Kings New York 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
• County: Kings
• 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 Kings New York Plan Participation Agreement is a comprehensive document that outlines the specific healthcare benefit provisions between Blue Cross Blue Shield Association (BC BSA) and Blue Cross Blue Shield of Missouri (BCBS). This agreement is crucial in ensuring that individuals residing in New York have access to quality healthcare services through BCBS. The agreement covers a wide range of provisions, including but not limited to: 1. Network Access: The Kings New York Plan Participation Agreement ensures that BCBS members have access to a robust network of healthcare providers in the state of New York. This includes hospitals, physicians, specialists, laboratories, and other medical facilities. 2. In-network Benefits: The agreement outlines the specific benefits that BCBS members can expect when receiving care from in-network providers in New York. These benefits may include coverage for hospital stays, surgeries, office visits, preventive care, prescription drugs, and diagnostic tests among others. 3. Out-of-network Care: The agreement also addresses provisions for out-of-network care, specifying the reimbursement rates and member cost-sharing responsibilities when seeking services from providers that are not part of the BCBS network. 4. Prior Authorization: The Kings New York Plan Participation Agreement may also require pre-authorization for certain medical procedures, tests, or medications. This allows BCBS to review the medical necessity and appropriateness of such services before providing coverage. 5. Utilization Review: The agreement includes provisions for utilization review programs, which help ensure that medical services are provided appropriately and efficiently. This process may involve review of treatment plans, length of hospital stays, and medical necessity determinations. 6. Claims and Payment: The agreement outlines the processes and timelines for submission, processing, and payment of claims by BCBS to healthcare providers. It also specifies the member's responsibility for payment of deductibles, co-payments, and coinsurance. It's important to note that there may be different types of Kings New York Plan Participation Agreements based on the specific BCBS plan or product offerings. These variations may include different benefits, cost-sharing arrangements, and network access options tailored to various member populations or employer groups. In summary, the Kings New York Plan Participation Agreement is a vital contractual document that establishes the relationship between BC BSA and BCBS. It ensures that BCBS members in New York have access to necessary healthcare services through a robust network of providers and outlines the specific benefit provisions and cost-sharing arrangements related to their healthcare coverage.

The Kings New York Plan Participation Agreement is a comprehensive document that outlines the specific healthcare benefit provisions between Blue Cross Blue Shield Association (BC BSA) and Blue Cross Blue Shield of Missouri (BCBS). This agreement is crucial in ensuring that individuals residing in New York have access to quality healthcare services through BCBS. The agreement covers a wide range of provisions, including but not limited to: 1. Network Access: The Kings New York Plan Participation Agreement ensures that BCBS members have access to a robust network of healthcare providers in the state of New York. This includes hospitals, physicians, specialists, laboratories, and other medical facilities. 2. In-network Benefits: The agreement outlines the specific benefits that BCBS members can expect when receiving care from in-network providers in New York. These benefits may include coverage for hospital stays, surgeries, office visits, preventive care, prescription drugs, and diagnostic tests among others. 3. Out-of-network Care: The agreement also addresses provisions for out-of-network care, specifying the reimbursement rates and member cost-sharing responsibilities when seeking services from providers that are not part of the BCBS network. 4. Prior Authorization: The Kings New York Plan Participation Agreement may also require pre-authorization for certain medical procedures, tests, or medications. This allows BCBS to review the medical necessity and appropriateness of such services before providing coverage. 5. Utilization Review: The agreement includes provisions for utilization review programs, which help ensure that medical services are provided appropriately and efficiently. This process may involve review of treatment plans, length of hospital stays, and medical necessity determinations. 6. Claims and Payment: The agreement outlines the processes and timelines for submission, processing, and payment of claims by BCBS to healthcare providers. It also specifies the member's responsibility for payment of deductibles, co-payments, and coinsurance. It's important to note that there may be different types of Kings New York Plan Participation Agreements based on the specific BCBS plan or product offerings. These variations may include different benefits, cost-sharing arrangements, and network access options tailored to various member populations or employer groups. In summary, the Kings New York Plan Participation Agreement is a vital contractual document that establishes the relationship between BC BSA and BCBS. It ensures that BCBS members in New York have access to necessary healthcare services through a robust network of providers and outlines the specific benefit provisions and cost-sharing arrangements related to their healthcare coverage.