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Non-Renewal of Private Fee-for-Service (PFFS) Plans for 2011

October 13, 2010

Due to network regulations from the Centers for Medicare & Medicaid Services, BlueCross will not offer non-network PFFS plans for 2011. However, we will be offering new, network plans across the state to meet the needs of your clients. To help you and our members, we will mail the attached letter and Medigap Basics insert to our members, along with a list of plan options available. The letter explains that we are not renewing members’ plans. It also explains what their rights are, as they will be disenrolled from their Medicare BlueSM Private, Medicare BlueSM Private Complete or Medicare BlueSM Private Complete Plus plans effective January 1, 2011.

Additional Information:

  • Medicare Advantage plans that do not have a provider network will no longer be available in South Carolina after December 31, 2010.• Members will have a special enrollment period beginning October 1, 2010, and ending January 31, 2011, to enroll in other Medicare Advantage or prescription drug plans.
  • Members who wish to return to original Medicare will not have to take any action.
  • Members will have either a January 1 or a February 1 effective date with their new plans. Note: A February 1 effective date may leave the members without drug coverage for the month of January.
  • Enrollment requests received from October 1 through December 31, 2010, will have an effective date of January 1, 2011. Enrollment requests received in January 2011 will have an effective date of February 1, 2011.
  • All members who have not taken action will be enrolled into original Medicare effective January 1, 2011. These members risk losing drug coverage.
  • Members have 63 days from the disenrollment dates from their Medicare Advantage plans to enroll in Medicare Supplement plans.
  • If a member qualifies for extra help, low-income subsidy, or is eligible for Medicaid or Medicare, Medicare will enroll him or her in a prescription drug plan if the member has not done so by December 31, 2011.
  • If a member is eligible for Medicaid, the state may pay his or her cost-sharing if the member is in original Medicare. The member will need to contact the South Carolina Department of Health and Human Services (SCDHHS) at the number listed at the end of this bulletin.
  • If a member receives help from Medicaid, he or she needs to contact SCDHHS to see how joining a new plan or returning to original Medicare affects his or her Medicaid coverage.

We are encouraging agents to reach out to their clients in non-renewing plans to assist them.

To submit the application with the correct election period, please refer to the page in the application titled “Attestation for Eligibility and Enrollment Period.” Check the box next to “My plan is ending its contract with Medicare or Medicare is ending its contract with my plan.”

Options for our Members

Options for 2011 are shown here. Members are strongly encouraged to act before December 31, 2010, to avoid the possibility of being without prescription drug coverage on January 1, 2011.Members affected by non-renewal of a PFFS plan can:

Member May Choose Action Member Needs to Take
Original Medicare No action needed
Original Medicare plus a Part D drug plan Select and enroll in a Part D drug plan
MA Plan Select and enroll in new plan
MAPD Plan Select and enroll in new plan
Original Medicare plus a Medicare Supplement Select and enroll in a Medicare Supplement plan
Original Medicare plus a Medicare Supplement plus a Part D drug plan Select and enroll in a Medicare Supplement and a Part D drug plan

For more information, please visit these websites:

Important Phone Numbers

  • Medicare: 800-MEDICARE (800-633-4227)
  • Social Security Administration: 800-772-1213
  • South Carolina Department of Insurance: 803-737-6160
  • South Carolina Health Insurance Pool: 800-868-9095
  • South Carolina Department of Health and Human Resources: 888-549-0820

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