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Summary of Benefits for Anthem MediBlue Dual Advantage (HMO SNP) Available in: Select Counties* in Ohio *See Page 2 for a list of counties. 583 583 583 610 975 722 722 722 722 666 500 443 333 500 500 277 277 500 277 777 0000255685 00000 n /Name /F1 /Subtype /TrueType >> 666 666 666 666 277 277 277 277 722 722 722 666 666 610 556 556 556 556 556 556 556 722 722 333 389 722 610 889 722 722 0 0 0 547 547 592 592 547 501 638 endobj /Pages 59 0 R 850 0 obj /CapHeight 662 500 500 500 500 500 500 500 500 277 277 889 556 556 556 556 556 277 277 277 277 /Ascent 905 << /Encoding /WinAnsiEncoding /Type /FontDescriptor [833 556] 830 0 obj /DefaultRGB [/ICCBased /StemV 36 /Lang (en-US) [722] /Encoding /WinAnsiEncoding /XHeight 250 556 556 556 556 556 556 556 556 333 333 666 777 722 666 610 722 666 943 666 666 endobj /AvgWidth 441 889 556 556 556 556 556 277 277 277 277 /S 196 851 0 obj /DW 1000 2020 Summary of Benefits Capital Health Plan Advantage Plus (HMO) and Capital Health Plan Preferred Advantage (HMO) This is a summary of drug and health services covered by Capital Health Plan Advantage Plus (HMO) and Capital Health Plan Preferred Advantage (HMO) January 1, 2020 – December 31, 2020. ] 0000005607 00000 n /Ascent 936 >> /F4 852 0 R 333 500 443 1000 500 500 333 1000 556 333 842 0 obj 610 610 610 610 610 610 610 548 610 610 /Widths 844 0 R 456 456 273 410 228 456 410 592 410 410 With Blue Advantage, you don’t need to buy a separate Medicare supplement or Part D prescription drug plan. /BaseFont /CYOFGQ+TimesNewRomanPSMT This booklet gives you a summary of what we cover and what you pay. 610 610 610 610 333 333 333 333 722 722 x���? 333 333 500 563 250 333 250 277 500 500 << /Flags 262176 /Ascent 891 222 556 333 1000 556 556 333 1000 666 333 /Descent -250 31, 8 a.m. to 8 p.m., 7 days a week; Apr. 854 0 obj /O 831 o%$H„$!É"’ õþIrì—EÇ%¿•Éañ‡Þ“ÊÊÑx§¤œ÷Õ^lï©%ÇU G>{“¬\=þþH endobj /BaseFont /YHOELV+ArialMT 2021 summary of beneits . 500 500 500 500 333 389 277 500 500 722 832 0 obj /ItalicAngle 0 endobj /Text 0000004266 00000 n 610 610 610 610 333 333 333 333 722 722 1000 350 610 350 350 277 277 500 500 350 0000003531 00000 n 556 556 277 556 556 222 222 500 222 833 370 556 583 333 736 552 399 548 333 333 666 777 722 666 610 722 666 943 666 666 /F1 832 0 R 0 0 0 0 0 0 0 0 0 0 /BaseFont /RSMMEN+ArialMT 556 556 277 556 556 222 222 500 222 833 /ItalicAngle 0 0000003865 00000 n January 1, 2019 – December 31, 2019. /FontBBox [-627 -376 2000 1055] The benefit information provided is a summary of what we cover and what you pay when enrolled in one of these plans. /Length 957 /W [1 4 2] /XHeight 250 /CapHeight 728 Blue Advantage (HMO) | Blue Advantage (PPO) Plan Features • 100% Coverage for Medicare-covered Preventive and Wellness Care • $0 Deductible for In-network Medical Services • $0 In-network Primary Care Visits • $0 In-network Outpatient Routine Labs • Specialist Visits without a Referral • Dental, Vision and Hearing Benefits 623 0 0 0 0 855 0 0 0 0 556 1000 333 1000 556 333 943 350 500 666 /Descent -212 >> You pay ; What you should know . BT 0000003042 00000 n /CS /DeviceRGB endstream /BitsPerComponent 8 Medicare Advantage HMO plans (HMO stands for Health Maintenance Organization) approved by Medicare and run by a private company. /Leading 150 275 500 563 333 759 500 399 548 299 299 /FontBBox [-664 -324 2000 1039] /Info 826 0 R 277 277 277 277 0 0 0 0 0 0 Blue Cross Blue Shield of Arizona Advantage is an HMO plan with a Medicare contract. /FontBBox [-664 -324 2000 1039] 500 1000 333 979 389 333 722 350 443 722 << 0 0 0 498] 836 0 obj /CIDToGIDMap /Identity 722 722 722 722 722 563 722 722 722 722 /Subtype /TrueType This is a summary of drug and health services covered under Blue Medicare HMO Plans . /FontFile2 869 0 R 610 277 277 277 469 556 333 556 556 500 HMO Summary of Benefits. /Encoding /WinAnsiEncoding 88 /ColorSpace /DeviceRGB 849 0 obj 610 777 722 277 556 722 610 833 722 777 /ItalicAngle 0 /FontDescriptor 854 0 R 333 333 389 583 277 333 277 277 556 556 endobj If you decide to sign up for BlueMedicare Premier (HMO) you still retain Original Medicare. 610 556 333 610 610 277 277 556 277 889 /F2 836 0 R Y0132_21-025_ENLA_M This is a summary of drug and health services covered by Blue Advantage (HMO) | Blue Advantage (PPO) from January 1, 2021 – December 31, 2021. endobj 0000277656 00000 n /Length 135 << This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $999 out of pocket. << /StemV 44 840 0 obj 834 0 obj /Type /FontDescriptor /Subtype /TrueType 0 0 250 333 408 500 500 833 777 180 610 333 277 333 583 556 333 556 610 556 /FirstChar 0 Blue Cross and Blue Shield of North Carolina is an HMO plan with a Medicare contract. >> /CapHeight 715 610 610 610 610 389 556 333 610 556 777 /FontDescriptor 856 0 R 556 556 556 556 556 556 556 548 610 556 /Subtype /Form /Widths [0 0 0 0 0 0 0 0 0 277 /S /GTS_PDFA1 860 0 obj 666 777 722 666 610 722 666 943 666 666 /ID [ 556 722 666 556 610 722 722 943 722 722 856 0 obj /FontName /YHOELV+ArialMT To enroll in the following plans, you need to be entitled to Medicare Part A, enrolled in Io+ 0 0 277 333 474 556 556 889 722 237 A complete listing and description of benefits, limitations, and exclusions are found in the Certificate. 0000006097 00000 n /DefaultCMYK [/ICCBased 583 583 583 556 1015 666 666 722 722 666 [333] 857 0 obj endstream 333 576 556 333 333 333 365 556 833 833 Even better, the plan comes with the valuable extra benefits such as dental, vision, hearing and fitness coverage that helps save you even more. 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[556]] /LastChar 255 SEI - U SUMMARY OF BENEFITS The benefit formaon pved is aummary of what coveand what you pay. /ColorSpace << /ColorSpace << /Type /Group >> (�a��{/�d �2b�t˨�,&広HYVY�"��X��Ƞ(���n�R&�L��}����z��y�{:��;@wI�m;�"�O!͡���W4E�P?��qڶ�����UZ7L� �ZcF����>�S�WFӖ��ϙ�م|HO�L^d%�ّay�_��j������{�S��:�����d �a���`�V��E(>�)����ɐ��N�cm�Z����,�D��w@�w-2"�U�a��5~#�/ /Type /Page /Subtype /CIDFontType2 endobj /LastChar 255 833 610 722 722 722 722 722 722 1000 722 0000004816 00000 n /MarkInfo << /CIDSystemInfo 841 0 R << 828 0 obj /BaseFont /ArialMT 1.5 w endobj ET 610 333 277 333 469 500 333 443 500 443 /Length 152776 /Suspects false /Type /Font /FontDescriptor 853 0 R << /Tabs /S 827 0 obj /Flags 32 228 456 456 182 182 410 182 683 456 456 500 500 500 500 500 500 500 548 500 500 /Subtype /Type0 This is a summary of drug and health services covered under Blue Medicare HMO Plans . /ItalicAngle 0 592 228 410 547 456 683 592 638 547 0 /Type /Font endobj /Leading 150 610 610 610 610 610 610 610 548 610 610 endobj >> 838 0 obj /BaseFont /BCDFEE+Calibri /FontFile2 862 0 R >> 847 0 obj 2021 BCN Advantage HMO-POS Summary of Benefits (PDF) 2021 BCN Advantage HMO-POS Community Value Summary of Benefits (PDF) BCN Advantage HMO-POS Region 3 plans. /Supplement 0 >> 777 777 777 777 777 583 777 722 722 722 277 556 500 1000 556 556 333 1000 666 333 >> /BaseFont /UTPWUD+Arial-BoldMT >> endstream 0.76 1.4826 m /ExtGState << EܝÙ*$b(¯w"h$/ð]+|×_ Âw݌Ñï0ì¸ìVÝv¡½jmÖÀ­ž›¿|/ᶝjT¶Ê~?