Benefit Highlights. Premera Blue Cross MEDICARE SUPPLEMENT PLANS. Discover a plan that s right for you. Effective MARCH 2015
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1 Effective MARCH 2015 Premera Blue Cross MEDICARE SUPPLEMENT PLANS Benefit Highlights Discover a plan that s right for you. Individual Medicare Supplement plans for residents of Washington state (excluding Clark County) BHBMSWA ( )
2 You ve worked hard to act any age you want. Now is the time when freedom is yours. Premera Blue Cross Medicare Supplement plans help you enjoy it Our Medicare Supplement plans give you peace of mind about your healthcare coverage throughout your retirement. They cover the growing costs Original Medicare alone leaves you to pay, and give you the freedom to see any doctor who accepts Medicare. Premera Blue Cross is a trusted name in healthcare and being helpful is number one in our book. Use the expertise of our highly-trained, local representatives to assist you in choosing the plan that s right for you. And know that if you ever have questions about the best way to use your plan, we re here to help. You can count on us The Premera Blue Cross Medicare Supplement plan portfolio was created based on the plan preferences our members have shown. With these plans, you can count on: The freedom to use any doctor or hospital that accepts Medicare Knowing that your plan is guaranteed renewable and portable Knowing that your coverage won t be terminated if your health changes Nationwide coverage when you travel
3 Premera Medicare Supplement Plans A Medicare Supplement plan can help pay some of the healthcare costs that Original Medicare doesn t cover, like copayments, coinsurance, and deductibles. Some Medicare Supplement plans also offer coverage for services that Original Medicare doesn t cover, like medical care when you travel outside of the United States. If you have Original Medicare and you buy a Medicare Supplement plan, Medicare will pay its share of the Medicare-approved amount for covered healthcare costs. Then your Medicare Supplement plan pays its share. With four plan options, it s easy to find the plan that is right for you. Plan A Rates as low as $151 a month A plan with basic coverage Plan A provides basic coverage for those with fewer hospital and physician expenses. Plan F Rates as low as $188 a month Our most popular plan Plan F provides 100% coverage for Medicare covered services. That means no copayments, coinsurance, or deductibles. High Deductible Plan F Rates as low as $80 a month Like Plan F, but with a high deductible and a lower monthly rate A nice fit if you prefer a high deductible health plan. You can use funds in an existing HSA (Health Savings Account) to pay for medical expenses applied to your deductible. Plan N Rates as low as $149 a month Coverage with a copay 100% coverage on all Medicare-covered inpatient hospital services. After you ve met your Part B deductible, you pay a copay for office visits and emergency room visits. For more in-depth information, please refer to the Medicare Supplement Outline of Coverage. Questions? We re here to help premera.com
4 DISCOVER a Medicare Supplement plan Plan details Plan A Basic coverage Plan F Our most popular plan Monthly rates (save $5 per month on rates listed below by enrolling in our Automatic Funds Transfer [AFT] program) Monthly rate $151 $188 Plan summary Your costs: Your costs: Doctor/hospital choice Any doctor or hospital that accepts Medicare Any doctor or hospital that accepts Medicare Deductibles Hospital - Part A: $1,260 Medical - Part B: $147 $0 Office visit $0 after Part B deductible $0 Inpatient hospital care $0 after Part A deductible (per benefit period*) $0 Skilled nursing facility $0/day (days 1 20) $157.50/day (days ) All costs (days 101+) $0/day (days 1 100) All costs (days 101+) Outpatient hospital care $0 after Part B deductible $0 Ambulance $0 after Part B deductible $0 Emergency care $0 after Part B deductible $0 Urgent care $0 after Part B deductible $0 Durable medical equipment $0 after Part B deductible $0 Outpatient lab/x-rays $0 after Part B deductible $0 Part B excess charges (above Medicare approved amounts) Not covered $0 Home health care $0 $0 Hospice $0 $0 Foreign travel coverage (not covered by Medicare) First $250 in charges (per calendar year) Not covered You pay first $250 in charges Remainder of charges (per calendar year) Not covered After the first $250 in charges, you pay 20% and amounts over $50,000 lifetime max Policy form numbers: Plan A ( ), ( ); Plan F ( ), ( ) *A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.
