PPO options grant members greater benefits if they access care through a physician in the network and use network providers for health services. The member does not have to select a primary care physician and can self-refer to any specialist physician in the network. If non-network providers are used, benefits are still payable but at a lower percentage and after a deductible is satisfied.
- Blue Cross Blue Shield Preventive Care Guidelines
- If provided or authorized by a network physician, expenses for routine physical exams, well baby & child care, immunizations, mammograms, etc., are covered at 100%.
- The Concordia Health Plan (CHP) does not provide coverage under Preventive Care Services for the following:
- Contraceptive methods and counseling
- Counseling for Domestic Violence - For members in a CHP PPO Option, Counseling for Domestic Violence and HIV are covered under the CHP behavioral health benefit administered by Cigna Behavioral Health. For members in Option HDHP, behavioral health benefits are administered by Blue Cross Blue Shield of Minnesota.
- Counseling for HIV
- Blue Cross Blue Shield Preventive Care Recommendations - These guidelines are recommended preventive care, however, your physician should always verify coverage.
- Charges for out-of-network care and services are not covered.
- If preventive doctor visits or screenings reveal potential medical concerns, your visit could change from preventive care to medical treatment or diagnosis for billing purposes.
- Provider Preventive Care Notice - A preventive care notice that you can share with your doctor to explain the preventive care billing process. We encourage you to print this notice and take it with you to your preventive care visits.
- One manual breast pump per pregnancy/delivery is covered as a preventive service at 100% under the Concordia Health Plan Options A – E and HDHP. The pump must be purchased through the medical benefit from a participating Durable Medical Equipment (DME) provider* – not a pharmacy benefit or retail store. BCBS does not require a prescription to process DME breast pump claims, but DME providers may require a prescription. The breast pump can be purchased prior to delivery and up to six- months postpartum.
*Choose "Support and Other Services", National BlueCard PPO, and your zip - after clicking enter, under “Other Service Type,” choose “DME/Medical Supplies” and search again.
Shingles Vaccine Coverage
Seasonal Flu Vaccine Coverage
- 100% covered with a network PPO provider as well as Express Scripts pharmacy network for Concordia Health Plan (CHP) members age 50 and older.
- October 1 - June 1: 100% covered. Members can present their Express Scripts prescription drug card at Express Scripts vaccine network retail pharmacies and receive the seasonal flu vaccine (shot or FluMist).
- If a member receives the vaccine at a pharmacy that does not participate in the Express Scripts vaccine network, the member would pay for the costs associated with the vaccine and submit a manual claim to Express Scripts for reimbursement.
- 100% covered at a participating provider’s office with no cost at time of service.
- If a member receives the vaccine at another provider (including community clinics), the member pays for upfront costs, and may submit a manual claim and receipt to BCBS for reimbursement. The receipt should show: provider name and address, date of service, type of service (flu vaccine), and service charges.