³™»ï /StemV 80 /FirstChar 0 /Type /Font �'�����'h��t:ߜ��뮗��ʹr~w�}��e******************************************************************************************************************************************************************************************************************************************************************************************************************�ߗd b�,�� ^��J2P��d�����f#G�[E��D6� �Y���i)G��k>�N�h�E(&)�Iv�b�̫U�Ͳ�٨�y�6�C�m�N{���1m�Ҫ��>��l޲�y�4�y��@EEEEEE��I�� �0�˒$s����%N�^��$�p��m�X��B ���@�Oĸ��Ip�p�O1O�։�$���#Q�9x�. /ItalicAngle 0 endobj This Summary of Benefits booklet gives you a summary of what Medicare HMO Blue SaverRx (HMO), Medicare HMO Blue ValueRx (HMO), Medicare HMO Blue FlexRx (HMO-POS) and Medicare HMO Blue PlusRx (HMO) cover and what you pay. /Filter /FlateDecode /ca 1 277 556 500 1000 556 556 333 1000 666 333 0 0 0 0 0 0 0 0 0 0 /Registry (Adobe) 835 0 obj << 19 /Metadata 787 0 R Summary of Benefits and Coverage. 610 333 277 333 469 500 333 443 500 443 /Encoding /WinAnsiEncoding /Encoding /WinAnsiEncoding BLUE ADVANTAGE HMO. /GS8 835 0 R /ImageB /XObject << 859 0 obj /Widths [0 0 0 0 0 0 0 0 0 250 /BaseFont /BCDEEE+ArialNarrow /Type /FontDescriptor 845 0 obj 500 500 500 333 259 333 583 350 556 350 /Subtype /Image 333 576 453 333 333 299 310 500 750 750 endobj 277 333 556 556 556 556 279 556 333 736 666 443 443 443 443 443 277 277 277 277 /FontBBox [-568 -306 2045 1039] /CapHeight 715 /Parent 59 0 R /CapHeight 728 /ColorSpace /DeviceRGB 0 0 277 277 354 556 556 889 666 190 << 833 610 666 666 666 666 666 666 1000 722 >> /CapHeight 750 /FontDescriptor 858 0 R 837 0 obj /Filter /FlateDecode >> endobj It doesn’t list every service that we cover or list every 92 0000008314 00000 n 0 0 0 0 544 533 0 0 0 0 277 333 556 556 556 556 259 556 333 736 Summary of Benefits . • If you want to compare our plan with other Medicare health plans, ask the other plans for their Summary of Benefits … /Contents [855 0 R] >> Blue Cross Medicare Advantage Premier Plus (HMO-POS) SM. xœì½|ə÷ߣ™Q,Ù23“lïz)œü“Ë%—Ü?wÿ»÷î½÷Í%—ÜvÍâAi×Ëkff‹™Á2Û²p4Ð\ÿ§ªgF#idËÉ:›Í§~©ôŽ[3ÝÕÕÕUß~ꩧd™ŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠjP! 854 0 obj S 556 1000 333 1000 500 333 943 350 500 666 BlueAdvantage HMO Plan on Pathway HMO Network . 500 443 333 500 500 277 277 500 277 777 [556] /FontDescriptor 851 0 R 829 0 obj 722 666 666 610 556 556 556 556 556 556 /BaseFont /ArialMT /W 847 0 R /CapHeight 662 /BitsPerComponent 8 [278] endobj 277 333 556 556 556 556 279 556 333 736 /FontName /JOVPPX+TimesNewRomanPSMT 333 333 500 563 250 333 250 277 500 500 556 1000 333 1000 556 333 943 350 500 666 For additional information, call Customer Service at 1-866-508-7145 (TTY 711). 333 576 537 333 333 333 365 556 833 833 855 0 obj endobj /CapHeight 716 /FontFile2 857 0 R << Medicare HMO Blue FlexRx also offers Medicare Part D prescription drug coverage—making it easy for you to get your medical and prescription benefits from one plan. endobj 860 0 R] 0000009686 00000 n 556 556 556 556 556 556 556 548 610 556 >> To help you make an informed choice about your health care coverage, we are providing Summary of Benefits and Coverage (SBC) documents for each of our plans. 500 1000 333 979 389 333 722 350 443 722 startxref 2020 summary of beneits premera blue cross medicare advantage core (hmo) h7245-006 . 0 0 0 0 0 0 0 0 0 0 x�]R�n�0��>��۔MBH��C5����!B*�2����������,o�=�����L�W=�'�I�K�a��r�K/=Ɖ��yE����|S|Z��Zv��e�3�i��b����(O��J}� r&��s"�3DO�zn �+�����yٛ�-�}Q@��Ŵ��I5-�F^�˨99�*sr��gkٹ�ϧ4>:c�uƕCI��όS� �(�Y+lKWt�X�Y�$B��Ț$ΙR�Jy�`���"J >> /Ascent 891 /FontBBox [-665 -210 2000 728] Blue Shield 65 Plus (HMO) Medicare Advantage Prescription Drug Plan. [228 0 291 0 456 729 0 157 273 273 39 0000008088 00000 n /Type /Font >> endobj 833 0 obj 277 277 277 277 0 0 0 0 0 0 Blue Shield 65 Plus Los Angeles County/Orange County January 1, 2020 – December 31, 2020. /FontName /KKYTOQ+Arial-BoldMT /ViewerPreferences 829 0 R >> /DefaultCMYK [/ICCBased /Ascent 905 556 1000 333 1000 500 333 943 350 500 666 But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Florida Blue HMO and not Original Medicare. >> 777 777 777 777 777 583 777 722 722 722 222 556 333 1000 556 556 333 1000 666 333 /Type /Catalog We are available Oct. 1 - Mar. /FirstChar 0 /FontBBox [-627 -376 2000 1055] 666 443 443 443 443 443 277 277 277 277 0000002538 00000 n /FontFile2 863 0 R /Marked true 333 576 453 333 333 299 310 500 750 750 /Root 828 0 R /Resources << 846 0 obj /MaxWidth 1182 << << << endobj 563 563 563 443 920 722 666 666 722 610 >> /Subtype /TrueType >> /FontFile2 867 0 R 0000203660 00000 n /Filter /FlateDecode 410] 556 556 500 389 279 389 583 350 556 350 /FontWeight 400 /Name /F2 stream /StemV 80 0 g /BaseFont /KKYTOQ+Arial-BoldMT 844 0 obj 0000010836 00000 n /F6 838 0 R endobj /Type /Font << /Type /XObject 3 /Height 238 777 777 777 777 777 583 777 722 722 722 1000 350 610 350 350 222 222 333 333 350 /L 532074 Hearing services • Hearing exam (Medicare-covered) • Routine (non-Medicare covered) hearing exam • Hearing aids: Dental services • Prophylaxis (cleaning) 0000003657 00000 n << /Ordering (Identity) 750 443 722 722 722 722 722 722 889 666 250 250 250 250 0 0 0 0 0 0 /Flags 32 500 500 500 500 333 389 277 500 500 722 /ToUnicode 846 0 R [556 556 556 556] 889 500 556 556 556 556 277 277 277 277 Premiums and benefits . /ItalicAngle 0 /Leading 150 556 556 500 389 279 389 583 350 556 350 [556] >> << Summary of Benefits Blue Cross Medicare Advantage Basic (HMO) SM. 45 /F2 836 0 R To view your benefit summary, enter the ID number from your BlueAdvantage membership card. endobj 722 722 556 500 443 443 443 443 443 443 /Type /XObject 1 - Sept. 30, 8 a.m. to 8 p.m., Mon. /ExtGState << premera blue cross medicare advantage core plus (hmo) h7245-008 /Type /Font >> /Flags 262176 /Type /FontDescriptor /E 355145 /Width 849 0000003594 00000 n /ProcSet [/PDF 0000306901 00000 n /FontName /UTPWUD+Arial-BoldMT January 1, 2020 – December 31, 2020. