Healthcare Reform Timeline

Frequently Asked Questions

 

Benefits/coverage

Plans that are not grandfathered provide coverage for routine patient costs received by a member who is participating in an approved clinical trial. Coverage includes phase I clinical trials and expands the types of conditions beyond cancer. 

Plans cover routine costs associated with a phase I, phase II, phase III, or phase IV clinical trial that is being done to prevent, detect, or treat cancer or a life-threatening disease or condition (a disease or condition from which the likelihood of death is probable unless the course of the disease or condition is interrupted). Routine patient costs are considered the medically necessary services that would be otherwise covered by a health plan if the member was not a part of a clinical trial.

To qualify, a clinical trial must be at least one of the following:

  • Federally funded
  • Conducted under an investigational new drug application reviewed by the Food and Drug Administration
  • A drug trial that is exempt from having such an investigational new drug application

This information is subject to change based on new or revised laws or regulations, and additional coverage rules and limitations may apply. For more information on how these benefits may apply to your coverage, please check your subscriber agreement or call Customer Service.

Benefits/coverage

Health insurance issuers like Blue Cross are obligated to pay claims for covered services rendered during the first month of the grace period. During the second and third months of the grace period, health insurance carriers may pend claims until the member has either paid the premiums owed or the grace period has ended. At the end of the grace period, if the member has not paid their premiums, claims may be denied.

During the grace period, Blue Cross will notify providers that their claims are pended because the member is in the grace period. In addition, we are working to ensure that when providers contact Blue Cross to confirm eligibility, they are informed that the member’s eligibility is pended as a result of the grace period. 

Members who may be eligible for this grace period will have a ZBN prefix on their ID card. It is important to note that not every member who purchases coverage through HealthSource RI in the individual market will be eligible for premium subsidies or for the grace period. 

For all other members enrolled through HealthSource RI or directly through Blue Cross, there will be a one-month grace period for members who are delinquent in paying their bills. Blue Cross will continue to pay claims during this one-month period.

Benefits/coverage

Blue Cross offers a variety of commercial plans through HealthSource RI to individuals and families as well as small businesses and their employees. These plans include VantageBlue, VantageBlue SelectRI, BlueSolutions for HSA, BasicBlue, and Blue Cross Dental. These plans operate in the same way whether they are purchased directly from Blue Cross or through HealthSource RI. Providers should continue to follow current practices for eligibility, benefits, care management, and claims processing. Please note that Medicare plans are not available through HealthSource RI.  

Benefits/coverage

Health plans provide full coverage for many preventive services with no cost sharing (deductibles, copays,  or coinsurances) when members visit in-network doctors. Preventive care is healthcare that is aimed at screening for and preventing disease, including:

  • Flu shots and other immunizations 
  • Blood tests 
  • Other screenings such as mammograms, Pap tests, and colonoscopies
  • Other preventive services covered under federal healthcare reform

When state law is more generous than the federal mandates for preventive services, we follow state law. For more information about preventive care services, please read this sheet.

Benefits/coverage

Provider responsibilities

HealthSource RI is a health insurance marketplace (also called an exchange) where Rhode Island individuals, families and small employers can compare and buy health plans. Blue Cross will be offering some of our commercial plans through HealthSource RI, and providers will participate if their contract includes our commercial plans.

Provider responsibilities
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