Insurance

Moline-Coal Valley School District No. 40 provides health insurance coverage through Blue Cross and Blue Shield of Illinois for eligible staff members, retirees and their dependents. A summary of the District’s various health insurance programs, Frequently Asked Questions, and insurance forms can be found in the sections below.

The District’s life insurance and long term disability (LTD) insurance programs are currently administered by Blue Cross Blue Shield of IL. The District provides eligible staff with $50,000 worth of term life insurance with the ability to purchase additional coverage for the member and dependents.

The District provides an Employee Assistance Program (EAP) through ComPsych via Guidance Resources. for staff members and their families. The EAP may be accessed by calling 866-899-1363.

For additional information regarding the District’s insurance programs you may access the websites listed below, or contact the Insurance Office at the Moline-Coal Valley Education Center at (309) 743- 8115.

Insurance and Physical Exams

General Insurance FAQ

Q. What is the calendar year deductible for health insurance?

A. $1,000 per individual, $2,000 per family, in network.

Q. What is the annual Out-of-pocket limit for health insurance?

A. $4,000 per individual, $8,000 per family, in network. (Includes deductible)

Q. How do I find out if my deductible or out-of-pocket has been met?

A. Register for Blue Access for Members on www.bcbsil.com to view claims, access explanation of benefits (EOB’s), estimate procedure costs, look up in network providers, and have access to many health and wellness tools.

Q. How do I sign up for Blue Access for Members?

A. BCBSIL helps you get the most out of your health care benefits with Blue Access for Members (BAM). You and all covered dependents age 18 and up can create a BAM account.

1. Go to bcbsil.com/member.

2. Click "Register Now" (or use this link).

3. Use the information on your BCBSIL ID card to sign up.

Q. Do all services require pre-certification with BCBS?

A. No, only hospital admittances require a pre-cert. Out-patient services do not.

Q. What pharmacies are in network? Are any pharmacies excluded?

A. The pharmacy network is the Preferred Pharmacy Network. Locally, those would include Walgreens, Walmart, Osco Drug, Amicare and Sams Club. You can also sign up for mail order through Express Scripts express-scripts.com/rx 833-715-0942, or for specialty drugs, order through Accredo accredo.com 833-721-1619. There are additional pharmacies in network that can administer vaccines only, however, CVS is excluded from use for Rx or vaccine administration.

Q. Do I have health insurance coverage while traveling abroad?

A. If you are outside of the US, Puerto Rico and US Virgin Islands, you may be able to take advantage of the Blue Cross Blue Shield Global Core when accessing covered services. Contact 800-810-2583 for assistance.

Q. What is MDLIVE and how do I access it?

A. Speak with a doctor – anytime, anywhere! Virtual visits allows you to consult a doctor for non-emergency situations by phone, mobile app or online video. Activate your account now so you can access this benefit when you need it! As of January 1, 2023, Talk Therapy is also available as part of this service.

1. Visit MDLIVE.com/bcbsil.

2. Click “Activate Now”.

3. Enter your BCBSIL Member ID # (found on your insurance card) and date of birth.

Once you are in your MDLIVE portal, you will want to load your personal information (allergies, etc.) and pharmacy information

Q. Do we have dental insurance?

A. Yes, dental coverage is available through MetLife. You can sign up for an account to view benefits, look up providers and print an ID card through mybenefits.metlife.com

Q. Do we have routine vision coverage?

A. Voluntary Vision coverage is available as a separate election through United Healthcare. Open enrollment occurs each year during the month of November with coverage beginning in January. If you are enrolled in the vision, you can access your account, look up providers and print an ID card by going to www.myuhcvision.com

Q. How many counseling sessions are available through our Employee Assistance Program?

A. Three face to face counseling sessions each for staff and dependents. Please call Disability Resources at 866-899-1363 to schedule an appointment. Web based resources are also available at guidanceresources.com company ID DISRES

12. How much life insurance does the District provide for eligible staff?

A. $50,000 worth of term life for the member for the length of employment. Eligible staff may also purchase supplemental life and dependent life insurance at your own cost. IMRF staff may purchase life insurance through the NCPERS program.

