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Medicare coverage made easy with Blue Cross Group Medicare Advantage Open Access (PPO) SM If you need personalized help, call 1-833-634-0442 TTY 711. Beginning March 16, help is available 8:00 a.m. – 9:00 p.m., CT, Monday - Friday. If you are calling from March 16 through September 30, alternate technologies (for example, voicemail) will be used during weekends. OPEH&W has made sure to provide you with a great cost saving plan. Administered by Blue Cross and Blue Shield of Oklahoma (BCBSOK), Blue Cross Group Medicare Advantage Open Access (PPO) is designed to provide coverage for the care you need, encourage you to maintain your good health, and help you manage your health care costs. Your costs will remain the same as what you pay today. IMPORTANT: NEW MEMBER NUMBER As a Blue Cross Group Medicare Advantage Open Access (PPO) member, you will have a new member number and ID card. Be sure to show your new card to your providers or their office staff. Remind them that your old ID is no longer valid. If the provider does not use your new number, your benefits cannot be confirmed and there may be delays processing your claims. Enrollment in Medicare Part A and Part B through the federal government is required for retirees to be eligible for any retiree Medicare plans, including this UT CARE plan. To have full coverage, you must sign up for Medicare Parts A & B and continue to pay your Part B premium. Please call the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778) or go to www.ssa.gov to enroll in Medicare. Medicare-eligible Retiree Benefits (include link to presentation) Watch this presentation to learn more about your plan benefits. Blue Cross Group Medicare Advantage Open Access (PPO) bundles extra health and wellness benefits with Original Medicare. | ||
| It covers most commonly used medical services such as provider visits, inpatient hospital and outpatient services, emergency care, and prescription drugs*. | ||
| This plan gives you the freedom to seek care across the country. You have the flexibility to go outside the network for the same cost. No referrals are needed. | ||
| Low copays on Medicare Part D outpatient prescription medicines to treat arthritis, high blood pressure, and osteoporosis, etc. | ||
| Comprehensive Part D drug list (formulary). | ||
| Over the Counter (OTC) monthly allowance with roll over. | ||
| Virtual telehealth visits. † | ||
| Hearing aid allowance of 3,000 for both ears, every three years. | ||
| Non-emergency transportation | ||
| Post discharge meal service | ||
| Nationwide network of pharmacies, convenient refills by mail and online ordering. | ||
| Rewards Program puts up to $100 worth of gift cards in your pocket for choosing healthy activities. †† | ||
| SilverSneakers® Fitness Program, 24/7 Nurseline, plus discounts on programs and purchases. | ||
| Carry one card and call one Customer Service number. | ||
| If you haven’t already, register for BAM at www.bluememberok.com . | ||
| This secure site and mobile app provide you easy access to view your health benefit information from anywhere. | ||
| You can: | ||
| Search for health care providers. | ||
| View claims status and up to 18 months of claims activity. | ||
| Request an ID card or print a temporary ID. | ||
| Find health and wellness information. | ||
| It’s Easy to Get Started! | ||
| Go to www.bluememberok.com or grab your smartphone and your member ID card and text † BCBSOKAPP to 33633 so you can use BAM while you’re on the go. | ||
| Your Providers | ||
| OPEH&W provides you an Open Access Medicare Advantage PPO plan that does not require the use of a network provider for coverage. Your benefit levels are the same if you use a Blue Cross and Blue Shield network or non-network provider. You may seek care from any providers nationwide that accept Medicare and agree to submit claims to BCBSOK. | ||
| IMPORTANT: NEW MEMBER NUMBER | ||
| As a new Medicare Advantage member, you have a new ID number and card. Be sure to show your new card to your providers or their office staff. Remind them that your old ID is no longer valid. If the provider does not use your new number, your benefits cannot be confirmed and there may be delays processing your claims. | ||
| Please note: Nearly 98% of providers nationwide accept Medicare assignment, but there are providers who do not accept Medicare or have “opted out.” Members may have lower out-of-pocket costs if they receive care from a provider who accepts Medicare assignment rather than one who does not, or who has opted out. | ||
| Medicare-assigned providers can decide what patients they want to see. We recommend that you confirm with providers that they will accept your plan and file claims with us directly. It may be helpful to refer to the plan as a Group Medicare Advantage Open Access PPO plan when talking with your provider. | ||
| Some high-cost medical services have more cost-effective alternatives that require prior authorization from the plan before your provider can proceed. | ||
| Provider Finder® | ||
