Summary of Medical Benefits (pdf)
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Choice Option Medical Plan Document (pdf)
Classic Option Medical Plan Document (pdf)
Basic Option Medical Plan Document (pdf)
Plan Amendment for Classic, Choice and Basic-April 2009 (pdf)
Michelle’s Law Medical Plan Amendments Jan 2010 (pdf)
- How do I get another ID card?
- Contact Allied at 800-288-2078 or click on Get ID Card.
- How do I answer the question, "WHAT INSURANCE DO YOU HAVE?"
- The doctor, hospital or provider is really asking you where do I send claims and who is paying the bill? The best answer is - Allied is the payor so send claims to the Allied address located on the ID card. BHP contracts with Allied to process all medical and dental claims. The real payor is you, the employees of the Butler Health Plan. Your premium dollars pay each claim-medical, prescription and dental.
- What is a Preferred Provider Organization (PPO)?
- A PPO is a large network of doctors and hospitals that agree to discounted fee.
Our primary PPO network, HealthSpan Preferred, provides employees and their families protection from health care costs. The PPO allows for discounted prices; you pay less and are protected from "balance billing" when you use an In-Network provider.
- A PPO is a large network of doctors and hospitals that agree to discounted fee.
- Is my doctor or hospital In-Network or Out-of-Network?
- Please call HealthSpan at 1-888-914-7726 or 513-551-1400 to verify In-Network Providers. If your provider is not in HealthSpan, call MultiPlan at 1-800-672-2140 or Emerald at 1-800-346-3141. MultiPlan is the national PPO network available to you when traveling or for students attending college out-of-state.
Although online directories are provided by HealthSpan and MultiPlan, the most current information is available by calling the PPOs. It is the member's responsibility to verify that the provider is in the network before the appointment is made.
- Please call HealthSpan at 1-888-914-7726 or 513-551-1400 to verify In-Network Providers. If your provider is not in HealthSpan, call MultiPlan at 1-800-672-2140 or Emerald at 1-800-346-3141. MultiPlan is the national PPO network available to you when traveling or for students attending college out-of-state.
- Do I need a referral to see a Specialist?
- No. You may self-refer to any physician in the network.
- My child attends a college out of the PPO Network region. How will the plan pay for medical, dental and prescription services?
- Emergency or Urgent Care claims away from home for college students are paid at the in-network benefit level. Other non-urgent services like check ups or non-emergency surgery are paid at the out of network benefit level unless you find a provider in the MultiPlan national PPO network which is listed on the back of your ID card. If you cannot find a provider in the national network, you may schedule the non-urgent services with the local in-network provider over the summer, semester breaks or times when the student is home.
There is no dental network so claims are paid at the current benefit level.
Express Scripts is a national company with pharmacies in every state. If your drug card was not accepted, you may send in your receipt for reimbursement consideration on a Express Scripts form with an attached receipt.
- Emergency or Urgent Care claims away from home for college students are paid at the in-network benefit level. Other non-urgent services like check ups or non-emergency surgery are paid at the out of network benefit level unless you find a provider in the MultiPlan national PPO network which is listed on the back of your ID card. If you cannot find a provider in the national network, you may schedule the non-urgent services with the local in-network provider over the summer, semester breaks or times when the student is home.
- What is the MultiPlan Network?
- This nationwide network of hospitals and doctors is offered in 50 states. When you are out of the tri-state region, call the Multiplan number on your ID card to locate a provider to get a discount on out-of-network claims and avoid the usual and customary charge.
- What is the Lab Card Program?
- A total voluntary benefit of free outpatient laboratory testing is available to you. You may request that your doctor's office collect your specimen and send them to Lab Card for testing. When your specimens are sent to Lab Card, BHP pays the full cost of outpatient laboratory work covered by the Plan. If you do not request Lab Card, your regular benefits will apply. Download Lab Card Description.
- Who do I notify for emergency admission or inpatient hospital stays?
- The provider must call the HealthSpan number on the back of the ID card to pre-certify a hospital admission. Your plan has a non-compliance penalty so be certain a call is made. Notify within two working days of emergency or urgent admissions. When the office is closed, you may leave a message and a Registered Nurse will return your call.