Eligibility Requirements

As with all health insurance products, applicants must meet certain eligibility requirements. The following summarizes the eligibility requirements for Independence Blue Cross’s Individual medically underwritten products.

Primary applicant must be between 18 and 64.
Spouse must be between 18 and 64. A primary applicant may apply to insure a spouse from whom he/she is separated, even if it is a formal, legal separation.
We will not consider a request to insure a spouse in a common-law marriage if such marriage took place after January 1, 2005. Common-law marriages entered into prior to January 1, 2005, are recognized by the Commonwealth of Pennsylvania, and in such cases these applicants are eligible for coverage.
Domestic partners are not eligible to apply for “individual and spouse” or “family” coverage.
Dependents up to age 26 are eligible to apply for coverage. This includes an applicant’s natural child, stepchild, legally adopted child, or a child placed for adoption. For any other dependent where the primary applicant is requesting coverage but the child is not in any of the categories defined above, a letter outlining the details and any relevant court papers should be submitted. Such information and documents will be reviewed on an individual basis to determine whether the dependent meets the definition of an eligible dependent.
Non-U.S. citizens must reside in the U.S. a minimum of six months before being eligible to apply for coverage. When applying for coverage, they must provide a copy of a student visa, “Permanent Resident Card” (better known as a “green card”), or application for either. In addition, they must have established care with a U.S. physician and be able to provide medical records when required by medical history. If they do not have a Social Security number, specify that, and Independence Blue Cross (IBC) will apply a “dummy” number for IBC’s records. Applicants should not put a tax ID number in the Social Security number section of the application.
Coverage is limited to Pennsylvania residents in Bucks, Chester, Delaware, Montgomery, and Philadelphia counties.
Any person eligible for Medicare or Medicare disability benefits is not eligible to apply.
Any family member who is pregnant, an expectant parent, or in the process of adoption or surrogacy, may not be eligible to be considered for coverage until after the child is born or adopted.
Once an individual is insured by IBC, a newborn child will be guaranteed enrollment if the member applies to add the child within 31 days of birth. If the member does not seek to insure the child until a later date, any future request will require completion of an application and full medical underwriting. The same rules will apply to an adopted child if application is made within 31 days of the child being placed in the member’s home.
In some foreign adoption cases, the adoption agency will require the adoptive parents to assume financial responsibility, including insurance obligations, as soon as the child is put on the plane. Other agencies require assumption of financial obligation as of the moment the child is turned over to the adoptive parents. Where such stipulations have been placed, IBC will need a copy of the adoption agreement. However, assuming all paperwork is in order, those children are eligible for consideration from the date of placement.
If a member wishes to insure a spouse, such requests will be subject to underwriting. There is no guaranteed enrollment provision for spouses even if application is made within 31 days of marriage. In addition, a request to add coverage for children (other than as stated above for newborns or newly adopted children) will be subject to medical underwriting.
For an applicant to qualify for the waiver of the preexisting exclusion clause under a Blue-to-Blue transfer, the applicant must have been enrolled in a Blue Cross^® or Blue Shield^® plan during the 12 months immediately preceding the effective date of this new plan. The applicant may receive credit for each month of prior coverage up to the entire exclusion period of 12 months. A certificate of creditable coverage will be required for each applicant before full or partial waiver of the preexisting clause will be considered except for applicants under age 19 and dependents under age 19 who will not be subject to a preexisting condition exclusion.
Waiver of the preexisting exclusion clause may be available to approved applicants who have been insured under any other group or individual health plan for the last 18 months without a break of more than 63 days prior to the application date. Partial credit does not apply for any other carrier’s coverage replacement. A certificate of creditable coverage from the previous carrier will be required for each applicant before a waiver of the preexisting exclusion clause will be considered except for applicants under age 19 and dependents under age 19 who will not be subject to a preexisting condition exclusion.