Who has to meet Healthy Blue Living℠ plan requirements?
Who is this for?
This information explains who has to follow the requirements of our wellness-based HMO plans to earn lower copays and deductibles.
Because the Healthy Blue Living and Healthy Blue Living Rewards℠ plans focus on wellness and prevention, it’s important that you meet the plan requirements if you want to earn intermediate or enhanced benefits.
It’s also important to know who has to meet those requirements so you don’t end up at the standard level, paying higher out-of-pocket costs.
Who has to meet the requirements?
Both you and your covered spouse, even if one of you is covered by another medical insurance plan (except Medicare).
Who doesn’t have to meet the requirements?
- Children and adult dependents, other than the member's spouse. We assign them enhanced, intermediate or standard benefits based on the member’s benefit level.
- Members whose Medicare coverage is primary.
What if my covered spouse or I can’t physically meet the requirements?
Your doctor just has to let us know. You can keep enhanced benefits as long as you follow plan requirements, and the treatment your doctor prescribes to improve the condition.
When your new spouse is added to your contract after the start of the plan year, he or she will receive your benefit level. The new spouse will then need to meet the requirements for intermediate or enhanced benefits during the first 90 days of the next plan year.