LEARN. COMPARE. ENROLL - 2020 Information K it Area
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LEARN.
COMPARE.
ENROLL.
Medicare Advantage Plans
2020 Information Kit
in the Gem State – Area 1
Boundary
Bonner
Kootenai
Benewah
Shoshone
Area 1
Latah
Clearwater
Nez Perce
Lewis
Idaho
Lemhi
Adams
Valley
Washington Clark
Custer Fremont
Payette
Gem
Boise
Teton
Madison
Jefferson
Ca
Butte
nyo
Bonneville
n
Blaine
Ada Elmore Camas
Bingham
Minidoka
Gooding
Lincoln
Caribou
Jerome Power
Bannock
Owyhee Twin Bear
Falls Cassia Oneida Lake
Franklin
Powered by Blue Cross of Idaho Care Plus, Inc. | Form No. 16-600 (09-19)
IDAHO COUNTIES COVERED
BY TRUE BLUE® (HMO) PLANS
Boundary
How We Can Serve You Bonner
To join a True Blue plan, you must be entitled to Medicare
Part A, be enrolled in Medicare Part B and live in our Kootenai
service area. Benewah
Shoshone
COVERED COUNTIES:
Latah
Clearwater
Ada, Adams, Boise, Bonner, Boundary, Canyon, Clark,
Nez Perce
Lewis
Elmore, Gem, Kootenai, Latah, Nez Perce, Owyhee, Idaho
Payette, Shoshone, Valley and Washington counties
COVERED COUNTIES FOR TRUE BLUE RX
Lemhi
Adams
Valley
PREFERRED (HMO): t Washington Clark
Ada and Canyon counties Payette
Custer Fremont
Gem
Boise
Teton
Madison
Jefferson
Ca
Butte
COVERED COUNTIES FOR TRUE BLUE RX
ny
on
Bonneville
Ada Elmore Camas Blaine
Bingham
ST. LUKE’S HEALTH PARTNERS (HMO): l
Minidoka
Gooding
Lincoln
Caribou
Ada, Adams, Boise, Canyon, Elmore, Gem, Owyee, Jerome Power
Bannock
Payette, Valley and Washington counties Owyhee Twin
Falls Cassia Oneida
Bear
Lake
Franklin
Terms to help you understand how
health plans work
PREMIUM COINSURANCE
The fixed cost you pay each month to be a A kind of cost sharing where you pay a
member of the health plan. percentage of the cost for some covered
services.
MEDICAL DEDUCTIBLE
The amount you pay before the health plan MAXIMUM OUT-OF-POCKET AMOUNT
helps with medical costs. Good news for you: A yearly limit on how much money you have
none of our plans have a medical deductible. to spend out of your own pocket for covered
healthcare. Once you reach that limit, you don’t
COPAY
pay anything for covered care for the rest of
A kind of cost sharing where you pay a fixed
your plan year.
dollar amount for some covered services.
ENROLL TODAY. ANNUAL ENROLLMENT PERIOD IS
OCTOBER 15 THROUGH DECEMBER 7.
KNOW WHAT TO EXPECT FROM YOUR HEALTH PLAN. MAKE THE CHOICE
THAT WORKS FOR YOU.
When it comes to finding the right Medicare coverage, we know you have choices.
Choosing the right health plan can seem confusing. Understanding how to make the
best choice is the first step in choosing the right plan with the coverage you want
and the benefits you deserve.
We are here to make it easier for you so you can get on with enjoying this exciting
time in your life with less worry, less hassle and more financial peace of mind.
There’s a reason why more Idahoans trust Blue Cross of Idaho Care Plus, Inc. than
any other health insurance company in the state. We understand when to step in and
help you through the health insurance process. We also know when to get out of the
way and let you work with your provider to take control of your health. And with
one of Idaho’s largest provider networks, chances are your provider is already
working with us.
We are Idahoans who have been helping Idahoans make the most informed
healthcare decisions for over 70 years. We’ve offered Medicare Advantage plans
since the program started in 1997, so we understand the important questions you
may have about Medicare Advantage. We give you the tools you need to make
informed decisions. We understand the important questions you may have about
Medicare coverage. Whether you are new to Medicare or returning as a valued
member, we will show you how to get the most out of your health plan.
If you’re already familiar with Medicare Advantage and want to jump into enrollment
right away, turn to the When to Enroll section (page 10). Make sure you review
the Benefits at a Glance and the Summary of Benefits before you complete your
enrollment.
Peter Sorensen,
Vice President of Medicare Advantage
H1350_MK20233_M
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. INFORMATION KIT 1
TAB LE OF CONTENTS
2 0 2 0 ME D I C A R E A D VA NTAGE P LANS
Here’s what’s inside:
Discover how Medicare works for you ................... 5
Learn how Medicare works and why choosing a Medicare Advantage plan
over Original Medicare can get you the coverage you need and the benefits
you deserve.
HELPFUL RESOURCES .................................................................................. 6
Formulary listing, latest doctor listing, latest participating pharmacies
listings, etc.
WHAT YOU NEED TO KNOW ABOUT MEDICARE ......................................... 7
Learn why Medicare Advantage is a good choice over Original Medicare,
how HMOs work and terms to help you understand the benefits and more.
WHEN TO ENROLL .................................................................................... 10
A checklist to help you prepare in enrolling for a Medicare Advantage plan.
FREQUENTLY ASKED QUESTIONS ............................................................. 11
Answers you need to enroll in a Medicare Advantage plan.
DETAILS ABOUT THE EXTRAS .................................................................... 13
Get more than Original Medicare.
2020 PRE-ENROLLMENT CHECKLIST ......................................................... 16
A helpful checklist to guide you to the right plan.
TRUE BLUE (HMO) SUMMARY OF BENEFITS .............................................. 17
In an easy-to-read chart, take a good look at our plans and what they cover.
FIND A DOCTOR, PHARMACY NETWORKS, DRUG LIST ............................. 39
We partnered with doctors and clinics all over Idaho to bring you high-quality care
you need and expect. Find a primary care provider (PCP) here. You can find dental
providers as well. We also offer you a convenient way to search for pharmacies
nearest you, and an easy way to look up prescription drugs in our formulary
(drug list).
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. INFORMATION KIT 3
Discover how Medicare works for you
Explore your options and
make the right choice
Learn how Medicare works and why choosing a Medicare Advantage plan over
Original Medicare can get you the coverage you need and the benefits you
deserve.
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. INFORMATION KIT 5
Helpful Resources
We make it easy to get answers to your questions and concerns about health
plans and benefits. Here are some helpful online resources and phone numbers to
direct you to the information you need. If you are looking for a network provider or
covered prescriptions, you can find it here.
1-888-494-2583
Calls to this number are free. October 1 to March 31, you can call us seven
days a week from 8 a.m. to 8 p.m. April 1 to September 30, you can call us
CALL
Monday – Friday from 8 a.m. to 8 p.m.
Customer Service also has free language interpreter services available for
non-English speakers.
1-800-377-1363
This number requires special telephone equipment and is only for people
TTY who have difficulties with hearing or speaking.
Calls to this number are free. We are available from 8 a.m. to 8 p.m.,
seven days a week.
FAX 1-208-387-6811
Blue Cross of Idaho Care Plus, Inc.
