Did You Know?

At OSF HealthPlans, we want to make sure you are as informed as you possibly can be before you access your care. The following topics are chosen based on the most frequently asked questions in our Member Services department. We hope this helps you to understand your coverage better. Please click on a topic to learn more about it:

Injuries at Work
Rising Pharmacy Costs
Do You Need Your Explanation of Benefits? (EOB)
Diabetic Supplies & Durable Medical Equipment (DME)
Full Time Student Coverage
Changing Your Primary Care Physician
The Birthday Rule
Newborn Baby Coverage
Emergency Room Coverage

Injured at Work?

Did you know if you are injured at work all claims related to the injury should be submitted to your employer’s Workers’ Comp carrier? It is important that you also contact your Primary Care Physician to keep him/her informed of your condition. They can also review any necessary referrals to make sure you continue to use OSF HealthPlans participating providers.

Why should you continue to use OSF HealthPlans participating providers? A Workers’ Comp carrier may deny the claim(s) submitted to them. If this happens, we may be responsible for payment. We would only pay the claim(s) if:

  1. The service is a covered benefit purchased by your employer.
  2. All of our guidelines are followed for receiving benefits.

This means that you must make sure your Primary Care Physician is informed and you have received the proper authorizations and referrals to in-network providers. Please refer to your Explanation of Coverage or call Member Services for more details.

Rising Pharmacy Costs backtotop.gif (457 bytes)

Prescription drug costs continue to escalate at a much faster pace than other medical cost components. Did you know many common brand name drugs have low cost alternatives called generics? In almost all cases, the generic alternative is just as effective as the more expensive brand name drug. Many generics are even made by the same company that makes the brand name. By choosing the generic equivalent, you may save money on your copayment amount. Your Primary Care Physician can help you determine if a specific lower cost generic drug will be as effective as a brand name drug.

Both generic and brand name drugs are required to meet the same standards of quality under strict FDA guidelines.

You can help control the rising cost of health care by asking your physician for the low cost generic equivalent.

Do You Need Your EOB? backtotop.gif (457 bytes)

Did you know you can call Member Services if you need your Explanation of Benefits (EOB)? Some reasons to receive your EOB include; coordinating benefits with another insurance company, Section 125 or just for your personal records. If you have not been receiving your EOBs and would like to, please call Member Services.

Diabetic Supplies & DME backtotop.gif (457 bytes)

Did you know diabetic supplies (test strips, lancets) are covered at 100% when purchased through Franciscan Medical Equipment and/or Family Medical plan in Peru, IL? Diabetic supplies do not require a referral, but all Durable Medical Equipment (nebulizers, c-pap machines, wheelchairs, crutches, etc.) require an authorization from the ordering physician. OSF Franciscan Medical Equipment is our participating provider for Durable Medical Equipment.

We Need Class Schedules! backtotop.gif (457 bytes)

Did you know that coverage for dependents who reach the maximum age listed in your Evidence of Coverage will automatically terminate unless we receive verification that your dependent is a full time student? You can simply send us a copy of their current class schedule from a certified university each semester they are enrolled (this is needed in August and January). We will then update your dependent’s record. Please keep in mind that this only applies if your employer offers this benefit. Some employers check dependent status or student verification for you. Please check with your employer’s benefit office or human resource department for their policy. This is your responsibility, we do not send notifications reminding you to provide student status.

Changing Your Primary Care Physician backtotop.gif (457 bytes)

Did you know when you change your Primary Care Physcian we make it easy for you? You can simply call Member Services and provide the following information:

  • New physician’s first and last name
  • New physician’s office location
  • Which family members are changing

If we receive notice by the 15th of the month, changes are effective the first of the following month. Confused? Refer to your Evidence of Coverage or call Member Services for clarification. After your change is processed, you will receive a new ID card with a letter notifying you of the effective date. If you visit the new physician prior to the effective date, you will be responsible for any unauthorized charges incurred from that visit.

Did you know that if your dependents are covered by two health insurance policies, you are NOT able to choose primary coverage? State law requires us to follow the birthday rule. The policy of the parent whose birthday occurs first during the year is the primary coverage. Please check your Evidence of Coverage for exceptions. Make sure you inform us of other insurance coverage as soon as possible.

Is My New Baby Covered? backtotop.gif (457 bytes)

Did you know new babies are NOT automatically added to your policy? Your employer’s benefit office or human resources department has an enrollment/change form that you MUST fill out within 31 days of the birth. They will then forward the form to us and we can process your new addition. Congratulations and best wishes from OSF HealthPlans!

Emergency Room Coverage backtotop.gif (457 bytes)

Did you know that earaches, sore throats and ankle sprains are not considered emergencies, but are included in the top reasons why people visit the Emergency Department?

None of these are emergencies. Your Primary Care Physician, an approved Urgent Care Facility or the OSF nurse triage line (if available in your area) should provide you care and/or direction in those types of situations.

Examples of emergencies include, but are not limited to:

  • Chest pain
  • Poisoning
  • Broken bones
  • Severe bleeding
  • Loss of consciousness
  • Convulsions

If you have an emergency, please seek immediate treatment at the nearest facility. You MUST call our HealthCare Management department within 48 hours of an emergency visit, even if your Primary Care Physician sent you there.

If an Emergency Department physician tells you they want you to see a specialist for follow-up, you must contact your Primary Care Physician and get a referral BEFORE seeing the specialist.

If you have any doubts or questions about emergencies, contact your Primary Care Physician. He or she can provide you support and direction.

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