After You Enroll in
Blue Cross MedicareRxSM


Print

After receiving your completed enrollment form, Blue Cross MedicareRx will send you:

  • An acknowledgement letter within 10 days of receiving your enrollment form.
  • After your enrollment has been approved, we'll send you a confirmation letter no later than ten (10) calendar days from receipt of CMS's confirmation of enrollment. This letter will include your ID card.
  • You will receive a Welcome Kit approximately two weeks after the ID card and confirmation letter. This package will include your Evidence of Coverage along with everything you'll need to know about being a member of Blue Cross MedicareRx.

Evidence of Coverage

The Evidence of Coverage (EOC) is a detailed document that explains the plan rules associated with Blue Cross MedicareRx. This document, together with your enrollment form, riders, coverage and the amendments that we may send to you, is our contract with you.


The EOC explains:

  • What is and is not covered by Blue Cross MedicareRx
  • How to get your prescriptions filled
  • What you will have to pay for your prescriptions
  • Your rights and responsibilities

Evidence of Coverage: Basic Plan 
Y0096_BEN_NM_EOCBASIC2014 Accepted 08302013

Evidence of Coverage: Value Plan 
Y0096_BEN_NM_ANOCEOCVALUE2014 Accepted 08232013

Evidence of Coverage: Plus Plan 
Y0096_BEN_NM_ANOCEOCPlS2014 Accepted 08232013

2014 Part D Spanish Evidence of Coverage: Basic Plan en Español 
Y0096_BEN_NM_EOCBasic2014SPA Accepted 08232013

2014 Part D Spanish Evidence of Coverage: Value Plan en Español 
Y0096_BEN_NM_ANOCEOCVALUE2014SPA Accepted 08232013

2014 Part D Spanish Evidence of Coverage: Plus Plan en Español 
Y0096_BEN_NM_ANOCEOCPLS2014SPA Accepted 08232013



Your Protections in this Plan

Blue Cross MedicareRx agrees to stay in the program for a full year at a time. Each year, the plan decides whether or not to continue offering prescription drug coverage for the following year. Should we decide not to continue offering Blue Cross MedicareRx, we will send you a letter explaining your options for Medicare prescription drug coverage in your area. Your Medicare coverage is not affected.


As for claims, if Blue Cross MedicareRx ever denies your prescription drug benefits, we will explain our decision to you. You always have the right to appeal and ask us to review the claim that was denied. In addition, if your physician prescribes a drug that is not on our formulary, is not a preferred drug, or is subject to additional utilization rules, you may ask us to make a coverage exception.


Guidelines for Disenrollment

Disenrollment from Blue Cross MedicareRx means ending your membership. Disenrollment can be voluntary or involuntary. We are not allowed to ask you to leave the Plan because of your health.


Voluntary Disenrollment


You can leave the Plan and join another Medicare prescription drug plan, Medicare Cost Plan, or Advantage Plan available in your area. It will take some time for your prescription drug coverage to end and your new prescription drug coverage to begin.


To voluntarily disenroll:

  • You must choose to leave the Plan.
  • You must provide a signed written notice to Blue Cross MedicareRx through your employer (if applicable).
  • Call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. If you are hearing or speech impaired, please call 1-877-486-2048.


Involuntary Disenrollment


HCSC Insurance Services Company (HISC) must disenroll an individual from Blue Cross MedicareRx in the following cases:

  • The individual moves out of the plan's service area and becomes ineligible to be an enrollee of Blue Cross MedicareRx.
  • The individual loses entitlement to Medicare.
  • The individual dies.
  • The Blue Cross MedicareRx contract is terminated or Blue Cross and Blue Shield of New Mexico discontinues offering Blue Cross MedicareRx in any portion of the area where it had previously been available.
  • The individual materially misrepresents information to HISC regarding reimbursement for third-party coverage.