HealthyBlue 2.0/HealthyBlue Advantage Member ... - CareFirst

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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
All health plans and providers mustprovide information to membersand patients regarding how theirinformation is protected. You willreceive a notice of privacy practicesfrom CareFirst BlueChoice or yourHealth Plan, and from your providersas well, when you visit their office.CareFirst BlueChoice has policies andprocedures in place to protect theconfidentiality of member information.Your confidential information includesProtected Health Information (PHI) andother nonpublic financial information.Because we are responsible for yourinsurance coverage, making sure yourclaims are paid, and you can obtainany important services related toyour health care, we are permittedto use and disclose (give out) yourinformation. Sometimes we are evenrequired by law to disclose yourinformation in certain situations. Youalso have certain rights to your ownprotected health information, and thereare some requirements you will have tofollow to allow other people to obtainyour information on your behalf.HealthyBlue Member Handbook29
Page 1: HealthyBlue 2.0 / HealthyBlue Advan
Page 4 and 5: Important InformationEmergency Assi
Page 6 and 7: Your HealthyBlue 2.0 Member ID Card
Page 8 and 9: HealthyBlue — The BasicsAs a Heal
Page 10 and 11: HealthyBlue: The Basics➤ Work wit
Page 12 and 13: CareFirst BlueChoice &CareFirst PPO
Page 14 and 15: Frequently Asked QuestionsWhy is my
Page 17 and 18: Emergency and Urgent CareWhen you h
Page 19: Coverage Outside the AreaBlueCard
Page 23 and 24: Additional BenefitsHow to Access In
Page 25 and 26: Health + WellnessUtilization Manage
Page 27 and 28: Administration of Your PlanPersonal
Page 29: CareFirst BlueChoice’s appeal pro
Page 33 and 34: HSA and HRA PlansThis section is sp
Page 35 and 36: HSA and HRA PlansHSA Plan Questions
Page 37 and 38: HSA and HRA PlansHealth Reimburseme
Page 39 and 40: HSA and HRA PlansPlease note: Some
Page 41 and 42: Definition of TermsHealth Maintenan
Page 43 and 44: Policy Form NumbersDC HealthyBlue G
Page 45 and 46: NotesHealthyBlue Member Handbook43
Page 48: The CareFirst BlueCross BlueShieldf

HealthyBlue 2.0/HealthyBlue Advantage Member ... - CareFirst

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