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Medical Coverage

Medical News

Received a Letter from Excellus and/or Express Scripts Stating Your Plan is Terminating? DON'T PANIC!
CASEBP recently added the Calm® App to our benefit offerings, and we want you to be aware of some communications that you may receive. We have spoken with Excellus, and because of this addition to the Plan, you may receive a letter or see on your online account that your plan is terming on 12/31/2022 and a new plan becoming effective on 01/01/2023. Anytime there is a change to the Plan, the Plan must be terminated in the Excellus system and then reinstated with the updated changes. This is why you will see the termination date of 12/31/2022 and a new effective date of 01/01/2023, as that is when the new benefits take effect. Please rest assured that there are no changes to your benefits besides adding the new benefit and you can disregard the letter.
At-Home COVID-19 Tests at No Cost to You! 
As part of its ongoing efforts to expand Americans' access to testing, the Biden-Harris Administration has required health plans to cover the cost of up to eight over-the-counter, at-home COVID-19 tests, effective December 19, 2022. This requirement means you will be able to go to a pharmacy or store, purchase a test, and either get it paid for upfront by your health insurance plan or get reimbursed for the cost by submitting a claim form. Click for more information on how it works, COVID Over-the-Counter Tests Flyer 

Some Key Points:
  • Each member is allowed eight over-the-counter, at-home COVID-19 tests per month.
  • You must purchase the tests at the pharmacy counter to have no upfront, out-of-pocket costs.
  • You should use the Direct Claim Form to request reimbursements for tests purchased from December 19, 2022, and on. You can submit electronically or via U.S.P.S. mail.
  • For more information about COVID-19 or to submit a receipt for reimbursement, visit the Express Scripts Resource Center, COVID-19 Resources and Vaccine Coverage | Express Scripts (express-scripts.com).
  • Get 4 tests for free! With the help of the U.S.P.S., households can request a total of four tests to be delivered for free. To learn more and order at-home tests, visit COVIDtests.gov - Free at-home COVID-19 tests.
Click to learn about the new hearing aid benefit now included in your coverage.
New Article: Glossary of Health Coverage and Medical Terms
This glossary has many commonly used terms, and is intended to be educational.

General Medical Coverage Information


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Easy access to your member card, benefits and coverage, claims and more 24/7/365


Submit Medical Claims to:
Online:
2. Click on "Claims."
3. Click on "Submit Claims."
4. Select "Medical or Vision Claims."
5. Follow the instructions on the screen.

or

Mail:
Excellus BCBS
P.O. Box 21146
Eagan, MN 55121 

Medical Forms

Please complete this form for medical claims. Medical claims can be submitted to Excellus BCBS, P.O. Box 21146, Eagan, MN 55121.
Please complete this form for medical claims for covered services received outside the United States, Puerto Rico, and the U.S. Virgin Islands. International medical claims can be submitted to Service Center, P.O. Box 2048, Southeastern, PA 19399.
Please complete this form when an injury or accident occurs. Please return form to CASEBP, P.O. Box 383, Grand Gorge, NY 12434 or fax number (607)-588-8916.
Please complete this form if you would like CASEBP to share information about you with people or other organizations. Please mail completed form to CASEBP, P.O. Box 383, Grand Gorge, NY 12434; fax to 607-588-8916; or email to [email protected]
Complete este formulario si desea que CASEBP comparta información sobre usted con personas u otras organizaciones. Envíe el formulario completo por correo a CASEBP, P.O. Box 383, Grand Gorge, NY 12434; o correo electrónico a [email protected]
Please complete this form if you would like Excellus BCBS to share information about you with people or other organizations. Please mail completed form to Excellus Health Plan, P.O. Box 21146, Eagan, MN 55121 or fax completed form to 315-671-7079.
Complete este formulario si desea que Excellus BCBS comparta información sobre usted con personas u otras organizaciones. Envíe el formulario completo por correo a Excellus Health Plan, P.O. Box 21146, Eagan, MN 55121 o envíe un fax al 315-671-7079.
Please complete this form if you receive a surprise bill for health care services and want the services to be treated at in-network.
Please complete this medical enrollment form and return to your district's Benefits Clerk.
Please complete this form to show proof of eligibility for dependents.
Please complete this form if you or any member of your family are enrolled in any other health or dental program.

Plan Documents

Revised December 4, 2012
Plan Document for PPO Plan A, PPO Plan B, and PPO Plan C.

Summary of Benefits and Coverage & Schedule of Benefits Documents

Basic services and benefit information for Indemnity Plans
Schedule of Benefits for Plan D
2022-2023 Summary of Benefits and Coverage for Plan D
Schedule of Benefits for Plan H
2022-2023 Summary of Benefits and Coverage for Plan H
Schedule of Benefits for Plan L
2022-2023 Summary of Benefits and Coverage for Plan L
Schedule of Benefits for Plan M
2022-2023 Summary of Benefits and Coverage for Plan M
Schedule of Benefits for Plan N
2022-2023 Summary of Benefits and Coverage for Plan N
Schedule of Benefits for Plan O
2022-2023 Summary of Benefits and Coverage for Plan O
Schedule of Benefits for Plan P
2022-2023 Summary of Benefits and Coverage for Plan P
Schedule of Benefits for Plan R
2022-2023 Summary of Benefits and Coverage for Plan R
Schedule of Benefits for Plan U
2022-2023 Summary of Benefits and Coverage for Plan U
Schedule of Benefits for PPO Plan A
2022-2023 Summary of Benefits and Coverage for PPO Plan A
Schedule of Benefits for PPO Plan B
2022-2023 Summary of Benefits and Coverage for PPO Plan B
Schedule of Benefits for PPO Plan C
2022-2023 Summary of Benefits and Coverage for PPO Plan C
2022-2023 Summary of Benefits and Coverage for HDHP A
2022-2023 Summary of Benefits and Coverage for HDHP B
2022-2023 Summary of Benefits and Coverage for HDHP Bronze

Helpful Information for Medical Coverage

Click to view the pricing information required by the Transparency in Coverage rules.

This glossary has many commonly used terms, and is intended to be educational.

Click to view what services require authorization before services are provided. To obtain authorization, please contact Excellus BCBS Prior Authorization Team at 1-800-363-4658.

Click to learn what a surprise medical bill is and what procedures to follow.
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