Frequently Asked Questions (FAQs)
2017 contract changes regarding third-party payers
- From whom does Blue Cross and Blue Shield of Kansas and BlueCross BlueShield Kansas Solutions accept premium payments?
- Effective Jan. 1, 2017, or on an enrolled group's effective date in 2017, Blue Cross and Blue Shield of Kansas and BlueCross BlueShield Kansas Solutions will only accept premium payments from a policyholder (group or individual), a family member of the insured, or entities from whom insurers are required by law to accept premium payments. These entities include:
- Ryan White HIV/AIDS Program under XXVI of the Public Health Service Act;
- Indian tribes, tribal organizations and urban Indian national organizations; and,
- state and federal government programs.
- What happens if my premium is paid by another entity, such as a non-profit foundation or a health care organization?
- After Jan. 1, 2017, if your premium payments are submitted by an ineligible third-party payer, we will not accept the payment. This means you risk having your policy cancelled and claims denied, meaning providers could bill you directly for the full cost of any services that you received.
- Why don't you accept premium payments from anyone?
- When individuals and businesses purchase health insurance, the premium dollars that they pay throughout their 12-month contract are pooled with dollars from other members, and BCBSKS and Solutions use those funds to pay for everyone's medical expenses as efficiently and effectively as possible. When third-party payers fund premiums, it usually results in claims costs that well surpass the amount of premium dollars paid. Often times, third-party payers only pay premiums while a person is sick and in need of expensive care. Once the care is received, the insurance is cancelled. This type of "churn" in the insurance pool only adds to the cost of premiums for all members.
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