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FAQ

Frequently Asked Questions

How do I enroll a new employee?
How do I make changes to a current employee’s coverage (i.e., address change, dependent changes, terminations, etc.)?
What is the enrollment/cancellation wash rule?
Who do I call if I have a question about a member’s claims or prescriptions?
How do I get a Highmark Blue Shield health insurance ID card?
Who is considered a dependent?
How long are dependents eligible to have coverage?
Full-time student dependents—To what age is my child eligible to be a full-time student dependent?
What are the reasons for a dependent to lose eligibility?
What insurance options are available for dependents who lose their eligibility for benefits?
How can members manage their account?
How can employers manage their group’s account?
What is COBRA? 
Coverage when traveling out of the area—The BlueCard® Program
How do I start the mail order prescription benefits?
What are the Medicare Secondary Payor Rules?
How do I enroll in the Medicare supplement plan(s)?
How can the Pennsylvania Medical Society Insurance Agency assist physician groups with additional insurance needs?
  


How do I enroll a new employee?


An enrollment form must be completed and then signed by the employee and employer. These forms should be mailed, emailed, or faxed to the Pennsylvania Medical Society Insurance Agency. If you choose to email or fax your forms, it is not necessary to also mail the originals.

Email address:  admin@pamedinsurance.com
Fax number:  717.561.6077 (HIPAA compliant)

Mailing Address:

Pennsylvania Medical Society Insurance Agency
P.O. Box 69067
Harrisburg, PA 17106

Please call us if you need a supply of enrollment forms. These forms are also available under the Forms / Resources section of this website.

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How do I make changes to a current employee’s coverage (i.e., address change, dependent changes, terminations, etc.)?

Simply call or email the Pennsylvania Medical Society Insurance Agency with the necessary information, and we will complete the required paperwork. Because a change form does not require a signature by the employee or employer, we will be glad to complete these forms for you. Or, if you prefer, you may complete the form and return it to us for processing.

Please call us if you need a supply of change forms. These forms are also available under the Forms/Resources section of this website. All completed forms should be mailed, emailed, or faxed to the Pennsylvania Medical Society Insurance Agency. If you choose to fax or email your forms, it is not necessary to also mail the originals.

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What is the enrollment/cancellation wash rule?

If a member is enrolling with an effective date of the 1st through the 15th of the month, they are charged for that entire month’s premium. If a member is enrolling from the 16th through the end of the month, they are not charged for that month’s premium.

If a member is cancelled with an effective date of the 1st through the 14th of the month, they are not charged for that month’s premium. If a member is cancelled from the 15th through the end of the month, the full month premium is charged.

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Who do I call if I have a question about a member’s claims or prescriptions?

Please direct all questions regarding claims or prescription issues to Highmark’s customer service (the number on the back of your ID card – 866.871.7579).

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How do I get a Highmark Blue Shield health insurance ID card?

ID cards for new employees will be mailed to the member’s home address within 7-15 business days. Employers may order duplicate cards by logging on to www.highmarkblueshield.com and clicking on the Employers tab. Employees may order duplicate cards by logging on to www.highmarkblueshield.com and clicking on Log in under Manage Your Plan. If you need assistance ordering additional ID cards, please call the Pennsylvania Medical Society Insurance Agency.

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Who is considered a dependent?

  • Newborn children
  • Stepchildren
  • Children legally placed for adoption
  • Legally adopted children or children for whom the employee or the employee’s spouse is the child’s legal guardian
  • Children awarded coverage pursuant to an order of court
  • Unmarried children up to the age of 25, provided they are full-time students (see description of full-time student below).
  • Unmarried children over age 19 who are not able to support themselves due to mental retardation, physical disability, mental illness, or developmental disability.
  • Domestic partners and their children. The group is responsible for determining if a person is eligible for coverage as a domestic partner and for reporting such eligibility.
  • Newborn children of an eligible dependent automatically have coverage for the first 30 days after birth but are not eligible to remain on the coverage unless they meet the requirements listed above for an unmarried child under 19 years of age.

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How long are dependents eligible to have coverage?

Dependent children are eligible for coverage until the first of the month following their 19th birthday, unless they marry or become employed full-time prior to age 19.

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Full-time student dependents—To what age is my child eligible to be a full-time student dependent?

Dependents are eligible as full-time students from age 19 until the first of the month following their 25th birthday. Dependents are not able to be listed/categorized as student dependents until the age of 19. Being a student dependent requires enrollment as a full-time student (defined as 12 credits hours per semester) in an accredited school, college, or university and solely dependent upon the employee for support.

The member must contact the Pennsylvania Medical Society Insurance Agency to have the dependent certified as a student (upon their 19th birthday).

Following initial certification, Highmark Blue Shield conducts an annual full-time student certification process each June. The purpose is to verify that the dependent is still a full-time student. The notice is sent to the member/contract holder. If this certification is not completed and returned to Highmark Blue Shield verifying continued student status, the dependent student’s coverage is cancelled.

Parents or Employers may also contact the Pennsylvania Medical Society Insurance Agency to verify the dependent is a full-time student each year in June.