Q. Does the District provide Long Term Disability Insurance?

A. Yes, eligible staff have Long Term Disability Insurance provided by the District. You may also be eligible for Disability through your pension provider. For more information, contact the insurance office.

Q. What is the “Spousal Rule”?

A. Eligible staff may cover their spouse under the health insurance, however, if the spouse is eligible for insurance through his/her employer, they must enroll in coverage with their employer as their primary coverage and can be covered as secondary under the District plan, as long as their other insurance is not a health savings account. The District offers only single and family rates for medical and dental insurance, there is not a separate rate to cover children only.

Q. When can I make changes in my insurance?

A. The open enrollment period, held each year during the month of November, is your only opportunity to enroll, change, or cancel most of your benefit elections, unless you have a qualifying life event during the year. Examples of qualifying life events include:

· Marriage

· Birth or adoption of a child

· Divorce

· Loss of other insurance coverage

If you experience one of these events and want to elect, change, or cancel your coverage, you must notify the Insurance Office within 30 days of the event. Otherwise, you must wait until the next open enrollment for a January 1 effective date. Contact the insurance office for the appropriate enrollment or change forms.

Q. When do I need to have my wellness physical and tobacco form turned in?

A. Wellness physicals and tobacco forms must be completed and received in the insurance office between the dates of January 1 – December 1 of each calendar year if you are covered under the medical insurance. Please refer to the FAQ’s regarding physicals and tobacco certification forms for more information.

For any other questions regarding insurance related matters, contact 309-743- 8115.

Wellness Exams - FAQ

Q: Who is required to have an annual physical?

A: All Active Employees and Retirees (retirees under age 65) covered by the Moline-Coal Valley School District health plan and their covered spouses (if this is the spouse’s primary insurance carrier) are required to have annual physicals, however we recommend you do this on your own as part of living a healthy lifestyle. If you are a Retiree or a spouse of a covered Retiree and you are over the age of 65, this is not required. You do not have to submit physicals on dependent children.

Q: Why have an annual physical exam?

A: Health experts agree that it’s easier, less expensive and more effective to prevent illnesses like obesity, cardiovascular disease and diabetes rather than treat them. Simple lifestyle habits like eating healthy, exercising, avoiding tobacco and seeing your healthcare network provider each year can make a big difference in your health now – and in the future.

Q: Who can perform an Annual Wellness Visit?

Physician (doctor of medicine or osteopathy)
Physician assistant
Nurse practitioner
Clinical nurse specialist
Medical professional (including a health educator, a registered dietitian, nutrition professional, or other licensed practitioner) or a team of such medical professionals working under the direct supervision of a physician (doctor of medicine or osteopathy)

Q: How much will the physical exam cost?

A: Wellness exams provided by a Blue Cross Blue Shield in network provider are covered 100% by your insurance with no cost sharing. When scheduling your appointment, be sure to tell them you are scheduling for the purpose of your wellness exam. If you are charged an office visit

copay, then the doctor’s office did not code your visit as preventive/wellness. Please note that if you are being treated for a condition in which you take regular medication (ie: high blood pressure, diabetes, high cholesterol) your doctor will most likely code as a medical visit. In this case, be sure they sign the form as you will be charge an office visit copay even though it’s a checkup. It’s all in how the doctor codes your visit. Your EOB will reflect a medical visit, not physical history, and therefore will not be accepted.

Q: Do I have to wait a full year between visits to have my next physical?

A: No, you do not have to wait, you can actually have multiple physicals a year as there are no maximum visits on wellness visits.

Q: What services are considered Preventive?

