Introduction and History of the Insurance Company
Justin Ford Kimball started an insurance company for teachers in 1929 called the Blue Cross. The company was later merged with another health insurance company called the Blue Shield, an insurance company for mining camp employers and officially named the combination the Blue Cross Blue Shield Association (BCBSA) in 1982. The company is headquartered in Chicago, Illinois and headed by President Scott Serota. It is a provider for the Federal Employee Health Benefits Plan, the largest insurance plan group in the world. With annual revenue of over $320 million and more than 190 million claims, the company is organized through 36 separate organizations in the USA serving all the 50 American states including other regions like Puerto Rico and the District of Columbia. It also has a presence in more than 170 countries spread throughout the world (Hunt, 2018).
Types of Coverage Offered
BCBSA offers several insurance options including HSA and FSA accounts, Health Reimbursement Arrangements (HRA), HMO & PPO plans. Under the FSA plan, the member is provided by an account in which they can save their money tax-free and use it to pay for their insurance deductibles as well as other health insurance expenses. The HSA account is the same as the FSA account but the account holder can only use the money saved for medically qualifying expenses. The other difference is that the money is tax deductible. The HRA plan is meant for those employers who cannot afford to pay the full insurance cover for their employees and are thus enabled to pay for partial cover that caters for only specific expenses (Hunt, 2018). HMO plan allows members to access comprehensive medical coverage under the health maintenance organization at low costs while for the PPO plan, members can be covered for expenses from providers outside the health maintenance organization and is thus more flexible.
Delegate your assignment to our experts and they will do the rest.
Types of Benefits offered and Exclusions
BCBSA provides a variety of benefits that include physical health, financial security as well as the general well-being and professional development (Blue Cross Blue Shield, 2018). Under the physical health, it provides general health, dental and vision plans. For financial security, the company covers disability, life and business travel insurance. It also provides other programs such as events and activities, employee assistance programs and pet care among others, for social development. The company does not offer benefits for supplies, services or charges for cosmetic surgery, government hospital services, routine physical examination, war injuries, normal pregnancy, self-inflicted injury, eyeglasses, certain foot care, rest cures, custodial care and transportation, uncovered dental care and removal of nerve interference (Blue Cross Blue Shield, 2018).
Policy on Pre-existing Conditions
Previously, Blue Cross Blue Shield was very sensitive to pre-existing conditions and responded differently to specific member conditions. If a member had a pre-existing condition at the time of application for insurance coverage, the company used to increase the premiums and in other cases even refuse to cover members. Such conditions could be of short-term as in the case of pregnancy, or long-term and fatal like in the case of cancer, but the company would respond in the same way regardless of the different conditions. The situation changed from January 1, 2014, when the Affordable Care Act was passed in the USA. This Act prohibits all insurance companies in the USA from denying coverage or charging more premiums to clients based on their medical history, thus eliminating the problem of accessing health insurance coverage with pre-existing conditions (Stevens, 2017).
Availability of any Specific Disease Policies
BSBCA provides insurance covers for specific illnesses. Some of these covers include critical illnesses. This cover is available only for those companies that have more than 50 eligible employees. The company designs specific policies for companies according to their employee needs. The employer can fully pay for it, let the employees pay for it or both parties may contribute towards the premiums (Blue Cross Blue Shield Michigan, 2019).
Payment/Fee Schedule Criteria
The company uses the schedule of Maximum Allowances for its members with the Preferred Provider Option (PPO) and revises it from time to time, providing its clients with updates on any new developments. Members who want to review this schedule are required to submit a Fee Schedule Request Form to the management through fax together with a signed Confidentiality Agreement. The company provides a newsletter called the Blue Review in which it includes any changes in the provider fee schedule on a monthly basis on the Procedure Code and Fee Schedule Update section. Information concerning specific code changes as well as quarterly reports on fee schedule updates is available in the company website through the downloading and submitting of a Fee Schedule Request Form (Blue Cross Blue Shield of Illinois, 2019).
Types of Payment Structures Offered
The company provides a variety of payment combinations and options which determine the amount a client pays to the health provider (Blue Cross Blue Shield North Carolina, 2019). These options include copayments, deductibles, and coinsurance. A copayment entails a fixed amount of money that a member needs to pay for a service that is covered by the insurance during the time that the health provider offers the service. A deductible is the amount of money that a member owes a service provider for a covered health service at the time when the insurance company has not started paying. Coinsurance is a member's portion of health care expenses as per the predetermined percentage.
Long-term Care Provisions
Blue Cross Blue Shield offers some long-term care insurance policies according to client needs (Seniorliving.org, 2018). There is a policy for nursing homes and skilled nursing but only for those seniors who require medical services while in these locations, which must be registered under the state's laws. It also covers assisted living but under specific conditions only. There must be a need for medical care, and each case determines the amount and level of medical care that will be covered. Hospice care is also covered for clients who enter such institutions having terminal illnesses, through a nursing home policy. For a patient to be covered, most policies should have been established earlier. In-home care is also covered. This is a service whereby a health provider goes to a seniors’ home to provide services to patients. The policy requires that the medical care provided must be less than eight hours a day or seven days a week for 21 or more days.
References
Blue Cross Blue Shield Association. (2019). Employee Benefits .
Retrieved from https://www.bcbs.com/careers/work-bcbsa/employee-benefits
Blue Shield Blue Cross Illinois. (2019). Fee Schedule . Retrieved from
https://www.bcbsil.com/provider/claims/fee_schedule.html
Blue Cross Blue Shield Michigan. (2019). Critical Illness . Retrieved
https://www.bcbsm.com/employers/plans/specialty-benefits/critical-illness.html
Blue Shield Blue Cross North Carolina. (2019). Health Plans for Individuals and Families.
Retrieved from https://www.bluecrossnc.com/shop-plans/individual-and-family-plans
Hunt, J. (2018, December 10). Blue Cross Blue Shield Insurance Company Review . The Balance. Retrieved from: https://www.thebalance.com/blue-cross-blue-shield-insurance-company-review-1969885
Seniorliving.org. (2018). Find Senior Care Covered by Blue Cross Blue Shield Near You.
Retrieved from h ttps://www.seniorliving.org/finance/blue-cross-blue-s hield/
Stevens, D. (2017, October 25). Blue Cross Blue Shield & Pre-existing Conditions. Pocket Sense. Retrieved from h ttps://pocketsense.com/blue-cross-blue-shield-p re-existing-conditions-12313378.html