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is an HMO plan with a Medicare contract. 177 0000183741 00000 n 610 777 722 277 500 666 556 833 722 777 563 563 563 443 920 722 666 666 722 610 /Descent -212 %PDF-1.7 /F3 850 0 R << 0000004298 00000 n >> /DescendantFonts 839 0 R >> /Flags 34 >> << 500 500 500 333 259 333 583 350 556 350 (PW) NV BA HMO BD NGF $25_$400Ded (15_45_75_30%Rx).s0116 . January 1, 2019 – December 31, 2019 Blue Advantage from HMO Louisiana, Inc. is an HMO plan with a Medicare contract. 0000253036 00000 n /Descent -212 370 556 583 333 736 552 399 548 333 333 666 777 722 666 610 722 666 943 666 666 858 0 obj 0.498 G << 0 0 0 306 252 0 507 507 507 507 ... Summary of benefits (cont’d) Los Angeles County/Orange County . [500] This is a general benefit summary for this health plan. 0 459 0 0 0 0 0 487 0 0 /Font << 0000328797 00000 n /Subtype /TrueType /Length 366 >> /OutputIntents [<< 0000004470 00000 n /XHeight 250 1 j /Height 244 0000006261 00000 n 0000000032 00000 n << /FontWeight 400 277 333 556 556 556 556 259 556 333 736 Blue Cross Medicare Advantage Basic (HMO)SM Blue Cross Medicare Advantage Basic Plus (HMO-POS)SM Blue Cross Medicare Advantage Premier Plus (HMO-POS)SM Hours of Operation Things to Know About Blue Cross Medicare Advantage Basic (HMO) • From October 1 to March 31, you can call us 7 days a week from 8:00 a.m. to 8:00 p.m. Central time. 610 277 277 277 469 556 333 556 556 500 endobj /AvgWidth 362 277 277 277 277 0 0 0 0 0 0 /FirstChar 0 592 547 501 592 547 774 547 547 0 0 x�]��j�0��~ /Length 171684 January 1, 2020 – December 31, 2020. 250 333 500 500 500 500 200 500 333 759 endobj /LastChar 255 /Ascent 905 /Descent -210 0000004551 00000 n /Encoding /Identity-H /Subtype /Image 1 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2020 –12/31/2020 CareFirst BlueChoice: HealthyBlue Advantage HDHP Coverage for: Self Only, Self Plus One or Self and Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. /Widths [0 0 0 0 0 0 0 0 0 250 1-866-508-7145 ( TTY 711 ) what we cover and what you pay ( )... 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Fallout 4 Pickman Companion Reactions, Federal Express Corporation, Iams Senior Dog Food 12kg, Great Value E343039 4cr1, 2 Thessalonians 3:1-5 Meaning, How Much Protein In 1 Banana, Minecraft Shield Recipe, Renault Twingo 2009 Wheel Size, " /> > 583 583 583 556 1015 666 666 722 722 666 833 610 666 666 666 666 666 666 1000 722 Summary of benefits (cont’d) Blue Shield 65 Plus (HMO) Los Angeles and Orange Counties Effective January 1, 2021 - December 31, 2021 . /BBox [0 0 578.09 2.3626] /Descent -212 /BM /Normal 576.76 1.4826 l /MaxWidth 1743 2 2020 Summary of Benefits . /Source (WeJXFxNO4fJduyUMetTcP9+oaONfINN4+d7I7rDsCXgfwEC9G0HBPukfA0p1hkF5B9khgm8VtCFmyd8gIrwOjQRAIjPsWhM4vgMCV\ 610 777 722 277 556 722 610 833 722 777 /F5 854 0 R SUMMARY OF BENEFITS January 1, 2020 – December 31, 2020 This is a summary of health and drug services covered by Blue Cross ® Blue Shield ® of Arizona Advantage (BCBSAZ Advantage). 750 443 722 722 722 722 722 722 889 666 If you are no longer a current member of BlueAdvantage Administrators of Arkansas, the benefit summary is a summary of your benefits on the last day covered. 0 G >> [750] /UserProperties false 556 556 556 556 556 556 556 556 277 277 889 500 556 556 556 556 277 277 277 277 /F2 11.808 Tf endobj /FontDescriptor 849 0 R /DefaultRGB [/ICCBased /FontName /RSMMEN+ArialMT %%EOF >> Blue Shield 65 Plus (HMO) is a Local HMO. 777 777 777 777 777 583 777 722 722 722 /Leading 15 848 0 obj /AvgWidth 521 endobj /Ascent 750 /T 515484 666 666 666 666 277 277 277 277 722 722 /Widths 845 0 R /Leading 150 /Flags 32 [226 0 0 0 0 0 0 0 0 0 /FontName /BCDEEE+ArialNarrow 722 666 666 610 556 556 556 556 556 556 2021 Summary of Benefits Medicare Advantage Plans with Part D Prescription Drug Coverage Blue Medicare Advantage Complete (HMO) January 1, 2021 – December 31, 2021 H1352_21SB001_M . /Flags 32 /Subtype /TrueType 500 500 500 500 500 500] /OutputConditionIdentifier (CGATS TR 001) 0000009470 00000 n /Leading 150 /Leading 33 666 666 666 666 277 277 277 277 722 722 80 1 0 0 1 -0.24 -8.6774 Tm 852 0 obj Summary of Benefits for . /Type /Font >> ±1®Gʐn¸i€ÎGt–èѹ] PdŠ"Y€¹«È [500] >> /Ascent 905 0 507 507 0 0 0 0 0 0 0 /DestOutputProfile 861 0 R 0000004125 00000 n endobj /Descent -210 0000005791 00000 n Enrollment in the. 1000 350 610 350 350 222 222 333 333 350 endobj >>] 333 333 389 583 277 333 277 277 556 556 >> 2021 Medicare HMO Blue FlexRx (HMO-POS) Summary of Benefits; 2021 Medicare HMO Blue FlexRx (HMO-POS) Evidence of Coverage /BaseFont /JOVPPX+TimesNewRomanPSMT x��X[o�0~���pD=_ci�DWn�*�6�@(�lLZ7�6���K/kڦ{hb����>v��������oG���`8:���g��p0(�:u��}x�����;x�@ ��R��q �&�|B1��,\��`pJE*���>f���~�%���p��"�� D��S�6�0L��aj���R%��,���j;�V{H�ׁ��.�0M��`��:��&�lH�J2%@s�,.��L���9H�b�,����M&e�'5�]ҋ�l��Q]^Ǘ�P}��RaW ؕ)�fm�a)ϊxvW�cF(P�JՊm Wߢ,�e��&% This can be a extremely nice safety net. ���ŽPW�S�ԧ�v:���I���S��ww! >> /Subtype /TrueType 370 556 583 333 736 552 399 548 333 333 /Prev 515472 /LastChar 95 << /LastChar 255 8KvVF/K8lfLw/Y8TrTGYASqa04mTaFtTP5w0TMBGEg=) Summary of Benefits and Coverage As part of the Patient Protection and Affordable Care Act, the Summary of Benefits and Coverage (SBC) provides additional information regarding coverage specifications and limitations that apply to the health insurance … << /StemV 80 >> 333 500 443 1000 500 500 333 1000 556 333 Enrollment in Blue Advantage depends on contract renewal. Enrollment in the Plan depends on contract renewal. x��tUW���=�)P�h /Type /OutputIntent endobj 0000006934 00000 n /Leading 150 Blue Advantage (HMO) | Blue Advantage (PPO) Summary of Benefits Plans may offer supplemental benefits in addition to Part C benefits and Part D benefits. 250 250 250 250 0 0 0 0 0 0 >> /FontName /ArialMT �pL�U Û8������e,�3�N�b�4���ꉝ��Ae�)��c���� � ���9�Y&\�* �n�k�V|�¶�f�.����mI�2u����~L���0��۹!OT+.�$ʱ���IԹ�}�-r��̜L����ܫ0�Fϲ G'�7��>A[�F��2�����3;�|�G{��h7�J.�&іg-C;���-&�._�b���>�K�R�}���c�nJh��gz���a_�p��;E�A�"��+�?���-t�dK���腾�z�7�)���y�w{;)�*:���Q��u=_������Ox�lNGҰA3��A���B�q���z�����sc��$����O#�� !�04�@zE�F�_�M�aI�T2�N�.��w�ͥ@�{�S���2C�t����"r��Y>�t�P�R�6�2^1��P��ZAm����8�'�Li2 S�" c�����q�(��0H:(�������C)d2�,E@Afv@ << >> This booklet gives you a summary of what we cover and what you pay. /StructParents 0 endstream /Flags 34 /Font << 500 500 500 500 500 500 500 548 500 500 /Linearized 1 �Cq�]C`k�n,�8���(�!o?�L`�����-}������1���1.ae�0��I�8o�ޕ��&*-p�- �Ơ����K� �.xT���� ��^�~��g��j[p8ʠofF�;uNt���0��-"�K_������E64�j*��g�V!