City Colleges of Chicago 2013 Benefits Open Enrollment - Due Monday, December 10, 2012!
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City Colleges of Chicago
2013 Benefits
Open Enrollment
Monday, November 26 —
Monday, December 10, 2012
Mark your Calendars…. Enrollment Forms are
Due Monday, December 10, 2012!
Part-Time IBEWCity Colleges of Chicago 2013 Open Enrollment:
November 26 — December 10, 2012
Open Enrollment is your opportunity to consider whether your current benefit enrollments are the right choices for you
and your family and when you can make changes to your medical, dental and vision coverages. If you do not want to make
PPO & HMO medical, dental or vision changes, you do not need to do anything. Your current PPO medical, dental
and vision coverage will automatically be continued for calendar year 2013.
The plan rates are changing as of January 1, 2013. The HMO and PPO medical benefits you are eligible for will also be
changing, so you should carefully read the following information.
Any changes you make during Open Enrollment will take effect on January 1, 2013. Decisions made during Open
Enrollment are binding through December 31, 2013, unless you have a family status change, such as marriage or birth of a
child. Dependents who become eligible during the year can be added to your coverage within 31 days of the family status
change. Eligible dependents are your legal spouse, domestic partner, civil union partner, children regardless of student status,
and physically or mentally handicapped children (regardless of age, as long as they are covered under the plan prior to their
26th birthday). Adopted, foster and stepchildren are also eligible for coverage. Documentation will be required when you
add a dependent.
Before you do anything, please note the following:
If you want to keep your current PPO medical, dental or vision coverage, you do not need to complete new
enrollment forms. Your current coverages will automatically be continued for calendar year 2013 at the new rates
shown on pages 5 and 7.
You will also need to complete a new enrollment form if you want to:
Change your current medical coverage plan
Add or drop dependents from your current medical, dental or vision coverage
Drop your medical, dental or vision coverage entirely
If you change medical plans, enroll in the dental plan or add dependents to either plan, you will not receive
new ID cards from the medical or dental plan vendor until after January 1, 2013. You may contact the medical
or dental plan vendor for verification of coverage or additional coverage information (see page 8).
After carefully reviewing this brochure, the enrollment forms for making changes are available:
At the open enrollment meeting scheduled at each location
At the Internet link, www.ccc.edu under 2013 Benefits Open Enrollment
From your Human Resources Administrator at your college
From the District Office of Human Resources, Benefits Division
Completed Enrollment forms are due by Monday, December 10, 2012
Send to:
City Colleges of Chicago
Human Resources, Benefits Division
226 West Jackson Blvd., 12th Floor
Chicago, IL 60606
2 Part-Time IBEWMedical Plans
The purpose of the City Colleges of Chicago’s medical plans is to provide protection from catastrophic out-of-pocket medical
expenses. During Open Enrollment, you may select single or family coverage from either the BlueCross BlueShield Health
Maintenance Organization (HMO) Plan – HMO BlueAdvantage – or the Participating Provider Option (PPO) Plan. In
addition, you may add or drop coverage for a spouse or a dependent child. The bi-weekly contributions you make for the
medical coverage you choose are shown on page 5. Deductions will be taken from your pay on a before-tax basis over 24 pay
periods. (If you do not receive any pay during a pay period, the deductions missed will be taken on the next paycheck issued.)
BlueCross BlueShield Identification Cards
All BlueCross BlueShield medical plan participants will receive new identification cards for calendar year 2013 by December
31, 2012. At that time, please use the new card and discard any old ID cards. Please provide a copy of your new ID card to
your doctor’s office for their records.
HMO BlueAdvantage Plan
The HMO BlueAdvantage Plan offers you medical care from one of the largest HMO networks in Illinois with over
3,700 primary care physicians, 5,500 specialists and 75 hospitals. You select a contracting medical group and primary
care physician (PCP) to provide your care and must obtain a referral from your PCP to see a specialist. You can select
a different PCP for each family member; HMO BlueAdvantage provides you with ID cards for each family member.
You can also change your PCP within the same medical group at any time. In order to change to a new PCP in a
different medical group, simply call (800) 892-2803.
HMO BlueAdvantage provides preventive services such as routine physical examinations and immunizations as well as
expanded coverage that include a vision care program and access to health care benefits when traveling or temporarily
living outside of Illinois. “Guest Membership” is especially valuable for members on extended travel out of state or for
covered students who are living out of state while attending school.
