Blue Links for Employers

FAQ

Below are links to frequently asked questions from employers. If you don't see the answer to your question, please don't hesitate to contact your account executive.

 

Enrollment and Renewals
Rates and Plan Information
Benefits and Eligibility
Dependent Coverage

 

 

Enrollment and Renewals

When will my account be up for renewal?
Typically, your renewal is on the anniversary date of your plan's initial effective date. For example, if your plan became effective on January 1, 2009, your renewal would be January 1, 2010.

I sent in an enrollment form. How will I know when it's been completed?
Your monthly statement will indicate all enrollment transactions that have been completed within the billing cycle.

One of my employees who is not active in the plan is looking for health care services—how should I follow up?
If the employee should already have been on the plan and has not yet been enrolled, you should contact your account executive for assistance.

When can a new employee join my group plan?

  • On his or her initial eligibility date, which can vary depending on the employer's guidelines
  • Date of hire
  • At the end of a set probationary period

If a subscriber lives in-state but, by law, must provide coverage for out-of-state dependents, can they all join the HMO?
Yes, they can; however, only emergency services are available out-of-state. In these situations, the subscriber should speak with his or her employer about other options that may be available through Blue Cross Blue Shield of Massachusetts.

Do pre-existing condition limitations apply?
Blue Cross Blue Shield of Massachusetts programs do not include pre-existing condition limitations. There may be a waiting period for some services when a member had no previous coverage. Some employer group plans may vary. Members may check with their human resources department or call the Member Service number on the front of their ID card.

If an employee has previously declined coverage, can he or she join the plan at any time?
An employee can only join the plan during a qualifying event or during the annual open enrollment period. For example, date of hire, involuntary loss of other coverage, date of birth of a baby, date of marriage, etc., are all qualifying events that allow an employee to join a plan. Some employers have different qualifying events. Refer to your company's policy for additional information.

Does each member in a family receive an ID card?
HMO Blue®, Blue Choice®, and PPO members each receive their own ID card. Indemnity plan subscribers receive two ID cards.

How long will it take for new cards to be delivered to my employees?
Identification cards will be received in 7 to 10 business days.

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Rates and Plan Information

Why are health care costs rising faster than the rate of inflation?

  • Expensive new technologies can now diagnose and treat conditions that previously may have been difficult even to detect
  • Direct-to-consumer drug advertising and direct marketing to physicians by pharmaceutical companies
  • Hospitals are putting needed investments toward new equipment and specialty facilities
  • Hospitals are consolidating to leverage their market position
  • Lower government reimbursement levels leave the private sector with a higher cost-sharing burden
  • Baby boomers are rapidly becoming the nation's seniors

At Blue Cross Blue Shield of Massachusetts, we believe the most promising way to slow rising health care costs is to improve the quality, safety, and effectiveness of the health care our members receive. It's an approach we've summarized in a simple equation: Quality = Affordability. We believe that better care will lead to more affordable care, and we are working to reach that solution. We believe this work as essential to fulfilling the promise we've made to our members: to always put their health first.

Are there less expensive options than my current plan?
Yes, in most cases. Selecting an HMO instead of a PPO or a PPO instead of an indemnity plan can lower your cost. These plans may be available with different levels of deductibles, copayments, and co-insurance. The higher deductibles, copayments, and co-insurance can further reduce the cost.

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Benefits and Eligibility

Can members access services anytime after their effective date, even if they have not yet received their ID card? If so, how?
Yes, the member is encouraged to return the completed application to the employer as soon as possible to expedite the enrollment process. He or she is asked to keep the pink copy of the application and use it as a temporary ID card until the ID card is issued. Your Blue Cross Blue Shield of Massachusetts account service team can assist members by verifying coverage to any provider who requests it.

If a member is hospitalized on his or her effective date of coverage, is the member still eligible and how are benefits handled?
Blue Cross Blue Shield of Massachusetts will begin coverage on the member's effective date. If services began prior to the effective date, Blue Cross Blue Shield of Massachusetts will pro-rate payment to the doctors, not to exceed the coverage maximum, if any.

Are members covered when they travel out of the state or country?
Through our BlueCard® program, Blue Cross Blue Shield of Massachusetts members can see participating providers throughout the United States and the world! This eliminates the need for paying up front for covered services and submitting for reimbursement in the U.S. and receiving discounts in other countries! Simply call BlueCard Worldwide Service at 1-800-810-BLUE (2583) or go to www.bluecares.com and click on Health Care Anywhere.