��N ��2��O���U�P��{������,y�J����C�T>? stream /Type /FontDescriptor 0 0 0 0 0 0 0 0 0 0 0000005255 00000 n 556 556 556 556 333 500 277 556 500 722 /Filter /FlateDecode 610 610 610 556 610 556] 333 333 389 583 277 333 277 277 556 556 xref 556 722 722 333 389 722 610 889 722 722 trailer 556 556 556 556 556 556 556 556 277 277 %ABCpdf 11200 /FirstChar 32 /Matrix [0.12455 0 0 30.475 0 0] /Encoding /WinAnsiEncoding /ItalicAngle 0 This document may be available in a non-English language. Summary of Benefits for Anthem MediBlue Dual Advantage (HMO SNP) Available in: Select Counties* in Ohio *See Page 2 for a list of counties. 583 583 583 610 975 722 722 722 722 666 500 443 333 500 500 277 277 500 277 777 0000255685 00000 n /Name /F1 /Subtype /TrueType >> 666 666 666 666 277 277 277 277 722 722 722 666 666 610 556 556 556 556 556 556 556 722 722 333 389 722 610 889 722 722 0 0 0 547 547 592 592 547 501 638 endobj /Pages 59 0 R 850 0 obj /CapHeight 662 500 500 500 500 500 500 500 500 277 277 889 556 556 556 556 556 277 277 277 277 /Ascent 905 << /Encoding /WinAnsiEncoding /Type /FontDescriptor [833 556] 830 0 obj /DefaultRGB [/ICCBased /StemV 36 /Lang (en-US) [722] /Encoding /WinAnsiEncoding /XHeight 250 556 556 556 556 556 556 556 556 333 333 666 777 722 666 610 722 666 943 666 666 endobj /AvgWidth 441 889 556 556 556 556 556 277 277 277 277 /S 196 851 0 obj /DW 1000 2020 Summary of Benefits Capital Health Plan Advantage Plus (HMO) and Capital Health Plan Preferred Advantage (HMO) This is a summary of drug and health services covered by Capital Health Plan Advantage Plus (HMO) and Capital Health Plan Preferred Advantage (HMO) January 1, 2020 – December 31, 2020. ] 0000005607 00000 n /Ascent 936 >> /F4 852 0 R 333 500 443 1000 500 500 333 1000 556 333 842 0 obj 610 610 610 610 610 610 610 548 610 610 /Widths 844 0 R 456 456 273 410 228 456 410 592 410 410 With Blue Advantage, you don’t need to buy a separate Medicare supplement or Part D prescription drug plan. /BaseFont /CYOFGQ+TimesNewRomanPSMT This booklet gives you a summary of what we cover and what you pay. 610 610 610 610 333 333 333 333 722 722 x���? 333 333 500 563 250 333 250 277 500 500 << /Flags 262176 /Ascent 891 222 556 333 1000 556 556 333 1000 666 333 /Descent -250 31, 8 a.m. to 8 p.m., 7 days a week; Apr. 854 0 obj /O 831 o%$H„$!É"’ õþIrì—EÇ%¿•Éañ‡Þ“ÊÊÑx§¤œ÷Õ^lï©%ÇU G>{“¬\=þþH endobj /BaseFont /YHOELV+ArialMT 2021 summary of beneits . 500 500 500 500 333 389 277 500 500 722 832 0 obj /ItalicAngle 0 endobj /Text 0000004266 00000 n 610 610 610 610 333 333 333 333 722 722 1000 350 610 350 350 277 277 500 500 350 0000003531 00000 n 556 556 277 556 556 222 222 500 222 833 370 556 583 333 736 552 399 548 333 333 666 777 722 666 610 722 666 943 666 666 /F1 832 0 R 0 0 0 0 0 0 0 0 0 0 /BaseFont /RSMMEN+ArialMT 556 556 277 556 556 222 222 500 222 833 /ItalicAngle 0 0000003865 00000 n January 1, 2019 – December 31, 2019. /FontBBox [-627 -376 2000 1055] The benefit information provided is a summary of what we cover and what you pay when enrolled in one of these plans. /Length 957 /W [1 4 2] /XHeight 250 /CapHeight 728 Blue Advantage (HMO) | Blue Advantage (PPO) Plan Features • 100% Coverage for Medicare-covered Preventive and Wellness Care • $0 Deductible for In-network Medical Services • $0 In-network Primary Care Visits • $0 In-network Outpatient Routine Labs • Specialist Visits without a Referral • Dental, Vision and Hearing Benefits 623 0 0 0 0 855 0 0 0 0 556 1000 333 1000 556 333 943 350 500 666 /Descent -212 >> You pay ; What you should know . BT 0000003042 00000 n /CS /DeviceRGB endstream /BitsPerComponent 8 Medicare Advantage HMO plans (HMO stands for Health Maintenance Organization) approved by Medicare and run by a private company. /Leading 150 275 500 563 333 759 500 399 548 299 299 /FontBBox [-664 -324 2000 1039] /Info 826 0 R 277 277 277 277 0 0 0 0 0 0 Blue Cross Blue Shield of Arizona Advantage is an HMO plan with a Medicare contract. /FontBBox [-664 -324 2000 1039] 500 1000 333 979 389 333 722 350 443 722 << 0 0 0 498] 836 0 obj /CIDToGIDMap /Identity 722 722 722 722 722 563 722 722 722 722 /Subtype /TrueType This is a summary of drug and health services covered under Blue Medicare HMO Plans . /FontFile2 869 0 R 610 277 277 277 469 556 333 556 556 500 HMO Summary of Benefits. /Encoding /WinAnsiEncoding 88 /ColorSpace /DeviceRGB 849 0 obj 610 777 722 277 556 722 610 833 722 777 /ItalicAngle 0 /FontDescriptor 854 0 R 333 333 389 583 277 333 277 277 556 556 endobj If you decide to sign up for BlueMedicare Premier (HMO) you still retain Original Medicare. 610 556 333 610 610 277 277 556 277 889 /F2 836 0 R Y0132_21-025_ENLA_M This is a summary of drug and health services covered by Blue Advantage (HMO) | Blue Advantage (PPO) from January 1, 2021 – December 31, 2021. endobj 0000277656 00000 n /Length 135 << This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $999 out of pocket. << /StemV 44 840 0 obj 834 0 obj /Type /FontDescriptor /Subtype /TrueType 0 0 250 333 408 500 500 833 777 180 610 333 277 333 583 556 333 556 610 556 /FirstChar 0 Blue Cross and Blue Shield of North Carolina is an HMO plan with a Medicare contract. >> /CapHeight 715 610 610 610 610 389 556 333 610 556 777 /FontDescriptor 856 0 R 556 556 556 556 556 556 556 548 610 556 /Subtype /Form /Widths [0 0 0 0 0 0 0 0 0 277 /S /GTS_PDFA1 860 0 obj 666 777 722 666 610 722 666 943 666 666 /ID [ 556 722 666 556 610 722 722 943 722 722 856 0 obj /FontName /YHOELV+ArialMT To enroll in the following plans, you need to be entitled to Medicare Part A, enrolled in Io+ 0 0 277 333 474 556 556 889 722 237 A complete listing and description of benefits, limitations, and exclusions are found in the Certificate. 0000006097 00000 n /DefaultCMYK [/ICCBased 583 583 583 556 1015 666 666 722 722 666 [333] 857 0 obj endstream 333 576 556 333 333 333 365 556 833 833 Even better, the plan comes with the valuable extra benefits such as dental, vision, hearing and fitness coverage that helps save you even more. 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[556]] /LastChar 255 SEI - U SUMMARY OF BENEFITS The benefit formaon pved is aummary of what coveand what you pay. /ColorSpace << /ColorSpace << /Type /Group >> (�a��{/�d �2b�t˨�,&広HYVY�"��X��Ƞ(���n�R&�L��}����z��y�{:��;@wI�m;�"�O!͡���W4E�P?