Compare Our Medicare Advantage Benefits Group BlueCHiP for Medicare Enrollment Guide

Transcription

1 Compare Our Medicare Advantage Benefits 2015 Group BlueCHiP for Medicare Enrollment Guide

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3 It s Time to Enroll! We re thrilled that your former or current employer has chosen Blue Cross & Blue Shield of Rhode Island (BCBSRI) for Medicare Advantage coverage! Your plan offers you the local service BCBSRI is known for, as well as these benefits: Peter Andruszkiewicz President and CEO The Living Fit discounted gym membership program ($5/month for a membership to any participating health club across the state, including several YMCA locations!) $150/year vision hardware allowance Blue Cross Dental coverage Prescription drug coverage Access to care coordination services Comprehensive benefit and health information on BCBSRI.com Look inside this enrollment guide for information about how to enroll. If you have any questions about your plan, please contact your former or current employer, or call us at (401) 351-BLUE (2583). We look forward to providing you with the quality coverage you deserve! Sincerely, Peter Andruszkiewicz President and CEO 3

4 Table of Contents What You Need to Know About Enrollment...5 Understanding Enrollment Periods...5 How to Enroll... 6 What to Expect After You Enroll...7 Living Fit Membership... 8 Multi-language Interpreter Services

5 What You Need to Know About Enrollment This section gives you everything you need to know about Group BlueCHiP for Medicare enrollment, including how enrollment periods work, how to enroll, and what you should expect after you enroll. Understanding Enrollment Periods When You Can Enroll or Change Your Plan Please check with your former or current employer about your available open enrollment period. To enroll for the first time Initial Coverage Election Period Three months before, the month of, and three months after you become eligible for Medicare To re-enroll or change your coverage Medicare Advantage Annual Enrollment Period October 15 to December 7 Coverage effective January 1 To disenroll Medicare Advantage Annual Disenrollment Period January 1 to February 14 If you have special circumstances Special Election Period Have questions or need help enrolling? Call (401) 351-BLUE (2583) or toll-free BLUE (2583), or TTY/TDD: 711. Hours: October 1, February 14, 2015, seven days a week, 8:00 a.m. to 8:00 p.m. February 15, September 30, 2015, Monday - Friday, 8:00 a.m. to 8:00 p.m. 5

6 How to Enroll Once your former or current employer has selected a Group BlueCHiP for Medicare plan, here s how you enroll: By paper application: Mail the application to: BlueCHiP for Medicare Department Blue Cross & Blue Shield of Rhode Island 500 Exchange Street, Providence, RI ; or Fax the application to (401) ! To avoid processing delays, please ensure that your application is filled out completely. It is very important that you sign and date the form and keep the member copy. If you are completing the application for someone else: Be sure to sign the application and note your relationship to the applicant. If you have durable power of attorney or legal guardianship for the applicant s health decisions, please enclose a copy of the legal document with the application. Your signature certifies that: You are authorized under state law to complete this enrollment, and Documentation of this authority is available upon request. Visit us: Warwick 300 Quaker Lane (Cowesett Corners shopping center) Hours: Monday Friday, 9:00 a.m to 5:00 p.m.; Saturday, 9:00 a.m. to 1:00 p.m. 6

7 What to Expect After You Enroll Shortly after you ve enrolled in a Group BlueCHiP for Medicare plan, you can expect to receive the following from Blue Cross & Blue Shield of Rhode Island: Enrollment confirmation: You ll receive a confirmation letter in the mail and another letter when Medicare approves your enrollment. Information about premium assistance If you qualify, you ll receive: A letter about how to get Extra Help from Medicare for your Part D prescription costs Information about eligibility for Medicare Savings Programs Your Welcome Kit You ll receive a package in the mail that contains: Your BlueCHiP for Medicare plan ID card Important information about your plan and its benefits Once you re a member: Get more from your plan: Register for a secure account on Medicare to enjoy members-only discounts, programs, and health information. Begin using your medical and pharmacy benefits on your effective date, which is noted in the enrollment confirmation letter we ll send to you. Enroll in our Care Management Program at no cost to talk to a BCBSRI healthcare professional about your health and any questions you have, or to help you set up a treatment plan (if appropriate). Call (401) or , ext (TTY/TDD: 711). 7

