There are limitations on who can help you pay for your health insurance and health care. Here's what you need to know.
For plans effective on or after January 1, 2017, members are bound by third party payment limitations under the terms of the policy/plan contract. Detailed information about our third party payment policy is available in our Third Party Payer Guidelines (PDF). To request a paper copy of the Guidelines please contact the number below.
Who we accept payment from
As required by law and applicable regulatory guidance, Blue Cross will accept premium and cost-sharing payments made on behalf of enrollees by the following persons/entities (in the case of a downstream entity, the entity that routinely collects premiums or cost sharing for such party):
- The Ryan White HIV/AIDS Program
- Other Federal and State government programs (or grantees) that provide premium and cost-sharing support for specific individuals
- Indian tribes, tribal organizations and urban Indian organizations
- Small employers that qualify as a Qualified Employer Heath Reimbursement Arrangement (QSEHRA) under the 21st Century Cures Act (Minn. Stat. § 62L.12(m)) Small Employer Attestation Form (PDF)
In addition, Blue Cross will accept premium and/or cost-sharing payments made on behalf of enrollees by third parties that obtain Blue Cross's prior approval to make such payments. To apply for approval, the third party payer must complete the Third Party Payer Form (PDF) and submit to Third.firstname.lastname@example.org or by mail:
Blue Cross and Blue Shield of Minnesota and Blue Plus
P.O. Box 64560
St. Paul, MN 55164
Who we do not accept payment from
Third parties not listed above (or from whom Blue Cross is not required by law to accept third-party payment) are referred to as “ineligible third parties.” For purposes of clarity, but not limitation, Blue Cross currently does not accept payment for premiums or cost-sharing from the following ineligible third parties for plans that are subject to Blue Cross’ Third Party Payer Guidelines:
- Commercial (or for-profit) entities with direct or indirect financial interests
- Hospitals, and other health care providers (including, without limitation, suppliers)
- For plans effective on or after January 1, 2017, the American Kidney Fund (AKF)
- Employers who pay those amounts on behalf of Individual plan members (excluding a self-employed individual paying for his/her own coverage)
Religious institutions and other not-for-profit organizations with direct or indirect financial interests may also be considered ineligible third parties.
This list may be updated from time to time at Blue Cross's sole discretion. Please refer to the Third Party Payer Guidelines (PDF) for a description of plans that are subject to this third party payment policy.
What happens when others try to pay
Blue Cross may, in its sole discretion and in accordance with applicable law and regulatory guidance, decline to accept premium and cost-sharing payments made directly or indirectly** by any other person or entity from which Blue Cross is not required by law to accept third-party premium and/or cost-sharing payments. “Payments” include those made by any means, for example: cash, check, money order, credit card payment, electronic fund transfer, etc.
Any cost-sharing paid by ineligible third parties will not be counted toward an enrollee’s deductible or out-of-pocket maximum. “Cost-sharing” includes payments such as deductibles, copayments and coinsurance. Blue Cross may make retroactive adjustments to account for any payments made by ineligible third parties.
Let us know if you have any changes
You are required to immediately notify Blue Cross of any change in information submitted in connection with the application for coverage or otherwise provided with respect to any third-party payment.
Why this is important
Any person or entity that violates these restrictions and/or makes any ineligible third party payment described above will be held responsible for and will be required to reimburse Blue Cross for all costs associated with the relevant plan or policy related to the violation or ineligible payment.
Payments of premiums and/or cost-sharing by ineligible third parties have the potential to create conflicts of interest, skew the health coverage risk pool and increase the risk of adverse selection. This is detrimental to the long-term viability of the health coverage market overall and can result in increased rates for the entire market.
Blue Cross maintains sole discretion with respect to its acceptance of third-party payments. Blue Cross may make changes to its administration of same at any time and as otherwise needed to support compliance with law and/or applicable regulatory guidance.
If you have questions about this third-party payment policy or whether Blue Cross will accept premium and/or cost-sharing payments made by a specific person or entity, we can help.
If you’re a Blue Cross member: Please call customer service at the number on the back of your member ID card
If you’re not a Blue Cross member: Please call 1-800-382-2000
**Indirect payments include, for example, an ineligible third-party making a check out to or otherwise paying the enrollee to permit the enrollee to pay amounts due to Blue Cross.