Can I check claims online?
Yes. Just log in to the member website (www.highmarkbcbs.com), 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.
How do I find doctors who have evening or weekend hours?
Click the "Find a doctor, hospital or other medical provider" on the Highmark BCBS Home Page (www.highmarkbcbs.com), 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 (www.highmarkbcbs.com), 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 (www.highmarkbcbs.com), select the "Members" tab, select the "Choose Providers" tab. You will find choices to select and can compare hospitals.
If I lose my ID cards, can I order new cards online?
Yes. Just log in to the member website (www.highmarkbcbs.com), 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.
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.
If I am declined for coverage, is my family still eligible?
No, under GuideStone Insurance Plans, dependents are only eligible for coverage if the eligible employee, retiree or student also has coverage.
What is underwriting?
Underwriting only applies to employers with less than 10 employees.
Underwriting is a review of an applicant's health to determine insurability. Coverage in GuideStone health plans is not effective until our underwriter approves the participant’s coverage. The underwriting process typically takes four to six weeks but could take longer during busier times of the year or if an application is incomplete. GuideStone recommends that applicants continue their prior insurance coverage until they receive a decision from our underwriter and GuideStone coverage is effective.
Term life, medical and disability plans require underwriting. Dental and accident plans do not require underwriting.
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.
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.
Do GuideStone PPO plans cover maternity care?
Yes, all of our PPO plans include maternity coverage. It does not need to be purchased separately.
Personal Plans
New applicants who are expecting a baby will not be excluded because of pregnancy and, if approved for health coverage, the maternity care will be covered according to your plan's benefits.
Group Plans
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:
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).
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.
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 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.
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 Preventive Care Schedule (pdf).
Can I change my health insurance mid-year?
Mid-year changes are generally not permitted unless the change is made within 60 days of one of the following qualifying events:
- Marriage/divorce
- Birth/adoption/placement for adoption
- Death
- Disability
- Continuation
- New employment (includes new seminary students)
- Loss of eligibility (termination of employment, layoff, seminary graduation, retirement)
Medical and dental plan changes are allowed during re-enrollment each fall. You should receive information with the rates and plan changes in early October. Your new plan(s) will be effective the following January 1.
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:
www.highmarkbcbs.com. 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).
What is re-enrollment?
Personal Plans
Each year medical and dental plan participants will receive a packet of information with rates and plan changes for the upcoming year. You have until the stated deadline (typically mid to late November) to elect (or re-enroll) into a medical and/or dental plan for the upcoming calendar year. To complete the re-enrollment process, sign into your online account and choose "Re-enrollment" from the Insurance tab.
Group Plans
Each year the employer will receive a binder of information with rates and plan changes for the upcoming year. The employer has until the deadline (typically mid to late October) to elect (or re-enroll) into a medical and/or dental plan(s) for the upcoming calendar year. Participants will need to contact the plan administrator for further information.
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.
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 GuideStone for instructions.
(Note: Medco Health allows the option of printing a temporary ID card for prescriptions. Simply create an account at www.Medco.com.)