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10 Commonly Asked Questions

Am I eligible?*

If you are a resident of Arizona, age 18 through 64 and not eligible for Medicare, you can apply for coverage. In most cases, approval will be based on your health history. Beginning in 2014, eligibility for new health insurance coverage will no longer be based on health status. Learn more.

How soon can I get coverage?

If you apply for a plan and pass underwriting you can usually receive an effective date as early as 3-4 days after we receive your completed application. If you have pre-existing medical conditions, coverage decisions can take longer if we have to obtain and review your medical records. Starting January 1, 2014, you will not be denied coverage because of a pre-existing condition including a disability. Those plans may be purchased after October 1, 2013 for January 1, 2014 effective dates.

Are affordable plans available?

Yes, we offer many options that are much more affordable than most people realize. Beginning in 2014, subsidies will be available on a sliding scale, based on income level, to help individuals and families purchase insurance through a federally-operated exchange. 

Are child-only plans available?

Not at this time. You must be 18 or older to apply for an individual health insurance policy. To obtain coverage for a child under the age of 18, the child must be a dependent on a covered parent’s plan. In addition, our plans allow children up to age 30 to obtain coverage under their parent’s plan. Qualified disabled children may stay on for a longer period.

Is preventive care covered?

Yes, all individual and family health plans that are available for purchase provide coverage for preventive care services without any member cost share.** Covered preventive care services include certain screening services, immunizations, routine physicals, well-baby care, diagnostic lab, pap smears and mammograms. If you have tests or services that are not included in the plan’s preventive care coverage, regular cost share will apply.

What happens if I have a pre-existing condition?

If you have a pre-existing condition, you might have to wait a certain period of time before the plan will provide coverage for that condition. Starting January 1, 2014, you will not be denied coverage because of a pre-existing condition including a disability.

If I have a sudden illness or need to be hospitalized, what plan will cover me?

All of our plans cover hospitalizationst. If you choose a plan with a lower deductible and higher coinsurance, it would have a higher premium, but would result in a lower out-of-pocket cost if you are hospitalized. Or, if you choose a plan with a higher deductible and higher coinsurance, which are often available at lower premiums, you will have to pay higher out-of-pocket costs. Compare plans now.

Can I get dental coverage?

Yes. We offer dental plans that cover both diagnostic care (oral examinations and dental X-rays) and preventive care (teeth cleaning and oral hygiene)t. Find out more.

What is the Affordable Care Act (ACA)?

The ACA is the federal healthcare reform law that was passed in March 2010. Since its passage, many federal regulations have also been enacted to implement the details and requirements. These laws are intended to make health insurance benefits more accessible to more people. The ACA requires most people over the age of 18 to have health insurance coverage no later than March 31, 2014. The 2014 health insurance plans will be available starting October 1, 2013. Learn more.

Disclaimer/Source

*Applicants must meet all eligibility requirements and qualify for coverage. 

**Preventive services are those services performed for screening purposes when the member does not have active signs or symptoms of a condition but do not include diagnostic tests performed because the member has a condition or an active symptom of a condition. Whether something is preventive is determined by the combination of procedure and diagnosis codes submitted by the provider.  Except for mammography, foreign travel immunizations, and routine vision exams for members under age five, preventive services are covered only at network providers.

tPlans do not cover all health care expenses and have exclusions and limitations. All plans generally exclude coverage for services, medications, and supplies that are experimental, investigational, cosmetic, for treatment of sexual dysfunction, or which BCBSAZ deems not medically necessary. PPO plans cover only complications of pregnancy and exclude routine maternity. All plans require precertification for inpatient surgery, specialty injectable and certain other medications.

All plans impose member cost share requirements. Depending on the plan, cost share may include copays, access fees, deductibles and coinsurance in percentages that vary based on plan type, deductible level, provider’s status, and benefit  type.