5 that s right for you Plan details High Deductible Plan F High deductible, lower cost Plan N Coverage with a copay Monthly rates (save $5 per month on rates listed below by enrolling in our Automatic Funds Transfer [AFT] program) Monthly rate $80 $149 Plan summary Your costs: Your costs: Doctor/hospital choice Any doctor or hospital that accepts Medicare Any doctor or hospital that accepts Medicare Deductibles $2,180 annual plan deductible Medical - Part B: $147 Office visit $0 after plan deductible $20 copay after Part B deductible Inpatient hospital care $0 after plan deductible $0 Skilled nursing facility After plan deductible: $0/day (days 1 100) All costs (days 101+) $0/day (days 1 100) All costs (days 101+) Outpatient hospital care $0 after plan deductible $0 after Part B deductible Ambulance $0 after plan deductible $0 after Part B deductible Emergency care $0 after plan deductible $50 copay after Part B deductible Urgent care $0 after plan deductible $0 after Part B deductible Durable medical equipment $0 after plan deductible $0 after Part B deductible Outpatient lab/x-rays $0 after plan deductible $0 after Part B deductible Part B excess charges (above Medicare approved amounts) $0 after plan deductible Not covered Home health care $0 $0 Hospice $0 $0 Foreign travel coverage (not covered by Medicare) First $250 in charges (per calendar year) Remainder of charges (per calendar year) After plan deductible: You pay first $250 in charges After plan deductible: After the first $250 in charges, you pay 20% and amounts over $50,000 lifetime max You pay first $250 in charges After the first $250 in charges, you pay 20% and amounts over $50,000 lifetime max Policy form numbers: High Deductible Plan F ( ( ), ( ); Plan N ( ), ( ) Questions? We re here to help premera.com
6 Extra member benefits and services Customer service Our responsive customer service teams are right here in Washington, not thousands of miles away. We re ready to help answer your plan and benefit questions, and we re trained and equipped to help get the answers you need, when you need them. Web tools Manage your health and policy online. Store and manage your health information online, and access health and fitness tracking tools at premera.com. 24-Hour NurseLine ** This free service connects you with registered nurses who answer your medical questions and advise you to get the care you need. Nurses are on call 24 hours a day, 7 days a week. All calls are confidential. Premera Senior Discounts program ** The Premera Senior Discounts program gives you discounts on things like fitness and weight management programs, eye care and hardware, laser vision correction, contact lenses, and hearing aids. **These programs are not insurance and may be discontinued at any time.
7 Medicare Glossary Medicare Part A helps pay for inpatient care in hospitals and skilled nursing facilities. Part A is available to most people who are eligible for Medicare at no cost. Medicare Part B is available for a monthly premium. Medicare Part B helps pay for doctor visits, lab tests, durable medical equipment and outpatient hospital treatment. Medicare Part B excess charge is the difference between the Medicare approved amount and is the amount a doctor or other healthcare provider is legally permitted to charge. Medicare Supplement plans help cover the growing costs Original Medicare alone leaves you to pay. Here are some other definitions to help you understand Medicare and Medicare Supplement benefits: Covered services the healthcare services and supplies for which your health plan(s) provides benefits. Deductible the amount you pay for healthcare before Original Medicare begins to pay. Cost shares the amount you pay, such as copays and coinsurance. Copay a flat fee you pay at the time a service is rendered. Coinsurance your share of the fee for a service. If your plan s coinsurance share is 20%, you pay 20% of the allowable charge and your plan pays the other 80% (after you meet your deductible). Questions? We re here to help premera.com
8 If you don t understand something, just ask us. It s our job to make things easy for you. Premera Blue Cross Medicare Supplement plan representatives can help answer your questions. Call toll free (TTY: 711) Monday Friday, 8 a.m. to 8 p.m. (7 days a week, 8 a.m. to 8 p.m., from October 1 through February 14) Enrolling is easy! You can: Enroll online Go to premera.com Enroll by mail Return your paper application to: P.O. Box 91120, MS295, Seattle, WA Enroll with your producer Schedule an appointment with your producer for help selecting a plan and submitting your application. Guaranteed acceptance You have a six-month window for guaranteed acceptance that begins the month you turn 65 and/or the month your Medicare Part B coverage begins. You must have Medicare Parts A and B to apply for a Medicare Supplement plan. Please contact the plan for other qualifying events that may allow guaranteed acceptance when applying for coverage. Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association ( )
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