To see if your current doctor is part of the HMO BlueAdvantage network or to help find the medical group and
PCP of your choice, search the Provider Finder® online at www.bcbsil.com, or call (800) 892-2803. If you are
choosing a new doctor, you may want to call the medical group to verify that the PCP is accepting new patients and
to request that your medical records be transferred from your current doctor. You may choose a different PCP for
each family member
If your current doctor is not in the HMO BlueAdvantage network and you or a family member are undergoing a
course of evaluation/treatment or will be in the second or third trimester of pregnancy when you join the plan on
January 1, 2013, you may request Transition of Care benefits. For more detailed information, call (800) 892-2803.
You will need to apply for these benefits by completing a Transition of Care Form available at www.ccc.edu under
2013 Benefits Open Enrollment
For more information about the plan, see the summary on page 9, the HMO BlueAdvantage information at the CCC web
site shown above, call (800) 892-2803, or go to www.bcbsil.com/member.
3 Part-Time IBEWMedical Plans Cont.
PPO Plan
The PPO Plan gives you freedom of choice and greater flexibility than the HMO Plan. You are not required to choose a
primary care physician and do not need a referral to see a specialist. The PPO offers a large network of contracting doctors
and hospitals – more than 33,000 physicians and specialists and over 200 hospitals in Illinois. In addition, PPO members have
access to care anywhere they live, work or travel, across the country and around the world.
When you use network providers, your benefits are paid at a higher level and your out-of-pocket expenses are lower due to
the provider discounts negotiated by BlueCross and BlueShield. The plan requires payment of deductibles and coinsurance
until you satisfy the out-of-pocket limit each calendar year. To find a doctor in the network, use the Provider Finder® at
www.bcbsil.com.
The plan will cover preventive services such as routine physical examinations. Benefits for mammograms, pap smear tests,
prostate tests, digital rectal examinations and colorectal screenings will also be provided. Vision and hearing discounts and
online health and wellness resources to help you manage your health care are also available.
Before you do anything, please note the following:
If you want to continue your current PPO medical coverage, you do not need to complete a new enrollment
form. Your coverage will automatically be continued for calendar year 2013 at the new rates shown below
If you want to change your medical coverage plan, to add or drop dependents, or to drop your medical
coverage entirely, you need to complete the appropriate medical enrollment form. The change you make will
be effective on January 1, 2013
If you are currently enrolled in a BlueCross BlueShield Medical Plan, you will receive a new identification
card by January 1, 2013. Please discard any old ID cards, and use the new cards
If you change medical plans, or add dependents, you will not receive a new ID card from the medical plan
vendor until after January 1, 2013. You may contact the medical plan vendor for verification of coverage or
additional coverage information (see page 8)
After carefully reviewing this brochure, the enrollment forms for making changes are available:
At the open enrollment meeting scheduled at each location
At the Internet link, www.ccc.edu under 2013 Benefits Open Enrollment
From your Human Resources Administrator at your college
From the District Office of Human Resources, Benefits Division
4 Part-Time IBEWMedical Plans Cont.
2013 Bi-Weekly Employee Contributions
BlueCross BlueShield
Single Coverage Family Coverage
Medical Plans
PPO $ 224.33 $612.09
HMO BlueAdvantage $220.00 $632.57
5 Part-Time IBEWDental and Vision Plans
The purpose of the City Colleges of Chicago’s dental and vision plans is to provide protection from large out-of-pocket
dental and vision expenses, and to encourage preventive care. During Open Enrollment, you may add or drop coverage for a
spouse or dependent child, or drop your coverage entirely. The bi-weekly contributions you make for dental and vision
coverage are shown on page 7. Deductions will be taken from your pay on a before-tax basis over 24 pay periods. (If you do
not receive any pay during a pay period, the deductions missed will be taken on the next paycheck issued.)
Dental Plan
The Dental Plan reimburses 100% of usual and customary (U & C) charges for preventive services (exams, cleanings and x-
rays every 6 months) and 80% of U & C charges for other covered services including fillings, crowns, root canals, periodontal
treatments and dentures. An individual $10 deductible applies each calendar year for all covered dental services except
preventive services. The maximum benefit for each family member is $1,500 per calendar year.
