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Information for members of Medicare Plus Blue Group PPOSM

Medicare Plus Blue Group PPOSM offers comprehensive coverage for hospital and medical care through a group plan sponsor. As a member of this plan, you retain your Medicare coverage, however your hospital and medical services are provided through our plan. Medicare Plus Blue Group PPOSM combines Original Medicare Part A (hospital) and Part B (medical) coverage and expands your coverage to include additional preventive services. (Some group plans may also include Medicare Part D prescription drug coverage.*)

Medicare Plus Blue Group PPOSM includes all your current Medicare benefits and much more.

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With Medicare Plus Blue Group PPOSM, you'll get:

  • Freedom to choose any doctor or hospital that accepts Original Medicare.
  • Lower out-of-pocket costs when you receive services from a doctor or hospital in our network
  • Nationwide coverage
  • No referrals needed to see specialists
  • Virtually no paperwork
  • One ID card for health services
  • Groups have the option of adding benefits not covered by original Medicare. For more information, please contact us.

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)*

If your employer or union group is currently enrolled in a Medicare Plus Blue Group PPO product, limitations and cost-sharing may apply. Consult your Evidence of Coverage for specific information about your benefits and cost-sharing responsibilities or call Member Services 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.

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

* Not all Medicare Plus Blue Group PPOSM 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.

Find a network provider

You can go to any doctor or hospital that accepts your Medicare Plus Blue Group PPOSM ID card. And, if you choose to see doctors and hospitals in our network, you'll minimize your out-of-pocket costs. To find a network provider in the state of Michigan:

If you need medical care outside of the state of Michigan, you may obtain care from any provider that accepts Medicare. If you receive services outside the state of Michigan, in-network cost sharing will apply for all medical services (except durable medical equipment, prosthetics and orthotics). To locate a provider outside the state of Michigan, please call Member Services 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 you are unsure whether your plan includes Medicare Part D prescription drug coverage, please contact your plan benefit administrator.

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People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to seventy-five (75) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Many people are eligible for these savings and don't even know it. For more information about the Extra Help program, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.

Important information about these plans

Medicare Plus Blue Group PPOSM and BCN Advantage HMO-POSSM are health plans with Medicare contracts. Prescription Blue Group PDPSM is a stand-alone prescription drug plan with a Medicare contract.

Medicare Plus Blue Group PPO

With the exception of emergency or urgent care, it will cost more to get care from non-plan or non-preferred providers in the state of Michigan. Your responsibility will be greater out-of-network when the out-of-network coinsurance is based on the Medicare allowed amount and the contracted amount is lower. You may receive services from any provider who accepts Original Medicare. In the state of Michigan, your out-of-pocket costs will be lower if you choose a network provider. To find a network provider in the state of Michigan, visit www.bcbsm.com/medicare/provdirectory.shtml.

For members traveling outside of Michigan or for those members that reside permanently outside of the state of Michigan, you may obtain care from any provider that accepts Original Medicare, and in-network cost-sharing will apply for all Medical services (except durable medical equipment, prosthetics and orthotics).

Medicare Plus Blue Group PPO and Prescription Blue PDP

Limitations, copayments and restrictions may apply.

Our network includes approximately 2,300 Michigan retail pharmacies, of which 86 percent are network pharmacies. Nationwide, most chain pharmacies are in our network, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies.

In general, benefits are only available at contracted network pharmacies. Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost sharing amount if you get your drugs at an out-of-network pharmacy. Quantity limitation and restrictions may apply. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Blue Cross Blue Shield of Michigan. For additional information on network pharmacies, please call Member Services at the phone number listed on the back of your member ID card.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, please call Member Services at 1-866-684-8216. TTY users should call 1-800-579-0235. Extended hours of operation through Feb. 14, 2012, are 8 a.m. to 8 p.m., seven days a week. Normal hours of operation are 8:30 a.m. to 5 p.m., Eastern time, Monday through Friday.

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change at the end of your plan year.

BCN Advantage HMO-POS

BCN Advantage HMO-POSSM is available in these counties: Allegan, Barry, Bay, Calhoun, Clinton, Eaton, Genesee, Gratiot, Ingham, Ionia, Jackson, Kalamazoo, Kent, Lapeer, Livingston, Macomb, Midland, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ottawa, Saginaw, Shiawassee, St. Clair, Tuscola, Van Buren, Washtenaw and Wayne. Premiums vary by county. You must continue to pay your Medicare Part B premium.

You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor BCN Advantage HMO-POS will be responsible for the costs.

If you are enrolled in BCN Advantage HMO-POS Option 2 or Option 3, you must use a network pharmacy to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use a network pharmacy. Quantity limitations and restrictions may apply. Our pharmacy network includes the majority of chain pharmacies, mail order through Medco or Walgreens, as well as long-term care and home infusion pharmacies. For additional information on network pharmacies, please call Member Services at 1-800-450-3680, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-430-3211. You may also write to: BCN Advantage HMO-POS, P.O. Box 5184, Mail Code A103, Southfield, MI 48086-5184.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on Jan. 1, 2013.

If you decide to have your BCN Advantage HMO-POS premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.

BCN Advantage HMO-POS is issued by Blue Care Network, which contracts with the federal government. BCN Advantage HMO-POS's contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed.

Medicare beneficiaries may enroll in BCN Advantage HMO-POS through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For more information, please contact Blue Cross Blue Shield of Michigan at 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704. To learn more about enrollment periods, please contact Member Services.