Pharmacy Coverage Changes for Utahns with Regence BlueCross BlueShield Individual Health Insurance Plans
Regence BlueCross BlueShield of Utah has announced a major update to premium payment and pharmacy coverage policies (for people with individual, not group, plans) that you should be aware of:
What’s Changing
- Shortened grace period for pharmacy coverage when full premiums are unpaid
- Updated monthly pharmacy claim processing during grace periods
A recent Regence memorandum to insurance brokers explained that they were forced to make the change due to increasing fraudulent enrollments. The memorandum stated:
When these members who haven’t paid any premium fill a prescription, all of our members absorb the cost. These unpaid prescription costs get distributed across all members through higher rates. This change ensures everyone pays their fair share while maintaining grace period flexibility.
Key Changes by Member Type
APTC Members (Advanced Premium Tax Credit)
- Pharmacy coverage is suspended after 30 days if premium isn’t paid
- Grace period remains 30-90 days, but prescriptions will not be issued according to plan documents after day 30
- Members who pay between days 30-90 must pay out-of-pocket for prescriptions, then submit claims for reimbursement
Direct Members
- Must pay premium by the 7th of each month to maintain pharmacy coverage
- Autopay typically processes on the 5th (or nearest business day)
- Payments after the 7th require out-of-pocket prescription costs and claim submission for reimbursement
If you have additional questions or need help navigating what these changes mean for you, contact Regence BlueCross BlueShield of Utah or ask us here at Ark Insurance Solutions.
