2013 Plan Details

As with any Medicare Advantage plan, members may enroll only during specific times of the year. Details about when you may enroll in Medicare Advantage plans are available at medicare.gov or by calling 1-800-665-8037, 8 a.m. - 8 p.m., seven days a week. (TDD/TYY 1-800-922-3140).

Blue Medicare PPO gives you the freedom to see providers in or out of network.¹ You can see specialists without a referral, and all medically necessary benefits are covered in and out of network. All PPO plans include Part D coverage.²

Available in Select Counties in North Carolina

Blue Medicare PPO is available in the following counties:

Alamance	Caswell	Franklin	Iredell	Northampton	Rowan	Waynes
Alexander	Catawba	Gaston	Johnston	Onslow	Sampson	Wilkes
Alleghany	Chatham	Gates	Jones	Orange	Scotland	Wilson
Anson	Chowan	Granville	Lee	Pamlico	Stanly	Yadkin
Ashe	Cleveland	Greene	Lincoln	Pender	Stokes
Avery	Columbus	Guilford	Madison	Perquimans	Surry
Beaufort	Cumberland	Halifax	Martin	Person	Tyrrell
Bertie	Davidson	Harnett	McDowell	Pitt	Union
Bladen	Davie	Haywood	Mecklenburg	Polk	Vance
Brunswick	Duplin	Henderson	Mitchell	Randolph	Wake
Cabarus	Durham	Hertford	Montgomery	Richmond	Warren
Caldwell	Edgecombe	Hoke	Nash	Robeson	Washington
Carteret	Forsythe	Hyde	New Hanover	Rockingham	Watauga

Providers and Specialists Without a Referral

You can choose in- or out-of-network providers and specialists without a referral. While you’ll need to select a primary care provider (PCP) for your care, you can still visit a doctor outside of the network, but you’ll be responsible for more of the cost for out-of-network services.

Network of Pharmacies

You can fill your prescriptions at participating pharmacies throughout the state. Most of the major chain pharmacies are part of our network, and you can fill your prescriptions at any of their locations nationwide. You can also fill your prescriptions through our mail order prescription program, which uses one of the largest network mail order pharmacies in the country.

¹ With the exception of emergency or urgent care, member liability with Blue Medicare PPO may be greater for services received out-of-network than services received in-network. Many out-of-network services are subject to coinsurance, which is based on the Medicare allowed amount and not on the potentially lower contract amount.

² Formulary applies for all plans that include Medicare prescription drug coverage.

Members may enroll in the plan only during specific times of the year. Contact BCBSNC for more information.

The benefit information provided is a brief summary, but not a complete description of benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan.

For Medicare Advantage and Part D plans, benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. For Medicare supplement plans, the changes occur on June 1 of each year. Please contact BCBSNC for details.

BCBSNC is a Medicare Advantage organization with a Medicare contract. BCBSNC is a Medicare-approved Part D sponsor. BCBSNC does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All BCBSNC items and services are available to all eligible beneficiaries in the service area. Limitations, copayments, and restrictions may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in CMS-approved service area. You must continue to pay your Medicare Part B premium.

If you would like Medicare Advantage or Part D documents in a different language or format, or your coverage has ended and you need proof of coverage or a Certification of Health Insurance Coverage, you can call us 7 days a week, 8 a.m. to 8 p.m.

Blue Medicare HMO:

1-888-310-4110 (TDD/TYY 1-888-451-9957)

Blue Medicare PPO:

1-877-494-7647 (TDD/TYY 1-888-451-9957)

Blue Medicare Rx (PDP):

1-888-247-4142 (TDD/TYY 1-888-247-4145)

Blue Medicare Supplement:

1-800-672-6584

The SilverSneakers program is provided by Healthways, Inc., a third-party vendor independent of BCBSNC. The program is available only to members covered under Blue Medicare HMO or Blue Medicare PPO plans. BCBSNC is not liable in any way for the services received; results are not guaranteed. Decisions regarding medical care should be made with the advice of a doctor. ^®, SM Marks of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina. ^®1 Mark of Healthways, Inc.

The information on this page is current as of 10/01/2012.

Y0079_5875 CMS Approved 10012012