Frequently Asked Questions
Q. Who is a Dependent?
A. The family members covered by your enrolment are called dependents. These include legally married spouse or common-law partner, and children born either in or out of wedlock. Dependents also include legally adopted children, stepchildren or foster children. Certain conditions may apply.
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Q. What is a Deductible?
A. This is an out-of-pocket expense that must be paid by the subscriber before accessing Major Medical benefits.
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Q. How do Major Medical Benefits work?
A. There is a limit on the amount that your basic plan will pay for surgery and other medical benefits in one year. The Major Medical benefit is a supplemental, stipulated lifetime amount that will be used to pay for benefits after the base amount has been exhausted. Some services, such as MRI, CAT scan and diagnostic tests are paid directly from Major Medical.
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Q. What is Coordination of Benefits?
A. If you have coverage under more than one health insurance plan, you are able to claim from both insurers up to a maximum not exceeding the amount you have paid for the service. This applies whether your plans are with the same insurer or different companies.
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Q. How does the Full House Benefit work?
A. The Full House benefit covers prescription drugs, dental and optical charges, for the subscriber and his/her covered dependent. If you visit a participating provider, the provider will verify your eligibility and then you will have to pay 20% of the cost. The provider will bill Blue Cross® for the 80%. When your Full House Maximum is exhausted, you will have to pay the provider in full for all charges. Your Full House Maximum is "refreshed" on your policy anniversary.
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Q. What types of Health Insurance Coverage are available?
A. Three types of health insurance coverage are available. These are:
• The Individual Plan, which covers the subscribers only.
• The Individual Plus One, which covers the individual subscriber, plus one dependent.
• The Family Plan, which covers the subscriber and two or more dependents, who may include their spouse (married or unmarried), biological children, legally adopted children and stepchildren up to the age of nineteen (19) years
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Q. Is coverage available for my child after 19 years of age?
A. Coverage may be extended to your dependent child if your policy includes overage dependent coverage. (Conditions apply.)
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Q. What if I need to make changes to my enrollment?
A. Certain changes in your marriage, family or employment status can affect your health coverage. To make adjustments to your existing group policy, you must notify your Personnel Department. If you have an Individual Plan, and wish to make changes to it, call or visit any Blue Cross of Jamaica Limited office.
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Q. When can I add my newborn baby?
A. The addition of a newborn will be effective 14 days after birth. If the newborn is hospitalized at the date of eligibility (14 days), the effective date will be the date following the date of discharge from the hospital.
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Q. When can I change my spouse on my health insurance plan?
A. You can cancel a spouse at any time. However, change of spouse is only allowed on your group's anniversary, unless you marry the spouse you are adding. (A copy of the marriage certificate is required).
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Q. How is the Consultation Fee paid?
A. Consultation fee is paid if a General Practitioner refers the subscriber to a Specialist. This amount is greater than what Blue Cross® would pay if there is no referral from your doctor, for example your gynaecologist and paediatrician. A maximum of one (1) visit is allowed per condition. A total of four (4) visits are allowed per contract year.
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Q. How is the Specialist Fee paid?
A. This is the amount that Blue Cross® will pay if you should visit a specialist/consultant without referral from your doctor, for example your gynaecologist and paediatrician. A maximum of five (5) visits are allowed per condition, per contract year.
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Q. I am leaving my Company, but wish to continue my insurance. What should I do?
A. You have thirty (30) days after your last deduction is made from that company, in which to convert your policy to one of our individual plans. If this is done, you will not have to serve a new waiting period.
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Q. Who should I contact to find out about purchasing an individual policy?
A. Any Sales Representative in our Sales Department can be of assistance to you.
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Q. How do I apply for a health policy with Blue Cross® through the credit union?
A. Contact any participating credit union to apply for membership.
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Q. I am solely responsible for my niece/nephew/sister/brother/grandchild. Can this child be a dependent on my plan?
A. Only if you have adopted the child and can produce legal papers to this effect.
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Q. I have not accessed my health benefits for the year, am I entitled to a refund or part of my premiums paid?
A. Health insurance provides coverage in the event of your incurring medical bills. There is no provision for the return of any part of the premiums paid.
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Q. Can my dependent daughter get Maternity Benefits?
A. This benefit is only applicable to female policyholders, or spouses of male policyholders, where maternity is a covered benefit.
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Q. What is a Basic Benefit?
A. The first level of covered medical expenses that are payable prior to the application of Major Medical.
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Q. What is the benefit period?
A. This is the period for which coverage applies. It is generally annual but could be for any other specified period of time.
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Q. What is co-payment?
A. An amount of money that the subscriber is required to pay out-of-pocket for some benefits e.g. 20% of the cost of prescription drugs.
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Q. When does coverage become effective?
A. Coverage becomes effective on the date the policy is issued or the time when the subscriber becomes eligible for coverage.
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Q. What are exclusions?
A. These are specifications outlining when coverage will not be given.
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Q. Does the lifetime maximum apply to all Blue Cross® Health Plans?
A. No. Lifetime maximum refers to benefits that each insured is entitled to under Major Medical.
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Q. Who is a policyholder?
A. A policyholder is a person who has a health insurance policy with us. The policyholder can be an employer or an individual participating in either an Individual or Group Plan.
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Q. Who is a provider?
A. The Doctor, Dentist, Pharmacy, Medical Laboratory, Optical Provider, Hospital and other facilities that provide health care services are providers. Participating Providers are providers who have been approved and registered to provide health care on behalf of and for Blue Cross of Jamaica Limited.
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Q. Who is a subscriber?
A. A subscriber is a person who has purchased and been issued health insurance.
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Q. What does usual, customary and reasonable charge mean?
A. Usual, customary and reasonable charge refer to fees charged by an individual/institution that are consistent with the going rate in a given region or geographical area.
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Q. How do I submit a claim to Blue Cross®?
A. Complete a claim form and submit to Blue Cross of Jamaica Limited with original receipts by mail or in person within 90 days of the date of the service.
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Q. What is the turnaround time on claims?
A. The average turnaround time on claims after receipt at our offices is 21 working days.
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Q. How does the overseas emergency service operate?
A. If you suffer a life threatening illness while overseas, it is important that you contact the toll free number on the back of your travel card within 48 hours of the illness. The service will be accessed and approved by their representative.
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Q. Who can a speak with about a concern that I have with my policy?
A. Our call center operators and customer service representatives are available to assist you.
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