Here at Benefit Packages, in conjunction with Blue Cross of California, we’ve learned over the years that a functional understanding of exactly what Medicare will cover and what Medicare won’t cover will be a significant part of protecting your family against unexpected injuries and medical expenditures. That’s why Benefit Packages prepared this guide for you. We recommend that you read through it carefully prior to making a choice regarding which type of Medicare supplement insurance plan will be most suited your particular needs. Of course, if you have any questions afterwards, please feel free to give us a call-we’ll be more than happy to assist you in any way that we can.
Generally speaking, as valuable as the Medicare program can be, it obviously has limitations. Medicare simply cannot be everything to everyone. Medicare does indeed cover all or a portion of a sizable number of participants’ medical expenditures; including both hospital stays and general practitioner fees. But, members are nevertheless responsible for deductibles and co-insurance payments. Besides, if your physician does not recognize Medicare assignments, your medical expenditures could easily exceed the Medicare programs approved charges leaving you to pay the difference out-of-pocket.
Protecting your family against the excessive financial strain that an expensive gap in Medicare program coverage is exactly what Blue Cross’ Medicare supplemental (“Medigap”) plans were created for.
To help provide reliable HMO-based Medicare Supplemental insurance to everyone, Benefit Packages dot com can offer consumers the Blue Cross Individual Select HMO Plan and Network. The Blue Cross Select Medicare Supplemental HMO Plan and Network were created specifically in order to give consumers the benefits and security of HMO coverage with an easily understood Network structure and the predictable costs that accompanies one. With Blue Cross’ Select HMO Network Medicare Supplement, consumers are free to choose from among over 13,000 primary care physicians as well as specialists in twenty-two counties here in California – all for just $25 per office visit.
If you’ve been searching for Medicare Supplemental healthcare coverage that can boasts comprehensive, hassle-free medical benefits, predictable costs, then Blue Cross of California’s Select HMO Plan might be an excellent choice. The Select HMO may also be ideal for consumers planning to start a family or who already have young children. Both the Blue Cross Senior SELECT and The Blue Cross Senior SELECT PLUS function as Medicare Supplemental Standard Plan A’s with supplementary benefits for medical services received “In-Network” as defined below:
- The Select HMO’s features low monthly premiums.
- The Select HMO’s are guaranteed to be renewable.
- Select Network features “ClaimFree” processing when participants use plan providers.
- Blue Cross Select Medicare Supplemental HMO’s offer a prescription drug benefits plan, that includes a convenient mail order program, that is available with the Blue Cross Senior Select Plus Plan.
- The BCL&H Select HMO’ features a dedicated toll-free customer service number.
- The Select plan allows participants to retain the freedom of choice available from Medicare for only a $5 co-payment for physician’s office visits (to participating prudent buyer physician) Plan members are not “captive” to healthcare providers specified by an HMO.
- Blue Cross Life and Health Select HMO allows its’ members the freedom to employ the general practitioner of their choice-from at least 40,000 Prudent Buyer Physicians, that includes specialists, without the need to first seek approval.
- The Select plan eliminates the majority of out-of-pocket costs for the Medicare Part A $912 deductible when you use a Participating Blue Cross Senior SELECT Hospital (or if you are admitted as an inpatient immediately following an emergency room visit for medical emergency at any hospital, anywhere in the U.S.).
- Pays* the Medicare Part B $110 annual deductible when you use Participating Prudent Buyer Providers.
- Benefits for Medicare Part B coinsurance, no matter which provider you choose.
- No cost to you for Medicare Part B excess charges when you use a Participating Prudent Buyer Physician, or any doctor who accepts Medicare assignment.
- Full conventional Medicare Benefits at all providers, inside and outside the state — anywhere in the U.S.
- You keep the freedom you have with Medicare, and you get to keep your Medicare card too!
BCL&H SELECT HMO EXCLUSIONS AND LIMITATIONS:
Even though Blue Cross Life and Health specifically designed its HMO Network to care for your health care needs, there are items that the BC-L&H medical Network does not offer coverage for. Therefore, Benefits Packages recommends that you take a moment or two and review the HMO NETWORK exclusions and limitations listed below:
- Dental care and treatment or treatment on or to the teeth and gums, unless covered under accidental injury.
- Outpatient Drugs and Medications – Coverage for medications, drugs and or other substances administered or dispensed in any outpatient setting unless the specific policy states otherwise.
- Durable Medical Equipment – The HMO assists Network members with medical equipment including but not limited to shoe inserts or orthopedic shoes, air conditioners, humidifiers and or air purifiers, exercise equipment, spas, treadmills, elevators, supplies for comfort support and or hygiene or correction appliances.
