Transcription
You’re coveredfrom coast to coastWith the Blue Cross National Network of providers, you canget the care you need across the country and pay nothing extra.MRK ALL NATNETWORK16NR101416.0316
At home or on the roadyou’re in-network, nationwideMembers of Blue Cross Medicare Advantage (PPO) SM can enjoythe same in-network benefits and low costs at home and away.You can travel with confidence.Find a provider easily, wherever you areWhether you’re a snowbird or working through your bucket list, if yourprimary residence is in a network area, your in-network benefits areavailable from providers in the counties listed inside this brochure.If you do not live in a network service area and need help finding aMedicare participating provider, use the online Provider Finder or call thenumber listed on your member ID card. Remember, the Medicare PPOplan network may be different from a commercial plan PPO network. You’ll have the highest level of coverage for any in-networkMedicare-participating provider anywhere in the country,after a small copayment or coinsurance. If you live in a non-network area, you’ll have coverage fornon-network Medicare providers at the in-network level.Non-network providers must:PROVIDER FINDER Agree to treat you (providers are not required to)Illinois Accept Medicare reimbursement Be willing to bill your Blue Cross Medicare Advantage PPOplan directlywww.bcbsil.com/medicare/mapd provider.htmlMontanawww.bcbsmt.com/medicare/mapd provider.htmlNew Mexicowww.bcbsnm.com/medicare/mapd provider.htmlOklahomawww.bcbsok.com/medicare/mapd provider.htmlTexaswww.bcbstx.com/medicare/mapd provider.htmlCALLIf you are already a Blue Cross Medicare AdvantagePPO member, call Customer Service at the numberlisted on the back of your member ID card.(TTY/TDD users should call 711). We are openbetween 8:00 a.m. and 8:00 p.m., local time,7 days a week. If you are calling from February 15through September 30, alternate technologies(for example, voicemail) will be used on theweekends and holidays.2If you are thinking about becoming a member, youcan find nationwide providers by calling the phonenumber listed on your enrollment materials.3
Blue Cross and Blue Shield (BCBSA)Medicare Advantage PPO Network-SharingStates and CountiesThe following states and Puerto Rico include participatingBCBSA Medicare Advantage PPO providers in all counties:AlabamaIndianaNew JerseyPuerto RicoCaliforniaKentuckyNew YorkSouth nPennsylvaniaWest VirginiaBCBSA Medicare Advantage PPO providers are available inthe following counties:ALABAMAParticipating BCBSA Medicare Advantage PPO Providers available inall ttCALIFORNIAParticipating BCBSA Medicare Advantage PPO Providers available inall glasEl PasoFremontJeffersonPuebloCONNECTICUTParticipating BCBSA Medicare Advantage PPO Providers available inall ghIndian i-DadeOkaloosaOrangeOsceolaPalm BeachPascoPinellasPolkSaint JohnsSanta RosaSarasotaSeminoleSt. conBakerBaldwinBanksBarrowBartowBen HilBerrienBibbBleckleyBrantleyBrooksBryan5
GEORGIA ff RichmondRockdaleSchleySpaldingStewartIDAHO rWheelerWhiteWilcoxWilkesWilkinsonParticipating BCBSA Medicare Advantage PPO Providers available inall countiesIDAHO6BannockBear omeKootenaiLatahLewisLincolnMadisonMinidokaNez PerceOneidaOwyheePayettePowerShoshoneTetonTwin IANAParticipating BCBSA Medicare Advantage PPO Providers available inall countiesKENTUCKYParticipating BCBSA Medicare Advantage PPO Providers available inall rwaterBenewahBinghamParticipating BCBSA Medicare Advantage PPO Providers available inall rcester7
MICHIGANNEW JERSEYParticipating BCBSA Medicare Advantage PPO Providers available inall countiesParticipating BCBSA Medicare Advantage PPO Providers available inall countiesMISSOURINEW int CharlesSaint LouisSaint Louis sonJudith BasinLakeLewis And sselshellParkPonderaPowellRavalliSandersSilver BowStillwaterSweet BeaverheadBig HornBlaineBroadwaterCarbonCascadeChouteauDeer LodgeFergusFlatheadGallatinGlacierGolden ValleyNEVADAClarkWashoeNEW oCibolaGuadalupeLos AlamosMoraRio ArribaSan MiguelSandovalSanta FeSocorroTorranceValenciaNEW YORKParticipating BCBSA Medicare Advantage PPO Providers available inall countiesNORTH burgMitchellMontgomeryNashNew 9
NORTH CAROLINA augaPUERTO RICOWayneWilkesWilsonYadkinYanceyParticipating BCBSA Medicare Advantage PPO Providers available inall countiesSOUTH CAROLINAParticipating BCBSA Medicare Advantage PPO Providers available inall countiesOHIOTENNESSEEParticipating BCBSA Medicare Advantage PPO Providers available inall countiesParticipating BCBSA Medicare Advantage PPO Providers available inall homaOkmulgeePaynePottawatomieRogersTulsaHood Participating BCBSA Medicare Advantage PPO Providers available inall DallasDentonFayetteFort arrantTravisWilliamsonUTAHDavisSalt LakeUtahWeberVIRGINIAAccomackAlbemarleAlexandria taBathBedford uckingham11