8 Discounted Gym Membership Take an Active Role in Your Health with Living Fit Being active can help improve your health and quality of life. That s why your Group BlueCHiP for Medicare plan includes Living Fit! This discounted gym membership program allows you to: Get an unlimited-use membership at any one network facility for just $5 per month. Pay month to month, and cancel at any time. Choose from over 50 local fitness centers, including YMCA locations. With your membership, you can also take advantage of everything the fitness center has to offer, including indoor swimming pools at many locations, fitness classes, and more. Participating Network Facilities This facility list is current as of August 1, Some facilities may have been added or removed after this guide was printed. To get the most up-to-date information, visit BCBSRI.com/ Medicare or call the BlueCHiP for Medicare Concierge Team. Connecticut Mystic Mystic YMCA* Putnam Anytime Fitness Putnam Massachusetts Seekonk Newman YMCA* Rhode Island Barrington Bayside Family YMCA* Bristol Bristol Total Fitness Coventry Anytime Fitness Coventry The Gym for Women *This facility has a swimming pool. 8

9 Cranston Cranston YMCA* Curves Cranston Cumberland Curves Cumberland Fore Court Racquet & Fitness Club East Greenwich Absolute Fitness* Ocean State Health and Fitness Gold s Gym East Providence Healthtrax Fitness & Wellness* Greenville Smithfield YMCA* Johnston Anytime Fitness Johnston Next Level Fitness Lincoln MacColl YMCA* Middletown Newport Athletic Club* Newport YMCA* Narragansett Anytime Fitness Narragansett Curves Narragansett North Kingstown Curves North Kingstown West Bay Family YMCA* North Providence Curves North Providence North Smithfield Curves North Smithfield Pawtucket Gold s Gym Pawtucket Family YMCA* Peace Dale River Bend Athletic Club South County YMCA* Portsmouth Peak Fitness Providence East Side/Mt. Hope YMCA* Tiverton Atlantic Health & Fitness Wakefield Luxe Fitness South County South County Hospital - Wellness & Prevention Center Questions? Warren 426 Fitness LCC Warwick Anything Fitness Warwick Healthtrax Fitness & Wellness* Kent County YMCA* The Gym, LLC Westerly Luxe Fitness Westerly Pawcatuck* YMCA West Warwick American Health Fitness Center* Curves West Warwick Forever Fit Inc. Woonsocket Landmark Heart Center Rhode Island Athletic Club* Woonsocket YMCA* Wyoming Anytime Fitness Wyoming Arcadia YMCA* If you have questions or want to check whether a facility participates in our network, please call the BlueCHiP for Medicare Concierge Team at TTY/TDD: 711. Our hours are October 1, 2014 February 14, 2015, seven days a week, 8:00 a.m. to 8:00 p.m. and February 15, 2015 September 30, 2015, Monday to Friday, 8:00 a.m. to 8:00 p.m. 9 *This facility has a swimming pool.

