WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 104 Part 12 Individual Policy This part applies to you when you enroll in this health plan as a direct pay member (and not as a group member under a group contract). Under an individual contract, the subscriber has an agreement with Blue Cross Blue Shield HMO Blue to provide the subscriber and their enrolled eligible spouse and other enrolled eligible dependents with access to health care services and benefits. The subscriber will make payments to Blue Cross Blue Shield HMO Blue for coverage in this health plan under an individual contract. For questions about enrollment and billing, you can call the Blue Cross Blue Shield HMO Blue customer service office. Important Note: If you enrolled in this health plan through the Massachusetts Health Connector, the subscriber has an agreement with the Health Connector and not Blue Cross Blue Shield HMO Blue. The subscriber will usually make payments to the Health Connector for coverage in this health plan. The Health Connector will send all notices to the subscriber. You must call the Health Connector directly for any questions about: your enrollment in this health plan; your premium payments; and any membership changes you need to make such as a change to your name or address. For any questions about your health plan coverage or your claims, you can call the Blue Cross Blue Shield HMO Blue customer service office. Eligibility and Enrollment for Individual Coverage Eligible Individual You are eligible for coverage in this health plan under an individual contract as long as you are a resident of Massachusetts. A “resident” is a person who lives in Massachusetts as shown by evidence that is considered acceptable by Blue Cross Blue Shield HMO Blue. This means Blue Cross Blue Shield HMO Blue may ask you for evidence such as a lease or rental agreement, a mortgage bill, or a utility bill. The fact that you are in a nursing home, a hospital, or other institution does not by itself mean you are a resident. And, you are not a resident if you come to Massachusetts to receive medical care or to attend school but you still have residency outside of Massachusetts. If you are under age 18 and you are requesting to enroll as a subscriber, the enrollment form must be completed by your parent or guardian. In this case, the person who is executing the contract (your parent or guardian) is not eligible for benefits under your coverage in this health plan. But, they will be responsible for acting on behalf of the subscriber as necessary and for paying the monthly premium for your coverage. The person who executes the contract will be considered your authorized representative. This health plan is not a Medicare supplement plan. If you are eligible for Medicare, this health plan cannot be issued to you. You should look at the Guide to Health Insurance for People with Medicare. You may be able to sign up for a health plan that is designed to supplement Medicare. To ask for a copy of the Guide, you can call the Blue Cross Blue Shield HMO Blue customer service office. (See Part 1.) If you are already enrolled in this health plan when you become eligible for Medicare, you may choose to stay enrolled. If you choose to remain enrolled, Medicare may provide coverage for the same health care services that are covered by this health plan. In this case, Medicare is the primary payor. Eligible Spouse The subscriber may enroll an eligible spouse for coverage in this health plan under their individual contract. An “eligible spouse” includes the subscriber’s legal spouse or legal civil union spouse. An