You can go to the dentist of your choice or to a dental provider in the Humana/CompBenefits PPO dental network of over
100,000 general dentists and specialists in all 50 states. To see if your current dentist is in the Humana/CompBenefits dental
PPO network or to find a network dentist, search the Provider Locator at www.compbenefits.com, go to www.ccc.edu
under 2013 Benefits Open Enrollment (section C), or call (800) 342-5209. You may choose different dental providers
for each family member. Since over 50% of the dentists in the Chicago Metropolitan area are in the Humana/CompBenefits
PPO dental network, there’s a good chance that your current dentist is a network provider and can continue providing
dental services to you at a reduced cost.
To determine your potential savings from using a network provider, you will need to contact the dental provider
you’ve selected for the negotiated service fees. On average, dental fees of network providers are generally 25% to 30%
less based on the discounts negotiated by Humana/CompBenefits. Therefore, for covered non-preventive services,
you pay 20% of a reduced amount that saves you money and allows you to receive more dental services before you
reach the $1,500 annual benefit maximum per family member.
The plan also pays a benefit of 50% for orthodontic treatment for dependent children only. If your dependent child is
undergoing orthodontic treatment under another group dental plan, you will need to complete an Orthodontic
Transition of Care Form available at the CCC website shown above and send it to Humana/CompBenefits by
December 31, 2012.
For more information about the plan, see the Dental Plan information in section C of the CCC web site shown
above, call (800) 342-5209, or go to www.compbenefits.com.
Vision Plan
The Vision Service Plan (VSP) offers you flexibility in choosing which provider to use for your vision care. You may
choose between a VSP provider or an out-of-network provider. Benefits are significantly higher if you select a VSP
network provider. The plan benefits include examinations and lenses every 12 months, and frames every 24 months.
There is an individual $10 copayment each calendar year for all covered services.
For more information about the plan, see the Vision Plan information in section C of the CCC web site at
www.ccc.edu under 2013 Benefits Open Enrollment, call (800) 877-7195, or go to www.vsp.com.
6 Part-Time IBEWDental and Vision Plan Cont.
Before you do anything, please note the following:
If you want to continue your current dental or vision coverage, you do not need to complete new enrollment
forms. Your coverages will automatically be continued for calendar year 2013 at the new rates shown below
If you want to add or drop dependents from your current dental or vision coverages, or drop your coverage(s)
entirely, you need to complete new enrollment forms indicating the changes you want to make. The change you
make will be effective on January 1, 2013
If you enroll in the dental plan or add dependents, you will not receive new ID cards from the dental plan
vendor until after January 1, 2013. You may contact the dental plan vendor for verification of coverage or
additional coverage information (see page 8)
Additional dental and vision plan information and enrollment forms for making changes are available:
At the open enrollment meeting scheduled at each location
At the Internet link, www.ccc.edu under 2013 Benefits Open Enrollment
From your Human Resources Administrator at your college
From the District Office of Human Resources, Benefits Division
2013 Bi-Weekly Employee Contributions
Plan Single Coverage Family Coverage
CompBenefits Dental $16.01 $44.68
VSP Vision Service Plan $3.83 $8.23
7 Part-Time IBEWImportant Telephone Numbers
You can obtain the following information by contacting the medical, dental and vision plan vendors shown below:
Verification of coverage under each plan
Covered and non-covered services, deductibles, copays and maximum out-of-pocket limits
Providers participating in each plan
Additional medical and dental plan identification cards
Customer Prescription
Group
Plan Service Customer Address Internet Address
Number
Number Service
BlueCross B09937 (800) 892-2803 Prime BlueCross BlueShield www.bcbsil.com/member
BlueShield Therapeutics: PO Box 805107
HMO (800) 423-1973 Chicago, IL 60680
BlueAdvantage
BlueCross P35146 (800) 772-6895 N/A BlueCross BlueShield www.bcbsil.com/member
BlueShield PO Box 805107
PPO Chicago, IL 60680
Medical
CVS Caremark CRXCC N/A (877) 542-0285 CVS Caremark www.caremark.com
