Direct pay changes
Health Plan Updates for 2023
Effective January 1, 2023, 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 2023, there is a new Pharmacy Benefit Manager to help:
- - Keep your pharmacy costs down
- - Maintain a large pharmacy network
- - Offer programs designed to improve your health
Please read the 2023 Benefits and Coverage Updates brochure and sign in MyBlue 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 2023 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.
If you purchased coverage directly from Blue Cross Blue Shield of Massachusetts and you want to:
- Continue your current coverage—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, 2021.
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, 2021.
If you purchased coverage through the Health Connector and you want to:
- Continue your current coverage—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, 2021.
- Change your plan during open enrollment—Starting November 1, 2020, you can go to 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.
There is no 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, 2021.
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.