Common use of Inter-Plan Medicare Advantage Program Clause in Contracts

Inter-Plan Medicare Advantage Program. Blue Cross and Blue Shield also participates in the Inter-Plan Medicare Advantage Program, the Inter-Plan Program for Members enrolled in a Medicare Advantage plan. In the event you elect to offer a Medicare Advantage plan to your Medicare-eligible Members, when Medicare Advantage Members access health care services outside of Massachusetts, the claim for those services will be processed through the Inter-Plan Medicare Advantage Program and presented to Blue Cross and Blue Shield for payment in accordance with the rules of the Inter-Plan Medicare Advantage Program policies then in effect. The Inter-Plan Medicare Advantage Program available to Members under this Agreement is described generally as follows. The cost of the covered health care service on which a Member’s cost share liability (such as coinsurance) is based will be either:  The Medicare allowable charge for covered services, or  The amount either Blue Cross and Blue Shield negotiates with the provider or the Host Plan negotiates with its provider on behalf of Blue Cross and Blue Shield members, if applicable. The amount negotiated may be either higher than, lower than, or equal to the Medicare allowable charge.

Inter-Plan Medicare Advantage Program. Blue Cross and Blue Shield also participates in the Inter-Plan Medicare Advantage Program, the Inter-Plan Program for Members enrolled in a Medicare Advantage plan. In the event you elect to offer a Medicare Advantage plan to your Medicare-eligible Members, when Medicare Advantage Members access health care services outside of Massachusetts, the claim for those services will be processed through the Inter-Plan Medicare Advantage Program and presented to Blue Cross and Blue Shield for payment in accordance with the rules of the Inter-Plan Medicare Advantage Program policies then in effect. The Inter-Plan Medicare Advantage Program available to Members under this Agreement is described generally as follows. The cost of the covered health care service on which a Member’s cost share liability (such as coinsurance) is based will be either:  • The Medicare allowable charge for covered services, or  • The amount either Blue Cross and Blue Shield negotiates with the provider or the Host Plan negotiates with its provider on behalf of Blue Cross and Blue Shield members, if applicable. The amount negotiated may be either higher than, lower than, or equal to the Medicare allowable charge.