WRITE PO Box 8406
Boise, ID 83707
medicare.bcidaho.com
bcidaho.com/FindTrueBlueDoctors
USEFUL
bcidaho.com/FindTrueBluePreferredDoctors
WEBSITES
bcidaho.com/FindTrueBlueStLukesHealthPartnersDoctors
bcidaho.com/DrugList
CENTERS medicare.gov
FOR If you want to know more about the coverage and costs of Original
MEDICARE Medicare, look in your current “Medicare & You” handbook. View it online or
AND get a copy by calling toll-free 1-800-MEDICARE (1-800-633-4227), 24 hours a
MEDICAID day, seven days a week. TTY users should call 1-877-486-2048.
Find your level of Extra Help (Part D)
medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-
EXTRA HELP
of-extra-help-part-d
1-800-772-1213 (TTY 1-800-325-0778)
6 INFORMATION KIT
What you need to know about
Medicare
Original Medicare doesn’t cover everything
Original Medicare
Part A + Part B
Original Medicare is a government insurance program. It helps cover your
hospital, medical and benefits if you are 65 or older, have certain disabilities
or end-stage renal (kidney) disease. But Original Medicare covers only about
80 percent of your medical and hospital expenses.
You are responsible for paying the other 20 percent of your medical and
hospital costs – and 100 percent of your prescription drug costs.
Original Medicare doesn’t set a limit on your out-of-pocket expenses, so it’s
difficult to predict your financial risk. Your expenses could be more difficult
to manage without additional coverage. Original Medicare doesn’t offer
prescription drug coverage, so you’ll need to purchase a plan that has Part D
prescription drug coverage included.
MEDICARE ADVANTAGE PLANS
Original Medicare
Part A + Part B + Part D
(most often)
+ Extra
Benefits
= Medicare
Advantage
(Part C)
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. INFORMATION KIT 7
What You Need to Understand about the Parts
of Medicare
These plans provide all of the benefits you are entitled to under Medicare – plus
extra benefits, including Medicare Part D prescription drug coverage. Medicare
Advantage plans provide these benefits through a contract with the government.
These plans are offered by companies such as Blue Cross of Idaho Care Plus, Inc.
Part B is medical coverage. Most Medicare
Part A is beneficiaries pay a premium for Part B
hospital coverage.
coverage.
Part B is
Part A helps cover your inpatient
medical
care in hospitals, or nursing coverage.
facilities, home health and hospice
care. Most people automatically Medicare Part B also covers a limited
get Part A without having to pay a number of outpatient prescription
monthly premium. drugs like chemotherapy (under limited
conditions). These are usually drugs given
directly by a doctor in an outpatient
hospital setting.
IMPORTANT: If you don’t sign up for Part B during your Initial
Enrollment Period, you may pay a permanent late enrollment
penalty of 10% for every year that you delay.
8 INFORMATION KIT
Medicare Part C and Part D are important options that can help you pay some
of the out-of-pocket costs not covered by Original Medicare. Blue Cross of Idaho
Care Plus, Inc. has a contract with Medicare to provide Part C and Part D coverage
in your community.
Part D is
Part C is prescription
also known drug coverage.
as Medicare
Advantage. Part D coverage is designed to help
lower your prescription drug costs. Part
Part C coverage is provided by D coverage is available in stand-alone
Medicare Advantage plans and plans or may be included with a Medicare
includes all of Part A and Part B Advantage plan.
coverage as well as extra benefits.
For some plans, you pay a monthly
premium.
Medicare Advantage plans include Medicare Part D coverage. You will pay a monthly
premium for Medicare Part D coverage unless you qualify for financial assistance.
You’ll likely pay less for your prescription, and often simply pay a copay or
coinsurance for your drug. Part D has four stages of coverage. In each stage you pay
a different share of the cost.
If you do not enroll for Part D prescription coverage when you
first become eligible for Medicare, you may be subject to a
late-enrollment penalty. The cost of the late enrollment penalty
depends on how long you went without Part D or creditable
prescription drug coverage. Visit medicare.gov for more
details.
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. INFORMATION KIT 9
When to Enroll
You may enroll in a Medicare Advantage or Part D
prescription drug plan as early as 3 months before
If you are ready to
the month you turn 65. This is called the Initial
Enrollment Period. enroll in a Medicare
Your Initial Enrollment Period lasts for 7 months – Advantage plan, simply
starting 3 months before the month you turn 65 turn the page.
and ending 3 months after the month you turn
65. You should sign up for Medicare three months
before you turn 65 even if you don’t plan to retire You’ll find everything
at 65.
you need to get started,
It’s important to choose a plan that includes
including an enrollment
Medicare Part D prescription drug coverage
during your Initial Enrollment Period. If you don’t, form, Medicare Star
you may be subject to a late enrollment penalty if Ratings for our plans,
you decide you want this coverage later.
and a pre-paid return
After your Initial Enrollment Period, you’ll have at
envelope.
least one opportunity each year to enroll or make
new choices during Medicare’s Annual Enrollment
Period, which is from October 15 through
If you need help, please
December 7.
give us a call at
Except under special circumstances, you may
only choose or change your Part C Medicare 1-888-494-2583, or
Advantage plan or Part D prescription drug plan TTY 1-800-377-1363.
each fall, during the Medicare Annual Enrollment
You can also contact
Period (AEP).
your independent
The choices you make during the Annual
Enrollment Period take effect January 1 of the insurance agent
upcoming year. This includes additional coverage for assistance.
you may need.
10 INFORMATION KITFrequently Asked Questions
Why choose a Medicare Advantage plan over
Original Medicare?
• Original Medicare (Parts A and B) only pays 80 percent for covered services.
• Original Medicare does not cap annual out-of-pocket expenses for covered
services.
If you have a year in which you need a lot of services, or multiple hospital stays, you
could end up paying tens of thousands of dollars – because there is no cap on your
financial responsibility.
With our Medicare Advantage plans, you will have the protection and peace of
mind knowing there is an annual out-of pocket maximum. If you reach the maximum
amount, you pay nothing for covered medical services for the rest of the year.
A few other questions to consider:
ARE MY DOCTORS IN YOUR NETWORK?
We contract with one of the largest provider networks in Idaho. There is a very good
chance that your doctors, hospitals and other providers are part of the True Blue
network. For the most up-to-date listing, please visit bcidaho.com/FindAProvider.
WHAT DO YOU COVER AND WHAT WILL I PAY?
We cover everything Original Medicare covers – and more! Review the Benefits at a
Glance brochure that came with this booklet. It provides a brief comparison of our
plans, letting you know what services are covered and what you will pay. See the
Summary of Benefits section of this booklet if you need more information on what
you pay for covered services.
ARE MY DRUGS COVERED?
Our Formulary (or list of covered drugs) has a wide range of generic and brand name
drugs to meet your needs. Our plans that include Part D coverage offer preferred
generic drugs at no cost from preferred network pharmacies. To see what drugs
we cover, and what pharmacies are part of our network, please visit bcidaho.com/
FindAPharmacy.
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. INFORMATION KIT 11WHY SHOULD I PICK A PRIMARY CARE PROVIDER (PCP)?
Our True Blue HMO (Health Maintenance Organization) plans require you to choose
a primary care provider (PCP). They are responsible for helping you navigate and
access health plan services.
NO REFERRALS REQUIRED.
None of our HMO plans require you to have a referral from your doctor to see in-
network providers of your choice. Some specialists might have their own policy to
ask you for a referral before you can see them.
