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Within 10 days of receiving your completed enrollment form, Blue Cross Medicare Advantage will send you an acknowledgement letter. After the Centers for Medicare & Medicaid Services (CMS) confirms your enrollment, we'll send you a confirmation letter within 10 days. This letter will include your ID card. You will also receive a Welcome Kit, which will be sent separately from your confirmation letter and ID card. This package will include your Evidence of Coverage along with everything you'll need to know about being a Blue Cross Medicare Advantage member.
The Evidence of Coverage (EOC) is a detailed document that explains the plan rules associated with Blue Cross Medicare Advantage. This document, together with your enrollment form, riders, coverage and the amendments that we may send to you, is our contract with you.
The EOC explains:
Evidence of Coverage
Y0096_BEN_TX_PPOANOCEOC2014 Accepted 08292013
Evidence of Coverage en Espanol
Blue Cross Medicare Advantage agrees to stay in the program for a full year at a time. Each year, the plan decides whether or not to continue offering Medicare Advantage Prescription Drug for the following year. Should we decide not to continue offering Blue Cross Medicare Advantage, we will send you a letter explaining your options for Medicare Advantage Prescription Drug coverage in your area. Your Medicare coverage is not affected.
As for claims, if Blue Cross Medicare Advantage ever denies your medical or prescription drug benefits, we will explain our decision to you. You always have the right to appeal and ask us to review the claim that was denied. In addition, if your doctor prescribes a drug that is not on our formulary, is not a preferred drug or is subject to additional utilization rules, you may ask us to make a coverage exception for your drug coverage, or a coverage determination for your medical coverage.
Disenrollment from Blue Cross Medicare Advantage means ending your membership. Disenrollment can be voluntary or involuntary. We are not allowed to ask you to leave the plan because of your health.
You may end your membership in our plan only during certain times of the year, known as enrollment periods. All members have the opportunity to leave the plan during the Annual Enrollment Period. In certain situations, you may also be eligible to leave the plan at other times of the year. Refer to your the Evidence of Coverage Section titled "When can you end your membership in our plan?"
To voluntarily disenroll:
Blue Cross and Blue Shield of Texas (BCBSTX) must disenroll an individual from Blue Cross Medicare Advantage in the following cases: