Regence Medicare Advantage PPO Plans

For more information, call one of our
Plan’s Medicare sales representatives,
8 a.m. to 5 p.m., Monday through Friday
DECISION GUIDE
toll-free: 1-844-REGENCE
(1-844-734-3623)
GET STARTED
READ. This booklet gives you all the tools you need to make
TTY users should call 711
an informed decision in choosing a Regence Medicare Advantage
Plan. It provides important information you need to evaluate your
options and find the plan that best fits your needs. It has easy-toread charts that compare benefits, gives you information about
additional programs and benefits you can enjoy as a Regence
BlueShield member and provides directions for how to enroll.
CALL. If you need additional help, or if you would prefer
an in-person meeting with one of our Plan’s Medicare sales
representatives, call us at 1-844-REGENCE (1-844-734-3623) from
8 a.m. to 5 p.m., Monday through Friday. TTY users should call 711.
ATTEND. We offer free informational meetings for you to learn
more about our Medicare Advantage plans. For the most current list
of meetings in your area, visit regence.com/medicare.
GO ONLINE. A wealth of information is available at your
fingertips at regence.com/medicare. You can search for your
provider in our network and check our formulary (list of covered
prescription drugs) for the prescription drugs you take.
2015
Regence Medicare Advantage
PPO Plans
P.O. Box 21267
Seattle, WA 98111
regence.com/medicare
08497-wa/07-14
© 2014 Regence BlueShield
Regence BlueShield serves select counties in the state of Washington
and is an Independent Licensee of the Blue Cross and Blue Shield Association
OR CALL YOUR INSURANCE AGENT.
Y0062_07978 Approved
Either way, there’s plenty of help available if you have questions.
WA | PPO | 2015
For more information, call one of our
Plan’s Medicare sales representatives,
8 a.m. to 5 p.m., Monday through Friday
DECISION GUIDE
toll-free: 1-844-REGENCE
(1-844-734-3623)
GET STARTED
READ. This booklet gives you all the tools you need to make
TTY users should call 711
an informed decision in choosing a Regence Medicare Advantage
Plan. It provides important information you need to evaluate your
options and find the plan that best fits your needs. It has easy-toread charts that compare benefits, gives you information about
additional programs and benefits you can enjoy as a Regence
BlueShield member and provides directions for how to enroll.
CALL. If you need additional help, or if you would prefer
an in-person meeting with one of our Plan’s Medicare sales
representatives, call us at 1-844-REGENCE (1-844-734-3623) from
8 a.m. to 5 p.m., Monday through Friday. TTY users should call 711.
ATTEND. We offer free informational meetings for you to learn
more about our Medicare Advantage plans. For the most current list
of meetings in your area, visit regence.com/medicare.
GO ONLINE. A wealth of information is available at your
fingertips at regence.com/medicare. You can search for your
provider in our network and check our formulary (list of covered
prescription drugs) for the prescription drugs you take.
2015
Regence Medicare Advantage
PPO Plans
P.O. Box 21267
Seattle, WA 98111
regence.com/medicare
08497-wa/07-14
© 2014 Regence BlueShield
Regence BlueShield serves select counties in the state of Washington
and is an Independent Licensee of the Blue Cross and Blue Shield Association
OR CALL YOUR INSURANCE AGENT.
Y0062_07978 Approved
Either way, there’s plenty of help available if you have questions.
WA | PPO | 2015
MEDICARE MADE EASY
Are you confused about how Medicare benefits work? Unsure if you’re
covered when you're traveling? Are you effectively using all of your benefits
to support your health?
Regence BlueShield makes it easy to choose, and use, your Medicare
Advantage plan. You can access all your benefits with one member
identification card and virtually no paperwork. Should you have a question
or need assistance, our customer service team is only a phone call away.
Regence Medicare Advantage Plans combine all of the benefits of Original
Medicare Parts A (hospital) and B (physician), and in some cases Part D
prescription drug coverage, into one easy-to-use plan. You also get extra
benefits and programs beyond what Original Medicare has to offer.
Get EXTRA BENEFITS and PROGRAMS
u Worldwide
coverage for urgent and emergency care. Travel without worrying
about access to care if you need it with the BlueCard Worldwide® program.
u Large
national PPO provider network through the Blue Medicare
Advantage PPO Network Sharing Program and no referrals needed to see a provider
of your choice.
u SilverSneakers®
Fitness program. Receive a free fitness membership and
access to more than 11,000 participating locations across the country. Unable to get to a
SilverSneakers location? A home fitness kit is available to help you get fit at home or on
the go.
u Regence
Advice24. Get the medical advice you need from a registered nurse any
time, day or night, using our toll-free medical advice line.
u My
Advocate. Find out if you qualify for, but are not receiving, assistance with
medical costs, heating bills, meal programs or other programs and social services.
