Blue Shield Prior Carrier Deductible Policy

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Oct 19, 2016, < 1 Minute Read

Confused about prior carrier medical deductible credits for a new Small Group that has recently moved to Blue Shield of California? Here is the eligibility and submission information.

Who is eligible and how to submit a request:

Blue Shield credit will be given for:

Employees that were covered under the prior employer-sponsored group plan:
- in the same calendar year as the new Blue Shield plan,
- moving from the same plan type, e.g. PPO to PPO or HMO to HMO only.

Blue Shield credit will NOT be given for:

Members moving from HMO to PPO or PPO to HMO.
Prescription drug coverage, unless coming from an HSA plan, because the deductibles are combined with medical.
Individual plans.
Out of pocket expenses.

Required documents:

A completed Prior Carrier Accummulation Request form. To avoid processing delays, submit the form by fax to 209.371.3049 after the group is approved and the members are installed into the system.
An EOB, for each family member, showing the amount of deductible that the family member has satisfied to properly apply the deductible credit.
If an EOB is not available, contact the prior carrier for a written letter showing the amounts for each individual family member.

Visit Blue Shield’s Producer Connection to learn more.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.