- Outpatient Speech Therapy – Select Network HMO does not provide coverage for members with outpatient speech therapy needs except following injury, surgery or non-congenital organic disease.
- Domiciliary, or rest related cures for which facilities and or the services of a general acute care hospital that are not medically required-including resident treatment centers, are excluded from Select HMO.
- Custodial Care – For the purposes of BC’s HMO, “custodial care needs” shall be defined as care that does not necessitate the services of trained health or medical personnel, including, but not limited to, help walking, bathing, preparation and feeding or special diet maintenance, dressing, or supervision of ordinarily self-administered medications.
- Dental implants.
- Hearing aids.
- BC’s Network HMO does not offer reimbursement coverage for contraceptive drugs or certain contraceptive devices, including Norplant’s and or Norplant kits, with the exception of injection delivered contraceptives administered by physicians. (please note: certain oral contraceptive devices/methods are covered under a Network’s prescription benefits schedule)
- Any and all medical services that are related to the evaluation and or treatment of issues related to infertility, including any and all tests, medications, consultations, surgical procedures, lab work and reversal of a sterilization procedure.
- Private duty nursing care, including both outpatient and inpatient services delivered by a private duty nurse.
- Contact lenses or eyeglasses unless otherwise specified the member’s Network policy.
- The HMO Network from Blue Cross Life & Health does not offer coverage reimbursements for certain eye care surgeries, including those exclusively for the purpose of correcting refractive defects of the eye including as myopia, presbyopia and or astigmatism.
- Diagnostic admissions
- The Select HMO from BC-L&H does not cover for mental or nervous disorders, substance abuse related issues, and or learning disabilities, except as specifically stated under the benefits sections of the Network policy.
- Orthopedic shoes (except when joined to braces) or shoe inserts, except for limited benefits as stated in the Policy.
- Orthodontic services related to braces applications, and or other orthodontic appliances.
- No payment will be made for services or supplies for the treatment of a preexisting condition during a period of six months following your Effective Date. Also, if you were covered under qualifying prior coverage within sixty-three days of becoming covered under this Agreement, the time spent under the qualifying prior coverage will be used to satisfy, or partially satisfy, the six-month period.
- Health services furnished through outdoor treatment programs.
- Medical consultations provided by either telephone and or fax.
- Educational healthcare services except those specifically provided and or arranged by BC Life and Health.
- Nutritional health counseling or food supplements, except those stated in your Network agreement.
- No benefits are provided for treatments furnished by non-contracting hospitals, except in the case of a medical emergency as specified by the Network.
- The HMO does not offer benefits for conditions covered by workers compensation legislation.
- Select HMO does not cover experimental and or investigative health care or therapy.
- The HMO does not cover supplies or services not specifically listed as covered under the Select HMO agreement.
- BCL&H’s Select network does not offer coverage for health services received before a members’ “Effective Date” (the date their coverage began) or during an inpatient hospital or alternative care facility stay that began before their “Effective Date,” or after coverage Network ends.
- Supplies or services that are not deemed medically necessary, as determined by Blue Cross of California Life and Health.
- Sex change and or gender change operations and or related treatments or studies.
- Services or supplies primarily intended for the purpose of weight-reduction or the treatment of obesity, or care involving weight reduction procedures as a primary method of treatment, except in the event of medically necessary treatments for member’s morbid obesity.
- The BC Select HMO does not reimburse amounts that exceed the Select HMO’s maximum coverage limitation.
- Routine physical exams, with the exception of preventive healthcare services (e.g., physical examinations for the purpose of licenses, insurance, employment, and or school are not covered).
- The HMO Network does not provide re-imbursement for either services or supplies for which no monetary charge has been made, or for which no charge will be made if the member had no health care insurance coverage, or services for which they are not legally obliged to pay.
- The Select HMO does not cover costs of cosmetic surgeries or surgical services related to physical beautification-including any medical complications arising from a cosmetic surgical procedure, except for procedures that are related to a reconstructive surgery performed to restore deformities or to correct an injured bodily function or otherwise medically necessitated reconstructive surgical procedures performed to restore symmetry following mastectomies.
We’re here to help consumers understand exactly what The BCL&H Select HMO’s coverage does include and does not include as they’re deciding whether or not to enroll. The listing above was intended as an overview only and The Select HMO Network’s booklet should definitely be consulted for a more comprehensive slate of the HMO’s exclusions and limitations. If you’d be interested in getting a copy, please feel free to contact us.
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