Concierge Knowledge Base

Benefits Resources

Benefits Team Resources
Ria Bell
Vice President, Benefits
ria.bell@aah.org

Katie McCann
Benefits Manager
Katie.mccann@aah.org

Sharon Tanner
Benefits Communications

sharon.tanner@aah.org

AAH Benefits Service Center
800-775-4784
M-F, 7am-6pm CT

2021 Plan Updates

Quick Care AAH Video Visit and E-Visits through LiveWell app

Available 24/7, Advocate Aurora Quick Care video visits help you quickly see a provider available through the LiveWell with Advocate Aurora Health app. Available in IL, MI, WI.

$20 co-pay


Provider Virtual Care Visits
If your physician (primary care, specialist or behavioral health provider) has determined a video visit is appropriate for your condition, they'll suggest and schedule one with you. If you'd like to request one yourself, call your provider's office directly to schedule the visit. 

Preferred Plan
Advocate Aurora Health Network
Primary care physician | $35 co-pay
Specialist physician | $60 co-pay

Select Plan
Advocate Aurora Health Network
Primary care physician | $35 co-pay
Specialist physician | $60 co-pay

Carrier Network
Primary care physician | 50% coinsurance after deductible
Specialist physician | 50% coinsurance after deductible
Select Plan Annual Deductible and Out-of-Pocket Maximum Increase
Annual Deductible in AAH Network
$950 Single
$1,900 all other coverage levels

Annual Out-of-Pocket Maximum in AAH Network

$5,500 Single
$11,000 all other coverage levels    
AAH Medical Plan Concierge Services

Effective Jan. 1, 2021:    

  • Waivers will still be part of the Utilization Management process--incorporated in the prior-authorization review workflow.  
  • Effective 1/1/2021, AAH Medical Plan Concierge will authorize care for all services in the Preferred, Select and OOA plans for both AAH and non-AAH providers.
  • Beginning in 2021, team members and their dependents enrolled in any Advocate Aurora Health medical plan must have their physician complete prior authorizations directly with the AAH Medical Plan Concierge. 
    ·Prior authorizations completed by BlueCross BlueShield of Illinois in 2021 will not be accepted.
    ·The AAH Medical Plan Concierge team was completing prior authorizations in 2020 if the member was enrolled in Anthem. This process will continue in 2021 as well.  Prior Authorizations completed by Anthem.

Medical Plan Overview

Plan Benefits
Anthem (Wisconsin)
844-205-5416, 8am-6pm, M-F
Website:  anthem.com

BlueCross BlueShield (most other states)
888-907-7870, 8am-6pm, M-F
Website: bcbsil.com

Pre-certification for Inpatient Treatment

For the remainder of 2020, BCBS of IL will continue to authorize pre-certifications for Inpatient Treatment for those enrolled with BCBS of IL.

BlueCross BlueShield (most other states)
888-907-7870, 8am-6pm, M-F
Website: bcbsil.com

For those enrolled in a medical plan with Anthem, AAH Medical Plan Concierge completes pre-certifications for inpatient treatment in 2020.

 
Beginning Jan. 1, 2021:

Team members and their dependents enrolled in an Advocate Aurora Health medical plan administered by BlueCross BlueShield of Illinois  must have their physician complete prior authorizations directly with the AAH Medical Plan Concierge. Prior authorizations completed by BlueCross BlueShield of Illinois in 2021 will not be accepted. If you are enrolled in an Advocate Aurora medical plan administered by Anthem (Wisconsin), continue to submit prior authorizations with the AAH Medical Plan Concierge as you have in 2020.  

Pre-certification for behavioral health care
AXCES Behavioral Health Advisor
800-454-6455
8:30am - 5pm, M-F
All after-hour health certifications will be processed next business day.

NOTE: Call for pre-certification BEFORE outpatient and inpatient behavioral health services are delivered.
Prescription Drugs
MedImpact
888-495-3299
medimpact.com

Aurora Mail-Order Pharmacy
844-409-0148
Website (click here)

Aurora Specialty Pharmacy
844-820-5600
Website (click here)
Flexible Spending Account (FSA)
ConnectYourCare
833-325-9996
ConnectYourCare.com/aah
Questions about other Advocate Aurora Health Benefits
AAH Benefits Service Center
800-775-4784 
Monday - Friday, 7am to 6pm
Website: aahbenefits.org

Eligibility

Who is eligible for medical benefits?
All regular Full-Time (72-80 hours), Part-Time A (60-71 hours) and Part-Time B (40-59 hours) team members and eligible dependents including spouse, partner, natural child, adopted child and stepchild.
When does coverage begin for a new team member?
If you are eligible, coverage for you and your eligible dependents can begin on the first of the month following your date of hire with Advocate Aurora Health or one of its affiliated companies.

