Non-profit organizations interested in paying premiums for individuals who purchase health insurance coverage from BlueCross BlueShield of Tennessee, Inc. on and off the Marketplace must apply for and receive approval from Blue Cross Blue Shield of Tennessee, Inc. in order for payments by such organizations to be accepted by BlueCross BlueShield of Tennessee, Inc. This policy, as further described below, will apply to premiums for health insurance coverage issued for the 2017 benefit year and thereafter.
BlueCross BlueShield of Tennessee (“BlueCross” or “We” or “Our”) joins the federal government, including the U.S. Department of Health and Human Services and its Centers for Medicare & Medicaid Services (“CMS”), and other organizations in the concern that payment of an individual’s premium for health care by a third-party can be problematic for the Marketplace. For example, payment of premiums by health care providers, such as a hospital or physician, can give rise to questions about conflicts of interest. CMS discourages health care providers from making premium payments and encourages health insurance issuers, such as BlueCross, to reject such payments. Payments of premiums by third-parties also can increase the risk of adverse selection for the Marketplace, thus negatively affecting the cost of health insurance for all Tennesseans. BlueCross also recognizes the important role played by certain foundations and other non-profit organizations in assisting individuals with their health insurance premiums so that these individuals continue to have access to health care coverage.
To balance these considerations, we are implementing this policy regarding payment by third-parties of premiums for health insurance coverage. This policy, which is effective for health insurance coverage issued for the 2017 benefit year and thereafter, applies to individual health insurance coverage issued by BlueCross, excluding Medicare Advantage. This includes coverage issued on or off the Federally Facilitated Marketplace (“FFM”) and regardless of whether the individual is simultaneously enrolled in Medicaid or has other coverage, coverage issued to an individual subscriber (including any dependents) eligible for or receiving premium subsidies through the FFM, and Medicare Supplement coverage. This policy does not apply to individuals enrolled in and receiving coverage under AccessTN as of January 1, 2016.
This policy, which is effective for health insurance coverage issued for the 2017 benefit year and thereafter, applies to individual health insurance coverage issued by BlueCross, except Medicare Advantage.
BlueCross accepts and will continue to accept premium payments on behalf of a Member from organizations from which We are legally obligated to do so, such as the Ryan White HIV/AIDS Program. BlueCross reserves the right to request from such organizations confirmation as to the applicability of federal law to premium payments made by these organizations.
All other organizations that would like to make premium payments on behalf of a Member must apply for and receive approval from BlueCross in order for BlueCross to accept premium payments on behalf of Members from such organization. Applications to make premium payments for coverage for the 2017 benefit year will be accepted on and after November 14, 2016.
BlueCross’s approval of an organization’s application to make premium payments on behalf of a member is at BlueCross’s sole discretion and, if granted, is applicable for a single benefit year. An organization must re-apply each year for approval to make premium payments on behalf of Members so long as this policy remains in effect.
An organization (“Applicant”) interested in applying to make premium payments on behalf of a Member should contact BlueCross for the application and information regarding the application process. Although not an exhaustive description of the application process or review criteria, BlueCross offers potential Applicants the following information and guidelines:
BlueCross reserves the right to administer this policy in the manner BlueCross determines appropriate in its sole discretion, including, without limitation, limiting the number of Approved Charitable Organizations and/or Members participating in approved assistance program at any time and at BlueCross’ sole discretion and changing and/or discontinuing this policy at any time.
For more information regarding the policy or the application process, including to request an application, please contact ThirdPartyPayor@BCBST.com.