10 Appendix 3 Multi-Language Insert Multi-language Appendix 3 Multi-Language Interpreter Insert Services Appendix 3 Multi-Language Insert Multi-language Multi-language Interpreter Interpreter Services Services English: English: We We have have free free interpreter interpreter services services to to answer answer any any questions questions you you may may have have about about our our health health or or drug drug plan. plan. To To get get an interpreter, interpreter, just just call call us us at at Someone Someone who who speaks speaks English/Language English/Language can can help help you. you. This This is is a a free free service. service. Spanish: Spanish: Tenemos Tenemos servicios servicios de de intérprete intérprete sin sin costo costo alguno alguno para para responder responder cualquier cualquier pregunta pregunta que que pueda pueda tener tener sobre sobre nuestro nuestro plan plan de de salud salud o o medicamentos. medicamentos. Para Para hablar hablar con con un un intérprete, intérprete, por por favor favor llame llame al al Alguien Alguien que que hable hable español español le le podrá podrá ayudar. ayudar. Este Este es es un un servicio servicio gratuito. gratuito. Chinese Chinese Mandarin: 我 Mandarin: 我 们 们 提 提 供 供 免 免 费 费 的 的 翻 翻 译 译 服 服 务 务,, 帮 帮 助 助 您 您 解 解 答 答 关 关 于 于 健 健 康 康 或 或 药 药 物 物 保 保 险 险 的 的 任 任 何 何 疑 疑 问 问 如 如 果 果 您 您 需 需 要 要 此 此 翻 翻 译 译 服 服 务 务,, 请 请 致 致 电 电 我 我 们 们 的 的 中 中 文 文 工 工 作 作 人 人 员 员 很 很 乐 乐 意 意 帮 帮 助 助 您 您 这 这 是 是 一 一 项 项 免 免 费 费 服 服 务 务 Chinese Chinese Chinese Cantonese: 您 Cantonese: 您 對 對 我 我 們 們 的 的 健 健 康 康 或 或 藥 藥 物 物 保 保 險 險 可 可 能 能 存 存 有 有 疑 疑 問 問,, 為 為 此 此 我 我 們 們 提 提 供 供 免 免 費 費 的 的 翻 翻 譯 譯 服 服 務 務 如 如 需 需 翻 翻 譯 譯 服 服 務 務,, 請 請 致 致 電 電 我 我 們 們 講 講 中 中 文 文 的 的 人 人 員 員 將 將 樂 樂 意 意 為 為 您 您 提 提 供 供 幫 幫 助 助 這 這 是 是 一 一 項 項 免 免 費 費 服 服 務 務 Tagalog: Tagalog: Mayroon Tagalog: Mayroon kaming Mayroon kaming libreng kaming libreng serbisyo libreng serbisyo sa serbisyo sa pagsasaling-wika sa pagsasaling-wika upang pagsasaling-wika upang masagot upang masagot ang masagot anumang anumang mga anumang mga katanungan mga katanungan ninyo katanungan ninyo hinggil ninyo hinggil hinggil aming aming planong aming planong pangkalusugan planong pangkalusugan o pangkalusugan o panggamot. o panggamot. Upang panggamot. Upang makakuha Upang makakuha makakuha tagasaling-wika, ng tagasaling-wika, tawagan tagasaling-wika, tawagan lamang tawagan lamang kami lamang kami sa kami Maaari Maaari kayong Maaari kayong tulungan kayong tulungan tulungan isang ng isang nakakapagsalita isang nakakapagsalita ng nakakapagsalita ng Tagalog. ng Tagalog. Ito Tagalog. Ito ay Ito ay libreng ay libreng serbisyo. libreng serbisyo. serbisyo. French: French: French: Nous Nous proposons proposons des des services services gratuits gratuits d'interprétation d'interprétation pour pour répondre répondre à à toutes toutes vos vos questions questions relatives relatives à à notre notre régime régime de de santé ou santé ou d'assurance- d'assurance- d'assurancemédicamentsmédicaments. Pour Pour accéder accéder au au service service d'interprétation, d'interprétation, il il vous vous suffit suffit de de nous nous appeler appeler au au Un Un interlocuteur interlocuteur parlant parlant Français Français pourra pourra vous vous aider. aider. Ce Ce service service est est gratuit. gratuit. Vietnamese: Chúng Vietnamese: Vietnamese: Chúng tôi Chúng tôi có tôi có dịch vụ có dịch dịch thông vụ dịch thông miễn dịch phí miễn để phí trả để lời trả các lời câu các hỏi câu về hỏi chương về sức chương khỏe sức và khỏe chương và trình chương thuốc trình men. thuốc Nếu men. quí Nếu vị quí cần vị thông cần dịch thông viên dịch xin viên gọi xin gọi sẽ có sẽ nhân có viên nhân nói viên tiếng nói Việt tiếng giúp Việt đỡ giúp quí đỡ vị. quí Đây vị. là Đây dịch là vụ dịch miễn vụ phí miễn. phí. German: Unser German: German: kostenloser Unser Dolmetscherservice kostenloser beantwortet Dolmetscherservice Ihren beantwortet Fragen Ihren zu Fragen zu unserem unserem Gesundheits- Gesundheits- und und Arzneimittelplan. Arzneimittelplan. Unsere Unsere Dolmetscher Dolmetscher erreichen erreichen Sie Sie unter unter Man Man wird wird Ihnen Ihnen dort dort auf auf Deutsch Deutsch weiterhelfen. weiterhelfen. Dieser Korean: Dieser Service Service ist 당사는 의료 ist kostenlos. kostenlos. 보험 또는 약품 보험에 관한 질문에 답해 드리고자 무료 통역 서비스를 제공하고 있습니다. 통역 서비스를 이용하려면 전화 번으로 H4152_multilanguage68 문의해 주십시오. 한국어를 하는 담당자가 도와 드릴 것입니다. 이 서비스는 무료로 H4152_multilanguage68 운영됩니다. H4152_multilanguage68 Russian: Если Approved у вас возникнут вопросы 101 относительно страхового или медикаментного плана, вы можете воспользоваться нашими бесплатными