WA | PPO | 2015
1
REGENCE MEDICARE
ADVANTAGE PLANS
Regence MedAdvantage + Rx
CLASSIC (PPO)
15 primary care copay
Regence MedAdvantage
BASIC (PPO) (no Rx)
15 primary care copay
$
●
$
●
●Deductible
●Deductible
●Freedom
●Freedom
●No
●No
waived for in-network primary
care services
to see any provider across the
United States
referrals required
●In-network
●Routine
● Vision
travel benefits
eye exam
hardware
● Preventive
dental
●Concierge
Service
waived for in-network primary
care services
to see any provider across the
United States
referrals required
●In-network
●Routine
● Vision
travel benefits
eye exam
hardware
●Preventive
dental
All PPO plan members receive:
●
Worldwide emergency and urgent care when you travel domestically or abroad
●
Vision: One routine eye exam per year
●
Annual
physical exam: An annual physical exam with no copay, coinsurance or
deductible, in addition to the Medical Annual Wellness Visit
●
Vision hardware: An allowance toward the purchase of glasses, lenses and
●
Preventive dental: Up to $500 annually for preventive dental services, such as
twice-yearly cleanings, X-rays and preventive dental exams
contact lenses
!
W
E
N
Additional dental coverage
available for PPO plan members
Regence PPO members can receive restorative dental services such as oral
surgery, extractions and implants with no deductible. This optional dental
coverage is available for an additional premium. See the Summary of Benefits
for details.
2
WA | PPO | 2015
WE HAVE YOU COVERED
across the country and around the world!
Travel the world with complete peace of mind.
Through the BlueCard Worldwide program, you have access to medical assistance services and
doctors and hospitals in more than 200 countries and territories around the world.1 When you receive
care from a participating provider, you’ll pay the out-of-pocket expenses (deductible, copay and
coinsurance) that you would normally pay under your PPO plan.
Get in-network benefits across the country—a special
advantage for Regence PPO members.
Regence PPO plan members can see any Medicare-contracted provider anywhere in the United
States. When traveling outside the service area, PPO members will also receive in-network benefits
by seeing Medicare Advantage PPO Blue Cross® and/or Blue Shield®-contracted providers through
the Blue Medicare Advantage PPO Network Program available in 35 states across the country.2
Wyoming
Michigan
In-network
coverage
Out-of-network
coverage
PUERTO RICO
Finding a Blue Medicare Advantage PPO provider is easy. Download the Blue National
Doctor & Hospital Finder App at bcbs.com/mobile, or use the National Doctor and Hospital
Finder at provider.bcbs.com.
Part D prescription drug coverage is not available outside the United States and its territories.
The Medicare Advantage PPO Network Sharing Program is only available with Regence Medicare
Advantage PPO plans.
1
2
WA | PPO | 2015
3
REGENCE SUPPORTS YOUR
HEALTH AND WELLNESS
Feel better and healthier–regardless of your
current fitness level.
Get fit, have fun and make friends by using your SilverSneakers
membership. You’ll have access to more than 11,000 participating
fitness facility locations across the country where on-site staff
members can help you meet your wellness goals. Locations offer
amenities such as exercise equipment and SilverSneakers fitness classes that are designed
specifically for active older adults and are taught by certified instructors (classes and amenities
vary by location). Don’t have access to a participating fitness location? SilverSneakers will send
you a home fitness kit that contains tools to achieve a healthier lifestyle at home or on the go.
Regence Advice24.
Get the medical advice you need from a registered nurse any time,
day or night, using our toll-free medical advice line.
4
WA | PPO | 2015
Save money when you fill a three-month supply
of your maintenance medication prescriptions.
Take advantage of greater savings and convenience for your ongoing prescription needs when you
order a three-month supply of your maintenance medications from an in-network retail pharmacy
or mail-order pharmacy. You pay only two times your monthly copay for a three-month supply of
generic drugs; brand-name prescriptions are only two and a half times your monthly copay.
You can get prescription drugs shipped to your home through our network mail order delivery
program. Typically, you should expect to receive your prescription drugs within 14 days from the
time that the mail order pharmacy receives the order. Should a prescription drug order not arrive
within the estimated time frame, help is available from Customer Service at 1 (800) 541-8981 from
8 a.m. to 8 p.m. Monday through Friday (from October 1 through February 14, our telephone
hours are 8 a.m. to 8 p.m., seven days a week). TTY users should call 711.
WA | PPO | 2015
5
3 EASY STEPS TO CHOOSING
THE RIGHT PLAN FOR YOU
●
1­ Search for your provider in our network.
●
2
Check our formulary for your prescription drugs.
Search for providers and view our formulary online at regence.com/medicare.
