Benefits: Insurance: Medical Insurance
Changing Elections
Electing or Declining Coverage
Filing Claims
How the Blue Cross PPO Plan Works
How the Blue Cross Traditional Plan Works
Medical Insurance
Medical Insurance
Eligible employees can enroll themselves and their eligible dependents for medical coverage, and have the choice of a Blue Cross of Idaho Traditional or PPO plan. Review the complete plan design online at:
State of Idaho Group Insurance Contracts
How the Blue Cross of Idaho Traditional Plan Works
After you pay an annual deductible, the plan generally pays 80% of most Allowable Charges. You can use any provider you want -- but you may save money when you use providers who belong to the Blue Cross of Idaho network of participating providers.
- Participating Providers have negotiated with Blue Cross of Idaho to provide plan participants with services at the plan's Allowable Charges. That means they'll accept plan benefits plus your share of the costs (any deductible, coinsurance or co payments) as payment in full.
- Non-Participating Providers may charge more than the plan's Allowable Charges, which means you're responsible for any amounts that exceed the Allowable Charges plus any deductible and coinsurance amounts.
To locate participating providers, refer to the Blue Cross of Idaho Online Provider Directory.
How the Blue Cross of Idaho PPO Plan Works
The PPO provides for In-Network and Out-of-Network benefits for most commonly provided services. After you pay an annual deductible, the plan generally pays 85% of most Allowable Charges provided by an In-Network provider. In-Network Physician Office Visits (office exam only) require a $20 co payment and are not subject to the annual deductible. Eligible Out-of-Network services are subject to a separate deductible, and are generally reimbursed at 70% of most Allowable Charges.
The PPO is not a managed care plan and you are not required to select a primary care physician. In addition, referrals are not required under the plan, you can use any provider you want. However, you save money when you use providers who belong to the Blue Cross of Idaho PPO network of participating providers.
- Participating Providers have negotiated with Blue Cross of Idaho to provide plan participants with services at the plan's Allowable Charges. That means they'll accept plan benefits plus your share of the costs (any deductible, coinsurance or co payments) as payment in full.
- Non-Participating Providers may charge more than the plan's Allowable Charges, which means you're responsible for any amounts that exceed the Allowable Charges plus any deductible and coinsurance amounts.
To locate participating providers, refer to the Blue Cross of Idaho Online Provider Directory.
Electing or Declining Coverage
To enroll yourself and eligible dependents, you must complete an enrollment form and return it to Human Resources. To decline coverage, complete the declination of coverage section of the medical enrollment form and return it to Human Resources.
Once you have enrolled in a medical plan, (PPO or Traditional), you may not change to the other plan type until the next Open Enrollment period.
Changing Elections
After your initial enrollment period, you may:
- Add family members at any time. You have 60 days to enroll new family members acquired through marriage, birth or adoption, in which case their coverage will begin the first of the month after they became part of your family (or, in the case of newborns and newborn adoptive children, on the date of birth). If you wait longer than 60 days to enroll them, coverage will be effective the first day of the month following the date you complete the enrollment form.
- Drop coverage for yourself or dependents at any time, (effective date being the first of the month after an election form is completed).
Filing Medical Claims
After you enroll, you will receive an identification card from Blue Cross of Idaho. Whenever you receive services from a participating or In-Network provider, just show your ID card - the provider will bill the plan on your behalf.
When you use a Non-Participating or Out-of-Network provider, you may have to make a claim for reimbursement.
- Submit a detailed invoice from your provider. Be sure to include your name, Blue Cross of Idaho subscriber identification number, and the name of your employer. The address is:
Blue Cross of Idaho
PO Box 7408
Boise, ID 83707