Direct pay changes
Health plan updates for 2020
Effective January 1, 2020, and upon renewal, we’re making changes to our health plans to ensure that we continue to meet the ongoing requirements of health care reform, while providing the high-quality, affordable coverage you expect from Blue Cross.
In 2020, you can enjoy updates that make your plan and benefits better, including:
- Acupuncture coverage—Up to 12 covered visits per calendar year
- Expanded pharmacy coverage—Making certain prescription medications more affordable and accessible
- Redesigned fitness and weight-loss reimbursements—New guidelines for reimbursements to make it easier for you to get money back each calendar year
To see how these and other updates will affect you, please read the 2020 Product and Benefit Updates brochure and log in to your account to review your current plan benefits.
As a Blue Cross member, you’re likely already enrolled in a health plan that meets all state and federal coverage requirements.* The changes we’re making in 2020 will keep your plan in compliance with federal and state law. You don’t need to take any action. We simply want you to be aware of all changes to your coverage.
*HMO Blue Essential doesn’t meet the Centers for Medicare & Medicaid Services requirement for Medicare Creditable Coverage. This requirement states the member’s prescription drug coverage is as good as or better than the standard Medicare Part D plan. HMO Blue Essential also doesn’t meet the minimum level of benefits for Minimum Creditable Coverage that adult tax filers need to be considered insured and avoid tax penalties in Massachusetts.
If you purchased coverage directly from Blue Cross Blue Shield of Massachusetts and you want to:
- Continue your current coverage—Simply continue to pay your bill, and your policy will automatically renew provided that the plan remains active. Any change to your premium will go into effect on January 1, 2020. NOTE: If you pay your bill quarterly, you may receive a revised invoice depending on your billing cycle.
- Change your plan during open enrollment—Starting November 1, 2019, you can sign in to or create a MyBlue account then click on View, Change, or Renew Your Plan. This link will direct you to the shopping site where you can select a new plan to go into effect on January 1, 2020.
If you purchased coverage through the Health Connector and you want to:
- Continue your current coverage—Simply continue to pay your bill, and your policy will automatically renew provided that the plan remains active. Any change to your premium will go into effect on January 1, 2020.
- Change your plan during open enrollment—Starting November 1, 2019, you can go to www.mahealthconnector.org, or you can call the Health Connector toll-free at 1-877-623-6765 or TTY: 1-877-623-7773. We encourage you to enroll and submit your payment as early as possible.
To find out if you’re eligible for a premium subsidy (financial help for your health plan’s premium), please contact the Massachusetts Health Connector at 1-877-MA-ENROLL (623-6765) or visit their website. Premium subsidies are only available through the Health Connector and only the Health Connector can assist you in determining your eligibility.
Important changes to your medical benefits in 2019
Effective January 1, 2019, we’re making changes to our health plans to help lower medical costs over the long term and expanding the types of programs that qualify for reimbursement under our Fitness and Weight-Loss benefits. These updates also ensure that we continue to meet the ongoing requirements of health care reform, while providing you with access to high-quality, affordable health plans.
For more information, please read the 2019 Product & Benefit Updates brochure and login to review your current plan benefits.
As a member of Blue Cross Blue Shield of Massachusetts, you’re likely already enrolled in a health plan that meets all state and federal coverage requirements.* The changes we’re making will keep your plan in compliance with federal and state law. There’s nothing you need to do. We simply want you to be aware of all changes to your coverage.
* HMO Blue Essential doesn’t meet the Centers for Medicare & Medicaid Services requirement for Medicare Creditable Coverage. This requirement states the member’s prescription drug coverage is as good as or better than the standard Medicare Part D plan.
Update on the Individual Health Insurance Mandate and 1099-HC's.
Recent legislation eliminated the individual mandate for health insurance at the federal level. However, Massachusetts has had its own requirement since 2007. Most Massachusetts residents over the age of 18 are still required to have health insurance coverage, or else they'll be charged a penalty.
The individual mandate is a requirement that most residents obtain health insurance coverage. Failing to have coverage that meets the minimum standards will result in a tax penalty.
We'll continue to send out the 1099-HC form to all members with a Massachusetts address on file. All tax forms will be mailed by January 31, 2018.
Summary of Benefits and Coverage
Under the federal Affordable Care Act, health insurers and group health plans are required to provide a Summary of Benefits and Coverage to those who have private insurance. This regulation is intended to give members clear and consistent information about their health plan. This will help you better understand and evaluate your choices.
Since September 23, 2012, we've been providing a Summary of Benefits and Coverage to you upon renewal, request, and when material changes occur, at no additional charge. We've also provided an online glossary to help you understand common health care terms.
Summary of Benefits and Coverage to replace current Summary of Benefits
We no longer create the benefit summaries that you may have received from us in the past. Instead, we'll provide the new Summary of Benefits and Coverage.
We don't provide a Summary of Benefits and Coverage for the following plans:
- Managed Blue for Seniors
- Medicare Advantage
- Medex®'
- Dental and vision plans
We'll continue to provide current benefit summaries for the plans listed above.
Summary of Benefits and Coverage services—as of September 23, 2012
- You can find the Summary of Benefits and Coverage on our website. You will receive a new Summary of Benefits and Coverage every time your plan renews.
- You can request a Summary of Benefits and Coverage from Member Service by calling the number on the front of your ID card. Within 7 business days of receiving your request, we will provide one copy of the Summary of Benefits and Coverage to you in electronic (PDF) format.
- If there are changes to your Blue Cross Blue Shield of Massachusetts plan(s) that require updating the Summary of Benefits and Coverage, we'll provide a new one within 30 days.
- Printed copies of the Summary of Benefits and Coverage are available upon request.
Learn more
Please visit Health care reform to access the health care glossary and get updates as they become available. If you have any questions, please call Member Service at the number on the front of your ID card.
Eligibility requirements
Beginning October 1, 2010, Massachusetts residents who are eligible for coverage through an employer-sponsored (group) plan will be ineligible for coverage in the individual (non-group) market.
Massachusetts residents must establish that they're ineligible for coverage through an employer-sponsored plan that meets MCC guidelines to be eligible for coverage in the individual market.
Enrollment requirements
Beginning December 1, 2010, Massachusetts residents will only be able to enroll in a plan in the individual market during the annual Open Enrollment period, unless they meet certain criteria.
Massachusetts residents may only obtain individual coverage outside of an Open Enrollment period if they establish that they requested non-group coverage within 63 days of termination of prior creditable coverage held for 18 or more months under a group health plan, governmental plan, or church plan. Additional restrictions may apply.
Any coverage issued based on your completed application today will be effective the first of the month following the receipt of your completed application.