Cost / Co-insurance 

Cost
  • Advocate Aurora Health pays the majority of the cost for your medical plan coverage, about 80%.Team members share in the cost.
  • The Preferred Plan is the lowest cost plan per pay period.
  • Team member contributions (premiums) are based on:the plan you choose (Preferred Plan or Select Plan); level of coverage you choose (single, single+spouse/partner, single+child(ren) or family; and your annual base salary.
  • You and a covered spouse/partner must also certify you are tobacco-free to avoid a $40 per paycheck (or $80 for both of you) Tobacco Surcharge.
  • If you cover your spouse and he/she is eligible for medical coverage through their employer, you will pay a $50 per pay period Spousal Surcharge.
  • You and your covered spouse can each earn up to $600 ($1,200 total for both of you) by completing designated Healthy Living Program activities; you receive these funds directly on your paycheck and can use them to offset your medical plan premiums.
Co-Pays
  • A co-pay is a fixed amount you pay for a health care service.
  • Co-pays allow you to seek care before having to meet your deductible.
  • Co-pays in the AAH medical plans do not count toward your deductible: however, they do count toward your out-of-pocket maximum.
  • In both the Preferred Plan and Select Plan, there are co-pays for primary care and specialist visits and other services when you use the AAH Network.
Deductible
The annual deductible is the amount you pay for health care services before the plan starts sharing the cost.

2021 Annual  Deductibles
Preferred Plan $250 -Single
$500 - All other coverage levels
Select Plan Using AAH Network
$950 - Single
$1,900 - All other coverage levels

Using Carrier Network
$3,200 - Single
$6,400 - All other coverage levels


Co-Insurance
Coinsurance is the percentage you and the plan each pay for services after you meet the annual deductible.

Preferred Plan: Must use AAH Network
Outpatient Surgery and Inpatient Admissions – Plan pays 80% of covered charges, you pay 20% coinsurance after you reach deductible.

Select Plan: If using AAH Network
Lab/Xrays, Urgent/Immediate Care/Outpatient Surgery, Inpatient Admission – Plan pays 80%, you pay 20% coinsurance after you reach deductible.

Select Plan: If using your medical plan carrier’s network
-  Primary Care and Specialist Visits, All Services, Outpatient Surgery and Inpatient Admission-- Plan pays 50%, you pay 50% coinsurance after you reach deductible.
-  Urgent/Immediate Care-- Plan pays 80%, you pay 20% coinsurance after you reach deductible. Out-of-Network No benefits paid.
Out-of-Pocket Maximum

The out-of-pocket maximum is the most you pay in a year for covered health care expenses.  After you reach the out-of-pocket maximum, the plan pays 100% of eligible services for the remainder of the year.

  • Your deductible, co-pays and coinsurance amounts you pay count toward your out-of-pocket maximum.
  • In the Select Plan, the total annual out-of-pocket maximum limits that apply to services received through the Advocate Aurora Health Network and through your carrier’s network cross apply; services received through one network will apply to the total annual out-of-pocket maximum limit that applies to services received through the other network.
2021 Annual Out-of-Pocket Maximum
Preferred Plan $4,250 - Single
$8,500 - All other coverage levels
Select Plan Using AAH Network
$5,500 - Single
$11,000 - All other coverage levels

Using Carrier Network
$8,000 - Single
$16,000 - All other coverage levels


ID Cards / Claims 

When do I receive an ID card?
  • Team members will receive ID cards from their plan’s carrier in December 2020 if they newly enrolled in a 2021 medical plan during Annual Enrollment.
  • New team members should receive an ID card within 30 days following enrollment.
What if I lose my ID card?

Contact your plan’s administrator:

Anthem (Wisconsin)
844-205-5416, 8am-6pm, M-F
Website: anthem.com

BlueCross BlueShield (most other states)
888-907-7870, 8am-6pm, M-F
Website: bcbsil.com

Who administers/processes claims for Preferred and Select Plans?

Advocate Aurora Health uses third-party providers to help administer the Preferred and Select Plans and process claims.