If a member's prior primary care provider (PCP) recommended surgery (or a certain course of treatment), will you honor that previous authorization?
Each case is reviewed individually; check with your account executive as soon as you know you are going to be offered coverage through Blue Cross Blue Shield of Massachusetts to have the case reviewed.

If a member wants to get a second opinion, will it be covered?
Yes. Please see your subscriber certificate for limitations and exclusions.

If a member is in the middle of a course of treatment on the effective date, can the member retain his or her own doctor even if that doctor is not in your network?
Each case is reviewed individually; check with your account executive as soon as you know you are going to be offered coverage through Blue Cross Blue Shield of Massachusetts to have the case reviewed.

If someone in an accident needs emergency care and cannot call his or her PCP, will the claims be paid?
Yes, all emergency services are covered without a referral from the member's primary care provider.

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Dependent Coverage

As a result of the health care reform law, eligibility provisions for dependent coverage have changed. Effective January 1, 2007, coverage for dependents, including adoptive children and newborns, has been extended to:

  • Age 26; OR
  • For two calendar years after the dependent is no longer claimed on the federal tax return of a member or member's spouse, whichever occurs first.

The two-year eligibility extension begins January 1 of the calendar year in which the dependent is no longer claimed on the federal tax return of a member or a member's spouse.

When can a member enroll a dependent who is now eligible for coverage under the new mandate?
Dependents who qualify under the new law may initially enroll as of January 1, 2007. We are treating the eligibility change like a qualifying event, in which an employer, in most cases, has the standard 60-day timeframe to enroll dependents. If qualifying dependents are not enrolled during this timeframe, a member will need to wait until the employer's next open enrollment period or after a qualifying event.

Will all dependents be covered up to the age of 26?
No. Under the law, family memberships must provide dependent eligibility coverage up to age 26, or for two years after the dependent is no longer claimed on the federal tax return of a member or member's spouse, whichever comes first.

When does a dependent's two-year eligibility extension begin?
The eligibility extension begins January 1 of the year in which a member can no longer claim a dependent on the federal tax return of the member or member's spouse. For example, if a member claims a 21-year-old child as a dependent on his or her tax return for 2006, and does not claim that child for 2007, the eligibility extension begins January 1, 2007, and ends December 31, 2008.

Does this law change Blue Cross Blue Shield of Massachusetts' policy on student dependent eligibility?
No, our student eligibility requirements remain the same. Thus, a student dependent who has not been claimed within the past two calendar years as a dependent on the federal tax return of a member or member's spouse will lose coverage at:

  • Age 25; OR
  • When he or she marries; OR
  • On November 1 following the date the student discontinues full-time classes or graduates; whichever occurs first.

Will Blue Cross Blue Shield of Massachusetts require verification from members upon initial enrollment of students or dependents?
No. The employer is responsible for making eligibility determinations and may require verification from members.

Will Blue Cross Blue Shield of Massachusetts continue the current student/dependent certification process?
We will not continue our current student/dependent certification process. To help ensure compliance, we will instead conduct an annual notification and auditing process, which will include an annual notification to subscribers with dependents age 18 and over, that

  • Outlines eligibility requirements; and
  • Directs subscribers to work with their employers regarding the continuation of eligibility for dependents or the cancellation of dependents who are no longer eligible.

In 2007, we plan to send members a notification in the first quarter. In 2008 and beyond, we will send the notification annually in September. In addition, we may audit employers and request eligibility documentation from members at that time.

Are employees who live outside of Massachusetts eligible for the new dependent coverage?
Yes. The dependent eligibility provision applies to all Massachusetts fully insured employers and their employees, regardless of where the employees live. However, other Subscriber Certificate provisions, such as HMO Blue® service area requirements, may limit benefits for services provided outside of a service area.

Will Blue Cross Blue Shield of Massachusetts require documentation to prove Internal Revenue Code dependency?
We expect employers to validate eligibility of all dependents prior to enrollment. However, we may audit employers and request eligibility documentation. We may also institute a verification process in the future.

If dependents receive medical care in early January 2007, but the enrollment is not submitted and processed until late January 2007, will the claims be paid?
For this qualifying event, enrollment received within the (standard) 60-day timeframe will be effective January 1, 2007. Once the dependent is enrolled, all claims covered under the provisions of the Subscriber Certificate will be processed accordingly.

If you have any questions, please contact your Account Executive.

Note: This law is mandated for insured businesses only, not for self-insured businesses.

Limitations and Exclusions: The member's subscriber certificate defines the terms and conditions of a plan. Should any questions arise concerning benefits, the subscriber certificate will govern. For a complete list of limitations and exclusions, please refer to the subscriber certificate.

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Blue Cross Blue Shield of Massachusetts

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