Blue Links for Employers

Update to Out-of-Network Provider Claims Reimbursements
for ASC PPO Plans

We're updating our standard out-of-network reimbursement benefit in order to reduce exposure to high, out-of-network charges. This update will take effect on 1/1/18 for eligible, fully insured PPO plans, and will now include eligible ASC PPO plans upon renewal in 2018.

For accounts currently offering the standard PPO out-of-network reimbursement benefit, we'll reimburse most out-of-network claims based on 150 percent of the Medicare fee schedule. When no Medicare fee is available for certain procedures, we'll use current, publicly-available fee reimbursement data, and adjust it for geographic variations to determine the fee for the claim.

Accounts currently using our standard PPO out-of-network reimbursement benefit can expect to be automatically updated to the new standard. Fully insured and ASC accounts currently offering a non-standard PPO out-of-network reimbursement rider will be given the opportunity to change to the new standard beginning 1/1/18, or discuss available non-standard rider options.

For more information, please contact your account executive.

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