Important information was emailed about
If you wish to enroll, you should submit
your enrollment as instructed no later than December 04, 2023. If you complete your enrollment by that
date, your coverage will become effective on January 01, 2024. By enrolling in the plan, you authorize us
to withhold your required contributions from your paychecks while your
coverage is in effect.
If you decide not to enroll at this
time, you should know that you will not have another chance to enroll until
January 1 of next year or upon the occurrence of a “special enrollment event”
as described in the Special Enrollment Rights Notice. Please sign below to
acknowledge that you have received this offer of coverage.
I understand that I am enrolling in a
health care plan, which requires that health care services must be provided
by participating providers. Failure to use a participating provider will
result in reduced coverage or no coverage for services that I receive, and I
will be fully responsible for any and all costs not covered by Blue Cross and
Blue Shield of Georgia/Blue Cross Blue Shield Healthcare Plan of Georgia
(BCBSGA) (as applicable).
I have received a complete listing of
participating providers. I understand that the participation status of any
provider may change from time to time. It is my responsibility to verify that
my health care provider is participating with BCBSGA/BCBSHP prior to
receiving services. I may verify participation status via BCBSGA's Web site,
www.anthem.com which is updated at least every 30 days. I may also verify
status by contacting the customer service number listed on my member ID card.
As required by the State of Georgia
regulations, the following is a summary of the financial arrangements with
the health care providers who are participating in the BCBSGA/BCBSHP network:
1. Hospital providers are paid according
to a contract which includes inpatient per diems, case rates, and discounted
fee for service arrangements depending on specific services provided.
2. Physicians are paid discounted fee
for service in accordance with a specific fee schedule, which has been
provided to them as contracted.
3.Laboratory services are provided
through a capitated per member per month flat fee.