Paying and processing claims
Understand details about your premiums, processes and claims.
Premiums and coverage periods
Paying premiums
For plans you buy on your own.
Getting a refund when you overpay
For individual and family plans, if you overpay your premium, we’ll credit your account or we can mail you a check for the amount.
For help with an overpayment, you can log in to your member account to send a secure message by clicking on "Get help" or call customer service at the number on the back of your member ID card.
Pay your premium online
For ease and convenience, you can pay your Medicare or individual and family plan premium online.
Coverage periods
Your premium needs to be paid before your coverage begins or continues.
Your coverage may have a grace period. This is when coverage continues even though your premium for the upcoming period has not been paid.
The length of the grace period varies based on how you bought your plan.
If you bought your health plan through MNsure and are getting advance payments of the premium tax credit:
You’ll have a grace period for three consecutive months if you’ve previously paid at least one full month’s premium during the benefit year.
During the grace period, we will pay all appropriate claims for care you received during the first month. Claims for care during the second and third months may not be paid immediately (they will be "pended"). You may also have to pay for prescriptions during the second and third months of the grace period.
If we don’t receive your premium payment by the end of the three month grace period, your coverage will be canceled back to the last day of the first month of the grace period. You are then responsible for paying for all your care from the second and third months of the grace period.
If you bought a health plan directly from Blue Cross, or you bought it through MNsure and are NOT getting advance payments of the premium tax credit:
We allow a 31-day grace period for payment, rather than three months.
In either case, if your coverage is canceled for nonpayment, you may not be able to get new individual and family health insurance coverage again until the next annual enrollment period unless you experience a qualifying event.
Claims and explanations of benefits
Submitting claims
If you visit an in-network doctor, hospital or other healthcare provider, you don’t need to submit a claim to us. Your provider will submit the claim for you.
If you visit an out-of-network doctor, hospital or other healthcare provider, you will need to submit one of these claim forms to us within the time noted in your contract.
Different plans may use different claim forms
Each form shows information you need to provide with the form, along with contact information for you to submit the form in the way you choose: mail, fax or email.
If you have questions about claims, please call customer service at the number on the back of your member ID card.
Denied claims after they’ve been paid
It's rare, but it's possible for a claim to be denied after it's been paid ("retroactively"). If this happens, you're responsible for paying your doctor for the cost of care you received.
How can claims be denied and how can your avoid it:
- It can happen if you haven't paid your premium for the time when you received care, so be sure to pay your premium on time.
- It can happen if we've made a mistake and paid too much to a provider. If we've paid for a part of a cost that was actually your responsibility, you'll need to pay your part to the provider.
Explanation of benefits
After you use your health plan benefits and we receive a claim for payment from your provider, we will send you an Explanation of Benefits (EOB).
An EOB is not a bill, but it helps you keep track of some important information, including:
- The health care services you received
- How much your health plan paid your provider
- How much you owe your provider for your care
Coordination of benefits
If you, your spouse or your covered dependents are covered by more than one health plan, we work with your other plan to coordinate how your expenses are paid by each plan.
Related resources
Things to know before you get care
Care outside your network
Your costs are much higher when you get care outside your network.
A network is a group of doctors, clinics, hospitals and other health care providers that you can see for a lower cost. If you choose to see providers that are not in your plan’s network, you will likely have to pay more or all of the cost of that care, so it’s important to stay in your network.
Medical necessity and prior authorization
Be sure services that need approval are approved in advance.
As part of your coverage, we provide services to help you get high quality care and save money by avoiding unnecessary costs. When you and your doctor are making decisions about your care and how your benefits work, we can help.
Exceptions for drug coverage
Sometimes, if your doctor feels that there isn’t a covered drug that meets your needs, they can request an exception so the drug can be covered by your plan.
This information may not apply to some group plans, Medicare plans or Medical Assistance (Medicaid) plans.