11 서비스를 문의해 주십시오. 제공하고 한국어를 있습니다. 하는 통역 담당자가 서비스를 도와 이용하려면 드릴 것입니다. 전화 번으로 이 서비스는 무료로 문의해 주십시오. 한국어를 하는 담당자가 도와 드릴 것입니다. 이 서비스는 무료로 운영됩니다. 운영됩니다. Russian: Если у вас возникнут вопросы относительно страхового или Russian: Если у вас возникнут вопросы относительно страхового или медикаментного плана, вы можете воспользоваться нашими бесплатными медикаментного плана, вы можете нашими бесплатными услугами переводчиков. Чтобы воспользоваться услугами переводчика, услугами переводчиков. Чтобы воспользоваться услугами переводчика, позвоните нам по телефону Вам окажет помощь позвоните нам по телефону Вам окажет помощь сотрудник, который говорит по-pусски. Данная услуга бесплатная. сотрудник, который говорит по-pусски. Данная услуга бесплатная. Arabic: Arabic: مترجم على للحصول لدينا. األدوية جدول أو بالصحة تتعلق أسئلة أي عن لإلجابة المجانية الفوري المترجم خدمات نقدم إننا مترجم على للحصول لدينا. األدوية جدول أو بالصحة تتعلق أسئلة أي عن لإلجابة المجانية الفوري المترجم خدمات نقدم إننا العربية يتحدث ما شخص سيقوم على بنا االتصال سوى عليك ليس فوري خدمة هذه. بمساعدتك يتحدث العربية ما شخص سيقوم على بنا االتصال سوى عليك ليس فوري خدمة هذه. بمساعدتك.مجانية.مجانية Hindi: हम र स व स य य दव क य जन क ब र म आपक ककस भ प रश न क जव ब द न क ल ए हम र Hindi: हम र स व स य य दव क य जन क ब र म आपक ककस भ प रश न क जव ब द न क ल ए हम र प स म फ त द भ ष य स व ए उप ब ध ह. एक द भ ष य प र प त करन क ल ए, बस हम पर प स म फ त द भ ष य स व ए उप ब ध ह. एक द भ ष य प र प त करन क ल ए, बस हम पर फ न कर. क ई व यक तत ज हहन द ब त ह आपक मदद कर सकत ह. यह एक म फ त स व ह. फ न कर. क ई व यक तत ज हहन द ब त ह आपक मदद कर सकत ह. यह एक म फ त स व ह. Italian: È disponibile un servizio di interpretariato gratuito per rispondere a Italian: È disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sul nostro piano sanitario e farmaceutico. Per un eventuali domande sul nostro piano sanitario e farmaceutico. Per un interprete, contattare il numero Un nostro incaricato che interprete, contattare il numero Un nostro incaricato che parla Italianovi fornirà l'assistenza necessaria. È un servizio gratuito. parla Italianovi fornirà l'assistenza necessaria. È un servizio gratuito. Portugués: Portugués: Dispomos Dispomos de de serviços serviços de de interpretação interpretação gratuitos gratuitos para para responder responder a Portugués: Dispomos de serviços de interpretação gratuitos para responder qualquer qualquer questão questão que que tenha tenha acerca acerca do do nosso nosso plano plano de saúde de ou medicação. a qualquer questão que tenha acerca do nosso plano de saúde ou de medicação. Para Para obter obter um um intérprete, intérprete, contacte-nos contacte-nos através através do do número número medicação Para obter um intérprete, contacte-nos através do número Irá Irá encontrar encontrar alguém alguém que que fale fale o idioma idioma Português Português para para o ajudar Irá encontrar alguém que fale o idioma Português para o ajudar. Este Este serviço serviço é gratuito. gratuito. ajudar. Este serviço é gratuito. French French Creole: Nou genyen sèvis entèprèt gratis pou reponn tout kesyon ou French Creole: Nou genyen sèvis entèprèt gratis pou reponn tout kesyon ou ta genyen konsènan plan medikal oswa dwòg nou an. Pou jwenn ta genyen konsènan plan medikal oswa dwòg nou an. Pou jwenn yon entèprèt, jis rele nou nan Yon moun ki pale Kreyòl kapab entèprèt, jis rele nou nan Yon moun ki pale Kreyòl kapab ede w. Sa a se yon sèvis ki gratis. ede w. Sa a se yon sèvis ki gratis. Polish: Umożliwiamy bezpłatne skorzystanie z usług tłumacza ustnego, który pomoże Polish: Umożliwiamy bezpłatne skorzystanie z usług tłumacza ustnego, który w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania pomoże w uzyskaniu odpowiedzi na temat planu zdrowotnego lub leków. Aby skorzystać z pomocy tłumacza znającego język polski, dawkowania leków. Aby skorzystać z pomocy tłumacza znającego język należy zadzwonić pod numer Ta usługa jest bezpłatna. polski, należy zadzwonić pod numer Ta usługa jest bezpłatna. Japanese: 当 社 の 健 康 健 康 保 険 と 薬 品 処 方 薬 プランに 関 するご 質 問 にお 答 えするため に 無 料 の 通 訳 サービスがありますございます 通 訳 をご 用 命 になるには にお 電 話 ください 日 本 語 を 話 す 人 者 が 支 援 いたします これは 無 料 のサー ビス です 11

12 The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. [Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance] may change on January 1 of each year. Blue Cross & Blue Shield of Rhode Island is an HMO plan with a Medicare contract. Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal. An independent licensee of the Blue Cross and Blue Shield Association. 500 Exchange Street Providence, RI /14 BMDS