15 «Subscriber_ID» «Group_ID» 10/20/17
October 2017
«Member_Name»
«Member_Address_Line_1»
«Member_Address_Line_2»
«Member_City», «Member_State» «Member_Zip»
Subscriber ID#: «Subscriber_ID»
If we do not hear from you by December 15, 2017, we will automatically renew your coverage and enroll you in the «M_2018_Plan_Name» plan.
Dear «Member_First»,
Thank you for being part of the Blue Cross of Idaho family. Your health insurance plan is set to renew on January 1, 2018. In this packet, you’ll find important information, including:
Your new monthly premium for 2018
Changes to your plan that are effective on January 1
What you should do to ensure any financial assistance continues next year
Please read this information carefully. You can also see information about your current and future plans by logging into your account at members.bcidaho.com.
YOUR NEW PREMIUM DEPENDS ON YOUR ADVANCED PREMIUM TAX CREDIT (APTC) For 2018, your monthly premium is $«M_2018_Total_Premium».Your financial assistance amount may be different for 2018, depending on changes to your household income and family size.
In 2017, you enrolled through Your Health Idaho with a total monthly premium of $«M_2017_Total_Premium»
and financial assistance of $«M_2017_APTC». The amount you paid each month was $«M_2017_BAL». If you are eligible for an APTC in 2018, you will receive information from the Idaho Department of Health and
You must call YHI to provide updated income and household size information so that the assistance you receive is correct. Once you receive your tax credit eligibility letter from the Department of Health and Welfare, you should preview the plan that you will be automatically re-enrolled in for any changes. You can do this by accessing your account on Your Health Idaho at yourhealthidaho.org on or after November 1, 2017.
YOU HAVE A CHOICE
You can choose a new health insurance plan for 2018 during the Open Enrollment period from November 1, 2017 until December 15, 2017. If you do not select a different plan by December 15, you will be automatically re-enrolled in your current plan.
Your Health Idaho Enrollment – Enroll in a new health plan through Your Health Idaho and continue to receive help paying for your health insurance costs if you qualify.
o If you qualify for help paying out-of-pocket costs like deductibles or copays, you must choose a Silver level plan in order to receive this help.
o Your Health Idaho will also check if you or your family members qualify for Medicaid or the Children’s Health Insurance Program (CHIP).
o You may also enroll in coverage through Your Health Idaho using a certified insurance agent or broker.
o Remember that if you receive a tax credit to help pay for your health insurance, you must report changes in your income and household size during the year to Your Health Idaho. If you do not report changes, you could owe money when you file your income tax return because your tax credit was based on outdated information.
Enrollment outside Your Health Idaho – Enroll in a new health plan directly with an insurance company during open enrollment, or get help from a local insurance agent or broker. If you qualify for financial assistance for paying your premiums and out-of-pocket costs, you must enroll through Your Health Idaho to receive those benefits.
We’ve worked hard to keep premiums down, but healthcare costs continue to rise. If you have questions about your plan, please call Blue Cross of Idaho customer service at 1-855-230-6862. If you need help exploring your plan options for 2018 coverage, «Contact_Variable_1»
Sincerely,
Blue Cross of Idaho Renewal Team
Enclosures
Policy Update, with personalized plan comparison
«Agent_Tag»
«Broker_Name»
«Broker_Address»
«Broker_City», «Broker_State» «Broker_Zip»
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CONTRACT UPDATES
To Your Blue Cross of Idaho Individual Contract
Please Read Carefully
Dear Blue Cross of Idaho Enrollee:
This Contract Update is a summary of the changes to your health insurance coverage effective on your Contract’s renewal date. We encourage you to review this carefully. For reference, the words and terms capitalized in this document are defined in your member contract.
2017 2018
Plan Name Silver 6000 Tribal No Deductible Silver 6000 Tribal No Deductible
Network «Network» «Network»
In-Network Out-of-Network In-Network Out-of-Network
Annual Deductible None None None None
Annual Out-of- Pocket Maximum Amount
None None None None
Coinsurance 0% 0% 0% 0%
Doctor Office Visits No charge No charge No charge No charge
Inpatient Hospital
Stays No charge No charge No charge No charge
Prescription Drugs
Tier 1 Preferred Generic - No charge Tier 2 Non-Preferred Generic - No charge Tier 3 Preferred Brand Name - No charge Tier 4 Non-Preferred - No charge
Tier 5 Preferred Specialty - No charge Tier 6 Non-Preferred Specialty- No charge Tier 7 Preventive – No charge
Tier 1 Preferred Generic - No charge Tier 2 Non-Preferred Generic - No charge Tier 3 Preferred Brand Name - No charge Tier 4 Non-Preferred - No charge
Tier 5 Preferred Specialty - No charge Tier 6 Non-Preferred Specialty - No charge Tier 7 Preventive – No charge
How To Submit Claims Section
Updates have been made to include that your Explanation of Benefits (EOB) can be received either
electronically or by mail. You can print an electronic copy or contact Blue Cross of Idaho Customer Service to request a paper copy by mail.
Term of Contract
Added language to explain that if your Contract was purchased through Your Health Idaho (YHI), you must contact YHI to request termination.
Major Medical Benefits
Added balance billing clarification language to Out-of-Network Emergency Services.
Added language to explain Prosthetic Appliance and Orthotic Device replacement items are not available when the
Eligibility Section
Clarified the Eligible Individual language.
Prescription Drug
Removed “Coinsurance or Copayment” language referenced in the Prescription Drug discount section.
Revised the Blue Cross of Idaho Pharmacy and Therapeutics Committee reviewed and implemented Prescription Drug exclusion and moved the exclusion to the General Exclusions and Limitations Section.
Clarified the Preferred Brand Name Drugs definition by removing the Blue Cross of Idaho Pharmacy and Therapeutics Committee determination language. Blue Cross of Idaho Pharmacy and Therapeutics Committee determinations are applicable to all tier Prescription Drugs.
Definitions Section
Added definitions for Emergency Services and Urgent Care Clinic.
Removed Out-of-Area Emergency Services definition.
Modified definition of Resident/Residency (of Idaho) language.
Exclusions and Limitations
Separated the convenience and beautification exclusion into four exclusions for clarification.
Added interpretation services billed by a Physician or Provider to the list of excluded services.
Removed the “Outpatient” term from the existing Therapeutic Boarding School and Residential Facility Treatment mental health exclusion.
Clarified the existing complications arising from services not covered exclusion.
Added exclusion to clarify treatment and injuries sustained while “Under the influence” of alcohol and/or drugs are not covered.
General Provisions Section
The Entire Contract-Changes section has been updated to include “application” as a listed item of the Contract.
The entire section of Subrogation and Reimbursement Rights of Blue Cross of Idaho has been replaced with new subrogation language.
Please note: This Contract Update is only a brief highlight of the changes made by Blue Cross of Idaho.
Nondiscrimination Statement: Discrimination is Against the Law
Blue Cross of Idaho 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 Qualified 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 Qualified interpreters
o Information written in other languages
If you need these services, contact Blue Cross of Idaho’s 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 services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with Blue Cross of Idaho’s Grievances and Appeals Department at:
Manager, Grievances and Appeals
3000 East Pine Avenue, Meridian, Idaho 83642
Telephone: (800) 274-4018 ext.3838, Fax: (208) 331-7493 TTY: 1-800-377-1363
Email: grievances&appeals@bcidaho.com
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, our Grievances and Appeals team is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office 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/office/file/ index.html.
Reference: https://federalregister.gov/a/2016-11458