��qڶ�����UZ7L� �ZcF����>�S�WFӖ��ϙ�م|HO�L^d%�ّay�_��j������{�S��:�����d �a���`�V��E(>�)����ɐ��N�cm�Z����,�D��w@�w-2"�U�a��5~#�/ /Type /Page /Subtype /CIDFontType2 endobj /LastChar 255 833 610 722 722 722 722 722 722 1000 722 0000004816 00000 n /MarkInfo << /CIDSystemInfo 841 0 R << 828 0 obj /BaseFont /ArialMT 1.5 w endobj ET 610 333 277 333 469 500 333 443 500 443 /Length 152776 /Suspects false /Type /Font /FontDescriptor 853 0 R << /Tabs /S 827 0 obj /Flags 32 228 456 456 182 182 410 182 683 456 456 500 500 500 500 500 500 500 548 500 500 /Subtype /Type0 This is a summary of drug and health services covered under Blue Medicare HMO Plans . /ItalicAngle 0 592 228 410 547 456 683 592 638 547 0 /Type /Font endobj /Leading 150 610 610 610 610 610 610 610 548 610 610 endobj >> 838 0 obj /BaseFont /BCDFEE+Calibri /FontFile2 862 0 R >> 847 0 obj 2021 BCN Advantage HMO-POS Summary of Benefits (PDF) 2021 BCN Advantage HMO-POS Community Value Summary of Benefits (PDF) BCN Advantage HMO-POS Region 3 plans. /Supplement 0 >> 777 777 777 777 777 583 777 722 722 722 277 556 500 1000 556 556 333 1000 666 333 >> /BaseFont /UTPWUD+Arial-BoldMT >> endstream 0.76 1.4826 m /ExtGState << EܝÙ*$b(¯w"h$/ð]+|×_ Âw݌Ñï0ì¸ìVÝv¡½jmÖÀ­ž›¿|/ᶝjT¶Ê~?³™»ï /StemV 80 /FirstChar 0 /Type /Font �'�����'h��t:ߜ��뮗��ʹr~w�}��e******************************************************************************************************************************************************************************************************************************************************************************************************************�ߗd b�,�� ^��J2P��d�����f#G�[E��D6� �Y���i)G��k>�N�h�E(&)�Iv�b�̫U�Ͳ�٨�y�6�C�m�N{���1m�Ҫ��>��l޲�y�4�y��@EEEEEE��I�� �0�˒$s����%N�^��$�p��m�X��B ���@�Oĸ��Ip�p�O1O�։�$���#Q�9x�. /ItalicAngle 0 endobj This Summary of Benefits booklet gives you a summary of what Medicare HMO Blue SaverRx (HMO), Medicare HMO Blue ValueRx (HMO), Medicare HMO Blue FlexRx (HMO-POS) and Medicare HMO Blue PlusRx (HMO) cover and what you pay. /Filter /FlateDecode /ca 1 277 556 500 1000 556 556 333 1000 666 333 0 0 0 0 0 0 0 0 0 0 /Registry (Adobe) 835 0 obj << 19 /Metadata 787 0 R Summary of Benefits and Coverage. 610 333 277 333 469 500 333 443 500 443 /Encoding /WinAnsiEncoding /Encoding /WinAnsiEncoding BLUE ADVANTAGE HMO. /GS8 835 0 R /ImageB /XObject << 859 0 obj /Widths [0 0 0 0 0 0 0 0 0 250 /BaseFont /BCDEEE+ArialNarrow /Type /FontDescriptor 845 0 obj 500 500 500 333 259 333 583 350 556 350 /Subtype /Image 333 576 453 333 333 299 310 500 750 750 endobj 277 333 556 556 556 556 279 556 333 736 666 443 443 443 443 443 277 277 277 277 /FontBBox [-568 -306 2045 1039] /CapHeight 715 /Parent 59 0 R /CapHeight 728 /ColorSpace /DeviceRGB 0 0 277 277 354 556 556 889 666 190 << 833 610 666 666 666 666 666 666 1000 722 >> /CapHeight 750 /FontDescriptor 858 0 R 837 0 obj /Filter /FlateDecode >> endobj It doesn’t list every service that we cover or list every 92 0000008314 00000 n 0 0 0 0 544 533 0 0 0 0 277 333 556 556 556 556 259 556 333 736 Summary of Benefits . • If you want to compare our plan with other Medicare health plans, ask the other plans for their Summary of Benefits … /Contents [855 0 R] >> Blue Cross Medicare Advantage Premier Plus (HMO-POS) SM. xœì½|ə÷ߣ™Q,Ù23“lïz)œü“Ë%—Ü?wÿ»÷î½÷Í%—ÜvÍâAi×Ëkff‹™Á2Û²p4Ð\ÿ§ªgF#idËÉ:›Í§~©ôŽ[3ÝÕÕÕUß~ꩧd™ŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠjP! 854 0 obj S 556 1000 333 1000 500 333 943 350 500 666 BlueAdvantage HMO Plan on Pathway HMO Network . 500 443 333 500 500 277 277 500 277 777 [556] /FontDescriptor 851 0 R 829 0 obj 722 666 666 610 556 556 556 556 556 556 /BaseFont /ArialMT /W 847 0 R /CapHeight 662 /BitsPerComponent 8 [278] endobj 277 333 556 556 556 556 279 556 333 736 /FontName /JOVPPX+TimesNewRomanPSMT 333 333 500 563 250 333 250 277 500 500 556 1000 333 1000 556 333 943 350 500 666 For additional information, call Customer Service at 1-866-508-7145 (TTY 711). 333 576 537 333 333 333 365 556 833 833 855 0 obj endobj /CapHeight 716 /FontFile2 857 0 R << Medicare HMO Blue FlexRx also offers Medicare Part D prescription drug coverage—making it easy for you to get your medical and prescription benefits from one plan. endobj 860 0 R] 0000009686 00000 n 556 556 556 556 556 556 556 548 610 556 >> To help you make an informed choice about your health care coverage, we are providing Summary of Benefits and Coverage (SBC) documents for each of our plans. 500 1000 333 979 389 333 722 350 443 722 startxref 2020 summary of beneits premera blue cross medicare advantage core (hmo) h7245-006 . 0 0 0 0 0 0 0 0 0 0 x�]R�n�0��>��۔MBH��C5����!B*�2����������,o�=�����L�W=�'�I�K�a��r�K/=Ɖ��yE����|S|Z��Zv��e�3�i��b����(O��J}� r&��s"�3DO�zn �+�����yٛ�-�}Q@��Ŵ��I5-�F^�˨99�*sr��gkٹ�ϧ4>:c�uƕCI��όS� �(�Y+lKWt�X�Y�$B��Ț$ΙR�Jy�`���"J >> /Ascent 891 /FontBBox [-665 -210 2000 728] Blue Shield 65 Plus (HMO) Medicare Advantage Prescription Drug Plan. [228 0 291 0 456 729 0 157 273 273 39 0000008088 00000 n /Type /Font >> endobj 833 0 obj 277 277 277 277 0 0 0 0 0 0 Blue Shield 65 Plus Los Angeles County/Orange County January 1, 2020 – December 31, 2020. /FontName /KKYTOQ+Arial-BoldMT /ViewerPreferences 829 0 R >> /DefaultCMYK [/ICCBased /Ascent 905 556 1000 333 1000 500 333 943 350 500 666 But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Florida Blue HMO and not Original Medicare. >> 777 777 777 777 777 583 777 722 722 722 222 556 333 1000 556 556 333 1000 666 333 /Type /Catalog We are available Oct. 1 - Mar. /FirstChar 0 /FontBBox [-627 -376 2000 1055] 666 443 443 443 443 443 277 277 277 277 0000002538 00000 n /FontFile2 863 0 R /Marked true 333 576 453 333 333 299 310 500 750 750 /Root 828 0 R /Resources << 846 0 obj /MaxWidth 1182 << << << endobj 563 563 563 443 920 722 666 666 722 610 >> /Subtype /TrueType >> /FontFile2 867 0 R 0000203660 00000 n /Filter /FlateDecode 410] 556 556 500 389 279 389 583 350 556 350 /FontWeight 400 /Name /F2 stream /StemV 80 0 g /BaseFont /KKYTOQ+Arial-BoldMT 844 0 obj 0000010836 00000 n /F6 838 0 R endobj /Type /Font << /Type /XObject 3 /Height 238 777 777 777 777 777 583 777 722 722 722 1000 350 610 350 350 222 222 333 333 350 /L 532074 Hearing services • Hearing exam (Medicare-covered) • Routine (non-Medicare covered) hearing exam • Hearing aids: Dental services • Prophylaxis (cleaning) 0000003657 00000 n << /Ordering (Identity) 750 443 722 722 722 722 722 722 889 666 250 250 250 250 0 0 0 0 0 0 /Flags 32 500 500 500 500 333 389 277 500 500 722 /ToUnicode 846 0 R [556 556 556 556] 889 500 556 556 556 556 277 277 277 277 Premiums and benefits . /ItalicAngle 0 /Leading 150 556 556 500 389 279 389 583 350 556 350 [556] >> << Summary of Benefits Blue Cross Medicare Advantage Basic (HMO) SM. 45 /F2 836 0 R To view your benefit summary, enter the ID number from your BlueAdvantage membership card. endobj 722 722 556 500 443 443 443 443 443 443 /Type /XObject 1 - Sept. 30, 8 a.m. to 8 p.m., Mon. /ExtGState << premera blue cross medicare advantage core plus (hmo) h7245-008 /Type /Font >> /Flags 262176 /Type /FontDescriptor /E 355145 /Width 849 0000003594 00000 n /ProcSet [/PDF 0000306901 00000 n /FontName /UTPWUD+Arial-BoldMT January 1, 2020 – December 31, 2020. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is an HMO plan with a Medicare contract. 177 0000183741 00000 n 610 777 722 277 500 666 556 833 722 777 563 563 563 443 920 722 666 666 722 610 /Descent -212 %PDF-1.7 /F3 850 0 R << 0000004298 00000 n >> /DescendantFonts 839 0 R >> /Flags 34 >> << 500 500 500 333 259 333 583 350 556 350 (PW) NV BA HMO BD NGF $25_$400Ded (15_45_75_30%Rx).s0116 . January 1, 2019 – December 31, 2019 Blue Advantage from HMO Louisiana, Inc. is an HMO plan with a Medicare contract. 0000253036 00000 n /Descent -212 370 556 583 333 736 552 399 548 333 333 666 777 722 666 610 722 666 943 666 666 858 0 obj 0.498 G << 0 0 0 306 252 0 507 507 507 507 ... Summary of benefits (cont’d) Los Angeles County/Orange County . [500] This is a general benefit summary for this health plan. 0 459 0 0 0 0 0 487 0 0 /Font << 0000328797 00000 n /Subtype /TrueType /Length 366 >> /OutputIntents [<< 0000004470 00000 n /XHeight 250 1 j /Height 244 0000006261 00000 n 0000000032 00000 n << /FontWeight 400 277 333 556 556 556 556 259 556 333 736 Blue Cross Medicare Advantage Basic (HMO)SM Blue Cross Medicare Advantage Basic Plus (HMO-POS)SM Blue Cross Medicare Advantage Premier Plus (HMO-POS)SM Hours of Operation Things to Know About Blue Cross Medicare Advantage Basic (HMO) • From October 1 to March 31, you can call us 7 days a week from 8:00 a.m. to 8:00 p.m. Central time. 610 277 277 277 469 556 333 556 556 500 endobj /AvgWidth 362 277 277 277 277 0 0 0 0 0 0 /FirstChar 0 592 547 501 592 547 774 547 547 0 0 x�]��j�0��~ /Length 171684 January 1, 2020 – December 31, 2020. 250 333 500 500 500 500 200 500 333 759 endobj /LastChar 255 /Ascent 905 /Descent -210 0000004551 00000 n /Encoding /Identity-H /Subtype /Image 1 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2020 –12/31/2020 CareFirst BlueChoice: HealthyBlue Advantage HDHP Coverage for: Self Only, Self Plus One or Self and Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. /Widths [0 0 0 0 0 0 0 0 0 250 1-866-508-7145 ( TTY 711 ) what we cover and what you pay ( )... 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blue advantage hmo summary of benefits

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blue advantage hmo summary of benefits

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Enrollment in the Plan depends on contract renewal. x��tUW���=�)P�h /Type /OutputIntent endobj 0000006934 00000 n /Leading 150 Blue Advantage (HMO) | Blue Advantage (PPO) Summary of Benefits Plans may offer supplemental benefits in addition to Part C benefits and Part D benefits. 250 250 250 250 0 0 0 0 0 0 >> /FontName /ArialMT �pL�U Û8������e,�3�N�b�4���ꉝ��Ae�)��c���� � ���9�Y&\�* �n�k�V|�¶�f�.����mI�2u����~L���0��۹!OT+.�$ʱ���IԹ�}�-r��̜L����ܫ0�Fϲ G'�7��>A[�F��2�����3;�|�G{��h7�J.�&іg-C;���-&�._�b���>�K�R�}���c�nJh��gz���a_�p��;E�A�"��+�?���-t�dK���腾�z�7�)���y�w{;)�*:���Q��u=_������Ox�lNGҰA3��A���B�q���z�����sc��$����O#�� !�04�@zE�F�_�M�aI�T2�N�.��w�ͥ@�{�S���2C�t����"r��Y>�t�P�R�6�2^1��P��ZAm����8�'�Li2 S�" c�����q�(��0H:(�������C)d2�,E@Afv@ << >> This booklet gives you a summary of what we cover and what you pay. /StructParents 0 endstream /Flags 34 /Font << 500 500 500 500 500 500 500 548 500 500 /Linearized 1 �Cq�]C`k�n,�8���(�!o?�L`�����-}������1���1.ae�0��I�8o�ޕ��&*-p�- �Ơ����K� �.xT���� ��^�~��g��j[p8ʠofF�;uNt���0��-"�K_������E64�j*��g�V!��N ��2��O���U�P��{������,y�J����C�T>? stream /Type /FontDescriptor 0 0 0 0 0 0 0 0 0 0 0000005255 00000 n 556 556 556 556 333 500 277 556 500 722 /Filter /FlateDecode 610 610 610 556 610 556] 333 333 389 583 277 333 277 277 556 556 xref 556 722 722 333 389 722 610 889 722 722 trailer 556 556 556 556 556 556 556 556 277 277 %ABCpdf 11200 /FirstChar 32 /Matrix [0.12455 0 0 30.475 0 0] /Encoding /WinAnsiEncoding /ItalicAngle 0 This document may be available in a non-English language. Summary of Benefits for Anthem MediBlue Dual Advantage (HMO SNP) Available in: Select Counties* in Ohio *See Page 2 for a list of counties. 583 583 583 610 975 722 722 722 722 666 500 443 333 500 500 277 277 500 277 777 0000255685 00000 n /Name /F1 /Subtype /TrueType >> 666 666 666 666 277 277 277 277 722 722 722 666 666 610 556 556 556 556 556 556 556 722 722 333 389 722 610 889 722 722 0 0 0 547 547 592 592 547 501 638 endobj /Pages 59 0 R 850 0 obj /CapHeight 662 500 500 500 500 500 500 500 500 277 277 889 556 556 556 556 556 277 277 277 277 /Ascent 905 << /Encoding /WinAnsiEncoding /Type /FontDescriptor [833 556] 830 0 obj /DefaultRGB [/ICCBased /StemV 36 /Lang (en-US) [722] /Encoding /WinAnsiEncoding /XHeight 250 556 556 556 556 556 556 556 556 333 333 666 777 722 666 610 722 666 943 666 666 endobj /AvgWidth 441 889 556 556 556 556 556 277 277 277 277 /S 196 851 0 obj /DW 1000 2020 Summary of Benefits Capital Health Plan Advantage Plus (HMO) and Capital Health Plan Preferred Advantage (HMO) This is a summary of drug and health services covered by Capital Health Plan Advantage Plus (HMO) and Capital Health Plan Preferred Advantage (HMO) January 1, 2020 – December 31, 2020. ] 0000005607 00000 n /Ascent 936 >> /F4 852 0 R 333 500 443 1000 500 500 333 1000 556 333 842 0 obj 610 610 610 610 610 610 610 548 610 610 /Widths 844 0 R 456 456 273 410 228 456 410 592 410 410 With Blue Advantage, you don’t need to buy a separate Medicare supplement or Part D prescription drug plan. /BaseFont /CYOFGQ+TimesNewRomanPSMT This booklet gives you a summary of what we cover and what you pay. 610 610 610 610 333 333 333 333 722 722 x���? 333 333 500 563 250 333 250 277 500 500 << /Flags 262176 /Ascent 891 222 556 333 1000 556 556 333 1000 666 333 /Descent -250 31, 8 a.m. to 8 p.m., 7 days a week; Apr. 854 0 obj /O 831 o%$H„$!É"’ õþIrì—EÇ%¿•Éañ‡Þ“ÊÊÑx§¤œ÷Õ^lï©%ÇU G>{“¬\=þþH endobj /BaseFont /YHOELV+ArialMT 2021 summary of beneits . 500 500 500 500 333 389 277 500 500 722 832 0 obj /ItalicAngle 0 endobj /Text 0000004266 00000 n 610 610 610 610 333 333 333 333 722 722 1000 350 610 350 350 277 277 500 500 350 0000003531 00000 n 556 556 277 556 556 222 222 500 222 833 370 556 583 333 736 552 399 548 333 333 666 777 722 666 610 722 666 943 666 666 /F1 832 0 R 0 0 0 0 0 0 0 0 0 0 /BaseFont /RSMMEN+ArialMT 556 556 277 556 556 222 222 500 222 833 /ItalicAngle 0 0000003865 00000 n January 1, 2019 – December 31, 2019. /FontBBox [-627 -376 2000 1055] The benefit information provided is a summary of what we cover and what you pay when enrolled in one of these plans. /Length 957 /W [1 4 2] /XHeight 250 /CapHeight 728 Blue Advantage (HMO) | Blue Advantage (PPO) Plan Features • 100% Coverage for Medicare-covered Preventive and Wellness Care • $0 Deductible for In-network Medical Services • $0 In-network Primary Care Visits • $0 In-network Outpatient Routine Labs • Specialist Visits without a Referral • Dental, Vision and Hearing Benefits 623 0 0 0 0 855 0 0 0 0 556 1000 333 1000 556 333 943 350 500 666 /Descent -212 >> You pay ; What you should know . BT 0000003042 00000 n /CS /DeviceRGB endstream /BitsPerComponent 8 Medicare Advantage HMO plans (HMO stands for Health Maintenance Organization) approved by Medicare and run by a private company. /Leading 150 275 500 563 333 759 500 399 548 299 299 /FontBBox [-664 -324 2000 1039] /Info 826 0 R 277 277 277 277 0 0 0 0 0 0 Blue Cross Blue Shield of Arizona Advantage is an HMO plan with a Medicare contract. /FontBBox [-664 -324 2000 1039] 500 1000 333 979 389 333 722 350 443 722 << 0 0 0 498] 836 0 obj /CIDToGIDMap /Identity 722 722 722 722 722 563 722 722 722 722 /Subtype /TrueType This is a summary of drug and health services covered under Blue Medicare HMO Plans . /FontFile2 869 0 R 610 277 277 277 469 556 333 556 556 500 HMO Summary of Benefits. /Encoding /WinAnsiEncoding 88 /ColorSpace /DeviceRGB 849 0 obj 610 777 722 277 556 722 610 833 722 777 /ItalicAngle 0 /FontDescriptor 854 0 R 333 333 389 583 277 333 277 277 556 556 endobj If you decide to sign up for BlueMedicare Premier (HMO) you still retain Original Medicare. 610 556 333 610 610 277 277 556 277 889 /F2 836 0 R Y0132_21-025_ENLA_M This is a summary of drug and health services covered by Blue Advantage (HMO) | Blue Advantage (PPO) from January 1, 2021 – December 31, 2021. endobj 0000277656 00000 n /Length 135 << This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $999 out of pocket. << /StemV 44 840 0 obj 834 0 obj /Type /FontDescriptor /Subtype /TrueType 0 0 250 333 408 500 500 833 777 180 610 333 277 333 583 556 333 556 610 556 /FirstChar 0 Blue Cross and Blue Shield of North Carolina is an HMO plan with a Medicare contract. >> /CapHeight 715 610 610 610 610 389 556 333 610 556 777 /FontDescriptor 856 0 R 556 556 556 556 556 556 556 548 610 556 /Subtype /Form /Widths [0 0 0 0 0 0 0 0 0 277 /S /GTS_PDFA1 860 0 obj 666 777 722 666 610 722 666 943 666 666 /ID [ 556 722 666 556 610 722 722 943 722 722 856 0 obj /FontName /YHOELV+ArialMT To enroll in the following plans, you need to be entitled to Medicare Part A, enrolled in Io+ 0 0 277 333 474 556 556 889 722 237 A complete listing and description of benefits, limitations, and exclusions are found in the Certificate. 0000006097 00000 n /DefaultCMYK [/ICCBased 583 583 583 556 1015 666 666 722 722 666 [333] 857 0 obj endstream 333 576 556 333 333 333 365 556 833 833 Even better, the plan comes with the valuable extra benefits such as dental, vision, hearing and fitness coverage that helps save you even more. 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[278] stream Thank you for your interest in Blue Cross and Blue Shield of Texas. [556]] /LastChar 255 SEI - U SUMMARY OF BENEFITS The benefit formaon pved is aummary of what coveand what you pay. /ColorSpace << /ColorSpace << /Type /Group >> (�a��{/�d �2b�t˨�,&広HYVY�"��X��Ƞ(���n�R&�L��}����z��y�{:��;@wI�m;�"�O!͡���W4E�P?��qڶ�����UZ7L� �ZcF����>�S�WFӖ��ϙ�م|HO�L^d%�ّay�_��j������{�S��:�����d �a���`�V��E(>�)����ɐ��N�cm�Z����,�D��w@�w-2"�U�a��5~#�/ /Type /Page /Subtype /CIDFontType2 endobj /LastChar 255 833 610 722 722 722 722 722 722 1000 722 0000004816 00000 n /MarkInfo << /CIDSystemInfo 841 0 R << 828 0 obj /BaseFont /ArialMT 1.5 w endobj ET 610 333 277 333 469 500 333 443 500 443 /Length 152776 /Suspects false /Type /Font /FontDescriptor 853 0 R << /Tabs /S 827 0 obj /Flags 32 228 456 456 182 182 410 182 683 456 456 500 500 500 500 500 500 500 548 500 500 /Subtype /Type0 This is a summary of drug and health services covered under Blue Medicare HMO Plans . /ItalicAngle 0 592 228 410 547 456 683 592 638 547 0 /Type /Font endobj /Leading 150 610 610 610 610 610 610 610 548 610 610 endobj >> 838 0 obj /BaseFont /BCDFEE+Calibri /FontFile2 862 0 R >> 847 0 obj 2021 BCN Advantage HMO-POS Summary of Benefits (PDF) 2021 BCN Advantage HMO-POS Community Value Summary of Benefits (PDF) BCN Advantage HMO-POS Region 3 plans. /Supplement 0 >> 777 777 777 777 777 583 777 722 722 722 277 556 500 1000 556 556 333 1000 666 333 >> /BaseFont /UTPWUD+Arial-BoldMT >> endstream 0.76 1.4826 m /ExtGState << EܝÙ*$b(¯w"h$/ð]+|×_ Âw݌Ñï0ì¸ìVÝv¡½jmÖÀ­ž›¿|/ᶝjT¶Ê~?³™»ï /StemV 80 /FirstChar 0 /Type /Font �'�����'h��t:ߜ��뮗��ʹr~w�}��e******************************************************************************************************************************************************************************************************************************************************************************************************************�ߗd b�,�� ^��J2P��d�����f#G�[E��D6� �Y���i)G��k>�N�h�E(&)�Iv�b�̫U�Ͳ�٨�y�6�C�m�N{���1m�Ҫ��>��l޲�y�4�y��@EEEEEE��I�� �0�˒$s����%N�^��$�p��m�X��B ���@�Oĸ��Ip�p�O1O�։�$���#Q�9x�. /ItalicAngle 0 endobj This Summary of Benefits booklet gives you a summary of what Medicare HMO Blue SaverRx (HMO), Medicare HMO Blue ValueRx (HMO), Medicare HMO Blue FlexRx (HMO-POS) and Medicare HMO Blue PlusRx (HMO) cover and what you pay. /Filter /FlateDecode /ca 1 277 556 500 1000 556 556 333 1000 666 333 0 0 0 0 0 0 0 0 0 0 /Registry (Adobe) 835 0 obj << 19 /Metadata 787 0 R Summary of Benefits and Coverage. 