Benefits You Can Count On. Information on Medicare Supplemental Coverage. anthem.com. Producer 8100CT (12/04)

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1 ' Benefits You Can Count On Information on Medicare Supplemental Coverage Producer 8100CT (12/04) anthem.com

2 Table of Contents For more than 60 years, the Blue Cross and Blue Shield symbols have stood for quality health coverage you can count on. Choosing the Right Medicare Supplemental Plan..pages 1-6 See these pages for descriptions of our eight available plans. Plans A, B, C, D, F, High-deductible F, H, J Guaranteed Acceptance (except Plans H and J) Getting the Most out of your Health Benefits.....pages 7-9 Programs and services to complement your health plan. SpecialOffers@Anthem SM Anthem Rewards SM anthem.com (featuring MyAnthem SM and MyHealth@Anthem ) How to Apply page 10 Complete your Enrollment Application today! Apply by mail Spousal/domestic partner discount Electronic Fund Transfer (EFT) For more information page 11

3 The Protection You Need You can rest easy with a Medicare Supplemental plan designed by Anthem Blue Cross and Blue Shield. For more than 60 years, Connecticut residents have relied on us for quality insurance coverage A choice of plans You can choose from plans offering a range of benefits: from basic core benefits like hospitalization and doctor visits to protection against unexpected expenses for doctors who bill beyond Medicare-approved charges. Some plans include benefits for prescription drugs! And all of our plans meet state and federal regulations. With our High-Deductible Plan F, you can save hundreds of dollars each year in Medicare Supplement plan premiums. (See the chart on page 6 of this brochure for a comparison of our different plans.) Guaranteed renewal Once you enroll, your coverage is guaranteed renewable. That means your policy cannot be cancelled, subject to the requirements of applicable law and the terms of your policy. And, you ll have no waiting period for pre-existing health conditions. Benefits that travel with you As a member, you never have to worry if you travel outof-state and need medical care. Your membership card will be honored by most doctors and hospitals throughout the United States, so you ll have coverage wherever you are in the U.S. on vacation, visiting family, or away for the weekend. Some of our plans also provide coverage while you re traveling outside of the U.S. 1

4 The Convenience You Want Anthem Blue Cross and Blue Shield makes it easy to use our Medicare Supplemental plans. Automatic claims filing You ll appreciate the convenience of having both your Part A and Part B claims filed for you automatically. And we consistently process all claims in an average of seven days or less. Choose your own doctor All of our Medicare Supplemental plans let you choose your doctors, hospitals and pharmacies. And you do not need a referral from your doctor in order to see a specialist for covered services, or obtain prior authorization from us before receiving covered services. Personal service Our dedicated customer service representatives are ready to help you with any membership, benefit or claims questions you may have. Representatives are available Monday through Friday from 7:30 a.m. to 5:00 p.m. Or, you can stop by our North Haven office and a representative will help you personally. 2

5 Choosing the Right Medicare Supplemental Plan We offer a choice of plans designed to protect you in and out of the hospital. Plan A Offers basic supplemental coverage. It pays basic benefits for your Part A hospital copayments for days 61 through 150. Additionally, it covers 20% of Part B services not covered by Medicare. Plan B Offers all the basic benefits of plan A plus, it covers your Part A hospital deductible each benefit period, which can be up to six times a year. Plan C Plan C offers all the benefits of our Plan B, and it covers your annual Medicare Part B deductible in full. In addition, Plan C provides benefits for skilled nursing facility care. If you travel internationally, you may want to consider Plan C; it covers you for medically necessary emergency care received outside the United States. Plan D Offers all the benefits of Plan B, plus it provides skilled nursing facility care and up to $1,600 in annual home health care benefits. You ll enjoy the convenience of receiving Medicare-approved services in the comfort of your own home. Medically necessary emergency care received outside the United States is also covered. Plan F It offers all the benefits of Plan C, plus it covers the Medicare Part B excess charges for providers who bill beyond Medicare-approved amounts. This can be especially important when traveling out of the state, or in the case of an emergency, when you may not be able to choose a doctor or specialist who accepts Medicare assignment. Plan descriptions continue on the next page 3

6 Choosing the Right Medicare Supplemental Plan (continued) High-Deductible Plan F Offering a much lower monthly premium than Plan F, you ll enjoy the same benefits after you meet a calendar year deductible of $1,730. With this plan, Medicare is still responsible for paying for Medicare-approved services. For example, under Part B, Physician and Medical Services, Medicare will pay 80% of approved services after the $110 Part B deductible has been met. Plan H Offers all the basic benefits and covers medically necessary emergency care received outside the United States. Plus, it provides benefits for your Medicare Part A deductible, skilled nursing facility care and $1,250 in prescription drugs annually. Plan J Offers all benefits of Plans C, D, F, High-Deductible F and H. Plus, it provides benefits for preventive care services not covered by Medicare, as well as extended prescription drug benefits up to $3,000 annually. Guaranteed Acceptance You are guaranteed acceptance into your choice of Plans A, B, C, D, F or High-deductible F. You re guaranteed acceptance into Plan H or Plan J if you re within 6 months of your Medicare Part B effective date. Please Note: If you are under age 65 and on Medicare due to disability, you are eligible for Plans A, B and C only. 4

