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| Blue Medicare PPO | ||
|---|---|---|
| Enhanced plan | Enhanced Plus plan | |
| Additional monthly premium1 | $67.40 | $101.60 |
| Provider choice |
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| Primary care physician office visits |
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| Inpatient Hospital benefits |
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| Medicare prescription drug benefit2 |
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| Features |
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For a complete outline of coverage, refer to the Summary of Benefits Summary of Benefits
.
To view PDF documents you need Adobe Acrobat Reader.
Further details of coverage, limitations and exclusions, and terms under which the policy can be continued in force, see your agent or write to the company.
Benefits, premium and/or copayment/coinsurance may change on January 1, 2009. Please contact Blue Cross and Blue Shield of North Carolina for more details.
1 As a member of one of the Blue Medicare HMO or Blue Medicare PPO, you must continue to pay the Medicare B premium in addition to your plan premium.
2 Formulary applies. Refer to the Guide to Medicare Prescription Drug Coverage for details on the Enhanced and Standard packages.
3 Except for emergency or urgent care, you may pay more for out–of–network provider services.
The information on this page is current as of 02/20/08.