Call us at 1-844-REGENCE (1-844-734-3623). TTY users should call 711. Our
Plan’s Medicare sales representatives are happy to answer your questions,
find a doctor or look up your medication for you.
●
3
Review our plans and identify the one with
the benefits that are most important to you.
Each plan has different premiums, copays and out-of-pocket maximums.
Review the highlights of our Medicare Advantage plans in the pages that
follow. A comprehensive list of benefits can be found in the Summary of
Benefits that is included in this packet.
6
WA | PPO | 2015
SERVICE AREAS AND PREMIUMS
WHATCOM
SKAGIT
SAN JUAN
ISLAND
CLALLAM
SNOHOMISH
KITSAP
KING
PIERCE
THURSTON
LEWIS
YAKIMA
WAHKIAKUM
COWLITZ
COLUMBIA
WALLA WALLA
SKAMANIA
KLICKITAT
Clallam, Columbia, Cowlitz, Island, King, Kitsap, Klickitat, Lewis,
Pierce, San Juan, Skagit, Skamania, Snohomish, Thurston,
Wahkiakum, Walla Walla, Whatcom, Yakima
Regence MedAdvantage Basic (PPO) (no Rx)
Regence MedAdvantage + Rx Classic (PPO)
$145
$167
WA | PPO | 2015
7
PPO BENEFIT HIGHLIGHTS
Regence
MedAdvantage + Rx
CLASSIC (PPO)
Regence
MedAdvantage
BASIC (PPO) (no Rx)
Monthly premium
$167
$145
Annual medical deductible1
(waived for in-network
primary care services)
$125
$50
Out-of-pocket maximum
$3,400 in-network
$5,100 combined
$3,400 in-network
$5,100 combined
Network
In
In
Out
Medical Benefits
Out
Preventive services and
screenings (including an
Annual Wellness Visit)
$0
Primary care office visit
$15
$25
$15
$25
Specialist office visit
$40
$50
$40
$50
X-rays
$0
20%
$0
20%
Lab services
$0
$0
$0
$0
Days 1-4:
$400
per day
Days 1-4:
$500
per day
Days 1-4:
$400
per day
Days 1-4:
$500
per day
Outpatient surgery –
ambulatory surgery center
$150
$200
$150
$200
Outpatient surgery – hospital
$250
$350
$250
$350
Inpatient hospital
Emergency room
$65 (in or out of network, waived if admitted within 48 hours)
Urgent care
$30
$30
$30
$30
Durable medical equipment
20%
30%
20%
30%
$40 per day
$70 per day
$40 per day
$70 per day
Skilled nursing facility
(days 1-100; no benefit
after 100 days)
Deductible waived for in-network primary care office visits, Medicare-covered preventive
services and in-network Medicare-covered Part B prescription drugs. Deductible also waived
for preventive dental, routine vision exam and routine vision hardware.
1
8
WA | PPO | 2015
PPO BENEFIT HIGHLIGHTS
Medical Benefits
Regence
MedAdvantage + Rx
CLASSIC (PPO)
Regence
MedAdvantage
BASIC (PPO) (no Rx)
Additional Benefits and Programs
Network
In
Out
Annual physical exam
Hearing aid
Routine eye exam
(one per year)1
Routine vision hardware
Preventive dental
(cleanings and X-rays)
Comprehensive dental
(optional, additional
premium applies)
SilverSneakers
Fitness program
Part D prescription
drug coverage
In
Out
$0
No coverage
$40
$40
Up to $100 allowed per year,
in or out of network
No coverage
$40
$40
Up to $100 allowed per year,
in or out of network
50%, up to $500 allowed per year, in or out of network
50%, up to $1,000 allowed per year, in or out of network
Included in plan at no additional cost
Included in plan;
see page 10 for details
No coverage
Routine vision care must be received from a Vision Service Plan (VSP) provider to be eligible
for in-network cost sharing. Visit vsp.com to search for a provider in your area.
1
WA | PPO | 2015
9
PRESCRIPTION DRUG COVERAGE
Benefit information
Prescription Drug
Coverage
Regence MedAdvantage + Rx
CLASSIC (PPO)
Annual Rx Deductible
$235
STAGE 1: Initial Coverage Stage
1-Month supply (in-network retail pharmacy)
Tier 1: Preferred generics
$8
Tier 2: Non-preferred generics
$15
Tier 3: Preferred brands
$45
Tier 4: Non-preferred brands
$95
Tier 5: Specialty drugs
26%
3-Month supply (in-network retail pharmacy or mail-order pharmacy)
Tier 1: Preferred generics
$16
Tier 2: Non-preferred generics
$30
Tier 3: Preferred brands
$112.50
Tier 4: Non-preferred brands
$237.50
Tier 5: Specialty drugs
Not applicable; limited to a 30-day supply
STAGE 2: Coverage Gap Stage (after prescription costs reach $2,960)
Generic drugs
You pay 65%
Brand drugs
You pay 45%
STAGE 3: C
atastrophic Coverage Stage (after you have paid $4,700 out of pocket)
10
Generic drugs
You pay the greater of 5% or $2.65
Brand drugs
You pay the greater of 5% or $6.60
WA | PPO | 2015
$
THE COVERAGE GAP
How it works
STAGE 1:
Initial Coverage
STAGE 2:
Coverage Gap
You pay a little
Plan pays most
•
•
You pay most
Plan pays a little
•
•
After you pay your annual
deductible (if applicable), you
pay a copay or coinsurance for
each prescription you fill.