VIRGINIA (continued)Buena Vista CityCampbellCarolineCarrollCharles CityCharlotteCharlottesville CityChesapeake CityChesterfieldClarkeColonial Heights CityCovington CityCraigCulpeperCumberlandDanville CityDickensonDinwiddieEmporiaEssexFairfax CityFairfaxFalls Church CityFauquierFloydFluvannaFranklin CityFranklinFrederickFredericksburg CityGalax leHalifaxHampton City12HanoverHarrisonburg CityHenricoHenryHighlandHopewell CityIsle Of WightJames CityKing and QueenKing GeorgeKing WilliamLancasterLeeLexington CityLoudounLouisaLunenburgLynchburg CityMadisonMartinsville CityManassas CityManassas Park CityMathewsMecklenburgMiddlesexMontgomeryNelsonNew KentNewport News CityNorfolk CityNorthamptonNorthumberlandNorton CityNottowayOrangePagePatrickPetersburg CityPittsylvaniaPortsmouth CityPoquoson CityPowhatanPrince EdwardPrince GeorgePrince WilliamPulaskiRadfordRappahannockRichmondRichmond CityRoanokeRoanoke hSmythSouthamptonSpotsylvaniaStaffordStaunton CitySuffolk CitySurrySussexTazewellVirginia Beach CityWarrenWashingtonWaynesboro CityWestmorelandWilliamsburg CityWinchester CityWiseWytheYork
2016 Medicare Advantage PPONetwork-Sharing States and zIslandKingKitsapKlickitatLewisPierceSan JuanSkagitSkamaniaSnohomishThurstonWahkiakumWalla WallaWhatcomYakimaWEST VIRGINIAParticipating BCBSA Medicare Advantage PPO Providers availablein all countiesPULL OUT FOR geDoorDouglasDunnEau ClaireFlorenceFond Du LacForestGrantGreenGreen a RichlandRockRuskSaint WausharaWinnebagoWoodParticipating States and Counties13
Backed by the brand you trustYou chose the nation’s largest member-owned health plan becauseyou trust its quality, strength and stability. We honor that trust bystaying committed to your health every day, everywhere.This information is not a complete description of benefits. Contact the planfor more information. Limitations, copayments, and restrictions may apply.Benefits, premiums and/or co-payments/co-insurance may change onJanuary 1 of each year.This information is available for free in other languages. Please call ourCustomer Service number at 1-877-299-1008. (TTY/TDD users should call 711).We are open between 8:00 a.m. and 8:00 p.m., local time, 7 days a week. Ifyou are calling from February 15 through September 30, alternate technologies(for example, voicemail) will be used on the weekends and holidays.Esta información está disponible en otros idiomas de forma gratuita.Comuníquese a nuestro número de Servicio al Cliente llamando al1-877-299-1008. (Los usuarios de TTY/TDD deberán llamar al 711). Nuestrohorario es de 8 a.m. a 8 p.m., hora local, los 7 días de la semana. Si ustedllama del 15 de febrero al 30 de septiembre, durante los fines de semana yferiados, se usarán tecnologías alternas (por ejemplo, correo de voz).Access in-network benefits from coast to coastWith the Blue Cross National Network of providers, you can get thecare you need across the country and pay nothing extra.16Blue Cross Medicare Advantage PPO members may visit any participatingBlue Cross and/or Blue Shield Medicare Advantage PPO provider in the UnitedStates, and pay network cost sharing. Blue Cross and/or Blue Shield MedicarePPO providers are available in the following 35 states and Puerto Rico:Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii,Idaho, Illinois, Indiana, Kentucky, Maine, Massachusetts, Michigan, Missouri,Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York,North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, SouthCarolina, Tennessee, Texas, Utah, Virginia, Washington, West Virginia andWisconsin. For some of the states listed, MA PPO networks are only availablein portions of the state.Blue Cross Medicare Advantage PPO members may see any Blue Cross and/orBlue Shield Medicare Advantage PPO contracted doctor or hospital outsidethe Blue Cross Medicare Advantage PPO service area in the above 35 statesand Puerto Rico and receive coverage at the highest level of benefits. If youreceive routine care from non-participating providers in the above 35 statesand Puerto Rico, you will receive a lower level of benefits, which will result inhigher out-of-pocket costs. In locations where participating Blue Cross and/or Blue Shield Medicare Advantage PPO providers are not available, membersmay visit any Medicare-eligible provider and receive coverage at the highestlevel of benefits. Emergency and urgently needed care is always covered atthe higher, network level.
PPO plans in Illinois, Montana, New Mexico, and Oklahoma are providedby Health Care Service Corporation, a Mutual Legal Reserve Company(HCSC). Blue Cross Medicare Advantage PPO plans in Texas are provided byHCSC Insurance Services Company (HISC). HCSC and HISC are IndependentLicensees of the Blue Cross and Blue Shield Association. HCSC and HISC areMedicare Advantage organizations with a Medicare contract. Enrollment inBlue Cross Medicare Advantage plans depends on contract renewal.
Blue Cross Medicare Advantage PPO members may see any Blue Cross and/or Blue Shield Medicare Advantage PPO contracted doctor or hospital outside the Blue Cross Medicare Advantage PPO service area in the above 35 states and Puerto Rico and receive coverage at the highest level of benefits. If you
