Oct. 23, 2019
Updated 11/21/2019
This notice has been updated to include a change to the 5th bullet point regarding Groups with BlueStagesSM.
Beginning Jan. 1, 2020, health care providers will notice new Blue Cross Medicare and Medicare Supplement group plan names and ID cards. Blue Cross Medicare AdvantageSM plan names for individuals will remain the same.
While the group plan names have changed, your experience as a health care provider will be the same. This name change will not affect member benefits.
New Group Plan Names:
- Blue Cross Group Medicare Advantage (HMO)SM is the new name of Blue Cross Medicare Advantage (HMO)SM for group Medicare members. This plan provides members access to providers within a defined network, with no out-of-network benefit.
- Blue Cross Group Medicare Advantage (PPO)SM is the new name of Blue Cross Medicare Advantage (PPO)SM for group Medicare members. This traditional PPO allows members to seek care in-network and out-of-network, typically providing cost savings for in-network care.
- Blue Cross Group Medicare Advantage Open Access (PPO)SM is the new name of Blue Cross Medicare Advantage (PPO) Employer GroupSM. This plan offers members access to willing providers nationwide who accept assignments from Medicare and are willing to bill Blue Cross and Blue Shield of Texas (BCBSTX). Coverage levels are the same for in-network and out-of-network care.
- Blue Cross Group MedicareRxSM is the new name of Blue Cross Group MedicareRx (PDP)SM. It provides Medicare Part D prescription drug coverage.
- Groups with the BlueStagesSM will see the plan name Blue Cross Group Medicare SupplementSM on their member ID cards for 2020. Other plan documents will say BlueStages . This Medicare supplement insurance plan helps members cover some costs not covered by Original Medicare, such as copayments and deductibles. Members can see providers nationwide who accept Medicare Assignment and are willing to bill BCBSTX.
Questions? Please refer to the Customer Service number on the back of the new group plan cards.
It is important to check eligibility and benefits for each patient before every scheduled appointment. Eligibility and benefit quotes include membership verification, coverage status and applicable copayment, coinsurance and deductible amounts. The benefit quote may also include information on applicable benefit prior authorization/prenotification requirements. Ask to see the member’s BCBSTX ID card and a driver’s license or other photo ID to help guard against medical identity theft.
Checking eligibility and benefits and/or obtaining benefit prior authorization/pre-notification or predetermination of benefits is not a guarantee that benefits will be paid. Payment is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation and other terms, conditions, limitations and exclusions set forth in your patient’s policy certificate and/or benefits booklet and/or summary plan description. Regardless of any benefit determination, the final decision regarding any treatment or service is between you and your patient. If you have any questions, please call the number on the member’s ID card.