Child Health Plus
We’ve served BlueCross BlueShield of Western New York members with Child Health Plus benefits since 1936. Your health is our purpose. We can help your child get and stay healthy.
Your child can get well-checkups, immunizations, vision care, dental care and more with BlueCross BlueShield of Western New York.
Get benefits like:
- Prescription drug coverage and over-the-counter medicines
- Specialist care, X-rays and lab tests
- Emergency hospital visits and inpatient hospital, medical and surgical care
When you need a referral:
For some services, you’ll need a referral from your primary care provider (PCP) before getting care. You’ll need to see your PCP before:
- Going to a hospital for nonemergency care.
- Getting medicine your PCP can’t give you.
Get these services from us without a referral:
For most services, you’ll go to your PCP or another doctor in your plan. We’ll pay for some services you get from a doctor who isn’t in your plan, including:
- Family planning
- Pregnancy services
- Emergency services
- School-based health center services
- Adult dental care (ages 21 and over)
- Behavioral health and substance abuse disorder services
- Certain doctors for children with special health care needs
We’ll also pay for the lab work and medicine related to this service:
- Adult vision care (age 21 and over)
Frequently asked questions
How do I get help after my child’s primary care provider’s (PCP’s) office closes?
Unless it’s a life-threatening emergency, do not go to the emergency room (ER). Instead, call our 24/7 NurseLine at 1-866-231-0847 (TTY 711) to talk to a nurse any time, day or night. Our nurses can answer questions about your health or help you find an urgent care facility near you.
Can I call my child’s specialist’s office directly to set up an appointment?
Your PCP will refer your child to a specialist. If your child needs specialist services that your child can’t get from a BlueCross BlueShield plan doctor, we’ll work with your child’s PCP to refer him or her to an out-of-plan specialist. Your child’s PCP must call BlueCross BlueShield at 1-866-231-0847 (TTY 711) to request approval for an out-of-plan referral.
My child’s plan has dental benefits. How do we choose a dentist?
If you need to find a dentist for your child, please call Healthplex toll free at 1-800-468-9868 (TTY 1-800-662-1220) Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 9 a.m. to 5 p.m. You can also call Member Services at 1-866-231-0847 (TTY 711). When your child visits the dentist, you should show your child’s plan ID card.
How do I get a copy of the BlueCross BlueShield provider directory?
Please call Member Services at 1-866-231-0847 (TTY 711) and request one. You can also view our provider directory online.
How do we see a doctor who is not a [BlueCross BlueShield] plan doctor?
Please call Member Services at 1-866-231-0847 (TTY 711) Monday through Friday from 8:30 a.m. to 6 p.m. with questions.
New Baby, New LifeSM BlueCross BlueShield of Western New York Healthy Rewards Incentive
- $25 incentive for prenatal visit in the first trimester or within 42 days of enrollment into BlueCross BlueShield
- $25 incentive for attending postpartum visit 21 to 56 days after delivery
- $25 incentive for attending at least six prenatal care visits
- $25 incentive for baby’s 2-week checkup within the first two weeks of life
- $25 incentive for attending at least six well-child checkups by 15 months of age
Different eligibility rules apply to each benefit. Look in your member handbook or call us at 1-866-231-0847 (TTY 711) to learn more.
Your pharmacy benefits
BlueCross BlueShield of Western New York works with Express Scripts to give you pharmacy benefits. Get low-cost prescriptions and over-the-counter (OTC) medications.
- $3 for brand-name drugs
- $1 for generic drugs
Preferred Drug List
BlueCross BlueShield has a preferred drug list (PDL), also called a formulary. It includes all medicines covered by Medicaid and Child Health Plus (CHPlus). Your doctor doesn’t have to get preapproval to prescribe medicines on this list. If your doctor wants to prescribe a drug that isn’t on this list, he or she will need to get preapproval from us before you can fill your prescription.
When there is a generic drug available, it will be covered. Generic drugs are equal to brand-name drugs and approved by the Food and Drug Administration. Requests for brand-name drugs when generics are available will need preapproval. You can email us to ask for an exception.
Preferred Drug List
- BlueCross BlueShield Preferred Drug List – English
- BlueCross BlueShield Preferred Drug List – Spanish
If you have any questions about your pharmacy benefit, please call Member Services at 1-866-231-0847 (TTY 711) Monday through Friday from 8:30 a.m. to 6 p.m. Eastern time.
Search for brand-name and generic drugs that are on your medication list.
You can search for your drug by:
- Typing the name (at least first three letters) of the drug in the search box.
- Using the A-Z list to search by the first letter of your drug. OR
- Clicking on therapeutic class of the drug.
Drug Interactions and Side Effects
Learn more about drug interactions or side effects on the ESI drug information website.
Getting your prescription filled is easy!
Simply take your prescription to a plan pharmacy. Find a pharmacy here. Your doctor can also call in the prescription to your local plan pharmacy. You will need to show your BlueCross BlueShield ID card to have a prescription filled.
It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about any medicines you’re taking.
You can use the links below to get more pharmacy information:
Express Scripts Member Reimbursement Form
- ESI Member Reimbursement Form - English
- ESI Member Reimbursement Form - Spanish
Common Over-the-Counter (OTC) medicines
Express Scripts Online Registration
Express Scripts Mail Order Form
Frequently asked questions
How can I find out what pharmacies are in the BlueCross BlueShield plan?
You can look in your new member enrollment package for a list of pharmacies in our plan. Or you can search our list of plan drugstores online. You can also call Member Services at 1-866-231-0847 (TTY 711) Monday through Friday from 8:30 a.m. to 6 p.m. Eastern time or ask your local pharmacy for help.
Are over-the-counter (OTC) products covered, and do I need a prescription?
We cover many OTC products, including pain relievers, antacids, contraceptives and some vitamins. All OTC products require a written prescription from your doctor and can be filled at any drugstore in our plan.
How does my doctor request preapproval?
Your doctor can call our Pharmacy department at 1-866-231-0847 (TTY 711).
What if a copay is required and I’m unable to pay it?
If you don’t have the required copay, your pharmacy (drugstore) should still provide the medicine. You will have to pay the copay at a later time.
How do I get medicine if I’m traveling?
We have pharmacies in our plan in all 50 states. If you need a refill while on vacation, ask your doctor for a new prescription to take with you. You can also ask your doctor to fax it to the closest drugstore in our plan where you’ll be visiting.
What happens if my medicines are lost or stolen?
If your medicines are lost or stolen, you should contact your doctor. Ask your doctor to authorize the pharmacy to refill your prescription early. The pharmacy may have to contact us for preapproval. Replacement of lost or stolen medicines will be reviewed on a case-by-case basis.
What if I paid out of pocket for a medicine and want to be reimbursed?
If you had to pay for a medicine, you may submit a request for reimbursement. You’ll need to mail a completed reimbursement request form along with any receipts to:
P.O. Box 14711
Lexington, KY 40512
Will I be able to receive my enteral nutrition, diapers and medical supplies through a pharmacy?
Enteral nutrition, diapers and durable medical equipment (DME) can be obtained through your (DME) benefit. You can get some medical supplies from your local pharmacy, like bandages, insulin syringes and glucose test strips.
BlueCross BlueShield of Western New York offers the New York State-sponsored Child Health Plus program. We can help you get the most out of your Child Health Plus benefits so you can help your family get and stay healthy.
Your child may be eligible for Child Health Plus if your child:
- Is under the age of 19.
- Is not eligible for Medicaid.
- Has little or no other health insurance coverage.
- Lives in one of the following counties: Allegany, Cattaraugus, Chautauqua, Erie, Orleans, or Wyoming.
A child does not have to be a U.S. citizen or legal resident to qualify for Child Health Plus. Participation in this program will not affect any future immigration status.
To find out more about eligibility, visit the New York Child Health Plus website.
Already a member and have questions?
Please call Member Services at 1-866-231-0847 (TTY 711) Monday – Friday from 8:30 a.m. – 6 p.m. Eastern time.
Your member handbook is your go-to guide for health services. It tells you how you can get the most from BlueCross BlueShield of Western New York. You’ll find answers to these items:
- Your benefits
- Your rights and responsibilities.
- How to get helpt after your doctor's office closes
- How to choose a primary care provider
- Renewing your coverage
- How to reach Member Services if you have a question
Notice of Privacy Practices
New Baby, New Life℠ BlueCross BlueShield Healthy Rewards Incentives
- Earn 250 points ($25) in rewards for attending a prenatal visit in the first trimester or within 42 days of enrollment into BlueCross BlueShield.
- Earn 250 points ($25) in rewards for attending at least six prenatal care visits.
- Earn 250 points ($25) in rewards for attending postpartum visit 21 to 56 days after delivery.
- Earn 250 points ($25) in rewards for baby’s checkup by 2 weeks of age.
- Earn 250 points ($25) in rewards for attending at least six well-child checkups by 15 months of age.
For more information, check online at www.bcbswny.com/healthyrewards or call 1-800-749-9036.