Frequently Asked Questions
Topics include:
Broker administration
- What tools are available to help brokers understand the application and underwriting process?
- How can a broker ensure that applications submitted are linked to him/her for commission purposes?
- If an applicant starts an electronic application using a broker-supplied link, will that application still be linked to the broker when the applicant goes back to finish the application?
- When will a paper application show up on ROAM?
1. What tools are available to help brokers understand the application and underwriting process?
The Brokers’ Individual Toolkit includes information on the underwriting and application process, rate information, uninsurable and ratable risks, and downloadable forms. In addition, there are guidelines on the rate ups, which may apply for various medical conditions.
2. How can a broker ensure that applications submitted are linked to him/her for commission purposes?
Individuals applying online must have cookies enabled before clicking the link embedded with your broker code and keep cookies enabled until they complete the registration process. This allows us to track their application to you. Your broker-specific link is created through the “Email Prospect” feature in ROAM. If paper applications are submitted, Section O of the application must be completed.
3. If an applicant starts an electronic application using a broker-supplied link, will that application still be linked to the broker when the applicant goes back to finish the application?
Yes, as long as the applicant uses the same login and password, the application will still be linked to the broker until the application expires (which happens after 30 days of inactivity). If an applicant creates a different login or uses a different broker link, the broker coding will no longer be in place.
4. When will a paper application show up on ROAM?
If Section O of the application is completed, it will be visible on ROAM as soon as the underwriting processing begins.
Application Process
- Will IBC accept faxed or scanned applications and other documents?
- May brokers use a copy of the “Broker and Sales Representative Information Sheet” or the application?
- May an applicant request a change to the effective date of the policy?
- Is the applicant responsible for contacting his/her physician if additional information is required during the underwriting process?
- Do we require a minimum number of months for a noncitizen applicant to be in the United States?
- Will IBC allow a family to apply as one individual and one individual and child(ren)?
1. Will IBC accept faxed or scanned applications and other documents?
IBC will accept faxed applications with ACH payment only. Please note that the original application may be requested at any time by underwriting and that brokers/producers who fax applications will be responsible for retaining the originals.
Paper applications with monthly billing will need to be sent directly to the IBC Underwriting Department. All underwriting mail should be sent to:
Independence Blue Cross
Individual Medical Underwriting
P.O. Box 41474
Philadelphia, PA 19101-1474
or by fax to 215-238-2280
Other underwriting documents (medical history questionnaires, additional medical information, requests to change effective dates) may be faxed. All such documents must be signed and dated and the originals maintained by the broker/producer.
2. May brokers use a copy of the “Broker and Sales Representative Information Sheet” or the application?
Brokers may make a copy of the application materials or use PDFs from ROAM, but the signature on the application must be original.
3. May an applicant request a change to the effective date of the policy?
An applicant may request a change to a future effective date provided it is within 90 days of the application date. Requests to backdate an effective date will not be accepted. The request must be submitted in writing with an explanation for why a change is being requested. Requests should be sent to:
Independence Blue Cross
Individual Medical Underwriting
P.O. Box 41474
Philadelphia, PA 19101-1474
or
by fax to 215-238-2280
Underwriting makes the final decision as to whether the request will be approved. Most commonly, an applicant will ask to change the effective date by a month because other insurance has already been paid. In those instances, the underwriter will approve the change. Other requests will be decided on a case-by-case basis.
4. Is the applicant responsible for contacting his/her physician if additional information is required during the underwriting process?
Yes, the applicant must request the additional information and is responsible for any charges related to this.
5. Do we require a minimum number of months for a noncitizen applicant to be in the United States?
Yes. Non-citizens must reside in the U.S. a minimum of six months before being eligible to apply for coverage. The application submission should include the date that residence in the U.S. commenced and a copy of the green card or application for same.
6. Will IBC allow a family to apply as one individual and one individual and child(ren)?
Yes, a family may choose to enroll in this way, and a husband and wife may enroll as two individuals.
Benefits
- How does the prescription deductible work for families?
- Once the maximum benefit is reached for the prescription plan, will the member receive the discounted cost for any other prescriptions?
- Is mail order available? Are oral contraceptives covered?
- Are the BlueCard® and Guest Membership programs available?
- Although there are no benefits for mental illness or substance abuse, are psychiatric medications covered?
- When will IBC allow a current member to upgrade or downgrade his/her coverage?
- Are the IBC guaranteed enrollment products still available?
- How do applicants set up a health savings account (HSA) if they select an HSA-qualified Individual PPO plan?
1. How does the prescription deductible work for families?
The prescription deductible applies to the Individual HMO copay plans only (HMO $10 Copay, HMO $15 Copay, HMO $20 Copay). The individual HMO deductible plans do not include a prescription deductible.
For the copay plans, once an individual prescription drug deductible is met, benefits begin for that member; when the family aggregate prescription drug deductible is met, benefits begin for the entire family. No one member may contribute more than his or her individual deductible toward the family deductible.
For example, a member’s contract has an indvidual prescription drug deductible of $100 and a family aggregate prescription drug deductible of $300. As soon as the $300 deductible is met by any combination of covered family members, with no more than $100 applied to a single family member, the family prescription drug deductible is met.
2. Once the maximum benefit is reached for the prescription plan, will the member receive the discounted cost for any other prescriptions?