Anthem (Wisconsin)
844-205-5416, 8am-6pm, M-F
Website: anthem.com

BlueCross BlueShield (most other states)
888-907-7870, 8am-6pm, M-F
Website: bcbsil.com


 
How do I know if my claim was paid?
  • You will receive an Explanation of Benefits (EOB) from your plan’s administrator once your claim has been processed.
  • The EOB will detail what was covered, the level of coverage and the amount, if any, you owe.
  • For specific questions, contact your plan administrator at the phone number listed on the back of your plan’s ID card or listed on your EOB.

Advocate Aurora Health Network

Who is in-network and who are approved providers in the Advocate Aurora Health Network?

The Advocate Aurora Health Network is the same network in the Preferred Plan and the Select Plan that includes more than 8,300 physicians, 26 hospitals, 500 outpatient locations

The AAH Network includes:

  • Physicians within the Advocate Medical Group, Aurora Health Care Medical Group as well as physician members of Advocate Physician Partners.
  • AMG West physicians, (i.e. legacy Dreyer Physicians, Dreyer Medical Clinic) and contracted providers in The Aurora Network are also in the AAH Network.
  • All Advocate and Aurora hospitals, Advocate and Aurora Outpatient Centers, Advocate and Aurora Immediate Care Centers, Advocate and Aurora Surgical Centers.
  • Advocate at Home and Aurora at Home
  • Advocate Clinic at Walgreens

Approved partners:
DuPage Medical Group Physicians
Note: Central DuPage Hospital (CDH) is NOT in the Advocate Aurora Network for inpatient admissions.

Approved Facilities:

  • Amita Health Mercy Medical Center Aurora
  • Bellin Hospital (psychiatric inpatient care)
  • Children’s Hospital of Wisconsin (under age 18)
  • Dreyer Ambulatory Surgery Center
  • Easter Seals DuPage
  • NorthShore Hospital & Pediatrics Northwestern
  • Northwestern Delnor Hospital
  • Rush-Copley
  • Select Specialty Hospital (vent-dependent patients)

Contact the AAH Medical Plan Concierge at 855-376-2386, Monday – Thursday, 8 a.m.-5 p.m. and Friday, 9 a.m. to 4:30 p.m.

How do I find a doctor or facility within the AAH Network or make sure my doctor is in the AAH Network?
NOTE:  Team members who reside OUTSIDE of the AAH service area are offered the Preferred Plan created for “out-of-area” participants. You and your covered dependents will be covered by the BlueCross BlueShield BlueCard Network; find a doctor by calling 888.907.7870 or online at www.bcbsil.com/go/advocate.
Can I use DuPage Medical Group and get in-network coverage?
  • Yes, DuPage Medical Group physicians are approved providers.
  • In-patient services must be provided at an Advocate Aurora Health hospital.
  • Your DuPage Medical Group doctor must admit you to an Advocate Aurora Health hospital or have your admission and care overseen by another DuPage Medical Group doctor who can admit you.

NOTE: Central DuPage Hospital (CDH) is NOT in the AAH Network for in-patient admissions by DuPage Medical Group.

Transition of Care / Approval of Care Outside of Network

I want to consider choosing the Preferred Plan but what if I am in the middle of treatment?
  • You may request to continue care or treatment with a non-Advocate Aurora Health provider for a specific period of time and then transition care to the Advocate Aurora Health Network. Examples:pregnancy, chemotherapy treatments.
  • You may also request to continue care with a non-Advocate provider if Advocate Aurora Health does not provide a service.
  • Contact the AAH Medical Plan Concierge or submit an online Request for Non-AAH Provider Form to see how you may transition or continue care. Call 1-855-376-2386, 8am-5pm, M-Th, 9am-4:30pm, F
  • Online form (click here)
If I am in the Preferred Plan, what steps do I need to take if I want to seek care outside of the AAH Network and have it covered at in-network benefits?
  • You should submit an online Request for Non-AAH Provider Form (click here)
  • You will need to include a short summary of the services you are requesting, and the name and contact information for the physician/hospital/facility where you are seeking care.
  • Contact the AAH Medical Plan Concierge with questions at 1-855-376-2386, 8am-5pm, M-Th, 9am-4:30pm, F.
What documents or other materials do I need to provide if I am seeking care outside of the AAH Network?
Include any documents that support the medical necessity to go outside of the AAH Network for care. Typically, this can be achieved by providing your most recent office visit notes.
How long will it take to find out if I can receive care outside the AAH Network with in-network benefits?
Once the online Request for Non-AAH Provider Form is submitted, a Concierge team member will follow up with you within 5 business days.
If I am in the Preferred Plan and I receive authorization from the AAH Medical Plan Concierge to receive care outside the AAH Network, will I receive in-network benefits?
  • If you are in the Preferred Plan and are authorized to receive care outside the AAH Network, your benefits will provide coverage at the same level as if you received care in-network.
  • We strongly recommend you tell your authorized non-network provider that your plan benefits will only pay reasonable and customary charges. You may be balanced billed for any amount over these rates if your provider charges more, so make sure you discuss and agree on charges with your provider before you receive care.
Once I receive approval for care outside the AAH Network, do I need to do anything else?
  • Each calendar year, you must receive re-authorization.
  • You will need a short summary of the services you are requesting, and the name and contact information for the physician/hospital/facility where you are seeking care.
  • Contact the AAH Medical Plan Concierge with questions at 1-855-376-2386, 8am-5pm, M-Th, 9am-4:30pm, F.
If I do not receive approval for care outside the AAH Network, can I appeal this decision?