COPAYS MAKE IT EASY.
One of the main features of HMO plans is that they generally feature predictable
copays for most services, rather than coinsurance ($20 copay versus 20 percent
coinsurance).
AM I COVERED WHEN I LEAVE IDAHO?
All of our plans feature worldwide coverage for urgent and emergency services.
Most of our HMO plans come with a Convenience Care benefit while seeing a
provider outside of Idaho.
Ask us for more details on coverage limits and restrictions
12 INFORMATION KITBenefits with our True Blue plans
Below, we’ve listed some of the benefits you get with our Medicare Advantage plans.
The copay or coinsurance for each benefit depends on the plan you pick.
ROUTINE EYEWEAR NEW FOR 2020 NURSE ADVICE LINE
MDLIVE®*
$35 copay, complete Easy, on-demand Call 24-hours a day,
pair of glasses doctor visits seven days a week
WELLNESS CONVENIENCE HEARING AIDS
PROGRAM CARE*
$50 annual copay for $2,500 maximum for Copays of $999
gym membership each calendar year or less
OVER-THE-COUNTER Optional Supplemental Dental Plans
HEALTHY SMILES BASIC
If you enroll in True Blue Rx, True Blue no Rx,
True Blue Rx Gem, True Blue Rx Preferred or
$40 every three months True Blue Rx St. Luke’s Health Partners, you can
on approved items add Healthy Smiles Basic for an additional $9.40
per month. Basic dental services have a six-month
waiting period without evidence of prior continuous
coverage.
*Not available for
St. Luke’s Health HEALTHY SMILES PLUS
Partners Plan. If you enroll in True Blue Rx Option I or True Blue
Rx Option II, you can add Healthy Smiles Plus for
an additional $23.40 per month. Preventive and
diagnostic dental services have no waiting period;
basic dental services have a six-month
waiting period without evidence of prior
continuous coverage.
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. INFORMATION KIT 13True Blue (HMO) Summary of Benefits
Every important decision
begins with information.
On the next few pages, you can see detailed benefit information about our
True Blue plans, including your out-of-pocket costs, your monthly premium,
what we cover and more.
With low office visit copays, a gym membership discount, preferred generic
prescriptions, low out-of-pocket maximums, and no referrals for specialists
visits, True Blue gives you an all-around approach to good health with
healthcare services from local providers you know and trust.
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. INFORMATION KIT 152020 Pre-Enrollment Checklist
True Blue Rx Gem, True Blue Rx, True Blue Rx Option I, True Blue Rx Option II,
True Blue Rx Preferred, True Blue Rx St. Luke’s Health Partners, True Blue No Rx
Before making an enrollment decision, it is important that you fully understand our
benefits and rules. If you have any questions, you can call and speak to a customer service
representative toll-free at 1-888-494-2583 (TTY 1-800-377-1363), 8 a.m. to 8 p.m., seven
days a week from October 1 to March 31. Between April 1 to September 30, we are open
Monday through Friday, 8 a.m. to 8 p.m.
UNDERSTANDING YOUR BENEFITS
Review the full list of benefits found in the Evidence of Coverage (EOC), especially for
those services for which that you routinely see a doctor. Visit medicare.bcidaho.com or
call 1-888-494-2583 (TTY 1-800-377-1363) to view a copy of the EOC.
Review the Provider Directory (or ask your doctor) to make sure the doctors you see
now are in the network. If they are not listed, it means you will likely have to select a new
doctor.
Review the Pharmacy Directory to make sure the pharmacy you use for any prescription
medications is in the network. If the pharmacy is not listed, you will likely have to select a
new pharmacy for your prescriptions.
UNDERSTANDING IMPORTANT RULES
In addition to your monthly plan premium, you must continue to pay your Medicare Part B
premium. This premium is normally taken out of your Social Security check each month.
Benefits, premiums and/or copayments/coinsurance may change on January 1, 2021.
Except in emergency or urgent situations, we do not cover services by out-of-network
providers (doctors who are not listed in the provider directory). Noncontracted providers
who are out of our network may deny care, except in an emergency or urgent situations.
You may be responsible for all of the cost associated with these services.
For more information, we are available 8 a.m. to 8 p.m., seven days a week from October 1
to March 31. Between April 1 to September 30, we are open Monday through Friday,
8 a.m. to 8 p.m. Call us toll-free at 1-888-494-2583 (TTY 1-800-377-1363).
Or visit us at medicare.bcidaho.com.
16 INFORMATION KITTRUE BLUE® (HMO)
AREA 1
202 0 S U M MARY OF BE NE FIT S
SERVING SELECT
COUNTIES IN IDAHO
Ada, Adams, Boise, Bonner,
Boundary, Canyon, Clark,
Elmore, Gem, Kootenai,
Latah, Nez Perce, Owhyee,
Payette, Shoshone, Valley
and Washington counties
H1350_MK20068_M Powered by Blue Cross of Idaho Care Plus, Inc. | Form No. 16-011 (09-19)Call us to learn more
CURRENT MEMBER? TOLL FREE PROSPECTIVE MEMBER? TOLL-FREE
1-888-494-2583 1-888-492-2583
TTY 1-800-377-1363 TTY 1-800-377-1363
We are available from 8 a.m. to 8 p.m. seven days a week, from October 1 to March 31.
Between April 1 to September 30, we are open 8 a.m. to 8 p.m., Monday through Friday.
WEBSITE MEDICARE
medicare.bcidaho.com medicare.gov
FOR MORE INFORMATION
bcidaho.com/FindTrueBlueDoctors
bcidaho.com/FindTrueBluePreferredDoctors
bcidaho.com/FindTrueBlueStLukesHealthPartnersDoctors
bcidaho.com/DrugList
Email: sales@bcidaho.com
The benefit information provided is a summary of what we cover and what you pay. It does not
list every service that we cover or list every limitation or exclusion. To get a complete list of
services we cover, please request the Evidence of Coverage. You can request an Evidence of
Coverage by calling Blue Cross of Idaho Care Plus, Inc. at the numbers listed above.
If you want to know more about the coverage and costs of Original Medicare, look in your current
“Medicare & You” handbook. View it online at medicare.gov or get a copy by calling toll-free
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day, seven days a week.
2 SUMMARY OF BENEFITS BLUE CROSS OF IDAHO CARE PLUSIDAHO COUNTIES COVERED
BY TRUE BLUE® (HMO) PLANS
Boundary
How We Can Serve You Bonner
To join a True Blue plan, you must be entitled to Medicare
Part A, be enrolled in Medicare Part B, and live in our Kootenai
service area. Benewah
Shoshone
Latah
COVERED COUNTIES: Clearwater
Nez Perce
Ada, Adams, Boise, Bonner, Boundary, Canyon, Clark, Lewis
Elmore, Gem, Kootenai, Latah, Nez Perce, Owyhee, Idaho
Payette, Shoshone, Valley and Washington counties
COVERED COUNTIES FOR TRUE BLUE RX
Lemhi
Adams
Valley
PREFERRED (HMO): t Washington Clark Fremont
Ada and Canyon counties
Custer
Payette
Gem
Boise
Teton
Madison
Jefferson
Ca
Butte
ny
COVERED COUNTIES FOR TRUE BLUE RX
on
Bonneville
Ada Elmore Camas Blaine
Bingham
ST. LUKE’S HEALTH PARTNERS (HMO): l
Minidoka
Gooding
Lincoln
Caribou
Ada, Adams, Boise, Canyon, Elmore, Gem, Owhyee, Jerome Power
Bannock
Payette, Valley and Washington counties Owyhee Twin
Falls Cassia Oneida
Bear
Lake
Franklin
Terms to help you understand how
health plans work
PREMIUM COINSURANCE
The fixed cost you pay each month to be a A kind of cost sharing where you pay a
member of the health plan. percentage of the cost for some covered
services.
