BlueCross BlueShield of North Carolina

Important Legal Information and Disclaimers

Blue Medicare HMO and Blue Medicare PPO

Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next.

Members may enroll in the plan only during specific times of the year. Contact us 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 copayments/coinsurance may change on January 1 of each year. Please contact us for details.

Blue Cross and Blue Shield of North Carolina is an HMO and PPO plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Blue Cross and Blue Shield of North Carolina 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 Blue Cross and Blue Shield of North Carolina 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 the CMS-approved service area. You must continue to pay your Medicare Part B premium.

If you would like Medicare Advantage 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
Blue Medicare PPO: 1-877-494-7647
For TDD/TTY: 1-888-451-9957

Blue Medicare Rx (PDP)

Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next.

Prescription drug coverage is not sold as a benefit of any Medicare supplement plan.

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 plans, benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. Please contact Blue Cross and Blue Shield of North Carolina for details.

Blue Cross Blue Shield of North Carolina is a PDP plan with a Medicare contract. Enrollment in Blue Cross Blue Shield of North Carolina depends on contract renewal. Blue Cross and Blue Shield of North Carolina 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 Blue Cross and Blue Shield of North Carolina 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 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 Rx (PDP): 1-888-247-4142
For TDD/TTY: 1-888-247-4145

Blue Medicare Supplement

CAUTION: POLICY BENEFITS ARE LIMITED TO THOSE APPROVED BY MEDICARE FOR PAYMENT.

Neither Blue Cross and Blue Shield of North Carolina nor its agents are endorsed by or affiliated with the United States government or the federal Medicare program.

This is only a summary of benefits describing the policies' most important features. The policy is the insurance contract. You must read the policy itself to understand all the rights and duties of both you and your insurance company. These policies may not fully cover all of your medical costs.

When you enroll in an attained-age plan, your rates will increase as you age, due to your age. Our rates will only increase due to age when you move from one age band to the next. In addition, rate adjustments will also be due to medical inflation or overall claims experience. Rates are subject to change June 1 of each year and are guaranteed for 12 months. Any change in rate will be preceded by a 30-day notice. Members will not be singled out for premium increases based on their individual health. Medicare policies that are attained-age should be compared to issue-age rated policies. Premiums for issue-age policies do not increase due to age as the insured ages.

Pre-existing conditions are conditions for which medical advice was given or treatment was recommended by, or received from, a physician within six months before the effective date of coverage. Coverage for such conditions may be subject to a six-month waiting period after the effective date of coverage.

Prescription drug coverage is not sold as a benefit of any Medicare supplement plan.

If your coverage with Blue Cross and Blue Shield of North Carolina has ended and you need proof of coverage or a Certification of Health Insurance Coverage, please call Customer Service at 1-800-672-6584. You can call us 7 days a week, 8 a.m. to 8 p.m.

Blue Medicare Supplement: 1-800-672-6584
For TDD/TTY: 1-888-451-9957

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U9391, 10/14

The information on this page is current as of 10/01/2014.

Y0079_ 6741 CMS pending