Blue Cross Idaho Medicaid Plus offered by Blue Cross of
Idaho Care Plus, Inc.
Annual Notice of Changes for 2021
You are currently enrolled as a member of Blue Cross Idaho Medicaid Plus. Next year, there will be some changes to the plan’s costs and benefits. This booklet tells about the changes.
What to do now
1. ASK: Which changes apply to you
Check the changes to our benefits and costs to see if they affect you. It’s important to review your coverage now to make sure it will meet your needs next year.
Do the changes affect the services you use?
Look in Section 1.4 for information about benefit and cost changes for our plan.
Check to see if your providers will be in our network next year. Are your providers you see regularly in our network?
Look in Section 1.2 for information about our Provider Directory.
Think about whether you are happy with our plan.2. COMPARE: Learn about other plan choices
Check coverage and costs of plans in your area. Visit Idaho Department of Health and Welfare’s dual eligible participant website at https://healthandwelfare.idaho.gov/Medical/Medicaid/DualEligibleParticipants/tabid/253 8/Default.aspx, email IdahoDuals@dhw.idaho.gov, or call an Idaho Department of Health and Welfare benefit specialist at 1-833-814-8568.
Look in Section 2 to learn more about your choices.
Once you narrow your choice to a preferred plan, confirm your costs and coverage on the plan’s website.3. CHOOSE: Decide whether you want to change your plan
If you don't join another plan by December 7, 2020, you will be enrolled in Blue Cross Idaho Medicaid Plus.
If you want to change to a different plan that may better meet your needs, you can switch plans between October 15 and December 7. Look in section 2.2, page 5 to learn more about your choices.
4. ENROLL: To change plans, join a plan between October 15 and December 7, 2020
If you don’t join another plan by December 7, 2020, you will be enrolled in Blue Cross Idaho Medicaid Plus.
If you join another plan between October 15 and December 7, 2020, your new coverage will start on January 1, 2021.
Additional Resources
This document is available for free in Spanish.
Please contact our Customer Service number at 1-800-289-7921 for additional
information. (TTY users should 711.) Our hours are 8 a.m. to 6 p.m., Monday through Friday.
This document may be available in alternate formats such as audio and large print. Please call Customer Service if you need this in another format.
About Blue Cross Idaho Medicaid Plus
Blue Cross Idaho Medicaid Plus is an HMO health plan with an Idaho Medicaid contract. Enrollment in Blue Cross Idaho Medicaid Plus depends on contract renewal and your eligibility as a dual eligible beneficiary.
When this booklet says “we,” “us,” or “our,” it Blue Cross of Idaho Care Plus, Inc. When it says “plan” or “our plan,” it means Blue Cross Idaho Medicaid Plus.
Summary of Important Costs for 2021
The table below compares the 2020 costs and 2021 costs for Blue Cross Idaho Medicaid Plus in several important areas. Please note this is only a summary of changes. A copy of the
Evidence of Coverage is located on our website at bcidaho.com/bcidahomedicaidplus. You may also call Customer Service to ask us to mail you an Evidence of Coverage.
Cost 2020 (this year) 2021 (next year) Monthly plan premium*
* You do not pay a monthly
premium for your Blue Cross Idaho Medicaid Plus coverage.
$0 $0
Medicaid-Covered Benefits You pay a $0 copay for Medicaid-covered benefits.
Members receiving Nursing Facility Long-Term Care Service may be required to pay a share of cost. The share of cost, if any, will be determined by Idaho Department of Health and Welfare.
You pay a $0 copay for Medicaid-covered benefits.
Members receiving Nursing Facility Long-Term Care Service may be required to pay a share of cost. The share of cost, if any, will be determined by Idaho Department of Health and Welfare.
Idaho Medicaid Aged & Disabled Waiver Services
(Not all participants qualify for these services.)
Members receiving Aged & Disabled Waiver Services may be required to pay a share of cost. The share of cost, if any, will be determined by Idaho Department of Health and Welfare.
Members receiving Aged & Disabled Waiver Services may be required to pay a share of cost. The share of cost, if any, will be determined by Idaho Department of Health and Welfare.