7 Medicare Supplemental Plan Comparison A choice of Medicare Supplemental Plans designed to protect you in and out of the hospital. Apply for any one of them NOW to avoid costly gaps in your Medicare coverage. Medicare does NOT pay Anthem Blue Cross and Blue Shield Medicare Supplemental PLAN A PLAN B PLAN C PLAN D PLAN F PLAN H PLAN J PAYS PAYS PAYS PAYS PAYS PAYS PAYS High- Deductible PLAN F NOTE: Deductibles and copayments are for Subject to change January 1, PART A HOSPITAL SERVICES $912 Inpatient hospital deductible each benefit period $228-a-day copayment for days in a hospital $456-a-day copayment for days (Lifetime Reserve) 100% of medicare allowable expenses for additional 365 days after Medicare hospital benefits stop completely Calendar year blood deductible (first 3 pints of blood) if the deductible is not met by the replacement of blood $114 per day for days in a skilled nursing facility PART B PHYSICIAN AND MEDICAL SERVICES $110 Part B Deductible 20% of Medicare approved amount (Part B coinsurance) after $110 Part B deductible is met 100% of Medicare Part B excess charges ADDITIONAL BENEFITS NOT COVERED BY MEDICARE At-home recovery benefits* (up to $1,600 per calendar year) Benefits for medically necessary emergency care received in a foreign country** Basic and extended outpatient prescription drug benefits (50% of charges, after a $250 annual deductible, up to $1,250 annually for Plan H, $3,000 annually for Plan J) Preventive Care (first $120 each calendar year) High-Deductible Plan F pays the same, or offers the same benefits as, Plan F after the member has paid a calendar year $1,730 deductible. This plan comparison and the enclosed Outline of Medicare Supplement Coverage provide a general discussion and overview of the Medicare Supplemental policies offered by Anthem Blue Cross and Blue Shield. The legal rights and responsibilities between Anthem Blue Cross and Blue Shield and its insureds are contained in the legal policies, which you should consult for full information. If there is any conflict between this marketing literature and Anthem Blue Cross and Blue Shield s legal policies, the legal policies shall govern. Subject to the requirements imposed by applicable law, Anthem Blue Cross and Blue Shield reserves the right to make subsequent changes in its Medicare Supplemental policies. * Our Plan D and Plan J pay up to $40 a visit (up to 7 visits a week, $1,600 a year) for home care that is certified by your physician as medically necessary for personal care during recovery from an injury or sickness and for which Medicare approved a home health care plan of treatment. Treatment must be received within 8 weeks of last approved Medicare visit. ** Plans C, D, F, High-Deductible Plan F, H and J pay 80% of charges (after a $250 calendar year deductible with a lifetime maximum of $50,000). Plans F and J provide coverage for the difference between the actual provider's charge as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare approved Part B charge. 5

8 Medicare Supplemental Plan Premiums For 2005 Plan Monthly Quarterly Annually A $ $ $1, B $ $ $1, C $ $ $1, D $ $ $1, F $ $ $1, High-Deductible Plan F $55.00 $ $ H $ $ $2, J $ $ $3, We, Anthem Blue Cross and Blue Shield, can only raise your premium if we raise the premium for all contracts like yours in this state, and may do so periodically. As a member, you will have three choices for billing: Monthly (through an Electronic Fund Transfer (EFT) from your bank account. To sign up, please see the enclosed application.) Quarterly Annually We also offer a 5% Spousal Discount if you are married or have a domestic partner and both of you enroll in one of our Medicare supplemental plans. *Rates will change effective January 1,

9 Get The Most From Your Health Benefits Take advantage of these programs and services that complement your Medicare Supplemental Plan. SM Save on health products and services It takes more than regular checkups with your doctor to stay active and healthy. It takes living right, exercising, eating well and keeping a positive outlook. SpecialOffers@Anthem SM can help you save on products and services that complement your healthy lifestyle. Contact lenses and frames Fitness clubs and martial arts centers Allergy & asthma relief products Weight loss programs Vitamins and mineral supplements Bicycle/inline skate helmets Baby care accessories and safety products Pedometers, heart rate and blood pressure monitors Self-help books and audiotapes Massage therapists Cosmetic dentistry Acupuncturists Appalachian Mountain Club memberships Hearing aids & hearing products Medical ID bracelets and pill box reminders/timers Elder care services and personal emergency response systems For a full listing of SpecialOffers@Anthem SM, please contact us or visit anthem.com. 7

10 Get The Most From Your Health Benefits (continued) Anthem Rewards SM Be active. Be healthy. Be rewarded! Be rewarded for taking your fitness and good health into your own hands! Sign up for the online Anthem Rewards SM program and walk, play ball, go skiing, mow the lawn. Everyday that you re physically active for at least 30 minutes and track your activity online you ll earn 10 points. Once you have 250 points, you can claim a reward for your healthy lifestyle. Or wait until you have 650, 1,250 or 1,850 points for even bigger and better rewards like sports equipment, personal electronics and camping gear. For a full list of rewards and some activities you might enjoy, go to anthemrewards.com/signmeupnow. anthem.com online tools to help track your health benefits 24/7 MyAnthem SM available through anthem.com is your personalized portal to the world of health and benefit information. You ll especially appreciate being able to take advantage of the online member self-services functions, like: Search for a participating physician, hospital or pharmacy View coverage information Check the status of claims Order a replacement member ID Register an address change Search health and wellness articles (MyHealth@Anthem ) Order a prescription refill Check for possible drug interactions Compare quality of hospitals for specific procedures And be sure to explore Life After 50, your link to information and resources targeting your specific needs! It s all just a click away! 8

11 Get The Most From Your Health Benefits (continued) the health information section of anthem.com, lets you: Search health and wellness articles View daily health news of interest to you Sign up for personalized weekly electronic newsletters View condition-specific self-care centers (for asthma, diabetes, heart disease, hypertension, weight control, etc.) Look up detailed nutrition information on 30,000 foods Participate in health assessments & interactive polls Keep a daily health diary Take a virtual tour. Visit our web site to experience the electronic tools we offer you! (anthem.com > Member > Connecticut > Virtual tour) 9

12 How to Apply Step 1: Fill out the enclosed Enrollment Application completely. Complete the Spousal Discount and Electronic Fund Transfer (EFT) portions if applicable. (See below for details.) Be sure to sign and date the form. Step 2: Complete the enclosed Health Statement if you are applying for Plan H or Plan J and you are outside your six-month Medicare enrollment period. (If more than six months have passed since your Part B effective date.) Step 3: Return the completed application and Health Statement, if applicable. Use the enclosed postage-paid envelope. (If envelope is missing, mail to: Anthem Blue Cross and Blue Shield, P.O. Box 1014, North Haven, CT ) Electronic Fund Transfer (EFT) We can automatically withdraw funds from your bank account to pay your plan premium. No more check writing. No more postage costs. Plus, you won t have to worry about a lapse in coverage because you forgot to pay your bill. You can begin using EFT with your second month s premium have funds transferred from either checking or savings even change banks! To sign up for Electronic Fund Transfer: Complete the appropriate section on your Medicare Supplement Enrollment Application. Make your first month s premium check out to Anthem Blue Cross and Blue Shield. (See rate sheet on page 6 for your chosen plan s monthly premium amount.) Spousal/domestic partner discount If you are married or have a domestic partner, and both of you enroll in one of our Medicare Supplemental plans, you can receive a 5% discount off your combined monthly premium! To receive your 5% discount, simply complete the appropriate section of your Medicare Supplement Enrollment Application. 10

13 For More Information Anthem Blue Cross and Blue Shield has been serving the people of Connecticut for more than 60 years. No other insurer can match that commitment and experience. So for health coverage you can count on, enroll in one of our Medicare Supplemental Plans today. To find out more, call your licensed Anthem Blue Cross and Blue Shield agent/producer. Or call

14 For more information, visit our Web site at anthem.com The content of this brochure is not a legal policy or contract It is intended as a quick reference to inform you about the health plans, programs and services available to individuals from Anthem Blue Cross and Blue Shield in Connecticut. Please refer to your contract documents to determine your rights to benefits and coverage, as well as your obligations under the health plan you purchase. In Connecticut, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association. Registered marks of the Blue Cross and Blue Shield Association. "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. SM "SpecialOffers@Anthem", "Anthem Rewards", "Anthem Healthy Solutions" are service marks of Anthem Insurance Companies, Inc. All of the offerings in the SpecialOffers@Anthem program are continually being evaluated and expanded so the offerings may change. Any additions or changes will be communicated on our website, anthem.com. These arrangements have been made to add value to our members. Value-added services and products are not covered by your health plan benefit. Available discount percentages may change from time to time without notice. Discount is applicable to the items referenced. ScriptSave, administered by The Medical Security Card Company, Inc. of Tucson, Arizona, is a value-added service for Anthem Blue Cross and Blue Shield s traditional Medicare Supplemental Plans and Group Retiree Health Plans that do not have a prescription drug benefit. The ScriptSave Prescription Drug Discount Card is not an insurance policy or benefit, and does not provide insurance coverage. The ScriptSave program can be discontinued at any time.