MEDICAL DEDUCTIBLE
The amount you pay before the health plan MAXIMUM OUT-OF-POCKET AMOUNT
helps with medical costs. Good news for you: A yearly limit on how much money you have
none of our plans have a medical deductible. to spend out of your own pocket for covered
healthcare. Once you reach that limit, you don’t
COPAY
pay anything for covered care for the rest of
A kind of cost sharing where you pay a fixed
your plan year.
dollar amount for some covered services.
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. SUMMARY OF BENEFITS 34 SUMMARY OF BENEFITS
Which doctors, hospitals and
pharmacies can I use?
True Blue plans have a network of doctors, hospitals, pharmacies and other
providers. If you use providers that are not in our network, the plan may not
pay for these services.
Our True Blue plans come with a primary care provider (PCP). This person
serves as your personal health advisor, helping you know what care you need
and how to get it. None of our HMO plans require you to have a referral from
your PCP to see other doctors.
• You can see our plan’s provider directory by visiting
bcidaho.com/FindTrueBlueDoctors,
bcidaho.com/FindTrueBluePreferredDoctors or
bcidaho.com/FindTrueBlueStLukesHealthPartnersDoctors.
• You can find pharmacies in our network by visiting
bcidaho.com/FindAPharmacy.
• Or call us and we can help you find a doctor or pharmacy, or send you a
provider directory.
Are my prescription drugs
covered?
Almost all of our True Blue plans cover Part D drugs. We also cover Part B
drugs such as chemotherapy drugs and other medicines given directly by
your doctor.
• Not all plans use the same list of covered drugs (formulary). This means
covered prescription drugs for each plan with Part D prescription drug
coverage may be different.
• True Blue Rx St. Luke’s Health Partners (HMO), True Blue Rx (HMO),
True Blue Rx Preferred (HMO) and True Blue Rx Gem (HMO) use the
Standard formulary.
• True Blue Rx Option I (HMO) and True Blue Rx Option II (HMO) use
the Performance formulary.
• See the complete covered drug list and any restrictions on our website
at medicare.bcidaho.com. Choose Prescription Resources from the
menu at the top of the page.
• You can search for drugs and their costs at bcidaho.com/DrugList.
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. SUMMARY OF BENEFITS 5True Blue Rx St. Luke’s True Blue Rx True Blue
Premiums and Benefits
Health Partners (HMO)* Preferred (HMO)** Rx Gem (HMO)
Plan Number H1350-023-001 H1350-021-000 H1350-022-001
Monthly Plan Premium
You must continue to You pay nothing You pay nothing You pay $15
pay your Medicare Part
B premium
Medical Deductible
These plans do not have You pay nothing You pay nothing You pay nothing
a medical deductible
Maximum Out-of- The most you pay for copays, coinsurance and other costs
Pocket Responsibility for covered Part A and Part B medical services for the year.
Does not include
prescription drugs or $5,800 $5,600 $5,400
monthly plan premium
Inpatient Hospital Prior authorization may be required for some services.
Coverage Our plans cover an unlimited number of days for an inpatient hospital stay.
$275 daily – 1-5 days $325 daily – 1-4 days $325 daily – 1-4 days
$0 daily – 6-90 days $0 daily – 5-90 days $0 daily – 5-90 days
Outpatient Hospital
Coverage $250 copay $250 copay $300 copay
Outpatient Hospital
Doctor Visits Tier 1 – You pay nothing
You pay nothing $5 copay
Primary Care Tier 2 – $10 copay
Specialists
No referral required for $40 copay $40 copay $40 copay
specialist visits
Preventive Care You pay nothing You pay nothing You pay nothing
Emergency Care If you are admitted to the hospital within 24 hours for the same condition,
you do not have to pay your share of the cost for emergency care.
$90 copay $90 copay $90 copay
Urgently Needed Cost sharing for necessary urgently needed services furnished
Services out-of-network is the same as for such services furnished in-network.
Urgent Care Tier 1 – You pay nothing
$40 copay $40 copay
Tier 2 – $40 copay
Worldwide Emergency
and Urgent Coverage
$90 copay $90 copay $90 copay
($25,000 benefit
maximum)
Diagnostic Services/ Prior authorization is required for some services by your doctor or other
Labs/Imaging network provider. Please contact the plan for more information.
*True Blue Rx St. Luke’s Health Partners is only available in Ada, Adams, Boise, Canyon, Elmore, Gem,
Owhyee, Payette, Valley and Washington counties.
**True Blue Rx Preferred is only available in Ada and Canyon counties.
6 SUMMARY OF BENEFITSTrue Blue True Blue Rx True Blue Rx True Blue
Rx (HMO) Option I (HMO) Option II (HMO) no Rx (HMO)
H1350-019-001 H1350-015-001 H1350-016-001 H1350-006-000
You pay $55 You pay $142 You pay $95 You pay $29
You pay nothing You pay nothing You pay nothing You pay nothing
The most you pay for copays, coinsurance and other costs
for covered Part A and Part B medical services for the year.
$6,200 $6,500 $6,400 $3,000
Prior authorization may be required for some services.
Our plans cover an unlimited number of days for an inpatient hospital stay.
$295 daily – 1-6 days $225 daily – 1-5 days $300 daily – 1-5 days $100 daily – 1-5 days
$0 daily – 7-90 days $0 daily – 6-90 days $0 daily – 6-90 days $0 daily – 6-90 days
$275 copay $250 copay $325 copay $100 copay
$10 copay $5 copay $10 copay $10 copay
$35 copay $30 copay $40 copay $25 copay
You pay nothing You pay nothing You pay nothing You pay nothing
If you are admitted to the hospital within 24 hours for the same condition,
you do not have to pay your share of the cost for emergency care.
$90 copay $90 copay $90 copay $90 copay
Cost sharing for necessary urgently needed services furnished
out-of-network is the same as for such services furnished in-network.
$40 copay $25 copay $40 copay $25 copay
$90 copay $90 copay $90 copay $90 copay
Prior authorization is required for some services by your doctor or other
network provider. Please contact the plan for more information.
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. SUMMARY OF BENEFITS 7True Blue Rx St. Luke’s True Blue Rx True Blue
Premiums and Benefits
Health Partners (HMO)* Preferred (HMO)** Rx Gem (HMO)
Plan Number H1350-023-001 H1350-021-000 H1350-022-001
Diagnostic Tests
20% of the cost 20% of the cost 20% of the cost
and Procedures
Lab Services Tier 1 – You pay nothing
$15 copay $10 copay
Tier 2 – $20 copay
Diagnostic Radiology
20% of the cost 20% of the cost 20% of the cost
(MRI, CT, PET)
X-rays Tier 1 – You pay nothing
$15 copay $15 copay
Tier 2 – $15 copay
Hearing Services
Medicare-covered exam
to diagnose and treat $45 copay $45 copay $45 copay
hearing and balance
issues
Additional Hearing
Benefits
$45 copay $45 copay $45 copay
Annual routine hearing
exam
Hearing Aids Up to two TruHearing-branded hearing aids every year
(one per ear per year). Benefit is limited to the TruHearing Advanced
and Premium hearing aids with an optional $75 additional cost per
rechargeable aid.