2 Blue Cross Idaho Medicaid Plus Annual Notice of Changes for 2021
Annual Notice of Changes for 2021
Table of Contents
Summary of Important Costs for 2021 ... 1
SECTION 1 Changes to Benefits and Costs for Next Year ... 3
Section 1.1 – Changes to the Monthly Premium ... 3
Section 1.2 – Changes to the Provider Network ... 3
Section 1.3 – Changes to the Pharmacy Network... 4
Section 1.4 – Changes to Benefits and Costs for Medical Services ... 4
SECTION 2 Administrative Changes ... 4
SECTION 3 Deciding Which Plan to Choose... 5
Section 3.1 – If you want to stay in Blue Cross Idaho Medicaid Plus ... 5
Section 3.2 – If you want to change plans ... 5
SECTION 4 Changing Plans ... 6
SECTION 5 Questions?... 6
Section 5.1 – Getting Help from Blue Cross Idaho Medicaid Plus ... 6
SECTION 1
Changes to Benefits and Costs for Next Year
Section 1.1 – Changes to the Monthly Premium
Cost 2020 (this year) 2021 (next year) Monthly premium
You do not pay a monthly premium for your Blue Cross Idaho Medicaid Plus coverage.
$0 $0
Section 1.2 – Changes to the Provider Network
There are changes to our network of providers for next year. An updated Provider Directory is located on our website at bcidaho.com/bcidahomedicaidplus. You may also call Customer Service for updated provider information or to ask us to mail you a Provider Directory. Please review the 2021 Provider Directory to see if your providers are in our network.
It is important that you know that we may make changes to the hospitals, doctors, and specialists (providers) that are part of your plan during the year. There are a number of reasons why your provider might leave your plan, but if your doctor or specialist does leave your plan you have certain rights and protections summarized below:
Even though our network of providers may change during the year, we must furnish you with uninterrupted access to qualified doctors and specialists.
We will make a good faith effort to provide you with at least 30 days’ notice that your provider is leaving our plan so that you have time to select a new provider.
We will assist you in selecting a new qualified provider to continue managing your health care needs.
If you are undergoing medical treatment you have the right to request, and we will work with you to ensure, that the medically necessary treatment you are receiving is not interrupted.
If you believe we have not furnished you with a qualified provider to replace your previous provider or that your care is not being appropriately managed, you have the right to file an appeal of our decision.
If you find out your doctor or specialist is leaving your plan, please contact us so we can assist you in finding a new provider to manage your care.
4 Blue Cross Idaho Medicaid Plus Annual Notice of Changes for 2021
Section 1.3 – Changes to the Pharmacy Network
In most cases, your Medicaid Drug List items are covered only if they are filled at one of our network pharmacies.
There are changes to our network of pharmacies for next year. An updated Pharmacy Directory is located on our website at bcidaho.com/bcidahomedicaidplus. You may also call Customer Service for updated provider information or to ask us to mail you a Pharmacy Directory. Please review the 2021 Pharmacy Directory to see which pharmacies are in our network.
Section 1.4 – Changes to Benefits and Costs for Medical Services
Please note that the Annual Notice of Changes tells you about changes to your Medicaid benefits and costs.
We are changing our coverage for certain medical services next year. The information below describes these changes. For details about the coverage and costs for these services, see Chapter 4,
Benefits Chart (what is covered and what you pay), in your 2021 Evidence of Coverage. A copy of the Evidence of Coverage is located on our website at bcidaho.com/bcidahomedicaidplus. You may also call Customer Service to ask us to mail you an Evidence of Coverage.
Cost 2020 (this year) 2021 (next year) Inpatient Psychiatric
Services
This benefit is available to members who are twenty-one (21) years of age and members age sixty-five (65) and over.
This benefit is available to members who are twenty-one (21) and older.
SECTION 2
Administrative Changes
Description 2020 (this year) 2021 (next year) TTY phone number for:
Customer Service for Medical Care and Medicaid Services
Appeals for Medicaid Services or Drugs, or Making a Complaint about Care or Drugs
Care Coordination
1-800-377-1363 This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
711
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
SECTION 3
Deciding Which Plan to Choose
Section 3.1 – If you want to stay in Blue Cross Idaho Medicaid Plus
To stay in our plan you don’t need to do anything. If you do not sign up for a different plan by December 7, you will automatically be enrolled in our Blue Cross Idaho Medicaid Plus.
Section 3.2 – If you want to change plans
We hope to keep you as a member next year but if you want to change for 2021 follow these steps:
Step 1: Learn about and compare your choices
You can join a different Idaho Medicaid Plus health plan,
-- OR-- You can join a Dual-Eligible Special Needs Plan (D-SNP). In select counties in Idaho, Blue Cross of Idaho Care Plus, Inc. offers a D-SNP called True Blue Special Needs Plan. For more information, please call Customer Service at 1-800-289-7921. (TTY only, call 711.) We are available for phone calls 8 a.m. to 6 p.m., Monday through Friday. Calls to these numbers are free. A Dual-eligible Special Needs Plans cover all medically-necessary and preventive services covered under Medicare Part A, Part B, and Part D prescription drug coverage, as well as additional services covered by Medicaid, including:
o Hospital, Medical, Prescription drugs, Behavioral Health, Nursing Home, Aged & Disabled (A&D) Waiver, Personal Care Services, Community Based
Rehabilitation Service, as well as Care Coordination.
