CHURCHWIDE HEALTHCARE - Pension Fund

Highmark BCBS Medical Program
About your Churchwide Healthcare
coverage
Welcome to Churchwide Healthcare (CWHC) coverage
through Christian Church Healthcare Benefit Trust
(CCHCBT). CCHCBT has contracted with Highmark BCBS
to act as Third-Party Administrator of the benefits program,
which gives you access to the BCBS system, one
of the most widely recognized and accepted throughout
the United States. For decades, the nationwide
BCBS family of independent plan providers has offered
members innovative health coverage designed to meet
their needs. You will be covered through the CWHC PPO
plan administered by Highmark BCBS. No matter where
you live in the United States, you may take advantage
of the expansive provider networks and discounts
arranged by the PPO plans around the country. In most
cases, you should not have to file claim forms or pay
anything except your co-payments, deductibles, etc.,
in advance. This guide explains your coverage through
CWHC and the PPO program. For more information,
such as details about how we cover a particular service
or prescription drug, please read your contract or use
one of the sources located in the front of this guide.
How does my medical plan work?
You pay less out-of-pocket if you use the physicians,
hospitals, and other health care providers that participate
in the BCBS PPO network. While you don’t need
referrals to visit specialists, you receive the highest
level of benefits when you use Preferred Providers. In
some instances, such as hospital admissions and home
healthcare services, Highmark BCBS can require prior
approval. In other words, Highmark BCBS must approve
the need for the care before you seek it, or they may
choose not to pay for such care.
To find preferred providers
(in-network):
Visit the www.highmarkbcbs.com web site
and click on “Find a Physician or Facility.”
Call 1-800-648-4078 to find out if the
provider you select is Preferred.
(Remember, you will reach your out-of-pocket maximum
quicker when you use Out-of-Network Providers.
Further, there are separate deductibles and out of pocket
limits for Out-of-Network medical services.) The medical
summary of benefits in the booklet shows a comparison
between benefits when you use In-Network
Providers and benefits when you use Out-of-Network
Providers. Also, keep in mind that your health plan pays
the Allowed Price for services and supplies. In-Network
Providers agree to accept the Allowed Price as payment
in full. When you use Out-of-Network Providers, you
must pay the difference between the Allowed Price and
the provider’s charge. Benefits for most services require
that you pay a deductible each year for In-Network
Providers’ services and Out-of-Network Providers’ services.
Once you have met your deductible, you share
the cost of your care through coinsurance. Deductible
and out-of-pocket amounts do not cross apply. Once
again, your coinsurance percentage amount for Out-of-
Network Providers is higher than the one for In-Network
Providers. You need only pay the deductible and coinsurance
until you meet your out-of-pocket maximum
for the year.
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