After You Enroll in Blue Cross
Medicare Advantage Dual Care
(HMO SNP)SM


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Within 10 days of receiving your completed enrollment form, Blue Cross Medicare Advantage will send you an acknowledgement letter. After the Centers for Medicare & Medicaid Services (CMS) confirms your enrollment, we'll send you a confirmation letter within 10 days. This letter will include your ID card. You will also receive a Welcome Kit, which will be sent separately from your confirmation letter and ID card. This package will include your Evidence of Coverage along with everything you'll need to know about being a Blue Cross Medicare Advantage member.

Evidence of Coverage

The Evidence of Coverage (EOC) is a detailed document that explains the plan rules associated with Blue Cross Medicare Advantage. 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 Medicare Advantage
  • How to get your filled
  • What you will have to pay for your medical care and prescriptions
  • Your rights and responsibilities

Evidence of Coverage - HMO SNP
Y0096_BEN_TMP_MAEOCCVR14 Approved 08222013

Evidence of Coverage - HMO SNP en EspaƱol
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Your Protections in this Plan

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

As for claims, if Blue Cross Medicare Advantage ever denies your medical or 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 doctor 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 for your drug coverage, or a coverage determination for your medical coverage.

Guidelines for Disenrollment

Disenrollment from Blue Cross Medicare Advantage 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 may end your membership in our plan only during certain times of the year, known as enrollment periods. All members have the opportunity to leave the plan during the Annual Enrollment Period. In certain situations, you may also be eligible to leave the plan at other times of the year. Refer to your the Evidence of Coverage Section titled "When can you end your membership in our plan?"

To voluntarily disenroll:

  • You must choose to leave the plan.
  • You must provide a signed written notice to Blue Cross Medicare Advantage 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

Blue Cross and Blue Shield of New Mexico (BCBSNM) must disenroll an individual from Blue Cross Medicare Advantage in the following cases:

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

This plan is available to anyone who has both Medical Assistance from the State and Medicare.