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Plan 65

General Questions Regarding Blue Cross and Blue Shield of Kansas Supplements

What is the difference between Plan 65 Benefit Plan C and Benefit Plan F?
The only difference between these two plans is the Part B excess charges. If a medical service provider does not accept Medicare assignment on a particular service, they can charge up to 15 percent above the Medicare allowed charge. With Benefit Plan C you would be responsible for those charges. With Benefit Plan F, BCBSKS would pay those charges.

Can a husband and wife get family coverage?
No.

Do you get a discount on premiums if you pay for a whole year?
No.

Can you go to any doctor or hospital or do you have to select a Primary Care Physician?
You can see any doctor and go to any hospital of your choice. Please note that if you live in an eligible county and choose to enroll in Plan 65-Select plan, you will be required to go to one of the Select hospitals, except in an emergency or for outpatient services.

Is there a lifetime maximum that Blue Cross and Blue Shield of Kansas will pay?
The only time there is a lifetime maximum would be on Benefit Plan C or Benefit Plan F for Foreign Travel, where the lifetime maximum is $50,000.

Are there waiting periods or pre-existing conditions?
No.

Is there any way you can lose your coverage?
The only way your coverage can be cancelled is if you fail to pay the premiums or the company becomes insolvent.

How often are premiums adjusted?
Premiums are adjusted on January 1 of each year.

How much do premiums increase?
You will have an age increase of approximately three percent each year until age 80. After age 80, you will no longer receive an age increase. You can also have an overall increase based on the rising costs of medical coverage and the premiums collected by BCBSKS versus the claims paid out. These changes will only happen on January 1 of each year.

Can I be refused coverage for any reason?
If you are over 65, more than 6 months past your Medicare Part B effective date, or do not have creditable coverage, you will have to medically qualify through our underwriting department and there is a chance of not qualifying.

Will my coverage work out of state?
Yes.

Do I have to file claims?
If your provider contracts with Medicare your claims will be filed automatically with Medicare. Once Medicare has processed its part the claim will be sent to BCBSKS for processing.

Will it cover a yearly physical exam?
If it is medically necessary.

What is the most popular plan with BCBSKS?
Plan 65 Benefit Plan F.

Am I allowed to switch to a different plan at a later time?
Yes, you may change from Benefit Plan F to Benefit Plan C, Benefit Plan N, Benefit Plan A or Benefit Plan K without medically qualifying.

However, if you want to change your plan from Benefit Plan C to Benefit Plan F, or from Benefit Plan N to Plan C or Plan F, or change from Benefit Plan K to Benefit Plan A, or from Plan A to Plan C or Plan F, you would have to complete a health statement and qualify through our underwriting department.

Will a representative come to my home to discuss the policies?
No, we prefer to handle everything over the phone and through the mail. This is one of the ways we are able to keep the premiums competitive.

What if I move permanently out of state?
You can keep your BCBSKS Medicare supplement or transfer to the Blue Cross and Blue Shield Plan of the state to which you are moving.

Why can't I enroll with you if I live in Johnson or Wyandotte counties?
BCBSKS is not licensed to sell insurance in Johnson or Wyandotte counties. These counties are under the jurisdiction of BCBS of Kansas City. You will need to call BCBS of Kansas City.

Are your policies based on attained age or issue age?
Attained age. This means that your age on Jan. 1 of each year is used to determine your premiums for the current year. In other words, if you are 68 on Jan. 1, your premiums will be based on that age for the entire year.

How do I know if I am accepted?
If you are within six months of your Medicare Part B effective date or your 65th birthday or have creditable group coverage, you are guaranteed acceptance the first of the month following our receipt of your application. If you are over 65 or if it has been longer than six months since your Medicare effective date, your application will be forwarded to our underwriting department. They will determine your eligibility. You will receive a letter stating whether you were accepted and what your effective date is. If you are denied, you will be given the reason(s) why.

Do you have an open enrollment period?
We accept applications all year. We do not have a specific open enrollment period during which you have to apply. Upon approval by our underwriting department your coverage will be made effective the first of the month following the receipt of your application.

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