Contact your plan’s administrator directly if you wish to appeal a denial.

Anthem (Wisconsin)
844-205-5416, 8am-6pm, M-F
Website: anthem.com

BlueCross BlueShield (Chicagoland)
888-907-7870, 8am-6pm, M-F
Website: bcbsil.com

Travel or Dependents Living Outside Area

Where can I get care if I am traveling outside of the AAH service area?

NOTE: Outside the AAH Service area is defined as your home zip code not being within 40 miles of an AAH hospital.

  • You and covered family members may seek care at:
    • Retail -based immediate care clinics such as Walgreens Take Care Clinic or an Urgent Care Center.
    • In a true medical emergency, you may go to the nearest emergency room.
  • If you are traveling and have a short-term illness or an injury that requires a higher level of care or treatment, contact the AAH Medical Plan Concierge at 1-855-376-2386, 8am-5pm, M-Th, 9am-4:30pm, F.

IMPORTANT: Important: Inpatient hospitalizations must be pre-certified. The AAH Medical Plan Concierge can assist with getting this processed initiated for you. 

For the remainder of 2020, BCBS of IL will continue to authorize pre-certifications for Inpatient Treatment for those enrolled with BCBS of IL.

BlueCross BlueShield (most other states)
888-907-7870, 8am-6pm, M-F
Website: bcbsil.com

For those enrolled in a medical plan with Anthem, AAH Medical Plan Concierge completes pre-certifications for inpatient treatment in 2020.

 
Beginning Jan. 1, 2021:

Team members and their dependents enrolled in an Advocate Aurora Health medical plan administered by BlueCross BlueShield of Illinois  must have their physician complete prior authorizations directly with the AAH Medical Plan Concierge. Prior authorizations completed by BlueCross BlueShield of Illinois in 2021 will not be accepted. If you are enrolled in an Advocate Aurora medical plan administered by Anthem (Wisconsin), continue to submit prior authorizations with the AAH Medical Plan Concierge as you have in 2020.  

What if I am traveling out of the country and need care?
  • The same guidelines for care apply as if traveling in the U.S.
  • You should also contact the AAH Medical Plan Concierge to support you if you need a higher level of care.

    IMPORTANT: Inpatient hospitalizations must be pre-certified. Call your plan administrator:
  • Contact your plan’s administrator:

    Anthem (Wisconsin)
    844-205-5416, 8am-6pm, M-F
    Website: anthem.com

    BlueCross BlueShield (Chicagoland)
    888-907-7870, 8am-6pm, M-F
    Website: bcbsil.com

I’m a team member with dependents who live outside the AAH service area. How do my dependents receive care?

Note:  Outside the AAH service area is defined as not being within 40 miles of an AAH hospital.

  • Both the Preferred Plan and Select Plan provide in-network coverage for dependents ages 18 to 26 who live or study outside the AAH service area.
  • No prior authorization for care is needed except for inpatient hospitalizations, inpatient surgeries and inpatient behavioral health care.See the back of your ID card for contact numbers.
  • For minor illness or injuries, dependents may use student clinics, retail clinics, immediate care centers or urgent care centers.
  • Dependents living outside the service area can see a local physician or specialist.Check to see if providers are in your plan administrator’s network since AAH has negotiated rates with these networks and you will pay less out of pocket.
  • If your dependent uses a provider not in your plan administrator’s network, the plan will pay 80% of reasonable and customary charges.
Team members who reside outside of the AAH service area are offered the Preferred Plan created for “out-of-area” participants.  You and your covered dependents will be covered by the BlueCross BlueShield BueCard Network.

If your dependent's address changes, you must update their address for them to receive  maximum plan benefits.