*Developmental Disability Services, Non-emergency Medical
Transportation, Medicaid Dental Services, and Intermediate Care Facility Services are available through Idaho Medicaid
Your new coverage will begin January 1, 2021.
Step 2: Change your coverage
To change to a different Idaho Medicaid Plus health plan, contact Idaho Department of Health & Welfare (IDHW) at 1-833-814-8568. IDHW benefit specialists will be happy to enroll you in the plan of your choice. You will automatically be disenrolled from Blue Cross Idaho Medicaid Plus.
To change to a Dual-Eligible Special Needs Plan (D-SNP), enroll in the D-SNP. You will automatically be disenrolled from Blue Cross Idaho Medicaid Plus.
6 Blue Cross Idaho Medicaid Plus Annual Notice of Changes for 2021
SECTION 4
Changing Plans
If you want to change to a different Idaho Medicaid Plus health plan for next year, you can do between October 15th and December 7th. The change will take effect on January 1, 2021. You can enroll in a Dual Eligible Special Needs Plan (D-SNP) at any time.
SECTION 5
Questions?
Section 5.1 – Getting Help from Blue Cross Idaho Medicaid Plus
Questions? We’re here to help. Please call Customer Service at 1-800-289-7921. (TTY only, call 711.) We are available for phone calls 8 a.m. to 6 p.m., Monday through Friday. Calls to these numbers are free.
Read your 2021 Evidence of Coverage (it has details about next year's benefits and costs)
This Annual Notice of Changes gives you a summary of changes in your benefits and costs for 2021. For details, look in the 2021 Evidence of Coverage for Blue Cross Idaho Medicaid Plus.
The Evidence of Coverage is the legal, detailed description of your plan benefits. It explains your rights and the rules you need to follow to get covered services and prescription drugs. A copy of the Evidence of Coverage is located on our website at bcidaho.com/bcidahomedicaidplus. You may also call Customer Service to ask us to mail you an Evidence of Coverage.
Visit our Website
You can also visit our website at bcidaho.com/bcidahomedicaidplus. As a reminder, our
website has the most up-to-date information about our provider network (Provider Directory) and our list of covered Medicaid Drug List items (Idaho Medicaid Drug List).
Section 5.2 – Getting Help from Medicaid
To get information from Idaho Medicaid you can call Idaho Department of Health and Welfare at 1-833-814-8568. TTY users should call 711.
Multi Language Interpreter Services:
complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Blue Cross of Idaho does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.
Blue Cross of Idaho:
• Provides free aids and services to people with
disabilities to communicate effectively with us, such as: o Qualifed sign language interpreters
o Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
o Qualifed interpreters
o Information written in other languages
If you need these services, contact Blue Cross of Idaho Customer Service Department. Call 1-800-627-1188 (TTY: 1-800-377-1363), or call the customer service phone number on the back of your card. If you believe that Blue Cross of Idaho has failed to provide these
you can fle a grievance with Blue Cross of Idaho’s Grievances and Appeals Department at:
Manager, Grievances and Appeals 3000 E. Pine Ave., Meridian, ID 83642 Telephone: 1-800-274-4018
Fax: 208-331-7493
Email: grievances&appeals@bcidaho.com
TTY: 1-800-377-1363
You can fle a grievance in person or by mail, fax, or email. If you need help fling a grievance, our Grievances and Appeals team is available to help you. You can also fle a civil rights complaint with the U.S. Department of Health and Human Services, Offce for Civil Rights electronically through the Offce for Civil Rights Complaint Portal, available at https://ocrportal.
hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TTY). Complaint forms are available at
http://www.hhs.gov/ocr/offce/fle/index.html.
ATTENTION: If you speak Arabic, Bantu, Chinese, Farsi, French, German, Japanese, Korean, Nepali, Romanian, Russian, Serbo-Croatian, Spanish, Tagalog, or Vietnamese, language assistance services, free of charge, are available to you. Call 1-800-627-1188 (TTY: 1-800-377-1363).
© 2020 by Blue Cross of Idaho Care Plus, Inc. (“Blue Cross of Idaho Care Plus”), an independent licensee of the Blue Cross and Blue Shield Association, with services provided by Blue Cross of Idaho Health Services Inc.
