Blue Cross Blue Shield of Michigan - Medicare 2010 - Information for members of Medicare Plus Blue Group PFFS

Information for Members
of Medicare Plus Blue Group PFFS ^SM

Medicare Plus Blue Group PFFS ^SM offers comprehensive coverage for hospital and medical care through a group plan sponsor. As a member of this plan, you still have Medicare coverage, but you get all your hospital and medical services through our plan. Medicare Plus Blue Group PFFS ^SM combines Original Medicare Part A (hospital) and Part B (medical) coverage and expands your coverage to include some preventive services. (Some group plans may also include Medicare Part D prescription drug coverage*.)

Medicare Plus Blue Group PFFS ^SM includes all your current Medicare benefits and much more.

With Medicare Plus Blue Group PFFS ^SM, you’ll get:

Nationwide coverage
Freedom to keep your own doctor
No referrals needed to see specialists
Diabetes self-monitoring training and supplies
Virtually no paperwork
One ID card for health and drug benefits (for some group plans)*

Our benefits include:

Preventive tests and physical exams
Office visits
Hospitalization
Outpatient surgery and services
Lab and radiology services
Home health care
Immunizations
Podiatry
Chiropractic services
Prostate cancer screening exams
Ambulance services
Medicare Part D prescription drug coverage (for some group plans)*

In addition to our medical and prescription drug plans, Medicare Plus Blue Group PFFS ^SM offers members a variety of programs designed to promote good health, safety and savings.

Medicare Plus Blue Group PFFS ^SM is a private fee-for-service plan. You can go to any doctor, hospital or other health care professional that is eligible to participate in Medicare and that accepts our plan's terms and conditions of payment and agrees to provide you with services.

Limits and cost-sharing may apply. Consult your Evidence of Coverage for specific information about your benefits and cost-sharing responsibilities or call Customer Service at 1-866-684-8216 from 8:30 a.m. to 5 p.m. Eastern time Monday through Friday. TTY users should call 1-800-579-0235.

For a current list of durable medical equipment vendors in your area, please call Customer Service at 1-866-684-8216 from 8:30 a.m. to 5 p.m. Eastern time Monday through Friday. TTY users should call 1-800-579-0235.

If your group plan includes Medicare Part D prescription drug coverage, you can:

Download the Medicare Plus Blue Group PFFS ^SM Comprehensive Drug Formulary (PDF 486K) to look up covered drugs.
Medicare Plus Blue Group PFFS ^SM Formulary changes (PDF 236K)
Download forms:
- Retail claim form (PDF 79K)
- Vaccine and administration (injection) claim form (PDF 61K)
- Mail order pharmacy order form (PDF 70K)
- Health, allergy and medication questionnaire (PDF 62K)

Your group plan may include drug utilization programs:

Prior Authorization and Step Therapy (PDF 128K)
Quantity Limits (PDF 64K)

If you are unsure whether your plan includes Medicare Part D prescription drug coverage, please contact your plan benefit administrator.

*Not all Medicare Plus Blue Group PFFS ^SM plans provide Medicare Part D prescription drug coverage. If you are unsure whether your plan includes Medicare Part D prescription drug coverage, please contact your plan benefit administrator.

Important information about this plan

Medicare Plus Blue Group PFFS^SM may be available to all Medicare beneficiaries of an employer group who are residents of the United States and its Territories, entitled to Part A of Medicare and enrolled in Part B.. Contact your Plan Benefit Administrator for specific eligibility requirements. Plan premiums are determined by your employer group. Please contact your Plan Benefit Administrator for information. You must pay your Medicare Part B premium and plan premiums required by the group. A Medicare Advantage private fee-for-service plan works differently than a Medicare supplement plan. Your doctor or hospital can continue to treat you if it agrees to accept our terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan's terms and conditions on our Web site at bcbsm.com/ma. You can also read more about how private fee-for-service plans work for you in our downloadable flyer (PDF 161K).The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. For more information, please refer to your Evidence of Coverage or contact your Plan Benefits Administrator. Formulary, pharmacy, premium and/or coinsurance may change on Jan. 1, 2011. Please contact your plan benefit Administrator for details. Medicare Plus Blue Group PFFS^SM is a health plan with a Medicare contract.

If your plan includes Medicare Part D prescription drug coverage, you may be able to get extra help to pay for your plan premiums and costs. To see if you qualify for getting extra help, call:

1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day, seven days a week;
The Social Security office at 1-800-772-1213 between 7 a.m. and 7 p.m. Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
Your state Medicaid office.

For more information about Medicare Plus Blue Group PFFS^SM, please call 1-866-684-8216 from 8:30 a.m. to 5 p.m. Eastern time Monday through Friday. TTY users should call 1-800-579-0235.

H9572 H2319 S5584_Web17rev4 CMS Approved 06162010

Information for Membersof Medicare Plus Blue Group PFFS SM

Information for Members
of Medicare Plus Blue Group PFFS ^SM