How to Change Your Dependent's Address

Emergency Room / Immediate Care / Urgent Care

What benefits are paid if I go to the emergency room?
  • Co-payment is $200 per visit.
  • Co-payment is waived if you are admitted to the hospital.
  • Same coverage if you are traveling or dependent lives outside AAH service area or is away at school and emergency care is required.
  • After deductible is met, plan pays 80%, you pay 20% coinsurance.
What benefits are paid if I use an Immediate Care or Urgent Care Center?
  • Preferred Plan: $60 co-pay
  • Select Plan: Plan pays 80%, you pay 20% coinsurance after you reach the deductible   

Hospital / Surgery Center Services 

How do I obtain pre-certification for inpatient hospital stays?

To obtain pre-certification – and the maximum benefits available under the plan – you or your physician must contact AAH Medical Plan Concierge.

NOTE: Inpatient services for treatment of behavioral health disorders—behavioral illness and substance abuse—also are subject to pre-certification, but this pre-certification must be provided through the Behavioral Health Certification unit.  The number is on the back of your ID card.

Do I need to get pre-certification for outpatient services?

No, outpatient surgery or outpatient non-surgery care does not need to be pre-certified.

There are select outpatient services for behavioral health disorders—behavioral illness and substance abuse—that are subject to pre-certification, but this pre-certification must be provided through AXCES Behavioral Health Advisor at 800-454-6455.

Preventive Care

Do I pay for preventive health services?
To the extent a service is considered a “preventive care service” it must be provided—under federal law—without any cost sharing requirements; no deductibles, co-payments or coinsurance will apply when the service is provided in-network.
How do I find out if a service is considered preventive?

Check with your plan administrator for specific questions.

Examples of preventive services include:

Routine care for children

  • Well Child exams
  • Immunizations
  • Flu/Pneumonia injection
  • Human Papilloma virus (HPV) vaccination (age 9 and older)

Routine care for adults:

  • Exam
  • Immunizations
  • Flu/Pneumonia injection
  • Human Papilloma virus (HPV) vaccination (age 26 and younger)
  • Shingles vaccination (age 50 and older)
  • Pap smear
  • Colonoscopy, proctosigmoidoscopy and sigmoidoscopy screenings (When performed as hospital outpatient or in an ambulatory surgical center or clinic; includes related services; if performed as part of surgical treatments (e.g. polyp removal, biopsies, etc.) general illness benefits will apply).

Behavioral Health Services 

What is considered a behavioral illness?

A behavioral illness is a disease that is commonly understood to be a mental disorder whether or not it has a physiological or organic basis. Treatment is generally provided by or under the direction of a behavioral disorder professional.

What steps should I take if behavioral care is needed?
  • AXCES Behavioral Health Advisor provides certification for all behavioral health inpatient stays.
  • Members seeking services should first call AXCES at 800-454-6455 to obtain pre-certification BEFORE receiving services from an approved provider.
  • This number is also on the back of your ID card.

Chiropractic Care 

Do the Preferred and Select Plans cover chiropractic care?
  • Preferred Plan: $60 co-pay, 20 visit limit
  • Select Plan: $60 co-pay, 20 visit limit if using AAH Network; 50% coinsurance after you reach the deductible, 20 visit limit  if using your carrier’s network.
  • Call the AAH Medical Plan Concierge at 1-855-376-2386 for assistance in locating AAH Network chiropractors.

Request for Non-Advocate Aurora Health Provider 

Medical Plan References 

Advocate Aurora Health Network

Advocate Physicians

The Aurora Network 

Approved Partners

DuPage Medical Group Physicians

Approved Facilities
Amita Health Mercy Medical Center Aurora
Bellin Hospital (psychiatric inpatient care)
Children’s Hospital of Wisconsin (under age 18)
Dreyer Ambulatory Surgery Center
Easter Seals DuPage
NorthShore Hospital & Pediatrics
Northwestern Delnor Hospital
Rush-Copley
Select Specialty Hospital (vent-dependent patients)

 

Physician Finder Tips & Resources

Anthem for team members (WI) (click here)

Anthem for guests (WI) (click here)


BlueCross BlueShield (most other states)
(click here)


Request for a Non-Advocate Aurora Health Provider
Request for Non-Advocate Aurora Health Provider (click here)
In rare cases, certain medical conditions and circumstances may qualify you to receive care from a non-Advocate Aurora Health Centered Network physician or hospital and to be covered at the same in-network level benefits for a specific period of time. Click on the link above to submit an online Request for Non-Advocate Aurora Health Provider.