Advanced $699 copay; Premium $999 copay
Dental Services Limited Medicare dental benefit (does not include services in connection
with care, treatment, filling, removal or replacement of teeth)
$40 copay $40 copay $40 copay
Additional Preventive $10 for routine oral $10 for routine oral $10 for routine oral
Dental Benefits exams, cleanings and exams, cleanings and exams, cleanings and
X-rays X-rays X-rays
Includes two oral exams, two cleanings, and two bitewing
X-rays every year and one full mouth X-ray every three years;
$500 coverage limit per year
*True Blue Rx St. Luke’s Health Partners is only available in Ada, Adams, Boise, Canyon, Elmore, Gem,
Owhyee, Payette, Valley and Washington counties.
**True Blue Rx Preferred is only available in Ada and Canyon counties.
8 SUMMARY OF BENEFITSTrue Blue True Blue Rx True Blue Rx True Blue
Rx (HMO) Option I (HMO) Option II (HMO) no Rx (HMO)
H1350-019-001 H1350-015-001 H1350-016-001 H1350-006-000
20% of the cost 10% of the cost 15% of the cost You pay nothing
$5 copay $10 copay You pay nothing You pay nothing
20% of the cost 10% of the cost 15% of the cost $175 copay
$15 copay $10 copay $15 copay You pay nothing
$45 copay $45 copay $45 copay $45 copay
$45 copay $45 copay $45 copay $45 copay
Up to two TruHearing-branded hearing aids every year
(one per ear per year). Benefit is limited to the TruHearing Advanced
and Premium hearing aids with an optional $75 additional cost per
rechargeable aid.
Advanced $699 copay; Premium $999 copay
Limited Medicare dental benefit (does not include services in connection
with care, treatment, filling, removal or replacement of teeth)
$35 copay $25 copay $30 copay $25 copay
$10 for routine oral $10 for routine oral
exams, cleanings and Not covered Not covered exams, cleanings and
X-rays X-rays
Includes two oral Includes two oral
exams, two cleanings, exams, two cleanings,
and two bitewing and two bitewing
X-rays every year and X-rays every year and
Not covered Not covered
one full mouth X-ray one full mouth X-ray
every three years; every three years;
$500 coverage limit $500 coverage limit
per year per year
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. SUMMARY OF BENEFITS 9True Blue Rx St. Luke’s True Blue Rx True Blue
Premiums and Benefits
Health Partners (HMO)* Preferred (HMO)** Rx Gem (HMO)
Plan Number H1350-023-001 H1350-021-000 H1350-022-001
Optional Healthy Smiles Basic Healthy Smiles Basic Healthy Smiles Basic
Supplemental
Dental Plan
$50 deductible; Basic dental services (fillings, extractions) covered
at 80% of maximum allowance after deductible; $750 benefit maximum
six-month waiting period for all basic services without proof
of continuous prior coverage
Vision Services
Medicare-covered
eye exam to diagnose You pay nothing You pay nothing You pay nothing
& treat diseases and
conditions
Additional Vision
Benefits
$20 copay $20 copay $20 copay
Annual routine eye
exam
Eyewear $35 copay for one pair of glasses (lenses and frames in the VSP Genesis
Collection); $50 allowance for non-Genesis frames. In lieu of glasses there is
a $100 allowance towards contacts. Benefit is for every two years.
Mental Health Services $275 daily – 1-5 days $325 daily – 1-4 days $300 daily – 1-4 days
Inpatient Visit $0 daily – 6-90 days $0 daily – 5-90 days $0 daily – 5-90 days
Outpatient Mental
Health Care $20 copay $40 copay $40 copay
(Individual and Group)
Skilled Nursing Facility Our plan covers up to 100 days per benefit period in a Skilled Nursing
(SNF) Facility. Prior authorization may be required for some services.
$0 daily – 1-20 days $0 daily – 1-20 days
$0 daily – 1-20 days
$160 daily – 21-63 days $160 daily – 21-63 days
$175 daily – 21-100 days
$0 daily – 64-100 days $0 daily – 64-100 days
Outpatient
Rehabilitation
Physical Therapy, $20 copay $40 copay $40 copay
Speech Therapy,
Occupational Therapy
*True Blue Rx St. Luke’s Health Partners is only available in Ada, Adams, Boise, Canyon, Elmore, Gem,
Owhyee, Payette, Valley and Washington counties.
**True Blue Rx Preferred is only available in Ada and Canyon counties.
10 SUMMARY OF BENEFITSTrue Blue True Blue Rx True Blue Rx True Blue
Rx (HMO) Option I (HMO) Option II (HMO) no Rx (HMO)
H1350-019-001 H1350-015-001 H1350-016-001 H1350-006-000
Healthy Smiles Basic Healthy Smiles Plus Healthy Smiles Plus Healthy Smiles Basic
$50 deductible; Basic $50 deductible; Basic
dental services (fillings, dental services (fillings,
extractions) covered extractions) covered
at 80% of maximum at 80% of maximum
Includes the benefits of Healthy Smiles Basic,
allowance after allowance after
plus preventive dental services (oral exams,
deductible; $750 benefit deductible; $750 benefit
cleanings, & X-rays) with no deductible or benefit
maximum six-month maximum six-month
maximum for in-network care
waiting period for all waiting period for all
basic services without basic services without
proof of continuous prior proof of continuous prior
coverage coverage
You pay nothing You pay nothing You pay nothing You pay nothing
$20 copay $20 copay $20 copay $20 copay
$35 copay for one pair of glasses (lenses and frames in the VSP Genesis
Collection); $50 allowance for non-Genesis frames. In lieu of glasses there is
a $100 allowance towards contacts. Benefit is for every two years.
$290 daily – 1-6 days $175 daily – 1-5 days $295 daily – 1-5 days $100 daily – 1-5 days
$0 daily – 7-90 days $0 daily – 6-90 days $0 daily – 6-90 days $0 daily – 6-90 days
$40 copay $25 copay $40 copay $25 copay
Our plan covers up to 100 days per benefit period in a Skilled Nursing
Facility. Prior authorization may be required for some services.
$0 daily – 1-20 days $0 daily – 1-20 days $0 daily – 1-20 days $0 daily – 1-20 days
$175 daily – 21-100 days $175 daily – 21-100 days $175 daily – 21-100 days $150 daily – 21-100 days
$40 copay $25 copay $40 copay $15 copay
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. SUMMARY OF BENEFITS 11True Blue Rx St. Luke’s True Blue Rx True Blue
Premiums and Benefits
Health Partners (HMO)* Preferred (HMO)** Rx Gem (HMO)
Plan Number H1350-023-001 H1350-021-000 H1350-022-001
Ambulance Prior authorization is required for non-emergency transportation.
Ground or Air transport $270 copay $270 copay $270 copay
Ambulatory Surgery
$250 $250 $300
Center
Transportation Not Covered Not Covered Not Covered
Medicare Part B Part B drugs are usually administered in an inpatient hospital setting, like
Prescription Drugs chemotherapy drugs. These are not the same as Part D prescription drugs.