Your plan pays the rest until the
total that you and the plan pay
reaches $2,960.
After your total drug costs
reach $2,960, you pay 65% of
the cost of generic prescription
drugs and 45% of the cost of
most brand-name prescription
drugs until your total out-ofpocket prescription drug costs
reach $4,700.
Total out-of-pocket costs are
the amounts paid by you in
the first two stages plus any
applicable drug manufacturer
discounts applied in the
Coverage Gap stage.
STAGE 3:
Catastrophic Coverage
You pay a little
Plan pays most
• •
After your total drug costs
reach $4,700, you pay the
greater of 5% coinsurance
or $2.65 copay for generic
drugs, and the greater of 5%
coinsurance or $6.60 copay for
brand-name drugs.
Your plan pays the rest of the
cost of your prescription drugs
for the rest of the calendar year
(through December 31, 2015).
Need extra help with prescription drug costs?
To determine if you qualify for extra help from Medicare to pay for your prescription drug premiums
and costs, call the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday
through Friday (TTY users should call 1-800-325-0778); or your State Medicaid Office.
WA | PPO | 2015
11
READY TO ENROLL?
LET’S GET STARTED!
Enrolling is easy:
ENROLL BY PHONE. Have one of our Plan’s Medicare
sales representatives enroll you over the phone by calling
1-844-REGENCE (1-844-734-3623). TTY users should call 711.
ENROLL ONLINE. Enjoy the convenience of applying online.
Visit regence.com/medicare and follow the instructions for
applying online.
ENROLL BY MAIL.
An enrollment application is included
in this packet or you can visit regence.com/medicare and download
an enrollment application.
●
1.Complete and sign your application. Verify that
the information from your Medicare card is listed
correctly on your enrollment application, or make
a copy of your Medicare card and attach it to your
enrollment application.
●
2.Use the postage-paid return envelope included in
this information packet to mail your completed and
signed application.
Applications can also be mailed to: PO Box 1827,
B32M, Medford, OR 97501. Please make sure
you have sufficient postage.
●
3. Do not send any payment with your
enrollment application.
Regence BlueShield is a Medicare Advantage plan with a Medicare contract. Enrollment in
Regence BlueShield depends on contract renewal. 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 copayments/coinsurance may change on January 1 of
each year. Anyone who resides in our service area may apply. Individuals must have both
Part A and Part B to enroll. You must continue to pay your Medicare Part B premium.
12
WA | PPO | 2015
For more information, call one of our
Plan’s Medicare sales representatives,
8 a.m. to 5 p.m., Monday through Friday
DECISION GUIDE
toll-free: 1-844-REGENCE
(1-844-734-3623)
GET STARTED
READ. This booklet gives you all the tools you need to make
TTY users should call 711
an informed decision in choosing a Regence Medicare Advantage
Plan. It provides important information you need to evaluate your
options and find the plan that best fits your needs. It has easy-toread charts that compare benefits, gives you information about
additional programs and benefits you can enjoy as a Regence
BlueShield member and provides directions for how to enroll.
CALL. If you need additional help, or if you would prefer
an in-person meeting with one of our Plan’s Medicare sales
representatives, call us at 1-844-REGENCE (1-844-734-3623) from
8 a.m. to 5 p.m., Monday through Friday. TTY users should call 711.
ATTEND. We offer free informational meetings for you to learn
more about our Medicare Advantage plans. For the most current list
of meetings in your area, visit regence.com/medicare.
GO ONLINE. A wealth of information is available at your
fingertips at regence.com/medicare. You can search for your
provider in our network and check our formulary (list of covered
prescription drugs) for the prescription drugs you take.
2015
Regence Medicare Advantage
PPO Plans
P.O. Box 21267
Seattle, WA 98111
regence.com/medicare
08497-wa/07-14
© 2014 Regence BlueShield
Regence BlueShield serves select counties in the state of Washington
and is an Independent Licensee of the Blue Cross and Blue Shield Association
OR CALL YOUR INSURANCE AGENT.
Y0062_07978 Approved
Either way, there’s plenty of help available if you have questions.
WA | PPO | 2015