A: Health Ed/Counseling Services, Immunizations, Routine Bone Density Test, Routine Breast Exam, Routine Colonoscopy, Routine Colorectal Cancer Screening-Lab, Routine Digital Rectal Exam, Routine Gynecological Exam, Routine Lab Procedures, Routine Mammogram, Routine Pap Smear, Routine Physical Exam, Routine Prostate Test, Smoking Cessation Program. Please keep in mind that if you have every had an abnormal test from some of these services such as a colonoscopy or mammogram, your doctor may associate a diagnosis code rather than a preventive code, which will then make these services go towards your deductible and coinsurance. Please be sure to communicate with your physician on how these services will be submitted to Blue Cross Blue Shield if you have had abnormal screenings in the past.

Q: Am I required to have all Preventive procedures that are listing above as applicable?

A: No, we are requiring that you get a routine physical examination as part of your preventive care on an annual basis. Any screenings, blood work, etc is to be performed at the discretion of your doctor and is based on your health, gender, age and family history. Only proof of the physical exam is required to be turned into the insurance office by either completing the form or submitting your Explanation of Benefits from Blue Cross Blue Shield no later than December 1.

Q: I have a heart issue and have follow ups on an annual basis, does this count as my annual exam?

A: No. You must have a regular physical exam including any lab work, if recommended, by your doctor.

Q: Does a routine pap smear and / or mammogram count as a physical exam?

A: No, your OBGYN will have to also perform a regular physical exam as well as order any blood work or other tests if he/she feels they are necessary. If your OBGYN will not perform a wellness physical, you will need to see your general practitioner.

Q: If I do not get my annual physical or my covered spouse does not get his/her annual physical, will I pay a penalty?

A: Yes, you will pay a surcharge in addition to your regular premium and will be locked into this rate for 1 year (January – December) For those that carry single coverage, the surcharge is $25 per month, and for family, the surcharge is $50 per month.

Wellness Physical Exam Form (PDF)

Vision Benefits

Blue Cross Blue Shield of Illinois

Tobacco Use and Cessation

Tobacco Use and Health Implications

Smoking and tobacco use can cause problems in many parts of your body and can lead to heart disease, heart attacks, high blood pressure, emphysema, lung cancer and other health problems.

Nicotine is an addictive mood-altering drug naturally found in tobacco and cigarettes. Over time, your body needs more nicotine to get that "good feeling" you might have gotten when you first started smoking. This makes quitting smoking hard.

People often try to quit many times before they are able to quit for good. But quitting will lead to better health for you and those around you. Good reasons to quit include:

·       You'll be healthier.

·       You will have more energy and breathe easier.

·       Your teeth will look better.

·       Your hair and clothes will smell better.

·       You will have a stronger sense of taste and smell.

·       You'll save money.

Your family and friends will be healthier if you quit smoking, too. Second-hand smoke can cause asthma and other health problems in people around you, especially children. If you're pregnant, and you quit smoking, your baby will get more oxygen and you'll be less likely to have problems with your pregnancy. You'll also lower your risk for heart disease and other health problems.

Some things that can help you quit smoking include:

·       Targeting a stop date and writing down your reasons for stopping.

·       Getting help from friends, family, your doctor and stop-smoking programs.

·       Lowering stress to curb the urge to smoke.

·       Choosing a specific plan to help you quit. Take medication, if necessary, and use it as directed.

·       Getting rid of all cigarettes, lighters, ashtrays and other smoking-related items.

·       Staying physically active. Exercise can help you fight cigarette cravings.

·       Preparing for slip-ups by focusing on your goals and reasons for quitting.

Physical feelings of quitting, such as headaches and crankiness most often start a few hours after the last cigarette but usually get better within 2–3 days. They get better every day you don't smoke. Breaking the smoking habit takes time, and you will need to change your daily routine to quit for good.

Quitting smoking now can help you live longer and stay healthier. People who quit smoking before the age of 50 cut their risk of dying in the next 15 years in half compared with those who keep smoking.