20% of the cost 20% of the cost 20% of the cost
Part D Prescription True Blue Rx St. Luke’s Health Partners, True Blue Rx Preferred and
Drug Deductible True Blue Rx Gem have Part D Deductibles. There is no deductible for
Tiers 1-2 Tier 1 and Tier 2 generic prescription drugs.
Tiers 3-5 $175 per year for $150 per year for $150 per year for
prescriptions in prescriptions in prescriptions in
Tiers 3-5 Tiers 3-5 Tiers 3-5
Annual Physical Exam You pay nothing You pay nothing You pay nothing
Benefit Services
Not covered $10 copay $5 copay
through MDLIVE®
Podiatry Services Foot exams and treatment if you have diabetes-related nerve damage
Medicare-covered foot and/or meet certain conditions.
exams and treatment $40 copay $40 copay $40 copay
Additional Podiatry
Benefits $40 copay per visit;
Not covered Not covered
6 visits per year
Routine foot care
Medical Supplies
Durable Medical
20% of the cost 20% of the cost 20% of the cost
Equipment
(wheelchairs, oxygen)
Prosthetics
20% of the cost 20% of the cost 20% of the cost
(braces, artificial limbs)
Diabetes Supplies You pay nothing You pay nothing You pay nothing
Diabetes Shoes/Inserts 20% of the cost 20% of the cost 20% of the cost
Wellness Programs Silver&Fit® Exercise and Healthy Aging Program
Silver&Fit®
$50 annually $50 annually $50 annually
Gym Membership
Silver&Fit® $10 annually $10 annually $10 annually
Home Exercise kits for two kits for two kits for two kits
Over-the-Counter $40 allowance every $40 allowance every $40 allowance every
(OTC) Items three months three months three months
*True Blue Rx St. Luke’s Health Partners is only available in Ada, Adams, Boise, Canyon, Elmore, Gem,
Owhyee, Payette, Valley and Washington counties. **True Blue Rx Preferred is only available in Ada
and Canyon counties.
12 SUMMARY OF BENEFITSTrue Blue True Blue Rx True Blue Rx True Blue
Rx (HMO) Option I (HMO) Option II (HMO) no Rx (HMO)
H1350-019-001 H1350-015-001 H1350-016-001 H1350-006-000
Prior authorization is required for non-emergency transportation.
$270 copay $250 copay $275 copay $175 copay
$275 $250 $325 $100
Not Covered Not Covered Not Covered Not Covered
Part B drugs are usually administered in an inpatient hospital setting, like
chemotherapy drugs. These are not the same as Part D prescription drugs.
20% of the cost 20% of the cost 20% of the cost 10% of the cost
There is no deductible for There is no deductible for
Tier 1 and Tier 2 generic No deductible Tier 1 and Tier 2 generic Not covered
prescription drugs. prescription drugs.
$100 per year for $250 per year for
prescriptions in No deductible prescriptions in Not covered
Tiers 3-5 Tiers 3-5
You pay nothing You pay nothing You pay nothing You pay nothing
$10 copay $5 copay $10 copay $10 copay
Foot exams and treatment if you have diabetes-related nerve damage
and/or meet certain conditions.
$40 copay $25 copay $40 copay $25 copay
Not covered Not covered Not covered Not covered
20% of the cost 20% of the cost 20% of the cost 10% of the cost
20% of the cost 20% of the cost 20% of the cost 10% of the cost
You pay nothing You pay nothing You pay nothing You pay nothing
20% of the cost 20% of the cost 20% of the cost 10% of the cost
Silver&Fit® Exercise and Healthy Aging Program
$50 annually $50 annually $50 annually $50 annually
$10 annually $10 annually $10 annually $10 annually
for two kits for two kits for two kits for two kits
$40 allowance every $40 allowance every $40 allowance every $40 allowance every
three months three months three months three months
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. SUMMARY OF BENEFITS 13How Part D Prescription Drug Coverage
Works
The costs you pay may change depending on the pharmacy you choose and when you enter another
stage of the Part D benefit. For more information on your pharmacy-specific costs and the stages of
your Part D benefit, please call us or get an Evidence of Coverage online at medicare.bcidaho.com.
STAGE 1 – ANNUAL DEDUCTIBLE Tier 1 and 2 generic drugs do not have a
You are responsible for the cost of your deductible.
prescription drugs until you have met the
deductible.
STAGE 2 – INITIAL COVERAGE PERIOD You pay a small amount until you reach $4,020
You are responsible for a limited in total drug costs. See the chart at the right for
copay or coinsurance. what you might pay.
STAGE 3 – COVERAGE GAP In most cases, you pay 25% for covered generic
You are responsible for a larger copay or drugs, and 25% (plus dispensing fee) for covered
coinsurance until you have met your brand drugs until you meet your $6,350 in true
true out-of-pocket costs. out-of-pocket costs. The amount paid by the
drug manufacturer combined with the 25% you
pay, count toward your true out-of-pocket cost.
STAGE 4 – CATASTROPHIC COVERAGE You pay the greater of either the copay
You are responsible for a limited copay or ($3.60 for generics, $8.95 for all others) or a
coinsurance. 5% coinsurance for the remainder of the plan
year.
We pay
You pay
14 SUMMARY OF BENEFITSPart D: Your Share of the Costs
The costs you pay may change depending on the pharmacy you choose and when you enter another
stage of the Part D benefit. For more information on your pharmacy-specific costs and the stages of
your Part D benefit, please call us or get an Evidence of Coverage online at medicare.bcidaho.com.
True Blue Rx
True Blue Rx
Rx Preferred
Rx Option II
Rx Option I
True Blue
True Blue
True Blue
True Blue
St. Luke’s
Partners
Rx Gem
Health
Formulary Name Standard Standard Standard Standard Performance Performance
$175 for $150 for $150 for $100 for $250 for
Part D Deductible $0
Tiers 3,4,5 Tiers 3,4,5 Tiers 3,4,5 Tiers 3,4,5 Tiers 3,4,5
PREFERRED RETAIL COST – 30-DAY SUPPLY
Tier 1
$0 $0 $0 $3 copay $0 $3 copay
(Preferred Generic)
Tier 2 (Generic) $6 copay $6 copay $6 copay $12 copay $12 copay $12 copay
Tier 3
$31 copay $31 copay $31 copay $31 copay $35 copay $37 copay
(Preferred Brand)
Tier 4
$90 copay $90 copay $90 copay $90 copay $85 copay $90 copay
(Non-Preferred)
Tier 5 (Specialty Tier) 29% of cost 30% of cost 30% of cost 31% of cost 33% of cost 28% of cost
NON-PREFERRED RETAIL COST – 30-DAY SUPPLY
Tier 1
$5 copay $15 copay $15 copay $15 copay $5 copay $10 copay
(Preferred Generic)
Tier 2 (Generic) $15 copay $20 copay $20 copay $20 copay $20 copay $20 copay
Tier 3
$47 copay $47 copay $47 copay $47 copay $45 copay $47 copay
(Preferred Brand)
Tier 4
$100 copay $100 copay $100 copay $100 copay $95 copay $100 copay
(Non-Preferred)
Tier 5 (Specialty Tier) 29% of cost 30% of cost 30% of cost 31% of cost 33% of cost 28% of cost
MAIL ORDER COST – 90-DAY SUPPLY
Tier 1
$0 $0 $0 $9 copay $0 $9 copay
(Preferred Generic)
Tier 2 (Generic) $18 copay $18 copay $18 copay $36 copay $36 copay $36 copay
Tier 3
$93 copay $93 copay $93 copay $93 copay $105 copay $111 copay
(Preferred Brand)
Tier 4
$270 copay $270 copay $270 copay $270 copay $255 copay $270 copay
(Non-Preferred)
29% of cost 30% of cost 30% of cost 31% of cost 33% of cost 28% of cost
Tier 5
(30-day (30-day (30-day (30-day (30-day (30-day
(Specialty Tier)
supply only) supply only) supply only) supply only) supply only) supply only)
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. SUMMARY OF BENEFITS 15Benefits you get with our True Blue plans
PLANS MAY OFFER SUPPLEMENTAL BENEFITS IN ADDITION TO PART C BENEFITS AND
PART D BENEFITS.