| Search Provider Finder® to find an in-network of doctors, specialists, hospitals and other health care providers for your Medicare Advantage Plan. While we encourage you to use network providers, your Open Access plan offers the flexibility to go outside the network for the same cost. No referral is needed. The providers you choose must 1) accept Medicare; 2) agree to see you as a patient; and 3) agree to bill the plan. Be sure to schedule a visit with your primary care provider (PCP) soon after your coverage effective date. | ||
| Provider Finder offers you more ways to search than ever before. You can look up doctors, hospitals and other providers by location. And you can research providers using patient reviews, and quality, certification and recognition information. | ||
| Find a Blue Cross & Blue Shield of Oklahoma Doctor or Hospital in Your Area | ||
| Find a Provider Who Accepts Medicare and Compare Doctors and Other Providers | ||
| Find a Provider Outside of Oklahoma | ||
| BlueCard® is a national program that enables you and your dependents to obtain health care services when traveling or living outside their Blue Plan service area. When you travel or live away from home for an extended period of time, you'll have the same benefits as your Blue Cross and Blue Shield of Oklahoma (BCBSOK) plan. Blue Cross and Blue Shield (BCBS) plans have the largest hospital and physician network in the United States. Outside the U.S., you'll have access to doctors and hospitals in more than 200 countries and territories around the world through the Blue Cross Blue Shield Global Core program. | ||
| The BlueCard Program Features: | ||
| Access to physicians and hospitals nationwide. | ||
| PPOs can be found in all 50 states, District of Columbia and Puerto Rico. | ||
| Receive network (highest) level of benefits | ||
| Claims filed by providers. | ||
| No balance billing – BlueCard providers accept the Blue Cross and Blue Shield of Texas allowed amounts for covered services and cannot bill you for charges which exceed the allowed amount. | ||
| Locate a Provider | ||
| When searching for a provider in the U.S., use our Provider Finder | ||
| When searching for a provider outside the U.S., visit the Blue Cross Blue Shield Global® Core Website | ||
| BlueCard coverage will vary depending on whether you choose a contracting or non-contracting provider. Be sure to call Customer Service at the number on the back of your member ID card before traveling. | ||
| Find a Provider while Traveling Internationally | ||
| If you require medical treatment while out of the country, you are only covered in an emergency per Medicare rules .The Blue Cross and Blue Shield Global Core program gives members traveling outside of the United States and its territories access to urgent and emergency medical assistance services and doctors and hospitals in more than 200 countries around the world. If you have questions about what medical care is covered when you travel, please call Customer Service or access information at the Global® Core Website . | ||
| Global® Core Claim Form | ||
| Pharmacies and Home Delivery | ||
| Log into Blue Access for Members℠ to check your drug list and learn more about your prescription drug benefits. If you have any questions about your prescription drug benefits, call the number on the back of your member ID card. Check the formulary and find retail pharmacies near you, using our drug and pharmacy finder tools. | ||
| Pharmacy Finder | ||
| Find preferred pharmacies using the Pharmacy Finder Tool . | ||
| Select "Pharmacies", then | ||
| Select "Continue without sign in", then | ||
| Select BCBS Oklahoma from the drop-down menu | ||
| Select ‘Yes’ to confirm you are a Retirement Benefit Enrollee. | ||
| Choose the retiree group Medicare plan you want and select "Continue" | ||
| Choose the pharmacy type you want, then | ||
| Enter your ZIP code, city and state, or address to find a pharmacy | ||
| Home Delivery Pharmacy | ||
| Choose convenience with our mail-order services. A 90-day supply of the medications you take regularly can be delivered directly to your home. This service offers: | ||
| Three ways to order refills: online, by phone or through the mail. | ||
| Up to a 90-day supply of your long-term medicine mailed at one time. | ||
| A choice to get a text, email or phone call to let you know when your order is received, and your prescriptions are mailed. | ||
| You will need to set up an account using your Member ID with one of two options: | ||
| AllianceRx Walgreens Pharmacy – Visit www.alliancerxwp.com/home-delivery or call MAPD – 1-877-277-7895 (TTY 711); PDP – 1-888-277-5475 (TTY 711). | ||
| Express Scripts® Pharmacy – Visit www.express-scripts.com/rx or call MAPD – 1-833-599-0729 (TTY 711); PDP – 1-833-715-0944 (TTY 711). | ||
| Specialty Pharmacy | ||
| Specialty medications are often prescribed to treat complex and/or chronic conditions and have unique shipping or handling needs. You may be able to fill specialty prescriptions at certain retail pharmacies, if they stock the medication. You also can use one of two specialty pharmacy options: | ||
| Accredo® – Visit www.accredo.com or call 1-833-721-1619 (TTY 711) to get started. | ||
| AllianceRx Walgreens Pharmacy – Visit www.alliancerxwp.com/specialty-pharmacy or call 1-877-627-6337 (TTY 711) to get started. | ||