District 40 Tobacco User Certification

Frequently Asked Questions: Tobacco User Certification Revised 10/10/17

Q: Who is required to complete the Tobacco User Certification form:

A: All Active Employees and All Retirees covered under the Moline-Coal Valley School District insurance plan, even is this plan is secondary for your dependent, must certify if they or their covered family member is a tobacco user on an annual basis. This includes all ages of dependents.

Q: If my spouse or child is a tobacco user, will I have to pay the higher premiums even though I do not use tobacco products?

A: Yes, if you cover them under your insurance policy though the District, you will have to pay the penalty based on family coverage. For those that carry single coverage, the surcharge is $100 per month, and for family coverage, the surcharge is $200 per month. Regardless of the number of tobacco users in your family, the fee is based on what coverage you carry.

Q: My dependent child does not live with me and I don’t know if they are a tobacco user, how do I answer if I don’t know?

A: Please answer this question to the best of your knowledge, but if you do find they are a tobacco user, please re-certify your form.

Q: What is considered Tobacco under this certification?

A: Cigarettes, Cigars, Chewing Tobacco, and Pipe tobacco. E-cigarettes are still unclarified under the Affordable Care Act, so as of now, e-cigarettes are not considered tobacco, but this may change in the future.

Q: I have quit smoking and using nicotine gum, am I considered a tobacco user?

A: No, as long as you are not using actual tobacco products, you are not a tobacco user. Nicotine gum, patches and medications are considered tobacco cessation medications and are covered under the Blue Cross Blue Shield tobacco cessation program.

Q: If I am a social tobacco user and only smoke/chew once in a while, do I certify that I am a tobacco user?

A: The Affordable Care Act has determined that if you use tobacco products more than 4 times per week, you are considered a tobacco user. That is defined as 4 USES per week, for example, smoke only 4 individual cigarettes per week, or chew tobacco 4 dips per week, that is considered a social smoker. Please DO NOT confuse this with DAYS per week. If you are unsure of this, please contact the insurance office 309-743-8115.

Q: What if I lie on the form, or quit and start back up again?

A: The form we are having you complete to self-certify your tobacco use is considered a legal document. Dishonesty can result in premium back pay and/or possible job termination. Medical claims incurred as a result of a tobacco related illness may also be denied. If you or your covered family member were not using and are now, you need to certify a new form.

Q: How long do I have to quit?

A: You will have until January 1st of each year to recertify.

Q: If I answer yes now to using tobacco, but I quit a few months after the deadline, can I recertify and get the lower rate?

A. No, you will be locked into the higher rate for 1 year (January - December) until the next certification.

Q: Does Blue Cross Blue Shield have a smoking cessation program available?

A: Yes, call the customer service number on your card to enroll 1-800-828-3116.

Q: Does Blue Cross Blue Shield cover tobacco cessation medication?

A: Yes, As of Sept. 1, 2014, in addition to the currently covered tobacco-cessation counseling and screening for members who use tobacco products, Blue Cross and Blue Shield of Illinois covers, with no cost share, two 90-day treatment regimens for tobacco cessation medications per benefit period. This coverage includes a variety of FDA-approved tobacco cessation medications (including both prescription and over-the-counter medications) when prescribed by a health care provider (listed below).

Prescription	Over-the-Counter (OTC)
Buproban (bupropion SR 150 mg tablets)	Nicotine Transdermal Kits
Chantix	Nicoderm CQ and generics
Nicotrol Inhaler	Nicorette gum and generics
Nicotrol NS	Nicorette lozenges and generics
Zyban (bupropion SR 150 mg tablets)

Q: Where else can I find help to quit?

A: American Cancer Society http://www.cancer.org/healthy/stayawayfromtobacco/index American Lung Association http://www.lung.org/stop-smoking/

National Cancer Institute http://www.cancer.gov/cancertopics/tobacco/smoking SmokeFree.gov http://smokefree.gov/

Tobacco Certification Form (PDF)

BlueCross BlueShield of Illinois Employee Assistance Program

BCBS-IL Disability Services Flyer