610 333 277 333 469 500 333 443 500 443 /Encoding /WinAnsiEncoding /Encoding /WinAnsiEncoding BLUE ADVANTAGE HMO. /GS8 835 0 R /ImageB /XObject << 859 0 obj /Widths [0 0 0 0 0 0 0 0 0 250 /BaseFont /BCDEEE+ArialNarrow /Type /FontDescriptor 845 0 obj 500 500 500 333 259 333 583 350 556 350 /Subtype /Image 333 576 453 333 333 299 310 500 750 750 endobj 277 333 556 556 556 556 279 556 333 736 666 443 443 443 443 443 277 277 277 277 /FontBBox [-568 -306 2045 1039] /CapHeight 715 /Parent 59 0 R /CapHeight 728 /ColorSpace /DeviceRGB 0 0 277 277 354 556 556 889 666 190 << 833 610 666 666 666 666 666 666 1000 722 >> /CapHeight 750 /FontDescriptor 858 0 R 837 0 obj /Filter /FlateDecode >> endobj It doesn’t list every service that we cover or list every 92 0000008314 00000 n 0 0 0 0 544 533 0 0 0 0 277 333 556 556 556 556 259 556 333 736 Summary of Benefits . • If you want to compare our plan with other Medicare health plans, ask the other plans for their Summary of Benefits … /Contents [855 0 R] >> Blue Cross Medicare Advantage Premier Plus (HMO-POS) SM. xœì½|ə÷ߣ™Q,Ù23“lïz)œü“Ë%—Ü?wÿ»÷î½÷Í%—ÜvÍâAi×Ëkff‹™Á2Û²p4Ð\ÿ§ªgF#idËÉ:›Í§~©ôŽ[3ÝÕÕÕUß~ꩧd™ŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠjP! 854 0 obj S 556 1000 333 1000 500 333 943 350 500 666 BlueAdvantage HMO Plan on Pathway HMO Network . 500 443 333 500 500 277 277 500 277 777 [556] /FontDescriptor 851 0 R 829 0 obj 722 666 666 610 556 556 556 556 556 556 /BaseFont /ArialMT /W 847 0 R /CapHeight 662 /BitsPerComponent 8 [278] endobj 277 333 556 556 556 556 279 556 333 736 /FontName /JOVPPX+TimesNewRomanPSMT 333 333 500 563 250 333 250 277 500 500 556 1000 333 1000 556 333 943 350 500 666 For additional information, call Customer Service at 1-866-508-7145 (TTY 711). 333 576 537 333 333 333 365 556 833 833 855 0 obj endobj /CapHeight 716 /FontFile2 857 0 R << Medicare HMO Blue FlexRx also offers Medicare Part D prescription drug coverage—making it easy for you to get your medical and prescription benefits from one plan. endobj 860 0 R] 0000009686 00000 n 556 556 556 556 556 556 556 548 610 556 >> To help you make an informed choice about your health care coverage, we are providing Summary of Benefits and Coverage (SBC) documents for each of our plans. 500 1000 333 979 389 333 722 350 443 722 startxref 2020 summary of beneits premera blue cross medicare advantage core (hmo) h7245-006 . 0 0 0 0 0 0 0 0 0 0 x�]R�n�0��>��۔MBH��C5����!B*�2����������,o�=�����L�W=�'�I�K�a��r�K/=Ɖ��yE����|S|Z��Zv��e�3�i��b����(O��J}� r&��s"�3DO�zn �+�����yٛ�-�}Q@��Ŵ��I5-�F^�˨99�*sr��gkٹ�ϧ4>:c�uƕCI��όS� �(�Y+lKWt�X�Y�$B��Ț$ΙR�Jy�`���"J >> /Ascent 891 /FontBBox [-665 -210 2000 728] Blue Shield 65 Plus (HMO) Medicare Advantage Prescription Drug Plan. [228 0 291 0 456 729 0 157 273 273 39 0000008088 00000 n /Type /Font >> endobj 833 0 obj 277 277 277 277 0 0 0 0 0 0 Blue Shield 65 Plus Los Angeles County/Orange County January 1, 2020 – December 31, 2020. /FontName /KKYTOQ+Arial-BoldMT /ViewerPreferences 829 0 R >> /DefaultCMYK [/ICCBased /Ascent 905 556 1000 333 1000 500 333 943 350 500 666 But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Florida Blue HMO and not Original Medicare. >> 777 777 777 777 777 583 777 722 722 722 222 556 333 1000 556 556 333 1000 666 333 /Type /Catalog We are available Oct. 1 - Mar. /FirstChar 0 /FontBBox [-627 -376 2000 1055] 666 443 443 443 443 443 277 277 277 277 0000002538 00000 n /FontFile2 863 0 R /Marked true 333 576 453 333 333 299 310 500 750 750 /Root 828 0 R /Resources << 846 0 obj /MaxWidth 1182 << << << endobj 563 563 563 443 920 722 666 666 722 610 >> /Subtype /TrueType >> /FontFile2 867 0 R 0000203660 00000 n /Filter /FlateDecode 410] 556 556 500 389 279 389 583 350 556 350 /FontWeight 400 /Name /F2 stream /StemV 80 0 g /BaseFont /KKYTOQ+Arial-BoldMT 844 0 obj 0000010836 00000 n /F6 838 0 R endobj /Type /Font << /Type /XObject 3 /Height 238 777 777 777 777 777 583 777 722 722 722 1000 350 610 350 350 222 222 333 333 350 /L 532074 Hearing services • Hearing exam (Medicare-covered) • Routine (non-Medicare covered) hearing exam • Hearing aids: Dental services • Prophylaxis (cleaning) 0000003657 00000 n << /Ordering (Identity) 750 443 722 722 722 722 722 722 889 666 250 250 250 250 0 0 0 0 0 0 /Flags 32 500 500 500 500 333 389 277 500 500 722 /ToUnicode 846 0 R [556 556 556 556] 889 500 556 556 556 556 277 277 277 277 Premiums and benefits . /ItalicAngle 0 /Leading 150 556 556 500 389 279 389 583 350 556 350 [556] >> << Summary of Benefits Blue Cross Medicare Advantage Basic (HMO) SM. 45 /F2 836 0 R To view your benefit summary, enter the ID number from your BlueAdvantage membership card. endobj 722 722 556 500 443 443 443 443 443 443 /Type /XObject 1 - Sept. 30, 8 a.m. to 8 p.m., Mon. /ExtGState << premera blue cross medicare advantage core plus (hmo) h7245-008 /Type /Font >> /Flags 262176 /Type /FontDescriptor /E 355145 /Width 849 0000003594 00000 n /ProcSet [/PDF 0000306901 00000 n /FontName /UTPWUD+Arial-BoldMT January 1, 2020 – December 31, 2020. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is an HMO plan with a Medicare contract. 177 0000183741 00000 n 610 777 722 277 500 666 556 833 722 777 563 563 563 443 920 722 666 666 722 610 /Descent -212 %PDF-1.7 /F3 850 0 R << 0000004298 00000 n >> /DescendantFonts 839 0 R >> /Flags 34 >> << 500 500 500 333 259 333 583 350 556 350 (PW) NV BA HMO BD NGF $25_$400Ded (15_45_75_30%Rx).s0116 . January 1, 2019 – December 31, 2019 Blue Advantage from HMO Louisiana, Inc. is an HMO plan with a Medicare contract. 0000253036 00000 n /Descent -212 370 556 583 333 736 552 399 548 333 333 666 777 722 666 610 722 666 943 666 666 858 0 obj 0.498 G << 0 0 0 306 252 0 507 507 507 507 ... Summary of benefits (cont’d) Los Angeles County/Orange County . [500] This is a general benefit summary for this health plan. 0 459 0 0 0 0 0 487 0 0 /Font << 0000328797 00000 n /Subtype /TrueType /Length 366 >> /OutputIntents [<< 0000004470 00000 n /XHeight 250 1 j /Height 244 0000006261 00000 n 0000000032 00000 n << /FontWeight 400 277 333 556 556 556 556 259 556 333 736 Blue Cross Medicare Advantage Basic (HMO)SM Blue Cross Medicare Advantage Basic Plus (HMO-POS)SM Blue Cross Medicare Advantage Premier Plus (HMO-POS)SM Hours of Operation Things to Know About Blue Cross Medicare Advantage Basic (HMO) • From October 1 to March 31, you can call us 7 days a week from 8:00 a.m. to 8:00 p.m. Central time. 610 277 277 277 469 556 333 556 556 500 endobj /AvgWidth 362 277 277 277 277 0 0 0 0 0 0 /FirstChar 0 592 547 501 592 547 774 547 547 0 0 x�]��j�0��~ /Length 171684 January 1, 2020 – December 31, 2020. 250 333 500 500 500 500 200 500 333 759 endobj /LastChar 255 /Ascent 905 /Descent -210 0000004551 00000 n /Encoding /Identity-H /Subtype /Image 1 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2020 –12/31/2020 CareFirst BlueChoice: HealthyBlue Advantage HDHP Coverage for: Self Only, Self Plus One or Self and Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. /Widths [0 0 0 0 0 0 0 0 0 250 1-866-508-7145 ( TTY 711 ) what we cover and what you pay ( )... 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