| Part of the advantage to having a Blue Cross Group Medicare Advantage Open Access plan is the benefits offered above and beyond standard health insurance. Here are some of the extra health and wellness benefits offered with our plans. | ||
| SilverSneakers® Fitness Program | ||
| Blue Cross Group Medicare Advantage plans include the SilverSneakers Fitness Program to help you achieve your health and fitness goals. Members have access to thousands of participating locations across the country. Some locations even offer group exercise classes led by trained instructors at select locations. | ||
| For more information, and to find SilverSneakers participating fitness locations: | ||
| Visit SilverSneakers | ||
| Call 1-888-584-7389 TTY 711, Monday – Friday, 8:00 a.m. – 8:00 p.m. ET. | ||
| Rewards Program | ||
| The Rewards Program gives Blue Cross Group Medicare Advantage members a healthy and easy way to earn up to $100 in gift cards from national and local retailers. You receive a gift card of your choice for completing Healthy Actions throughout the year. Here are some of the Healthy Actions you can complete once per year: | ||
| Annual wellness visit | ||
| Annual flu vaccine | ||
| Colorectal cancer screening | ||
| Fall risk assessment | ||
| The Healthy Activity Portal is a website owned and operated by HealthMine, Inc., an independent company that provides digital health and personal clinical engagement tools and services for Blue Cross and Blue Shield of Oklahoma. | ||
| 24/7 NurseLine | ||
| Blue Cross Group Medicare Advantage plan members can call a registered nurse, 24 hours a day, 7 days a week to get help with health concerns and general health tips. You can access the 24/7 Nurseline at 1-800-631-7023 TTY 711. | ||
| For medical emergencies, call 911. This program is not a substitute for a doctor’s care. Talk to your doctor about any health questions or concerns. | ||
| Blue365® | ||
| Blue365 offers premier health and wellness discounts to BCBSOK members and it is free to join. You can find savings like: | ||
| Discounts on exercise clothes and shoes | ||
| Discounted gym memberships and fitness aids like Fitbits | ||
| Savings on eye exams, glasses, contacts, and hearing aids | ||
| Check the Blue365 website regularly for the most current discounts. | ||
| * Most doctors accept Medicare. The provider must be willing to accept Medicare assignment and bill Blue Cross and Blue Shield of Oklahoma. † Non-emergency medical service in Montana and New Mexico is limited to interactive online video. Non-emergency medical service in Arkansas and Idaho is limited to interactive online video for initial consultation. †† Registration is required to participate. Visit www.BlueRewardsOK.com to register and see what Healthy Actions earn rewards. If you do not have internet access, call customer service using the phone number on the back of your insurance card. Maximum annual rewards of $100. One reward per Healthy Action per year. Healthy Action dates of service must be in the current plan year. Healthy Actions that earn rewards are subject to change. SilverSneakers® is a wellness program owned and operated by Tivity Health, Inc., an independent company. Tivity Health and SilverSneakers® are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries. Accredo is a specialty pharmacy that is contracted to provide services to members of BCBSOK. The relationship between Accredo and BCBSOK is that of independent contractors. Accredo is a trademark of Express Scripts Strategic Development, Inc. Express Scripts® Pharmacy is a pharmacy that is contracted to provide mail pharmacy services to members of BCBSOK. The relationship between Express Scripts® Pharmacy and BCBSOK is that of independent contractors. Express Scripts® Pharmacy is a trademark of Express Scripts Strategic Development, Inc. Express Scripts is an independent company and is solely responsible for the products and services that it provides. Blue365 is only available to Blue Cross and Blue Shield of Oklahoma (BCBSOK) members with active health plan coverage. Members who do not have active health plan with BCBSOK will not be able to register on the Blue365 website. The relationship between Blue365, its vendors and BCBSOK is that of independent contractors. Blue365 is a discount program available to BCBSOK members who have medical coverage with BCBSOK. This is NOT insurance. Some of the services offered through Blue365 may be covered under your health plan. Please refer to your benefit booklet or call the customer service number on the back of your ID card for specific benefit information under your health plan. Use of Blue365 does not affect your premium nor do costs of Blue365 services or products count toward your plan deductible, calendar year or lifetime maximums. Discounts are only available through participating vendors. BCBSOK does not guarantee or make any claims or recommendations regarding the services of products offered by Blue365 and its vendors. You may want to consult with your physician prior to use of these services and products. Services and products are subject to availability by location. BCBSOK reserves the right to discontinue or change this discount program at any time without notice. |
The only non-profit public trust health plan; owned, ran and for Oklahoma's local government organizations.