People with Cal MediConnect who have limited income and resources may qualify for extra help to pay for the monthly premiums, annual deductibles, and copayments related to the Medicare Prescription Drug plan.
Blue Shield of California Promise Health Plan provides access to Part D drugs at the correct Low Income Subsidy (LIS) level when provided with evidence of LIS eligibility regardless of whether or not the health plan and Centers for Medicare & Medicaid Services (CMS) systems match. Blue Shield of California Promise Health Plan updates its system with the LIS status confirmed by the Best Available Evidence (BAE).
If you believe you qualify for extra help, and you believe that you are paying an incorrect cost-sharing amount when you get your prescription at a pharmacy, you have several options. Our plan has established a process that allows you to either:
- Request assistance in obtaining evidence of your proper copayment level, or;
- If you already have the evidence, to provide this evidence to us.
Blue Shield of California Promise Health Plan will accept the following documents as evidence of your proper copayment level. These documents can be provided by you, your pharmacist, advocate, representative, family member, or other individual acting on your behalf. You may mail or fax these documents, and they include:
- A Supplemental Security Income (SSI) "Notice of Award" with an effective date
- An "Important Information" letter from SSA confirming that you are automatically eligible for extra help
For more information, call Blue Shield Promise Cal MediConnect Plan Member Services at (855) 905-3825 (TTY: 711), 8 a.m. to 8 p.m., seven days a week.
For additional information about the Centers for Medicare & Medicaid Services (CMS) Best Available Evidence (BAE) policy, visit the CMS Website.