Can I check claims online?
Yes. Just log in to the member website, select "Members," and then select the "Your Spending" tab. On this tab, choose "View Your Claims." You will be able to search Medical claims online.
Does GuideStone offer COBRA?
No, GuideStone's medical plans are exempt from COBRA, but we do have a provision for continuation of some insurance products depending on the situation. More information regarding this policy.
What does "coinsurance maximum" mean?
The maximum amount for which you are responsible, in addition to applicable deductible, for eligible expenses incurred during the benefit period (generally, in one year).
What is a copay?
The fixed, up-front dollar amount you pay for certain covered expenses. Office visit copay amounts do not apply toward your deductible or coinsurance, and they do not accumulate toward the out-of-pocket maximum.
What is the difference between “Deductible” and “Family deductible”?
The deductible is the up-front out-of-pocket expense. Participants must meet their deductible with eligible charges before claims will be paid. The family deductible is when family members, together, meet the plan amount determined to be the family deductible. Then, the plan will consider all family members to have met their deductibles. One individual cannot contribute more than the individual deductible amount toward the family deductible.
How do I find doctors who have evening or weekend hours?
Click the "Find a doctor, hospital or other medical provider" link on the Highmark BCBS Home Page, then access the advanced search page. Near the bottom you can check to have the search results return only providers who have evening or weekend hours.
How do I find a summary of healthcare expenses?
Log in to the member website, select the "Members" tab, select the "Your Spending" tab and then choose "View Your Expense Summary." You will be able to view and/or download a summary of healthcare expenses.
How do I find information regarding hospital quality?
Log in to the member website, select the "Members" tab, select the "Choose Providers" tab. You will find choices to select and can compare hospitals.
I've been enrolled for coverage; when will I receive my ID cards?
Health plan participants should receive two separate ID cards, one from Highmark Blue Cross Blue Shield (for healthcare), another from Medco Health (for prescriptions). You should receive your ID cards within a few weeks of your enrollment date. If you need to see a doctor or fill a prescription before your new ID cards have arrived, please contact your HR department or refer to the Important Reminders page of your enrollment packet for instructions.
Note: Medco Health allows the option of printing a temporary ID card for prescriptions. Simply create an account at www.Medco.com.
How do I locate providers who accept GuideStone's PPO plans?
GuideStone plans utilize the Blue Cross Blue Shield "BlueCard" PPO network. This is the largest national provider network in America. In fact, one in three Americans — 88 million people — are covered by BCBS. BCBS negotiates significant provider discounts for in-network care, resulting in lower out-of-pocket healthcare expenses for participants. BCBS maintains an easy-to-use website for fast access to claims, medical information and provider searches. You may also locate participating doctors and hospitals by calling the BCBS toll-free provider search hotline at 1-800-810-BLUE (1-800-810-2583).
Do GuideStone PPO plans cover maternity care?
Yes, all of our PPO plans include maternity coverage. It does not need to be purchased separately.
New applicants who are eligible for a Group Plan and expecting a baby will not be excluded because of pregnancy. Maternity care will be covered according to your plan's benefits.
For participants enrolled in a GuideStone PPO plan, Highmark BCBS also offers an education and support program called Baby BluePrints. This program is designed to help expectant families better understand every stage of pregnancy and make more informed care and lifestyle-related decisions. Enrollment is voluntary. If an expectant mother is interested, she can contact Highmark to enroll at 1-866-918-5267. Program offerings include the following:
- Access to pregnancy-related information on the member site.
- Baby BluePrints enrollment package.
- Vouchers for free gifts throughout pregnancy.
- Proactive outreach, nurse health coaching and/or case management.
- Postpartum depression program.
- Reimbursement for childbirth education classes (taken at any location).
If I lose my ID cards, can I order new cards online?
Yes. Just log in to the member website, select "Members," select the "Your Coverage" tab and then choose "Request ID Cards." You will be able to request ID cards online and receive them via U.S. mail within 7–10 days.
Do GuideStone health plans cover pre-existing conditions?
If you or your dependents have had at least 12 months of continuous medical coverage prior to applying for GuideStone's health plans, there are no pre-existing condition limitations on your GuideStone plan. You must submit a Certificate of Creditable Coverage from your former insurer, if applicable, as proof of prior coverage for GuideStone to waive any limitations.
If you did not have medical coverage for a full 12 months, or if there was a break in coverage of more than 63 days, GuideStone medical plans have a pre-existing condition limitation. This limitation restricts coverage for a 12-month* period for you or your dependents’ pre-existing conditions.
A pre-existing condition, whether physical or mental, is a condition for which medical advice, diagnosis, care or treatment was recommended or received within the six-month period prior to enrolling in the plan. As of October 1, 2010, pre-existing condition limitations have been eliminated for individuals under age 19.
If a condition is considered to be pre-existing, benefits for treatment of this condition will be limited only for the first 12 months. Any conditions unrelated to the pre-existing condition will receive standard benefits according to the plan.
*The limitation period may be shortened if you or your dependents’ previous coverage ended fewer than 63 days before your GuideStone application for coverage was received. When GuideStone receives proof of prior medical coverage, we will notify you of any reduction to the limitation period.
What is a primary care physician copay?
The amount you pay for an office visit to a network primary care physician such as a pediatrician, general practitioner, family practitioner, internist or gynecologist.
What is a PPO provider or network provider?
A Preferred Provider Organization (PPO) is a network provider — a doctor, hospital or other health care facility that has entered into a contract to provide medical services or supplies at agreed-upon rates to you or your covered dependents under the plan.
Who is considered a "specialist"?
Any physician not considered a primary care physician. Chiropractic care is paid according to standard plan provisions (number of visits annually are limited).
What wellness and preventive care services are covered on GuideStone’s PPO Plans?
Covered services are based on a preventive health schedule which includes preventive services for children and adults based on recommendations from the U.S. Preventive Service Task Force, the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. View the Preventive Care Schedule.
I need to file a claim. What do I need to do?
This depends on what kind of claim it is.
- For services received domestically from in-network providers, you do not need to do anything. The provider files the claim on your behalf.
- For services received domestically from out-of-network providers, you are responsible for submitting the claim. Use the out-of-network claims form and follow the instructions on the form.
- For services received overseas, you are responsible for submitting the claim. Use the BlueCard International Claim Form and follow the instructions on the form.
How do I see my prescription information on Medco’s website?
To review your prescription history, simply:
- Log in with your email address and password at Medco's website.
- To view information on your prescription or your prescription history, click on “Prescription history” on the left side menu bar.
Note: To verify your identity, you may be asked to enter the Rx number from a recently filled retail or mail-order prescription. This should be located on your prescription. If you do not have your Rx number, please contact Medco at 1-800-555-3432.
To find information on a specific prescription, enter the prescription number (Rx number) in the box at the top of the “Prescription history” page and click “go.”
How do my prescription benefits work?
As of January 1, 2012, your medical plan no longer has a separate prescription drug deductible. That means that you and your medical plan will share the cost of prescriptions immediately. You will pay 20% of the drug costs up to a maximum amount per prescription. Please be sure to provide your pharmacist with your ID card before filling a prescription.