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What are the reasons for a dependent to lose eligibility?

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What insurance options are available for dependents who lose their eligibility for benefits?

Thirty days prior to the dependent’s cancellation date, or once the cancellation date is entered in Highmark’s system if less than 30 days notice, a Conversion Notice is sent to the member/dependent with an offer to purchase guaranteed issue direct-pay coverage from Highmark Blue Shield.

You may also contact the Pennsylvania Medical Society Insurance Agency to apply for one of Highmark Blue Shield’s individual medically underwritten products.

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How can members manage their account?

Members have an on-line resource to manage their account. They are able to find a provider or pharmacy, view benefit booklets, view their drug formulary, view their medical and drug claims, and request ID cards. Just log onto www.highmarkblueshield.com, click on the Members tab, and register to log on.

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How can employers manage their group’s account?

Employers have a simple and convenient way to manage their Highmark health insurance account and customer service information from anywhere, at anytime. They have on-line access to currently enrolled members; their group’s benefits, group numbers, and rates; forms, resources, and member account management tools; customer service area to send an email; frequently asked questions; educational pieces; and additional insurance needs. Just visit our secure site at www.pamedinsurance.com/highmark and log in with your username and password. Please contact the Pennsylvania Medical Society Insurance Agency to receive your username and password.

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What is COBRA?

COBRA provides certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates. This coverage, however, is only available when coverage is lost due to qualifying events.

Group health plans for employers with 20 or more employees on more than 50 percent of its typical business days in the previous calendar year are subject to COBRA. Both full and part-time employees are counted. Part-time employees count as a fraction of an employee – access website address below for details.

Groups with less than 20 employees are not able to enroll individuals in COBRA.

Please go to http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html for additional information about COBRA coverage.

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Coverage when traveling out of the area—The BlueCard® Program

The BlueCard® Program is best defined as a very large and extensive Blues network. The creation of this program was facilitated by the National Blue Cross/Blue Shield Association. When traveling anywhere in the United States, if you need medical care and use the services of a Blue Shield provider that participates in the same network as your coverage, the procedure will be treated as an in-network service.

The key is to ensure that you go to a Blues provider that participates in the same network. For example, if you are insured through a PPO product, make sure that the out-of-area physician or hospital participates in its regional Blues PPO network.

Follow these five (5) steps for health coverage when you're away from home in the United States:

As a PPO member, the doctor will recognize the logo which will ensure that you will get the PPO level of benefits.

*Coverage may vary for each Blue Cross and/or Blue Shield Plan, so be sure to check with your Plan before traveling.

After you receive care, you will not have to complete any claim forms or pay up-front for medical services other than the usual out-of-pocket expenses (non-covered services, deductible, co-payment, and co-insurance). You will be sent a complete explanation of benefits.

If you need to access a provider outside the United States, call the BlueCard Worldwide Service Center at 1-800-810-BLUE or call collect at 804-673-1177 for information on hospitals and doctors. If you are hospitalized, you must call the Service Center in order for them to arrange cash-less access with the hospital. In an emergency, go to the nearest hospital and then call the BlueCard Worldwide Service Center if you are hospitalized. Contact your Blue Cross and Blue Shield Plan for pre-authorization, if necessary.

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How do I start the mail order prescription benefits?

Highmark Blue Shield uses Medco as its Pharmacy Benefits Manager (PBM). The home delivery pharmacy service provides convenience and cost savings. For example, you pay a two-month co-payment amount for three months of prescriptions.

For new prescriptions, ask your doctor for a script for 90 days, plus refills (if appropriate) for up to one year. The member should mail the prescription along with payment in a postage-paid envelope (please contact the Pennsylvania Medical Society Insurance Agency for these envelopes). Payments can be made by check, money order, or credit card.

Members can also ask their doctor to call 1-888-EASYRX1 for instructions on faxing a new prescription. You have the option to place a refill order on Highmark Blue Shield’s website (www.highmarkblueshield.com), by telephone at 1-800-4REFILL, or by mail. Please note it takes 10 to 14 days for delivery after notification to the PBM is made.

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What are the Medicare Secondary Payor Rules?

Medicare due to Age:

Medicare due to Disability:

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How do I enroll in the Medicare supplement plan(s)?

An employee who is Medicare eligible and eligible to enroll in the Medicare supplement plans must first enroll in both Medicare Part A and Part B. Once they receive confirmation that they are enrolled in Medicare Part A and Part B, contact the Pennsylvania Medical Society Insurance Agency to obtain the forms needed to make the change.

Changes to the Medicare supplement plan can only be effective the first of the month. Completed paperwork must be received prior to the anticipated effective date.

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How can the Pennsylvania Medical Society Insurance Agency assist physician groups with additional insurance needs?

It is our mission and privilege to meet the insurance needs of Pennsylvania Medical Society members. Our commitment to service is of great importance, and we are always looking for new and unique ways to assist and meet the evolving insurance needs of physicians. In this regard, if you have additional insurance needs such as long-term care, disability (group or individual), life (group or individual), business liability, or professional liability, we will gladly assist you. Please contact an agent.

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