Benefits Value Advisor
- CAT or CT Scans
- Endoscopy Procedures
- Colonoscopy Procedures
- Maternity Care and Delivery
- Back or Spinal Surgery
- Knee Surgery
- Shoulder Surgery
- Hip Replacement or Joint Replacement Surgery
Check out the Benefits Value Advisor - Member Rewards sheet for details about various medical procedures and potential reward amounts.
Benefits Value Advisor Highlights
- For example, if your doctor wants you to receive an MRI of your knee, you can contact a Benefits Value Advisor. The Advisor can tell you about several contracting, in-network MRI providers and the estimated cost for an MRI at each provider. This way, you will have more information when choosing where to have your MRI. If you like, the Advisor can then schedule the MRI for you with the medical provider you choose, and help you with any pre-certification needs.
- Member communications and information from Benefits Value Advisors are not meant to replace the advice of health care professionals and members are encouraged to seek the advice of their doctors to discuss their health care needs. Decisions regarding course and place of treatment remain with the member and his or her health care providers.
- Cost estimates are just an estimate. In addition to your usual deductibles, copayments and/or coinsurance, the actual cost of the services may vary based on a number of factors including the date of service, the actual procedure performed, what services were billed by the provider and your particular benefit plan. Coverage is subject to the limitations and exclusions of your plan.
Learn more about how you can receive medical services at a cost-effective location and possibly earn a reward (up to $500): Benefits Value Advisor Flyer
Member Rewards is a voluntary program that educates consumers by reminding you that you have choices when it comes to your health care.
- If your doctor recommends a particular medical service, Member Rewards can point you to lower-cost options at in-network facilities in your area.
- If you choose a cost-effective option, you can qualify for a cash incentive.
Member Rewards does not offer medical advice and is not a substitute for medical care from your doctor but it can help you optimize your healthcare by making you aware of your options.
As a voluntary program, members have the final choice in where they are receiving their care. Member Rewards will help members get a better understanding of the differences in costs between health care facilities.
- The Member Rewards program helps to drive down the cost of health care for members and keeps their groups overall utilization down, which in turn, keeps their yearly premiums down, keeping more money in their paycheck.
- The program also gives members a cash incentive when they use the tool to shop for, and utilize, those alternatives.
- By offering lower cost and convenient locations for common procedures/services, members save on out-of-pocket costs.
No. Member Rewards is free to members.
All active employees currently under the age of 65 (non-Medicare eligible) who are enrolled in the health benefit plan through their employer, and their enrolled dependents, are eligible for the Member Rewards program.
- If you are eligible for the program, then you are automatically enrolled and can use the service at any time.
No. The Member Rewards program does not affect your benefits in any way. All benefit, pre-authorization and pre-certification guidelines still apply, and this program does not affect your claim payment.
- This program does not take the place of any pre-certification requirements you may have as part of your benefits.
Member Rewards targets costly procedures, such as mammograms, MRIs and physical therapy; services that are planned in advance. For a full list of services please call the BVA or log online through Blue Access for Members (BAM).
Qualifying for an incentive is simple and fast. If your doctor recommends a particular medical procedure, service, or test, contact Member Rewards either by telephone or online prior to receiving the medical service.
- If you call BVA, a representative will tell you if the service you are researching is eligible, and if it is, will give you cost-effective options in your area that qualify for an incentive. If you go online you can view a list of eligible medical services and procedures and the cost-effective options in your area.
- In either case, if you choose one of the options identified by Member Rewards, you can qualify for an incentive.
Shopping prior to having the procedure gives you time to explore your options and get a new referral from your doctor if necessary.
No. In order to be eligible for an incentive you must have shopped with Member Rewards at least one day prior to your appointment.
If you qualify for an incentive, a check will be mailed to you 60 days from the date of service of your procedure.
No. Member Rewards is contracted by Blue Cross Blue Shield of Illinois and will receive your processed claim information automatically. You are not required to send in anything to Member Rewards in order to receive your incentive.
For questions related to your incentives you can call the BVA at the number on the back of your medical card.
If you receive incentives of $600 or greater in one year, Sapphire Digital will send you a 1099 tax form to file with the Internal Revenue Service.
No. Member Rewards is completely voluntary. You can receive an incentive by choosing any of the options suggested by Member Rewards.
- If you prefer to go to a facility that is not on the list of options suggested by Member Rewards, you can do that, too. You will not receive an incentive, but you will have the benefit of knowing that lower cost options are available to you if you want them.
No, you will not have to change your primary care physician. However, you may need to have a discussion with your doctor about getting referred to a cost-effective location, where you can save money and qualify for incentives.
The Member Rewards program is based on eligible procedures and the facilities that offer those procedures at a cost-effective rate. We are currently unable to provide specific physician information for most groups.
- Physicians may have the ability to treat at multiple locations. We encourage members to share the cost-effective information with the primary care physician to help determine which specialist they should see.
If you are already scheduled at the most cost-effective facility on the Member Rewards list, you still qualify for an incentive simply for making the phone call or going online and exploring your options. You must shop to receive the incentive.
Some medical services and procedures are not eligible under the Member Rewards program. It is best for you to contact the BVA for further assistance regarding your cost and benefits.
All health centers on your Member Rewards list are part of BCBS’s network and have met strict quality standards. The facilities are well-known and fully licensed to provide services. You may consult your doctor or BVA for more information regarding quality.
No. Member Rewards does not share personal information about you or your dependents with your employer or anyone else. It is completely confidential. Member Rewards may send your employer aggregate data (such as how many people from your company used the program in a given year), but your personal, identifiable information will not be shared.
Yes. Member Rewards is a fully mobile platform. You can use it with any mobile device and access through the BCBS mobile app.
Yes. If your doctor has referred you for more than one type of service (for example: knee surgery, an MRI, and post-surgery physical therapy), you can shop for all services at the same time, or opt to shop for each individually. The choice is yours.