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After receiving your completed enrollment form, Blue Cross MedicareRx will send you:
The Evidence of Coverage (EOC) is a detailed document that explains the plan rules associated with Blue Cross MedicareRx. 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: Basic Plan
Y0096_BEN_ OK_EOCBASIC2014 Accepted 08302013
Evidence of Coverage: Value Plan
Y0096_BEN_ OK_ANOCEOCVALUE2014 Accepted 08232013
Evidence of Coverage: Plus Plan
Y0096_BEN_ OK_ANOCEOCPLUS2014 Accepted 08232013
2014 Part D Spanish Evidence of Coverage: Basic Plan en Español
Y0096_BEN_OK_EOCBASIC2014SPA Accepted 08232013
2014 Part D Spanish Evidence of Coverage: Value Plan en Español
Y0096_BEN_OK_ANOCEOCVALUE2014SPA Accepted 08232013
2014 Part D Spanish Evidence of Coverage: Plus Plan en Español
Y0096_BEN_OK_ANOCEOCPLUS2014SPA Accepted 08232013
Blue Cross MedicareRx agrees to stay in the program for a full year at a time. Each year, the plan decides whether or not to continue offering prescription drug coverage for the following year. Should we decide not to continue offering Blue Cross MedicareRx, we will send you a letter explaining your options for Medicare prescription drug coverage in your area. Your Medicare coverage is not affected.
As for claims, if Blue Cross MedicareRx ever denies your 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 physician 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.
Disenrollment from Blue Cross MedicareRx 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 can leave the Plan and join another Medicare prescription drug plan, Medicare Cost Plan, or Advantage Plan available in your area. It will take some time for your prescription drug coverage to end and your new prescription drug coverage to begin.
To voluntarily disenroll:
HCSC Insurance Services Company (HISC) must disenroll an individual from Blue Cross MedicareRx in the following cases: