Confidence comes with every card. 2017 Kent, Muskegon, Oceana and Ottawa counties BCN Advantage SM HMO MyChoice Wellness and BCN Advantage SM HMO HealthySaver Make the Most of BCN Advantage is an HMO plan with a contract. Enrollment in BCN Advantage depends on contract renewal. www.bcbsm.com/medicare
Welcome to your enrollment kit BCN Advantage HMO Plans Benefits at a glance brochure for the following plans and counties: BCN Advantage MyChoice Wellness and BCN Advantage HealthySaver in Kent, Muskegon, Oceana and Ottawa counties Summary of Benefits itemizes each plan s benefit. Star Rating sheet explains the star rating our plans have received from the Centers for & Medicaid Services. 1 Seminar flier gives times, dates and locations of meetings you can attend. We'll help you be as active as you want in your retirement, too can be hard to understand. We re here to break it down for you. This easy guide will: Help you better understand your options by learning how works Introduce you to Advantage and our 2016 4.5 stars out of 5 stars BCN Advantage HMO plans Suggest five steps to help you find a plan that fits your lifestyle and finances Help you make the most of your hard earned benefits Follow the steps, enroll in a plan and enjoy your favorite retirement activities knowing you have the security of a BCN Advantage plan. Enrollment form and business reply envelope include how to complete and mail. According to U.S. News & World Report, Blue Care Network is among the top U.S. Advantage providers in 2016. 2 STEP 1 Take a few minutes to look through the materials in your enrollment kit. We ve filled it with practical resources and tips so you can make the most of. 1 evaluates plans based on a 5 star rating system. Star ratings are calculated each year and may change from one year to the next. 2 U.S. News & World Report: Best Advantage Plans 2016, October 15, 2015.
Our plans focus on your wellness Our partners form a network of providers and hospitals united in support of your commitment to be healthy and stay within your budget. A plan right that's for you HealthySaver and MyChoice Wellness are offered through a network of doctors and hospitals affiliated with Mercy Health in West Michigan, and allows us to deliver high quality managed care to you. Convenient care that can save you money You're invited to enjoy the benefits of our cost-conscious BCN Advantage HMO plans if you live within our service area and are eligible for. Our benefits go beyond Original ; you pay no deductible on medical services, and you re covered for preventive dental and vision care. Unlike Original, your out-of-pocket spending has an annual limit. Part D prescription drug coverage is included. MyChoice Wellness primary care office visits are at no additional cost and for HealthySaver it's a $5 copay per visit. Enjoy many in-network preventive services at no additional cost.* SilverSneakers fitness membership. You'll have one member ID card, one bill and one customer service contact. *If nonroutine diagnostics or other types of services are provided during your visit, you may be responsible for a copay or coinsurance.
We cover you beyond Original We're a health maintenance organization, or HMO, which means you choose a primary care physician, or PCP, to manage your medical and health needs. Your PCP coordinates care with other specialists and provides referrals as appropriate. Any care you receive that's provided, arranged or authorized by the HMO and your PCP within the HMO network is covered. Yes, prescription drug coverage is included The MyChoice Wellness and HealthySaver plans include Part D prescription drug coverage. Our network includes 98 percent of Michigan pharmacies 3, and when you use Express Scripts or Walgreens Mail Order there s no extra cost for home delivery. 4 Our extensive retail pharmacy network outside Michigan includes most retail chain pharmacies as well. You can review our approved drug lists, known as formularies, at www.bcbsm.com/formularymedicare. As a MyChoice Wellness or HealthySaver plan member, if you re taking a drug that s not on our approved drug list or a drug that is subject to additional requirements or limits, you may be able to get a temporary supply. Your doctor can help you request an exception or choose an alternative drug on our list. Use the contact information on the back cover to get more details about our drug transition policy. Welvie empowers you An astounding one in five people will have surgery this year. 5 If you're one of them, you'll learn firsthand what a great resource our Welvie program is. Designed by surgeons, it walks you through the entire decision-making process, from diagnosis to recovery, in a unique internet-based, step-by-step process. 6 Care management and behavioral health services when you need them Our health care management services help you stay healthy, enhance your quality of life and support recovery. If you have a condition that qualifies you, your own care management nurse will build a personal care plan for you. For emotional or mental distress, including depression and drug or alcohol abuse, a specialized case manager will work with you to get you the right care and services. 3 January 2015 NCPDP/BCBSM BCN Pharmacy Network database. 4 Walgreens and Express Scripts are independent companies contracted by Blue Care Network and BCN Advantage HMO plans to provide pharmacy mail order services to our members. 5 Welvie Claims Analysis, 2014. 6 Welvie is an independent company contracted by Blue Care Network to provide services to our members. Welvie provides a surgery decision support program. Stay informed with Your Health Advantage Learn about health trends, lifestyle news and more from our award winning member magazine Your Health Advantage.
STEP 2 Choose the best plan for your health and your wallet. As you evaluate your options, consider these potential costs: Deductible the amount you must pay before your plan begins to pay its share Coinsurance the percentage of the cost of the service you pay Copayment a fixed dollar amount you pay for health care services, such as an office visit, medical test or prescription drug Out of pocket maximum the most you have to spend for copays, coinsurance and deductibles in any given year STEP 3 Review the plan's Summary of Benefits, which describes what the plan covers, what it doesn't cover and what your share of the costs will be. Note: it is not a list of every service, limitation or exclusion. Optional extras For a low monthly premium, you can add optional supplemental dental, vision and hearing benefits that work with the coverage you get with the BCN Advantage HMO plan you select. They include: An allowance for elective contact lenses or eyeglasses every 24 months Extra coverage for hearing exams and hearing aids A dental allowance each calendar year No cost dental fluoride treatment and unlimited brush biopsies Reduced cost fillings, root canals, simple extractions, crowns and crown repairs
What's the Best plan you for? STEP 4 Answer the questions on the next page to be sure the plan you choose matches your needs and priorities.
How do you decide which plan fits? As you consider your health care needs and estimate your costs, answering these questions can help you choose wisely: Are the doctors I want to see in the network? How often do I see my primary care doctor? How often do I see a specialist? How many times have I been in the hospital in recent years? What prescription drugs do I take? Are my prescription drugs costly? How much do I travel within Michigan, the U.S., the world? Would a fitness membership benefit me? Do I need preventive dental or vision benefits? Buy or build You can get your coverage one of two ways: You can buy a complete package a Advantage plan. A Advantage plan can stretch your dollars, combining coverage into a single, convenient plan with extra benefits that often includes prescription drug coverage. Or you can build your own package of coverage, starting with Original Part A (which you likely qualify for based on your work history) and Part B (covers medical services and is required by the government to have drug coverage). You can add Part D, which is stand-alone drug coverage. Then you can add a Supplement plan. Buying coverage packaged together in one plan is a popular option. That s supported by a recent report by the Henry J. Kaiser Family Foundation. Advantage enrollment has increased in virtually all states over the past year. Almost one in three people on (31% or 17.6 million beneficiaries) is enrolled in a Advantage plan in 2016. 7 Part A Original Part B Original Part C Advantage Part D Prescription drugs Supplement (Medigap) C Supplement Hospital care Skilled nursing facility care Hospice Home health care Doctor visits Mental health care Outpatient surgery Lab tests Durable medical equipment Everything in Parts A and B Many plans cover prescription drugs Most plans include a fitness program membership, dental and vision Other added benefits complete the triangle Prescription drugs Helps pay some of the out of pocket costs you have with Original 7 Source: May 11, 2016, The Henry J. Kaiser Family Foundation
SilverSneakers Fitness membership Improve your overall well being with Healthways SilverSneakers Fitness program at no additional cost for our members. This energizing program offers options that allow you to work out when, where and how you want. SilverSneakers includes: A fitness membership with access to all basic amenities at more than 13,000 locations nationwide, plus SilverSneakers group exercise classes at many locations SilverSneakers FLEX classes, such as dance, tai chi, yoga and walking groups offered in neighborhood locations such as parks, recreation centers and adult living communities SilverSneakers Steps to use at home for those who have a disability, are recovering from a medical procedure or illness, live in a rural area or experience traffic difficulties and can t make it to a fitness center Online resources including tools to assess your health and track your activity, fitness advice, meal plans and healthy recipes to download, and connection with the SilverSneakers community for added support To find fitness locations or learn more about the program, visit www.silversneakers.com or call SilverSneakers at 1 866 584 7389 8 a.m. to 8 p.m. Eastern time, Monday through Friday. TTY users call 711. You must use network facilities to obtain this benefit. Healthways is an independent company not associated with the Blue Cross Blue Shield Association. Blue Care Network and BCN Advantage HMO plans contract with Healthways to offer the SilverSneakers fitness program benefit. Healthways, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarks of Healthways, Inc. and/or its subsidiaries. 2016 Healthways, Inc. All rights reserved.
Things to know about Advantage plans You re still in. In most cases, you enroll in a plan for a year. You can only join a plan at certain times during the year. You still get complete Part A and Part B coverage as long as you continue to pay your Part B premium. Your plan will have a yearly limit on your out of pocket costs for medical services. Once you reach the yearly out of pocket limit of a plan, you pay nothing for covered services. You can call the plan before you get care to see if the service is covered and what your cost may be. You can join a plan even with a pre existing condition, with the exception of end stage renal disease, or ESRD. STEP 5 Ask us questions. can be confusing and complex, whether you re enrolled now or making a first time decision as you turn 65. We know you want to make the most of your hard earned benefits. Call a Blue Care Network representative or meet with an independent BCN Advantage agent at a place and time convenient for you. We believe it s an important step to finding the right plan for your lifestyle, health and budget. U.S. News and World Report lists Blue Care Network among the best Advantage Plans in Michigan in 2016 for, "offering consistently highly rated Advantage plans." 10 10 U.S. News & World Report, Best Part D Plans 2016, October 15, 2015.
We have a contract with When you enroll in a MyChoice Wellness or HealthySaver plan, Blue Care Network provides your benefits, not Original. You ll only need to show your BCN Advantage member ID card for care. You should put your red, white and blue card away for safekeeping. Be sure you can join a MyChoice Wellness or HealthySaver plan You re eligible to enroll in a MyChoice Wellness or HealthySaver plan if: You re entitled to Part A and are enrolled in Part B. You must continue to pay your Part B premium. It s a separate premium you pay to. You re a resident of Michigan, meaning you reside in the state at least six months each year and you live in Kent, Muskegon, Oceana or Ottawa counties. You don t have ESRD, except under certain conditions, according to federal law. Annual Enrollment Period Once you ve joined, the Annual Enrollment Period is Oct. 15 through Dec. 7. During the enrollment period, you can: Join a Advantage medical plan or Part D prescription drug plan Switch to a different Advantage medical plan or Part D prescription drug plan Change from a plan with Part D prescription drug coverage to one without it (you cannot join a Advantage plan that includes Part D drug coverage and a stand-alone Part D plan at the same time) Disenroll from a Advantage plan With Advantage, special circumstances may mean you have a Special Election Period during which you can switch your plan, including if you: Are moving out of your current plan s service area Move into or out of a facility, such as a nursing home Qualify for extra help (you get both and Medicaid, receive Supplemental Security Income or apply for and receive federal financial help, or you re a beneficiary of the Part D low income subsidy)
If you re turning 65, you can enroll in a MyChoice Wellness or HealthySaver plan during your Initial Enrollment Period, which is shown below. This seven month window starts three months before your birthday month and runs until three months after your birthday month. If you miss signing up for during that time, you can enroll between Jan. 1 and March 31 of each year. Your start date will then be in July of the year you enroll. When to enroll 3» months before 2» months before Seven month window 1» month before Your birthday month «1 month after «2 months after «3 months after Many things about can be complex, but enrolling is pretty simple Enroll in a MyChoice Wellness or HealthySaver plan online, by phone or by filling out and mailing in the enclosed application form. You ll need your red, white and blue card. Anyone eligible for in your household must enroll separately. No payment is needed when you enroll. We ll call you to confirm your intent to join the plan. If we don t reach you by phone, we ll send a letter saying has confirmed your enrollment. This usually happens within 30 days. Once enrolled, you ll get a BCN Advantage member ID card and packet about how to use and make the most of your benefits. Advantage disenrollment is easy, too You can disenroll from your Advantage plan and switch to Original anytime between Jan. 1 and Feb. 14 each year. If you make the switch during that time, you ll have until Feb. 14 to add a Part D prescription drug plan. Your coverage will begin the first day of the month after the plan gets your enrollment request. Beware of the late enrollment penalty If you don t enroll in a Part D prescription drug plan when you first become eligible, or if you have a break in coverage of at least 63 consecutive days, may add a late enrollment penalty to your Part D plan premium. If you sign up for a Advantage plan during your initial enrollment period when you re turning 65, you ll avoid that penalty.
Learn more, compare plans or enroll in a MyChoice Wellness or HealthySaver plan Call a sales representative at 1 888 563 3307 from 8 a.m. to 9 p.m. Eastern time, Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users call 711. Attend a free Blue Care Network learning event about. See the schedule of seminars included in your kit. Visit a Blue Care Network walk in center. Contact an independent agent licensed to sell a BCN Advantage HMO plan. Complete the enclosed application and mail it to us. Enroll on our website at www.bcbsm.com/medicare. Go to the CMS Online Enrollment Center located at www.medicare.gov. Blue Care Network walk in centers Visit one of our walk in centers to meet with a certified health plan advisor or independent Blue Care Network agent who s able to sell Advantage plans. Our walk in centers are open from 9 a.m. to 4:30 p.m. Monday through Friday. Visit www.bcbsm.com/index/health insurance help/locations.html to see maps, get directions and find out when agents are available. Ann Arbor Detroit Flint Grand Rapids Holland Lansing Marquette Portage Southfield Traverse City Utica Other important information This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary. You must continue to pay your Part B premium. H5883_S_17MCWHSPreEnrlBkCMS Accepted 09112016 DB 15804 SEP 16 R055412