Frequently Asked Questions

Member Access allows members to manage your health benefits through our secure online member self-service program. We have a variety of secure resources available to active members:

Member Survey - Tell us what you think

Update Your Account

Request New ID Card

Change Your Primary Care Physician

Check Member's Eligibility Status and *Benefits

Check Member's Accumulations

Check Claims/Encounter Status

Member Certificate Booklets

Healthcare Advisor

Print Online Agreement

WellPoint Pharmacy Member Self Service

Yes, employees will receive a comprehensive benefits booklet which describes coverage provisions to every subscriber. These booklets are sent to the Employer for distribution to their employees who are covered by the health plan.

A pre-existing condition is a condition for which medical advice, diagnosis, care or treatment was recommended or received within the previous 6 months preceding the effective date of the coverage of an individual member.

For members covered by a Traditional (Indemnity) Plan or by BlueChoice PPO, benefits for services shall not be available for any illness, injury or other pre-existing condition (except for maternity services, for which the pre-existing condition limitation is not applicable) until a member has had creditable coverage for 12 consecutive months.

For members covered by BlueChoice Healthcare Plan (HMO), there are no pre-existing condition limitations. All in-network, covered services are eligible for benefits from the member's first day of coverage.

For members covered by BlueChoice Option (POS), there is no pre-existing condition limitation for in-network services. For out-of-network services, benefits are not available during a pre-existing limitation period. The pre-existing limitation period may be reduced or eliminated by the submission of a certificate of prior creditable coverage. The pre-existing limitation period does not apply to maternity services.

Yes

Initial enrollees and eligible dependents, who were previously enrolled under the group coverage which was replaced by the plan are eligible for coverage on the effective date of the plan. Any employer or pre-existing waiting periods which were not satisfied under previous creditable coverage must be satisfied and credit will be given for the length of time already served.

Depending on the type of plan the member has, many services are available.

Members and their dependents are covered anywhere in the world, provided the bill is translated into U.S. currency. The bill will be paid at our Usual Reasonable and Customary rates.

Yes

If an employer averaged 20 or more full time employees in the prior calendar year, they must offer COBRA continuation during the next year.

Employees and dependents covered by any comprehensive group medical plan are eligible for the portability provisions of HIPAA.

Time served under the prior carrier counts if the gap between when coverage ended and full time employment began did not exceed 90 days. Additionally, employee waiting periods count toward satisfaction of pre-existing condition waiting periods, including gaps between coverage and full time employment, as described.

There will be no product changes; however administrative changes will occur to protect the member's individually identifiable information.

Prior group coverage, COBRA coverage, individual (non-catastrophic) coverage, Medicare (Part A or B), Medicaid, CHAMPUS, Federal Employees Benefit Program, and other Government programs.

Any time served towards an employer-imposed waiting period counts toward any pre-existing waiting period that must be satisfied.

Proof of prior coverage will be necessary; the member should contact the customer service department of the prior health plan to request a certificate of creditable coverage. A copy of this certificate should be submitted to the employer and/or the new insurance carrier.

HIPAA does not affect individual policies.

The member should contact the customer service department of the prior health plan to request a certificate of creditable coverage. A copy of this certificate should be submitted to the employer and/or the new insurance carrier.

We offer a wide array of medical, dental and vision plans for both groups and employees. A complete list of products and services may be found on our Web site.

Pharmacy coverage is not optional at the subscriber level. However, groups under 100 lives can elect not to have pharmacy coverage on PPO and Traditional Plans. Pharmacy coverage is optional for all plans (Traditional, PPO, HMO and POS) for groups with more than 100 lives.

Sold Group Enrollment Forms Required:

Master Application

Individual Applications including Refusal Applications

Handicap/Disabled Member Certification Form

Medical Questionnaires

Single Case Commission Agreement

Copy of Prior Carrier's Bill

Benefit Booklet

Signed Group Assessment and Rate Request Form

Certification of Dependency Form for foster children applying

No

We must receive complete enrollment packages must be received by the 20th of the month prior to the effective date.

In most cases, yes.

In most cases, yes.

We accept paper enrollment forms for all size groups. Tape enrollment information is preferred for larger groups with access to this capability

Not at the present time.

Individual medical underwriting requiring no medical records is turned around in approximately ten working days. Group applications submitted for medical review are processed within 48 hours.

All of our networks (HMO, POS, PPO and Traditional/PAR) are comprised of independent physicians, practicing out of their private offices, as well as a wide array of independent facilities offering a comprehensive range of health care services.

Paper directories are updated quarterly for our HMO and POS plans; PPO and Traditional (Indemnity) are updated semi-annually. On-line directories are updated monthly.

Yes, the first month's premium is required.

Brokers who are appointed to sell on our behalf may access the Online Quoting function or call the Rapid Quote Line at (866) 215-4879 (select option 4). Groups should contact their Broker or Sales Representative for a quote.

Contact your Broker or Sales Representative.

50% of the Employee cost.

No.

Your Sales Representative

Send a written request for the change to your Account Representative.

Six months

If the member, the member's spouse, or the member's dependents have duplicate coverage under another one of our group programs, any other group medical expense coverage, or any local, state or governmental program, (except school accident insurance coverage and Medicaid) then benefits payable under the plan will be coordinated with the benefits payable under the other program. Our liability in coordinating will not be more than 100% of the usual, customary and reasonable (UCR) amount or the contracted amount.

An appeal may be initiated by calling Customer Care.

Anytime a non-network (including a non-PAR) provider is used.

Continuation of a disabled employee's coverage is dependent upon your company's internal policies.