Changes in Enrollment Status Any change in enrollment status, such as death, divorce, etc., must be reported to Blue Cross & Blue Shield as soon as possible. The change must be made on an Application for Coverage form. This form may be obtained from Blue Cross & Blue Shield.
SPECIAL NOTE ON MEDICARE It is a retiree/surviving spouse’s responsibility to contact Blue Cross & Blue Shield when the retiree or a covered dependent becomes entitled to Medicare (upon reaching age 65 or eligibility through Social Security disability).
Non-Medicare Eligible Retirees, Surviving Spouses, and Dependents The Plan is the primary payer for a retired employee, surviving spouse, or dependent of a retired employee or surviving spouse who is under age 65, is not on Social Security disability, and is not covered as an active employee under another plan. Non-Medicare eligible retirees and surviving spouses may choose Select Coverage or Base Coverage. Plan primary benefits are found in Summaries of Benefits and Covered Services sections of this Plan Document.
Medicare Coordination Medicare is the primary payer for a retired employee, surviving spouse, or dependent of a retired employee or surviving spouse who is:
Age 65 or older. Under age 65 with Social Security disability. Under age 65 with end-stage renal disease after the first 30 months of Medicare eligibility.
Medicare coordination provisions are subject to change in accordance with changes in the federal Medicare program.
When Medicare is primary, the Plan will provide 100% toward the Medicare deductible and coinsurance amounts not covered by Medicare. The Plan only provides benefits for covered expenses outlined in this Plan Document.
Benefits are allowed based on the difference between the Medicare maximum allowable charge and the amount Medicare paid (or the difference between the Medicare allowed amount and the amount Medicare paid if assignment is accepted by the provider). This provision applies regardless of whether or not the provider participates in Medicare or contracts directly with the participant. Benefits are paid for a covered expense that is not covered by Medicare.
If a retired employee, dependent of a retired employee, surviving spouse, or dependent of a surviving spouse is eligible for Medicare and does not elect Medicare Part A or B, benefits will be reduced as though Medicare is the primary payer. The Plan will calculate benefits assuming the participant has both Medicare A and B. It is important to enroll in Medicare Part A and B to receive maximum benefits.