can be either mailed or faxed to UnitedHealthcare (FSA claims administrator). The address and fax number are located at the top of the form.
If I choose BCBS, does the spousal surcharge apply?
Yes. If a spouse has access to group insurance coverage through his/her employer, and chooses to decline that coverage to enroll in a Caterpillar health care plan, then the spousal surcharge will apply.
How many cards will I receive (dental, vision, health care) when participating in the BCBS plan option?
You will receive three cards:
VSP does not provide ID cards - just tell your provider you have VSP.
If I'm covered by Blue Cross Blue Shield, who do I contact for questions about claims, preauthorization or benefit coverage?
Refer to your Blue Cross Blue Shield ID card, or:
Do copays count toward the out-of-pocket maximum?
Yes. Copays and coinsurance do apply to the out-of-pocket maximum.
Do copays count toward the deductible?
No. Copays do not count toward the individual or family deductible.
Are copays under the Blue Cross Blue Shield medical coverage waived once the out-of-pocket maximum is satisfied?
Yes, for the remainder of the calendar year.
If I want a second opinion, is that a covered service?
Yes. If you want a second opinion, contact BCBS to find an in-network provider:
Note: UHC members can use 2nd.MD for second opinions. The 2nd.MD benefit is currently not available to BCBS members.
How do I find doctors or hospitals in the Blue Cross Blue Shield network?
To find a provider, visit BCBS's website:
What if I use a doctor or hospital that isn't in the network?
Blue Cross Blue Shield will not cover any benefits to out-of-network providers. You will be responsible for the entire cost of the claims.
How are prescription drugs covered?
Under the BCBS plan option, prescription drug coverage is administered by Caterpillar’s prescription benefit manager, Magellan Rx. All participants who enroll in the Blue Cross Blue Shield plan option will use the Caterpillar Drug Formulary.
What is provided for dental coverage?
The dental coverage is the same as the Caterpillar PPO dental plan and is administered by Cigna. You will receive a dental ID card from Cigna.
Is chiropractic care covered by the Blue Cross Blue Shield plan option? Are there chiropractors in the network?
Yes. Contact Blue Cross Blue Shield for preauthorization requirements and network providers.
If I travel and require health care while away, will it be covered?
As a plan participant, emergency medical services outside of the Blue Cross Blue Shield National network and Caterpillar NetWork are always covered, with no preauthorization required.* If you're unsure if your condition warrants emergency attention, contact Blue Cross Blue Shield:
Routine care from out-of-network providers is not covered.
*The definition of a medical emergency is based on the perspective of an ordinarily prudent layperson. Services are covered if you could reasonably expect the absence of medical attention to result in placing your health in serious jeopardy, serious impairment to bodily functions or serious dysfunction of any bodily organ or part.
Am I covered if I travel outside the United States?
As a Blue Cross Blue Shield member, you and your covered dependents can receive treatment while traveling, including outside the United States. However, many health care benefit plans have requirements for notifying your doctor and/or Blue Cross Blue Shield for emergency and non-emergency treatment. Contact BCBS for your specific coverage guidelines while away from home.
Will the Blue Cross Blue Shield plan option cover emergency room visits?
Yes, but you will pay the full negotiated rate for ambulance and ER services until you meet your deductible, then you will pay coinsurance. For an ER visit, you also pay an extra $125 fee, which is waived if you are admitted as an inpatient. Non-emergency care should be treated at the physician office or urgent care facility to avoid the higher out-of-pocket costs.
How does Medicare coverage work with my benefits under the Blue Cross Blue Shield plan optioin?
If you are on the Caterpillar Group Plan and qualify for Medicare, Medicare serves as your primary insurance and the Blue Cross Blue Shield plan option as your secondary insurance. Blue Cross Blue Shield will only pay after Medicare has paid for the claim or service. You will need to enroll in Medicare Part A and Part B.
How do I know how much my copays are in the BCBS plan options?
Benefit plan information is available to you and your providers by contacting Blue Cross and Blue Shield:
I received a bill for a facility charge when I went to the doctor? Why?
If you receive services at a doctor's office that is located in or associated with a hospital, it is possible that facility will bill you a separate "facility charge" in addition to your doctor visit copay. This is a valid charge; deductible and/or co-insurance will apply according to the terms of your plan.
Why do the website and other materials refer to Blue Cross Blue Shield of Illinois?
Blue Cross Blue Shield of Illinois is the location of the claims processing center and customer service center. However, Blue Cross Blue Shield is offered to all members throughout the United States as long as the member resides in one of the designated zip codes for Blue Cross Blue Shield.