What do providers need to know about changes being implemented for Blue Cross plans in 2014?

Upon renewal, Blue Cross plans sold in the individual and small employer group market will need to include essential health benefits. All member cost sharing for an essential health benefit will apply to the member’s out-of-pocket maximum. This will include copayments for office visits that typically don’t apply to the member’s out-of-pocket maximum.

Once the out-of-pocket maximum is met, the member will have 100 percent coverage in network. It is more important than ever for providers to verify a member’s benefits and eligibility prior to rendering services as many changes will be implemented as groups renew in 2014 into ACA-compliant plans.

To determine whether a member’s plan has renewed, providers should check the effective date (under member coverage) on the Plan Summary page in the Eligibility section of BCBSRI.com. It is safe to assume that the member’s plan has not renewed if the effective date is prior to January 1, 2014.

Important note: Since groups will be renewing into plans that comply with several new healthcare reform regulations, it is very important for providers to remember to verify a member’s eligibility and benefits.