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2021 Benefit Information for Members
View and download information for your 2021 plan through December 31, 2021.
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Reimbursement, Enrollment and Representation Forms
Claims and Reimbursement
Enrollment
- Enroll in a Capital BlueCross Plan
Appoint a Representative to Discuss Your Options with us
Print, complete and send back this form to allow a family member or friend to communicate with us on your behalf. You can also call the Member Services number on your ID card and request a copy be mailed to you.
Appeals and Grievance
Appoint a Representative to assist with your Appeal
Let someone file a grievance (complaint), ask for coverage or make an appeal for you.
This person is your appointed representative. An appointment is good for one year from the date that you and your representative sign an Appointment of Representative form.
- Complete this form below and mail it to us. Any time your representative makes a request for you, they should send us a signed copy.
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National and Local Medicare Coverage Information
The Centers for Medicare and Medicaid Services (CMS) works to expand and improve coverage for Medicare participants. There are National Coverage Determinations (NCD’s) and Local Coverage Determinations (LCD’s) issued throughout the year that expand health care coverage for various services. Listed below are some of those new coverage determinations.
- January 2020:
Expanded coverage for Diagnostic tool for breast/ovarian cancer - January 2020:
Medicare Coverage: Acupuncture for Chronic Lower Back Pain - March 2020:
Expansion of Telehealth Services - March 2020:
Regulatory Changes to Address COVID-19 Patient Surge - September 2020:
Next Generation Sequencing (NGS) for Medicare patients with Germline Cancer - September 2020:
End-Stage Renal Disease Treatment Choices - November 2020:
Update on ESRD payment policy for renal dialysis for individuals with acute kidney injury - November 2020:
Chimeric Antigen Receptor (CAR) T-cell Therapy cancer treatment is covered with an effective date of August 7, 2019
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Quality Improvement Organization
You should contact the Quality Improvement Organization if you have a complaint about the quality of care you have received. For example, you can contact the Quality Improvement Organization if you were given the wrong medication or if you were given medications that interact in a negative way.
Livanta (Pennsylvania’s Quality Improvement Organization)
Contact
Phone: 888.396.4646 (TTY: 888.985.2660)
Fax: 1.833.868.4057
Visit the Livanta website.
Write by mail:
Livanta BFCC-QIO Program
10820 Guilford Road, Suite 202
Annapolis Junction, MD 20701
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Publications
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Get the most out of your coverage today.
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Updated October 1, 2020
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