HMO Product Clarification: Member Claim Payments with Medicare as Primary Payer - Blue Links for Employers

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Special Announcements

HMO Product Clarification:
Member Claim Payments with Medicare as Primary Payer

Member cost sharing, as described in a member's subscriber certificate or benefit description, applies for covered services when:

The member is appropriately enrolled in certain managed care plans with us and Medicare,
Medicare is the primary coverage, and
We receive a claim for balances after Medicare payment.

Who Does This Apply To?
Members who have Medicare as their primary payer and are enrolled in a fully-insured or self-funded managed care product (e.g., HMO Blue^®, Network Blue^®, and Blue Choice^®) that is not a Medicare supplement or Medicare replacement plan, such as Medicare Advantage.

To determine if we can eliminate the cost share under our plans for enrolled members who meet the above criteria, please contact your account executive.

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