HealthyBlue 2.0/HealthyBlue Advantage Member ... - CareFirst

Ending or ContinuingYour CoverageEnding Your CoverageYour coverage or your dependents’ coverage withCareFirst BlueChoice may automatically end forcertain reasons. These reasons may include but arenot limited to:➤ You are no longer employed by the companythat carries your CareFirst BlueChoicecoverage;➤ Your employer cancels coverage with CareFirstBlueChoice;➤ Divorce from a policyholder; or➤ A covered dependent turned 26 years of age.Please refer to your Evidence of Coverage/Agreementor contact Member Services for more information.Continuing Your CoverageIf you have group coverage and are changing jobsor your dependents’ status changes, please speakto your employer, your payroll office or MemberServices about the options available to you andyour eligible dependents to continue health carebenefits. The options available are specified inyour Evidence of Coverage/Agreement.If your group coverage ends, you and yourdependents may be eligible under federal laws tocontinue your coverage with CareFirst BlueChoice atyour own expense under the Consolidated OmnibusBudget Reconciliation Act of 1985 (COBRA) orsimilar state program. Your former employer isresponsible for supplying eligible beneficiaries withthe details about COBRA coverage.You and your dependents may also be eligibleunder state laws to continue your coverage withCareFirst BlueChoice at your own expense.Contact your employer or Member Services foradditional information.Another option may be a CareFirst BlueChoiceconversion policy. See your Evidence of Coverage/Agreement for information. A conversion policyis a non-group policy offered to members whoare losing their group benefits under certainconditions. A conversion policy is a contract thatprovides individual or family medical coverage.Dental, vision and prescription plans cannot beadded to the conversion policy.Eligible members can enroll for conversioncoverage after their eligibility for group coverageends. You should check with your employer to seehow soon you must enroll after your coverage ends.Members who end or lose their group coverage maybe entitled to a conversion policy in the followingsituations:➤ The policyholder’s eligibility for his or hercurrent group coverage ends;➤ Termination of spouse’s and dependents’eligibility due to the policyholder’s death;➤ Termination of marriage to the policyholder;➤ Termination of the group agreement if thegroup has not provided for continued coveragethrough another plan, and termination is not aresult of the group’s failure to pay premiums;or➤ Termination of dependent’s eligibility due toreaching the age limit or marriage.If you are interested in receiving a conversionpolicy application, please contact MemberServices at the telephone number on yourmember ID card.Portability (HIPAA)The Health Insurance Portability and AccountabilityAct of 1996 (HIPAA) ensures that individuals whohave health insurance do not experience a gap incoverage due to termination or departure fromtheir current job. A member terminating coveragewith an insurance carrier will receive a Certificateof Creditable Coverage indicating the length oftime they have had health insurance coverage. ThisCertificate of Creditable Coverage is used to reduceany waiting time for pre-existing conditions thatmay be part of subsequent health insurance coverage,as long as there has not been a break in coverage formore than 63 days.When a member terminates with CareFirstBlueChoice, they receive a Certificate of HealthPlan Coverage that indicates how long the memberwas covered. The member should then present thecertificate to the new insurance carrier. This willreduce or eliminate waiting periods for pre-existingconditions under the member’s new policy.REMEMBER:HIPAA is designedto help you keepand maintainhealth insurancecoverage due totermination ordeparture fromyour current job.28 HealthyBlue Member Handbook