Below, we’ve listed some of the benefits you get with our Medicare Advantage plans. The copay
or coinsurance for each benefit depends on the plan you pick.
ROUTINE EYEWEAR HEARING AIDS OVER-THE-COUNTER
$35 copay, complete Copays of $999 $40 every three months
pair of glasses or less on approved items
Get low out-of-pocket Save big on your hearing You also get help with over-
costs with Vision Service with coverage through the-counter (OTC) products
Plan (VSP) providers for TruHearing. such as vitamins, pain
your yearly vision exam. relievers, cold medicine
• A hearing exam plus and bandages.
• $20 copay for your three follow-up visits
yearly vision exam • $40 every three months
• Hearing aids with
to spend on approved
• $35 copay for a copays of $999 or
items
complete pair of less and optional $75
glasses from the additional cost per aid • Your allowance resets
Genesis Collection for rechargeability. January, April, July and
(frames and lenses) Call TruHearing at October
Call VSP at 1-800-877-7195 1-855-205-5392 or visit
or visit vsp.com to learn truhearing.com for more
more. information.
New Benefits for 2020
MDLIVE®
Visit with a doctor privately and securely with an easy, on-demand mobile app, video
or phone. Visit MDLIVE at mdlive.com/bcimedicare for more information. Or call
1-844-296-8784 (TTY 711) any time or day. Not available for the True Blue Rx St. Luke’s
Health Partners plan.
16 SUMMARY OF BENEFITSWELLNESS CONVENIENCE CARE NURSE ADVICE LINE
PROGRAM
$50 annual copay for $2,500 maximum for Call 24-hours a day,
gym membership each calendar year seven days a week
For only $50 a year, For care while you are Any time, day or night, you
Silver&Fit gets you a within the U.S. but outside can speak with a registered
membership at any of the state of Idaho, our nurse at no cost to you.
network fitness club and Convenience Care program
provides you with $2,500 Ask questions about your
exercise centers around
coverage at no additional prescriptions, finding a
the state and across the
cost to you. doctor or specialist, or
country.
understanding a health
Some restrictions apply.
If you aren’t up for condition.
See the Evidence of
heading to the gym, you
Coverage for complete
can get two home fitness
details. Not available for
kits a year for only $10.
the True Blue Rx St. Luke’s
Health Partners plan.
Optional Supplemental Dental Plans
HEALTHY SMILES BASIC
If you enroll in True Blue Rx, True Blue no Rx, True Blue Rx Gem, True Blue Rx Preferred
or True Blue Rx St. Luke’s Health Partners you can add Healthy Smiles Basic for an
additional $9.40 per month. Basic dental services have a six-month waiting period
without evidence of prior continuous coverage.
HEALTHY SMILES PLUS
If you enroll in True Blue Rx Option I or True Blue Rx Option II, you can add Healthy
Smiles Plus for an additional $23.40 per month. Preventive and diagnostic dental
services have no waiting period; basic dental services have a six-month waiting period
without evidence of prior continuous coverage.
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. SUMMARY OF BENEFITS 172020 Pre-Enrollment Checklist
True Blue Rx Gem, True Blue Rx, True Blue Rx Option I, True Blue Rx Option II,
True Blue Rx Preferred, True Blue Rx St. Luke’s Health Partners, True Blue No Rx
Before making an enrollment decision, it is important that you fully understand our
benefits and rules. If you have any questions, you can call and speak to a customer service
representative toll-free at 1-888-494-2583 (TTY 1-800-377-1363), 8 a.m. to 8 p.m., seven
days a week from October 1 to March 31. Between April 1 to September 30 we are open
Monday through Friday, 8 a.m. to 8 p.m.
UNDERSTANDING YOUR BENEFITS
Review the full list of benefits found in the Evidence of Coverage (EOC), especially for
those services for which that you routinely see a doctor. Visit medicare.bcidaho.com or
call 1-888-494-2583 (TTY 1-800-377-1363) to view a copy of the EOC.
Review the Provider Directory (or ask your doctor) to make sure the doctors you see
now are in the network. If they are not listed, it means you will likely have to select a new
doctor.
Review the Pharmacy Directory to make sure the pharmacy you use for any prescription
medications is in the network. If the pharmacy is not listed, you will likely have to select a
new pharmacy for your prescriptions.
UNDERSTANDING IMPORTANT RULES
In addition to your monthly plan premium, you must continue to pay your Medicare Part
B premium. This premium is normally taken out of your Social Security check each month.
Benefits, premiums and/or copayments/coinsurance may change on January 1, 2021.
Except in emergency or urgent situations, we do not cover services by out-of-network
providers (doctors who are not listed in the provider directory). Noncontracted providers
who are out of our network may deny care, except in an emergency or urgent situations.
You may be responsible for all of the cost associated with these services.
For more information, we are available 8 a.m. to 8 p.m., seven days a week from October 1
to March 31. Between April 1 to September 30 we are open Monday through Friday,
8 a.m. to 8 p.m. Call us toll-free at 1-888-494-2583 (TTY 1-800-377-1363).
Or visit us at medicare.bcidaho.com.DISCRIMINATION IS AGAINST THE LAW
Blue Cross of Idaho and Blue Cross of Idaho Care Plus, services or discriminated in another way on the basis of
Inc, (collectively referred to as Blue Cross of Idaho) race, color, national origin, age, disability or sex, you can
complies with applicable Federal civil rights laws and file a grievance with Blue Cross of Idaho’s Grievances
does not discriminate on the basis of race, color, national and Appeals Department at:
origin, age, disability or sex. Blue Cross of Idaho does Manager, Grievances and Appeals
not exclude people or treat them differently because of 3000 E. Pine Ave., Meridian, ID 83642
race, color, national origin, age, disability or sex. Telephone: 1-800-274-4018 ext. 3838
Blue Cross of Idaho: Fax: 208-331-7493
• Provides free aids and services to people with Email: grievances&appeals@bcidaho.com
disabilities to communicate effectively with us, such as: TTY: 1-800-377-1363
o Qualified sign language interpreters You can file a grievance in person or by mail, fax,
o Written information in other formats (large or email. If you need help filing a grievance, our
print, audio, accessible electronic formats, other Grievances and Appeals team is available to help you.
formats) You can also file a civil rights complaint with the U.S.
