Blue Cross Blue Shield of Illinois (NIHIP)  - Employer Plan

Who is the client? NIHIP is a consortium of school districts in northern IL.

Announcements: NA

Enrollment - Vida.com/BCBSIL - Select “BCBSIL”

Blue Cross of IL in HGP

Critical Note: When assisting these members with enrollment although it says NIHIP in B2B you will need to put BCBSIL  into the HGP.

BCBSIL FAQs

Transitions:

• Vendor Transitions:

  • Prior Health and Wellness Vendor? Omada & EncircleRx

     

• Anti-Obesity medication transitions (AOM, member currently on GLP-1):
  • What coverage does Vida provide?
    • Use Case 3 (Vida sole prescriber, COM - Center of Obesity Management)
  • When does a member have to transition by? 

    • When discussing options with members please refrain from saying grace period. You can say 
      "The plan reviewed all authorizations set to expire early this year and decided to extend the expiration dates. Yours has been updated to remain active until March 31st."

       

      • Key Reminder for Agents:
      • Don't Say: "You are in a grace period."

      • Do Say: "The plan extended the date."

         

        • 90 day extension in effect for all PAs expiring before 3/31, but hard cutoff is being implemented for ALL current GLP-1 utilizers. Prior Authorizations will be honored through their existing expiration 
  • Does Vida have Prior Authorization bypass enabled (goldcarded)? YES
  • What program will the AOM transition member go into?
    • MWL Group
  • How does an AOM transition member get to a Vida Medical Provider?
    • Submit Lab requirements
    • Submit Medical record requirements
    • Complete Contact Form
    • RD session is bypassed in group MWL 

Vidapedia

• See below or Vidapedia for more information on:
  • Account Eligibility:
    • Who is eligible? Employees, spouses, dependents who are 18+ and carry BCBSIL medical coverage. Vida is not available to members under an HMO plan at this time.
    • Is Cobra or retirees eligible? It would apply to members on a PPO plan, they may or may not be eligible, check B2B.
    • How do I look up eligibility? B2B
    • How often does it update? Daily
    • Where should non-eligible members be referred? Please refer them to the number on the back of their insurance card.
  • Devices:
    • Vendor Transition members DO NOT automatically receive a device form
    • Standard Device Criteria
    • Clinical Device FAQs
  • Programs
  • Medication Management
  • External Account Resources
    • To find Pharmacy Benefits information
  • Prescribing Overview: Use Case 3 (Vida sole prescriber, COM - Center of Obesity Management)
    • Drug Coverage and formulary
    • GLP-1 coverage information

Prescribing Policy: NIHIP Members and Prior Authorizations (PAs)

This guidance clarifies the specific limitations regarding existing Prior Authorizations (PAs) for members covered under the NIHIP benefit. These rules are essential for ensuring NIHIP members maintain medication access and understand when new action is required from a Vida provider.

Existing Prior Authorization (PA) Policy

If a member currently has a PA from a non-Vida provider for their medication, that PA will only be honored until 3/31 or its expiration date, whichever comes first, provided the member keeps the exact same dosage.

• Condition	PA Validity	Required Member Action
  Same Dosage Maintained	Valid until 3/31	The member must schedule a consultation with their Vida Prescribing Provider before the validity end date to avoid a gap in coverage.
  Dosage Changes	Immediately void.	Mandatory: The member must immediately schedule an appointment with their Vida Prescribing Provider to get a new prescription and PA process started through Vida.

Population Details

• 90% of membership lives in Illinois
  • Employees: 8,009
  • Spouses + Dependents: 5,307
  • Total: 13,316
• Is there VSC calling? YES
• Bilingual Population? NA
• Translation Services? YES

Additional Info

• TBD