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Direct pay changes

Health plan updates for 2021

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, 2020, you can sign in to or create a MyBlue account, then click 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, 2020, 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 2020

Effective January 1, 2020, 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 2020 Product & Benefit Updates brochure and log in 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 Form 1099-HC.

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, 2020.

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

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 seven 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

Effective 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

Effective 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.

View plan prices and buy online now

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ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Call 1-800-472-2689 (TTY: 711).

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al número de Servicio al Cliente que figura en su tarjeta de identificación llamada 1-800-472-2689 (TTY: 711 ).

ATENÇÃO: Se fala português, são-lhe disponibilizados gratuitamente serviços de assistência de idiomas. Telefone para os Serviços aos Membros, através do número no seu cartão ID chamar  1-800-472-2689 (TTY: 711 ).

ATTENTION : si vous parlez français, des services d’assistance linguistique sont disponibles gratuitement. Appelez le Service adhérents au numéro indiqué sur votre carte d’assuré appel 1-800-472-2689  (TTY : 711 ).

注意:如果您讲中文,我们可向您免费提供语言协助服务。请拨打您 ID  卡上的号码联系会员服务部 通话 1-800-472-2689(TTY  号码:711 )。

ATANSYON: Si ou pale kreyòl ayisyen, sèvis asistans nan lang disponib pou ou gratis. Rele nimewo Sèvis Manm nan ki sou kat Idantitifkasyon w lan (Sèvis pou Malantandan Rele 1-800-472-2689 TTY: 711 ).

LƯU .: Nếu quý vị n.i Tiếng Việt, c.c dịch vụ hỗ trợ ng.n ngữ được cung cấp cho quý vị miễn ph.. Gọi cho Dịch vụ Hội vi.n theo số tr.n thẻ ID của quý vị Cuộc gọi 1-800-472-2689 (TTY: 711 ).

ВНИМАНИЕ: если Вы говорите по-русски, Вы можете воспользоваться бесплатными услугами переводчика. Позвоните в отдел обслуживания клиентов по номеру, указанному в Вашей идентификационной карте вызов  1-800-472-2689 (телетайп: 711 ).

ការជូនដំណឹង៖ ប្រសិនប. ើអ្នកនិយាយភាសា ខ្មែរ សេ  វាជំនួយភាសាឥតគិតថ្លៃ គឺអាចរកបានសម្  រាប ់អ្នក។ សូមទូរស័ព្ទទ ៅផ ្នែ កសេ  វាសមា  ជិកតាមល េខន  ៅល.  ើប ័ណ្ណ សម្  គាល ់ខ្លួ ខ្លួ នរប ស់អ្នក ហៅ  1-800-472-2689 (TTY: 711) ។

ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativa chiamata  1-800-472-2689 (TTY: 711 ).

참고 : 한국어를 사용하는 경우 언어 지원 서비스를 무료로 사용할 수 있습니다. 신분증에있는 전화 번호 1-800-472-2689 (TTY : 711)로 회원 서비스에 연락하십시오.

ΠΡΟΣΟΧΗ: Εάν μιλάτε Ελληνικά, διατίθενται για σας υπηρεσίες γλωσσικής βοήθειας, δωρεάν. Καλέστε την Υπηρεσία Εξυπηρέτησης Μελών στον αριθμό της κάρτας μέλους σας (ID Card) κλήση 1-800-472-2689 (TTY: 711 ).

UWAGA: Osoby posługujące się językiem polskim mogą bezpłatnie skorzystać z pomocy językowej. Należy zadzwonić do Działu obsługi ubezpieczonych pod numer podany na identyfikatorze zadzwoń 1-800-472-2689 (TTY: 711 ).

ध्यान दें: य दि  आप ह िन् दी बोलते ह ैं, तो भा षा  सहाय  ता  सेवा एँ, आप के लि ए नि :शुल्क  उपलब्ध ह ैं। सदस्य  सेवा ओं को आपके आई.डी. कार  ्ड पर दि ए गए नंबर पर कॉल करें  कॉल 1-800-472-2689 ( टी .टी .वा ई.: 711).

ધ્યાન આપો:  જો તમે ગુજરા તી બોલતા  હો, તો તમને ભા ષા કીય  સહાય  તા  સેવા ઓ વિ ના  મૂલ્યે  ઉપલબ્ધ છે. તમા રા  આઈડી કાર  ્ડ પર આપેલા  નંબર પર Member Service  ને કૉલ કરો કૉલ કરો 1-800-472-2689 (TTY: 711).

PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag 1-800-472-2689 (TTY: 711 ).

お知らせ:日本語をお話しになる方は無料の言語アシスタンスサービスをご利用いただけます。ID カードに記載の電話番号を使用してメンバーサービスまでお電話ください 呼び出す 1-800-472-2689(TTY: 711 )。

ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstützung zur Verfügung. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen 1-800-472-2689 (TTY: 711 ).

ຂໍ້ຄວນໃສ່ໃຈ: ຖ້າເຈົ້າເວົ້າພາສາລາວໄດ້, ມີການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໃຫ້ທ່ານໂດຍບໍ່ເສຍຄ່າ. ໂທ ຫາ ຝ່າຍບໍລິການສະ ມາ ຊິກທີ່ໝາຍເລກໂທລະສັບຢູ່ໃນບັດຂອງທ່ານ ໂທ 1-800-472-2689 (TTY: 711).

BAA !KOHWIINDZIN DOO&G&: Din4 k’ehj7 y1n7[t’i’go saad bee y1t’i’ 47 t’11j77k’e bee n7k1’a’doowo[go 47 n1’ahoot’i’. D77 bee an7tah7g7 ninaaltsoos bine’d44’ n0omba bik1’7g7ij8’ b44sh bee hod77lnih call 1-800-472-2689 (TTY: 711).

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