• Provides free language services to people whose Department of Health and Human Services, Office for
primary language is not English, such as: Civil Rights electronically through the Office for Civil
Rights Complaint Portal, available at https://ocrportal.
o Qualified interpreters
hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
o Information written in other languages U.S. Department of Health and Human Services, 200
If you need these services, contact Blue Cross of Idaho Independence Avenue SW., Room 509F, HHH Building,
Customer Service Department. Call 1-800-627-1188 Washington, DC 20201, 1-800-368-1019, 800-537-7697
(TTY: 1-800-377-1363), or call the customer service (TTY). Complaint forms are available at
phone number on the back of your card. If you believe http://www.hhs.gov/ocr/office/file/index.html.
that Blue Cross of Idaho has failed to provide these
ATTENTION: If you speak Arabic, Bantu, Chinese, Farsi, French, German, Japanese, Korean, Nepali, Romanian,
Russian, Serbo-Croatian, Spanish, Tagalog, or Vietnamese, language assistance services, free of charge, are
available to you. Call 1-800-627-1188 (TTY: 1-800-377-1363).
Arabic: Nepali:
فإن خدمات المساعدة اللغوية، إذا كنت تتحدث العربية اذكر اللغة:مملحوظة ध्यान दिनुहोस्: तपार्इंले नेपाली बोल्नुहुन्छ भने तपार्इंको
निम्ति भाषा सहायता सेवाहरू निःशुल्क रूपमा उपलब्ध छ
(رقم هاتف الصم1-800-627-1188 اتصل برقم.تتوافر لك بالمجان । फोन गर्नुहोस् 1-800-627-1188 (टिटिवाइ: 1-800-377-
.(1-800-377-1363:والبكم 1363) ।
Bantu: Romanian:
ICITONDERWA: Nimba uvuga Ikirundi, uzohabwa ATENȚIE: Dacă vorbiți limba română, vă stau la
serivisi zo gufasha mu ndimi, ku buntu. Woterefona dispoziție servicii de asistență lingvistică, gratuit.
1-800-627-1188 (TTY: 1-800-377-1363). Sunați la 1-800-627-1188 (TTY: 1-800-377-1363).
Chinese: Russian:
注意：如果您使用繁體中文，您可以免費獲得語言援 ВНИМАНИЕ: Если вы говорите на русском языке, то
助服務。請致電 1-800-627-1188（TTY：1-800-377- вам доступны бесплатные услуги перевода. Звоните
1363）。 Farsi: 1-800-627-1188 (телетайп: 1-800-377-1363).
تسهيالت زبانی بصورت رايگان، اگر به زبان فارسی گفتگو می کنيد:توجه Serbo-Croatian:
1-800-627-1188 با.برای شما فراهم می باشد OBAVJEŠTENJE: Ako govorite srpsko-hrvatski,
.) تماس بگيريدTTY: 1-800-377-1363( usluge jezičke pomoći dostupne su vam besplatno.
French: Nazovite 1-800-627-1188 (TTY- Telefon za osobe sa
ATTENTION: Si vous parlez français, des services oštećenim govorom ili sluhom: 1-800-377-1363).
d’aide linguistique vous sont proposés gratuitement. Spanish:
Appelez le 1-800-627-1188 (ATS : 1-800-377-1363). ATENCIÓN: si habla español, tiene a su disposición
German: servicios gratuitos de asistencia lingüística. Llame al
ACHTUNG: Wenn Sie Deutsch sprechen, stehen 1-800-627-1188 (TTY: 1-800-377-1363).
Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Tagalog:
Verfügung. Rufnummer: 1-800-627-1188 (TTY: 1-800-
377-1363). PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari
kang gumamit ng mga serbisyo ng tulong sa wika
Japanese: nang walang bayad. Tumawag sa 1-800-627-1188
注意事項：日本語を話される場合、無料の言語支援 (TTY: 1-800-377-1363).
をご利用いただけます。1-800-627-1188（TTY:1-800-
377-1363）まで、お電話にてご連絡ください。 Vietnamese:
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn
Korean: ngữ miễn phí dành cho bạn. Gọi số 1-800-627-1188
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를
무료로 이용하실 수 있습니다. 1-800-627-1188 (TTY: (TTY: 1-800-377-1363).
1-800-377-1363)번으로 전화해 주십시오. Form No. 3-1187 (08-19)3000 East Pine Avenue | Meridian, Idaho | 83642-5995 PO Box 8406 | Boise, Idaho | 83707-2406 Toll-Free 1-888-494-2583 | TTY 1-800-377-1363 Blue Cross of Idaho Care Plus, Inc. is an HMO health plan with a Medicare contract. Enrollment in Blue Cross of Idaho Care Plus, Inc. depends on contract renewal.©2019 Blue Cross of Idaho Care Plus, Inc. (“Blue Cross of Idaho Care Plus”) is an Independent Licensee of the Blue Cross and Blue Shield Association, with services provided by Blue Cross of Idaho Health Service, Inc. Out-of-network/noncontracted providers are under no obligation to treat members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
With one of Idaho’s
largest provider networks,
we’ve got you covered.
Essential Resources
Find Providers, Pharmacies, Dentists and Formularies (Drug List)
We partnered with doctors and clinics all over Idaho to bring you high-quality
care you need and expect. Learn how to find primary care providers (PCP),
specialists and dental providers. We also offer you a convenient way to search
for pharmacies nearest you, and an easy way to look up prescription drugs in
our formulary (drug list).
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. INFORMATION KIT 37Looking for Provider/Pharmacy Directory,
Formulary or Dental Providers?
NETWORK PROVIDERS, PHARMACIES AND DRUG LIST
If you need help finding a network provider or pharmacy, you can call customer service at
1-888-494-2583 (TTY users call 1-800-377-1363). We are open seven days a week, 8 a.m.
to 8 p.m. October 1 through March 31. Between April 1 and September 30, we are open
Monday through Friday, 8 a.m. to 8 p.m. If you would like a copy mailed to you, you may
call the number above or request one through our website. In-network providers and
pharmacies are available on our website beginning October 1, 2019.
FIND AN IN-NETWORK PROVIDER ONLINE
bcidaho.com/FindAProvider
FIND AN IN-NETWORK PHARMACY ONLINE
bcidaho.com/FindAPharmacy
FORMULARY (DRUG LIST) ONLINE
bcidaho.com/DrugList
NETWORK DENTAL PROVIDERS
FIND A DENTIST ONLINE
bcidaho.com/FindADentist
POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC. INFORMATION KIT 39Our Find a Doctor/Dentist tool makes it easy
to find in-network providers anywhere
Blue Cross of Idaho Care Plus, Inc. works with healthcare providers who agree to
provide services at discounted rates to help save you money. When you see an in-
network provider, you get the most out of your health benefits. Follow the steps
below to find an in-network provider.
1 Visit bcidaho.com. Select
Find a Doctor on the homepage.
FIND IT ONLINE:
IN-NETWORK
PROVIDER
2 2A – Select the Log In button at the top right and bcidaho.com/
log in to your member account. FindAProvider
2B – Choose your network.
To search for a provider without logging in, select FOR MORE
a provider network from the drop down list INFORMATION
(example: MAHMO – True Blue HMO).
OR ASSISTANCE,
CALL US AT
1-888-494-2583
(TTY: 1-800-377-1363)
October 1 to March 31,
seven days a week from
8 a.m. to 8 p.m. Between
2A April 1 to September 30,
you can call us
Monday – Friday
from 8 a.m. to 8 p.m.
2B
40 INFORMATION KITYou can also read