PPO PO Box 94467
Prescription Palatine, IL 60094
CompBenefits CD0739 (800) 342-5209 N/A CompBenefits www.compbenefits.com
Dental P.O. Box 8236
Chicago, IL 60680
Vision 12-00-1733- (800) 877-7195 N/A VSP www.vsp.com
Service Plan 0001 P.O. Box 997100
(VSP) Sacramento, CA
95899
8 Part-Time IBEWHMO PPO Plan PPO Plan
Benefit Highlights
BlueAdvantage In-Network Out-of-Network
Plan
Annual Deductible
Individual None $500 $1,000
Family None $900 $1,000 per family member
Annual Out-of-Pocket Maximum
Individual $1,500 $2,500 (including deductible) $3,000 (including deductible)
Family $3,000 $4,000 (including deductible) $9,000 (including deductible)
Lifetime Maximum Benefit
(per person) Unlimited Unlimited
Preventive Care Services
(No co-payment, deductible or co-insurance) 100% 100%
Physician Services
Office Visit - Primary Care Physician 100% (after $25 copay) 80% (after $10 copay)
70%
Office Visit - Specialist Physician 100% (after $35 copay) 80% (after $20 copay)
Hospital Services *
Inpatient or Outpatient 100% (after $300 copay) ** 80% (after $100 copay) 70%
Emergency Room Visit 100% (after $200 copay) 80% (after $175 copay) 70% (after $100 copay)
* PPO members must contact the Medical Services Advisory (MSA) at least 1 business day prior to a
non-emergency hospital admission and within 2 business days of an emergency or maternity hospital
admission; otherwise, an additional $500 copay applies.
** There is no copay for outpatient preventive endoscopic surgical procedures such as colonoscopies.
Mental Health Services
Inpatient 100% (after $300 copay) 80% 70%
Outpatient 100% 80% 70%
Chemical Dependency Services
Inpatient 100% (after $300 copay) 80% 70%
Outpatient 100% 80% 70%
Other Covered Services
(e.g., physical therapy, home health care) 100% (after $15 copay/visit) 80%
Prescription Drugs
Retail (30 day supply)
Reimbursed at 75% of network
$20 $10
Generic Copay rate minus $10 copay
Reimbursed at 75% of network
$30 $20
Brand Formulary Copay rate minus $20 copay
Reimbursed at 75% of network
$45 * $40 *
Brand Non-Formulary Copay rate minus $40 copay
Mail-Order (90 day supply)
Reimbursed at 75% of network
$40 $20
Generic Copay rate minus $20 copay
Reimbursed at 75% of network
$60 $40
Brand Formulary Copay rate minus $40 copay
Reimbursed at 75% of network
$90 * $80 *
Brand Non-Formulary Copay rate minus $80 copay
* If you choose a non-formulary drug when a generic is available, you pay the cost difference between
them in addition to the copay.
This sheet only highlights the benefit plans. For additional information, contact the District Office of Human Resources, Benefits Division.
9 Part-Time IBEWLegally Required Annual Notices For
Medical Plan Participants
The following notices are being provided to you as required by federal law. Your City Colleges of Chicago
(CCC) medical plan is in compliance with these mandates and provides coverage for these benefits.
If you have questions about these notices, please contact BlueCross BlueShield as shown below:
PPO Plan: Call (800) 772-6895 or go to www.bcbsil.com/member
HMO BlueAdvantage Plan: Call (800) 892-2803 or go to www.bcbsil.com/member
The Newborns’ and Mothers’ Health Protection Act (NMHPA)
Group health plans and health insurers may not, under federal law, restrict benefits for hospital length of stay in
connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or
96 hours following a cesarean section. However, federal law does not prohibit the attending provider, after
consulting with the mother, from discharging the mother or newborn earlier than the applicable 48 or 96 hours.
Federal law also does not require the attending provider to obtain the plan’s authorization for length of hospital
stays that do not exceed the applicable 48 or 96 hours. An attending provider does not include a plan, hospital,
managed care organization or other issuer.
Women’s Health and Cancer Rights Act (WHCRA)
Federal and State of Illinois legislation require group health plans and health insurers to provide coverage for
reconstructive surgery following a mastectomy. Specifically, these laws state that health plans that cover
mastectomies must also provide coverage in a manner determined in consultation with the attending physician
and patient for:
reconstruction of the breast on which the mastectomy has been performed;
surgery and reconstruction of the other breast to produce a symmetrical appearance
prostheses and treatment for physical complications for all stages of mastectomy, including lymphedemas
(swelling of the lymph glands).
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