Yes, once the maximum annual benefit is reached, the member can take advantage of IBC’s discounted costs when he/she purchases additional prescriptions at a participating pharmacy.
3. Is mail order available? Are oral contraceptives covered?
Yes, the mail-order program is available, and oral contraceptives are covered.
4. Are the BlueCard® and Guest Membership programs available?
Yes, both programs are available to members by calling 1-800-810-BLUE (1-800-810-2583). BlueCard provides access to urgent care across the country. BlueCard Worldwide® provides access to urgent care around the world. The Guest Membership Program provides coverage for students and travelers out of the area.
5. Although there are no benefits for mental illness or substance abuse, are psychiatric medications covered?
Yes, psychiatric medications are covered through the prescription drug benefit.
6. When will IBC allow a current member to upgrade or downgrade his/her coverage?
A member may downgrade coverage at any time. Although a member may apply to upgrade upgrade at any time, all upgrades are subject to medical underwriting.
7. Are the IBC guaranteed enrollment products still available?
Yes, guaranteed enrollment plans are still available.
8. How do applicants set up a health savings account (HSA) if they select an HSA-qualified Individual PPO plan?
Applicants who select an HSA-qualified Individual PPO plan may check the box in Section A of the application (“Yes, I’d like an HSA account set up through Bancorp. Please send Bancorp my information.”) Independence Blue Cross has a preferred relationship with The Bancorp Bank, an independent company, to provide HSA services. Applicants may also use another bank of their choice.
For more information about HSA accounts and eligibility, individuals should visit the Department of the Treasury website at http://www.treas.gov/offices/public-affairs/hsa.
Members who wish to set up an HSA account after they have applied and been approved for coverage may still do so. They should complete the 
Bancorp HSA Enrollment Request form and return it to:
Independence Blue Cross
Direct Pay
P.O. Box 41452
Philadelphia, PA 19101
or by fax to 215-238-7067.
Preexisting conditions exclusion
- If an applicant is on a medication during the look-back period prior to enrollment, does the use of that medication constitute “treatment received” for the purposes of the preexisting condition exclusion?
- How will IBC communicate to an applicant that his/her coverage is approved but that certain conditions are subject to the preexisting condition exclusion?
- How does the preexisting condition exclusion apply if an applicant has had prior coverage with another Blue plan?
- Are individuals with coverage from another health carrier eligible to submit Certificates of Creditable Coverage?
1. If an applicant is on a medication during the look-back period prior to enrollment, does the use of that medication constitute “treatment received” for the purposes of the preexisting condition exclusion?
Yes, use of a prescription medication does constitute treatment received for purposes of the preexisting condition exclusion.
2. How will IBC communicate to an applicant that his/her coverage is approved but that certain conditions are subject to the preexisting condition exclusion?
Upon approval, members will not receive a notice specifying the conditions subject to the preexisting condition exclusion. The preexisting condition exclusion will be applied through the IBC claims payment system.
3. How does the preexisting condition exclusion apply if an applicant has had prior coverage with another Blue plan?
Applicants coming from another Blue plan may qualify for a Blue-to-Blue transfer that would allow them to reduce or waive the waiting period for a preexisting condition. The applicant must have or have had prior health coverage with a Blue Cross® or Blue Shield® plan that has been in force for up to 12 months without a break in coverage prior to the requested effective date of the current application. The applicant may receive credit for each month of prior coverage up to the entire exclusion period of 12 months.
Please note that prior creditable coverage does not guarantee acceptance into this medically underwritten program. All applications are subject to underwriting approval.
4. Are individuals with coverage from another health carrier eligible to submit Certificates of Creditable Coverage?
Yes. If an applicant has had continuous health insurance coverage for the past 18 months without a break of more than 63 days prior to the date of application, a certificate of creditable coverage from the existing insurer can be submitted for consideration to waive the preexisting exclusion clause.
Please note that prior creditable coverage does not guarantee acceptance into this medically underwritten program. All applications are subject to underwriting approval.
Rates/Billing
- If an applicant submits a check for the first month’s premium using the rates for standard risk but is actually approved with one of the other risk categories, will IBC require the additional premium before the case is enrolled?
- May Individual members make premium payments using a credit card?
- Are the rates for the medically underwritten plans guaranteed? When will the rates change for a member who moves into a higher age band?
1. If an applicant submits a check for the first month’s premium using the rates for standard risk but is actually approved with one of the other risk categories, will IBC require the additional premium before the applicant is enrolled?
No. If the applicant accepts coverage, IBC will continue the enrollment process. The additional premium will be billed/deducted in the next billing cycle.
2. May Individual members make premium payments using a credit card?
No. But members may pay electronically using the ACH (Automated Clearing House) process.
3. Are the rates for the medically underwritten plans guaranteed? When will the rates change for a member who moves into a higher age band?
Rates are guaranteed for new members for the first six months of coverage, regardless of any rate or age band increases for the Individual medically underwritten products. After the first six months, rates can change at any time subject to the prior approval of the Pennsylvania Insurance Department. Members will receive advance notification of any future rate changes.
The new rates will be based upon the age, gender, and family coverage status of the contract holder as of the date the rate change takes effect. The rates for members moving into a higher age band will change only when the rates change for the entire enrollment in these products.
Frequently Asked Questions
