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Coverage

Frequently Asked Questions


Coverage

Where can I find price quotes for individual coverage?
After I apply, when does my coverage take effect?
What is a preexisting condition?
If I select Traditional coverage, must I include Major Medical?
What if I only need coverage for a short time?
My former employer provided my heath care coverage. Does this qualify me for anything special?
What is COBRA and how does it relate to my applying for coverage?
What if I become ill while away from home?
What if I travel outside the country?
As an individual, can I enroll in the prescription drug, vision or hearing programs?
Can my coverage be cancelled without my consent?

Where can I find price quotes for individual coverage?

The individual coverage section of the web site has our published rates for each product, including TraditionalComprehensive, HIPAA Comprehensive, Special Care and Security (for individuals receiving Medicare Benefits).



After I apply, when does my coverage take effect?

Your coverage may begin on either the first or the fifteenth of the month that follows the receipt of your completed application. If you are changing from a Capital BlueCross program or another Blue plan located outside of our service area, your effective date will be the same as the cancellation of your prior coverage.



What is a preexisting condition?

A physical or mental health condition that exists prior to the date a health insurance plan takes effect, whether or not any medical advice, diagnosis, care or treatment was recommended or received prior to the date coverage takes effect.



If I select Traditional coverage, must I include Major Medical?

Our individual Traditional coverage is sold to include Major Medical, which provides coverage for services not covered under the basic hospital and medical-surgical programs



What if I only need coverage for a short time?

Capital Advantage Insurance Company (CAIC), a wholly-owned subsidiary of Capital BlueCross, offers a Short-Term Major Medical product that provides coverage for up to six months. Call 800.784.2242 for more details.



My former employer provided my heath care coverage. Does this qualify me for anything special?

If you are converting from a Capital BlueCross program or group coverage from a Blue plan located outside the service area, you may be eligible to enroll without being subject to preexisting condition limitations. Even if you did not have Blue plan coverage, you can obtain coverage from us. (See preexisting conditions question above and HIPAA). You may also qualify as HIPAA eligible.



What is COBRA and how does it relate to my applying for coverage?

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you and your dependents may be eligible to purchase group medical coverage through your employer under certain conditions (i.e., termination, death, divorce, etc.). For more details, contact your employer.



What if I become ill while away from home?

Your health care benefits travel easily across the country. Your ID card is your direct link to care anywhere in the country (except with Special Care).   When you show your ID card to any participating hospital or doctor across the United States, you'll receive the same special treatment as a local member. For covered services, participating providers accept our payment as payment in full, reducing your out-of-pocket expenses. With non-participating providers, you may have to pay more out of your own pocket.  More than 85 percent of all hospitals and doctors throughout the United States contract with member plans of the BCBSA.



What if I travel outside the country?

Through BlueCard Worldwide your benefits travel with you. Whether your are traveling across the United States or around the globe, there is a network of participating hospitals and professional providers available to you in over 200 countries. If you are admitted to a participating hospital, all you have to do is show your ID card. If you have to see a doctor or visit a hospital that is not a participating facility, ask for an itemized copy of the bill (translated to English if possible) for the services you received. You may have to pay the provider for these services. When you get home, submit the claim for any applicable reimbursement. For more information on BlueCard Worldwide or searching for a provider outside the U.S. you can go to BCBS.com and click on "Healthcare Anywhere" on the left side of the page.



As an individual, can I enroll in the prescription drug, vision or hearing programs?

These programs are not offered separately for Individual Account coverage. In some instances, coverage is included for prescription drugs or routine vision and hearing disorders. For example, our Comprehensive andTraditional plans include prescription drug coverage.



Can my coverage be cancelled without my consent?

We guarantee that your coverage is renewable if the premiums are paid in a timely manner. An Individual Account is cancelled only if you committed fraud in obtaining coverage, or if Capital BlueCross no longer offers the product which you are covered under.