District of Columbia Plan Participation Agreement between Blue Cross Blue Shield Assoc. and Blue Cross Blue Shield of MO regarding healthcare benefit provisions

• Category: Corporations - Public - Participation
• State: Multi-State
• Control #: US-EG-9383
• Format: Word; Rich Text

Description

Plan Participation Agreement between Blue Cross and Blue Shield Association and Blue Cross and Blue Shield of Missouri regarding health care benefit provisions (Federal Employee Program) dated January 1, 1995. 13 pages. The District of Columbia Plan Participation Agreement between Blue Cross Blue Shield Assoc. And Blue Cross Blue Shield of MO is a comprehensive agreement outlining the healthcare benefit provisions for individuals residing in the District of Columbia insured by Blue Cross Blue Shield of MO. This agreement ensures that the members receive adequate healthcare coverage and outlines the terms and conditions that both parties must adhere to. The agreement covers various aspects of healthcare benefits, including but not limited to: 1. Medical Services: The agreement specifies the types of medical services covered under the plan, such as hospitalizations, surgeries, preventive care, emergency services, diagnostic tests, and specialist consultations. It also outlines the reimbursement rates for different services. 2. Prescription Drugs: The agreement includes provisions for coverage of prescription drugs, specifying the medications included in the formulary, drug tiers, co-payment or coinsurance amounts, and any prior authorization requirements for certain medications. 3. Mental Health and Substance Abuse Services: This section of the agreement outlines the coverage for mental health and substance abuse treatment, including outpatient counseling, inpatient rehabilitation, and medication-assisted treatment. It may also include provisions for managing mental health parity requirements. 4. Preventive Care: The agreement emphasizes the importance of preventive care services, such as vaccinations, screenings, and wellness visits, which are often covered at no or low cost to the member to promote overall health and wellbeing. 5. Network Providers: It specifies the network of healthcare providers and facilities available to plan members. This includes primary care physicians, specialists, hospitals, laboratories, and imaging centers. The agreement may also provide information on out-of-network services and associated costs. 6. Cost-sharing and Deductibles: The agreement details the cost-sharing provisions, including deductibles, co-payments, and coinsurance, which the members are required to pay when accessing different services. This helps members understand their financial obligations and plan for potential healthcare expenses. 7. Claims and Reimbursement: The agreement outlines the process for submitting and processing claims, including any applicable timeframes and required documentation. It also explains the reimbursement methods, such as direct payment to the provider or reimbursement to the member. Different types of District of Columbia Plan Participation Agreements between Blue Cross Blue Shield Assoc. And Blue Cross Blue Shield of MO regarding healthcare benefit provisions may exist based on the specific plan options available to members. These could include: 1. Individual Plans: These are plans that individuals purchase directly from Blue Cross Blue Shield of MO for themselves and their families. 2. Employer-Sponsored Plans: These are plans provided by employers to their employees, with Blue Cross Blue Shield Assoc. And Blue Cross Blue Shield of MO serving as the administrators and insurers. 3. Medicaid Managed Care Plans: These plans cater to Medicaid beneficiaries who have chosen Blue Cross Blue Shield Assoc. And Blue Cross Blue Shield of MO as their managed care organization in the District of Columbia. It's important to note that the specific details of each plan may vary, and individuals should review their plan materials or consult with their insurance provider for accurate information regarding their healthcare benefit provisions.

The District of Columbia Plan Participation Agreement between Blue Cross Blue Shield Assoc. And Blue Cross Blue Shield of MO is a comprehensive agreement outlining the healthcare benefit provisions for individuals residing in the District of Columbia insured by Blue Cross Blue Shield of MO. This agreement ensures that the members receive adequate healthcare coverage and outlines the terms and conditions that both parties must adhere to. The agreement covers various aspects of healthcare benefits, including but not limited to: 1. Medical Services: The agreement specifies the types of medical services covered under the plan, such as hospitalizations, surgeries, preventive care, emergency services, diagnostic tests, and specialist consultations. It also outlines the reimbursement rates for different services. 2. Prescription Drugs: The agreement includes provisions for coverage of prescription drugs, specifying the medications included in the formulary, drug tiers, co-payment or coinsurance amounts, and any prior authorization requirements for certain medications. 3. Mental Health and Substance Abuse Services: This section of the agreement outlines the coverage for mental health and substance abuse treatment, including outpatient counseling, inpatient rehabilitation, and medication-assisted treatment. It may also include provisions for managing mental health parity requirements. 4. Preventive Care: The agreement emphasizes the importance of preventive care services, such as vaccinations, screenings, and wellness visits, which are often covered at no or low cost to the member to promote overall health and wellbeing. 5. Network Providers: It specifies the network of healthcare providers and facilities available to plan members. This includes primary care physicians, specialists, hospitals, laboratories, and imaging centers. The agreement may also provide information on out-of-network services and associated costs. 6. Cost-sharing and Deductibles: The agreement details the cost-sharing provisions, including deductibles, co-payments, and coinsurance, which the members are required to pay when accessing different services. This helps members understand their financial obligations and plan for potential healthcare expenses. 7. Claims and Reimbursement: The agreement outlines the process for submitting and processing claims, including any applicable timeframes and required documentation. It also explains the reimbursement methods, such as direct payment to the provider or reimbursement to the member. Different types of District of Columbia Plan Participation Agreements between Blue Cross Blue Shield Assoc. And Blue Cross Blue Shield of MO regarding healthcare benefit provisions may exist based on the specific plan options available to members. These could include: 1. Individual Plans: These are plans that individuals purchase directly from Blue Cross Blue Shield of MO for themselves and their families. 2. Employer-Sponsored Plans: These are plans provided by employers to their employees, with Blue Cross Blue Shield Assoc. And Blue Cross Blue Shield of MO serving as the administrators and insurers. 3. Medicaid Managed Care Plans: These plans cater to Medicaid beneficiaries who have chosen Blue Cross Blue Shield Assoc. And Blue Cross Blue Shield of MO as their managed care organization in the District of Columbia. It's important to note that the specific details of each plan may vary, and individuals should review their plan materials or consult with their insurance provider for accurate information regarding their healthcare benefit provisions.