FAQ Special Care

Does Special Care cover prescription drugs, vision, or dental care?

If I use a provider outside of the state, will Special Care cover the bill?

If an individual is married and applying for single coverage, why are both incomes required?

Can a person enroll in Special Care who lost adultBasic coverage due to the end of that program on February 28, 2011?

Does Special Care cover prescription drugs, vision, or dental care?
No. Special Care does not cover prescription drugs, vision, or dental.

If I use a provider outside of the state, will Special Care cover the bill?

It is important to understand the basics of how your benefit program works. To receive full coverage for eligible services, you must receive these services from a Special Care participating provider. If you choose to go to a provider who does not participate with Special Care, you will be responsible for paying for services at the time of the visit.

Special Care Hospital Benefits
Non-emergency Care

• Special Care members may receive services from all Independence Blue Cross participating hospitals in the five-county area which includes Bucks, Chester, Delaware, Montgomery, and Philadelphia counties, as well as those participating hospitals in Berks, Lancaster, Lehigh, and Northhampton counties. Non-emergency admissions to a hospital that does not participate with Independence Blue Cross are not covered.

Emergency Care

• If it is medically necessary for you to receive emergency care, you may go to any hospital for covered services.
• It is important to realize an emergency room should be used only for very serious or life-threatening illnesses or accidents. Routine care or treatment related to symptoms of a less serious nature may not be eligible emergency room services and should be directed to your personal physician.

Special Care Doctor and Medical-Surgical Benefits
Highmark Blue Shield participating providers agree to accept the Special Care Program allowance as payment-in-full for covered services. If services are received from a provider who does not participate with Highmark Blue Shield, you must pay the differences between the Blue Shield Special Care allowance and the provider’s actual charge.

If an individual is married and applying for single coverage, why are both incomes required?
Eligibility for the program is based on the total gross income for the entire household.

Can a person enroll in Special Care who lost adultBasic coverage due to the end of that program on February 28, 2011?
Yes. For adultBasic members who are applying for Special Care coverage by May 2, 2011, Independence Blue Cross will waive the pre-existing condition exclusion as well as the required income eligibility review.