2024 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 9. Coordinating Benefits With Medicare and Other Coverage
Page 146
Section 9. Coordinating Benefits With Medicare and Other Coverage
Page 146
When we are the primary payor, we process the claim first.
When the Original Medicare Plan is the primary payor, Medicare processes your claim first. In most cases, your claim will be coordinated automatically and we will then provide secondary benefits for the covered charges. To find out if you need to do something to file your claims, call us at the customer service phone number on the back of your Service Benefit Plan ID card or visit our website at www.fepblue.org.
We waive some costs if the Original Medicare Plan is your primary payor – We will waive some out-of-pocket costs as follows:
When Medicare Part A is primary –
Note: Once you have exhausted your Medicare Part A benefits:
When Medicare Part B is primary –
Note: We do not waive benefit limitations, such as the 25-visit limit for home (skilled) nursing visits. In addition, we do not waive any coinsurance or copayments for prescription drugs.
You can find more information about how our Plan coordinates benefits with Medicare in our Medicare and You Guide for Federal Employees available online at www.fepblue.org.
When the Original Medicare Plan is the primary payor, Medicare processes your claim first. In most cases, your claim will be coordinated automatically and we will then provide secondary benefits for the covered charges. To find out if you need to do something to file your claims, call us at the customer service phone number on the back of your Service Benefit Plan ID card or visit our website at www.fepblue.org.
We waive some costs if the Original Medicare Plan is your primary payor – We will waive some out-of-pocket costs as follows:
When Medicare Part A is primary –
- Under Standard Option, we will waive our:
- Inpatient hospital per-admission copayments; and
- Inpatient Member and Non-member hospital coinsurance.
- Inpatient hospital per-admission copayments; and
- Under Basic Option, we will waive our:
- Inpatient hospital per-day copayments.
Note: Once you have exhausted your Medicare Part A benefits:
- Under Standard Option, you must then pay any difference between our allowance and the billed amount at Non-member hospitals.
- Under Basic Option, you must then pay the inpatient hospital per-day copayments.
When Medicare Part B is primary –
- Under Standard Option, we will waive our:
- Calendar year deductible;
- Coinsurance and copayments for inpatient and outpatient services and supplies provided by physicians and other covered healthcare professionals; and
- Coinsurance for outpatient facility services.
- Calendar year deductible;
- Under Basic Option, we will waive our:
- Copayments and coinsurance for care received from covered professional and facility providers.
Note: We do not waive benefit limitations, such as the 25-visit limit for home (skilled) nursing visits. In addition, we do not waive any coinsurance or copayments for prescription drugs.
You can find more information about how our Plan coordinates benefits with Medicare in our Medicare and You Guide for Federal Employees available online at www.fepblue.org.
• Tell us about your Medicare coverage
You must tell us if you or a covered family member has Medicare coverage, and let us obtain information about services denied or paid under Medicare if we ask. You must also tell us about other coverage you or your covered family members may have, as this coverage may affect the primary/secondary status of this Plan and Medicare.
You must tell us if you or a covered family member has Medicare coverage, and let us obtain information about services denied or paid under Medicare if we ask. You must also tell us about other coverage you or your covered family members may have, as this coverage may affect the primary/secondary status of this Plan and Medicare.
• Private contract with your physician
If you are enrolled in Medicare Part B, a physician may ask you to sign a private contract agreeing that you can be billed directly for services ordinarily covered by Original Medicare. Should you sign an agreement, Medicare will not pay any portion of the charges, and we will not increase our payment. We will still limit our payment to the amount we would have paid after Original Medicare’s payment. You may be responsible for paying the difference between the billed amount and the amount we paid.
If you are enrolled in Medicare Part B, a physician may ask you to sign a private contract agreeing that you can be billed directly for services ordinarily covered by Original Medicare. Should you sign an agreement, Medicare will not pay any portion of the charges, and we will not increase our payment. We will still limit our payment to the amount we would have paid after Original Medicare’s payment. You may be responsible for paying the difference between the billed amount and the amount we paid.