Information for Medicare Plus Blue Group PPO plan members

Use these links to access information about your plan

Commonly used forms
Commonly used Medicare Advantage and prescription drug plan forms
Claims forms
Forms for members who have group Medicare Part D prescription drug coverage with Medicare Part D prescription drugs claims, vaccine and administration claims, and reimbursement.

Use these links to access additional resources

Contact information
How to get in touch with a customer service center.
Part D prescription drug transition policy
Review our policy about formulary transitions under certain conditions.
Member discounts and wellness programs
In addition to our medical and prescription drug plans, we offer members a variety of programs designed to promote good health, safety and savings.

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Important information about these plans

Medicare Plus Blue Group PPOSM and BCN Advantage HMO-POSSM are health plans with Medicare contracts. Prescription Blue Group PDPSM is a stand-alone prescription drug plan with a Medicare contract.

Medicare Plus Blue Group PPO

With the exception of emergency or urgent care, it will cost more to get care from non-plan or non-preferred providers in the state of Michigan. Your responsibility will be greater out-of-network when the out-of-network coinsurance is based on the Medicare allowed amount and the contracted amount is lower. You may receive services from any provider who accepts Original Medicare. In the state of Michigan, your out-of-pocket costs will be lower if you choose a network provider. To find a network provider in the state of Michigan, visit www.bcbsm.com/medicare/provdirectory.shtml.

For members traveling outside of Michigan or for those members who reside permanently outside of the state of Michigan, you may obtain care from any provider that accepts Original Medicare, and in-network cost-sharing will apply for all Medical services (except durable medical equipment, prosthetics and orthotics).

Medicare Plus Blue Group PPO and Prescription Blue PDP

Limitations, copayments and restrictions may apply.

Our network includes approximately 2,300 Michigan retail pharmacies, of which 86 percent are network pharmacies. Nationwide, most chain pharmacies are in our network, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies.

In general, benefits are only available at contracted network pharmacies. Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost sharing amount if you get your drugs at an out-of-network pharmacy. Quantity limitation and restrictions may apply. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Blue Cross Blue Shield of Michigan. For additional information on network pharmacies, please call Member Services at the phone number listed on the back of your member ID card.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, please call Member Services at 1-866-684-8216. TTY users call 711. Extended hours of operation Jan. 1 through Feb. 14 are 8 a.m. to 8 p.m. Eastern time, seven days a week. Normal hours of operation are 8:30 a.m. to 5 p.m., Eastern time, Monday through Friday.

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on Jan. 1 of each year.

BCN Advantage HMO-POS

BCN Advantage HMO-POSSM is available in these counties: Allegan, Barry, Bay, Calhoun, Clare, Clinton, Crawford, Eaton, Genesee, Gladwin, Grand Traverse, Gratiot, Huron, Ingham, Ionia, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lapeer, Livingston, Macomb, Mecosta, Midland, Missaukee, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ottawa, Roscommon, Sanilac, Saginaw, Shiawassee, St. Clair, Tuscola, Van Buren, Washtenaw and Wayne. Premiums vary by county. You must continue to pay your Medicare Part B premium.

You must use plan providers, except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers, neither Medicare nor BCN Advantage HMO-POS will be responsible for the costs.

If you are enrolled in BCN Advantage HMO-POS Option 2 or Option 3, you must use a network pharmacy to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use a network pharmacy. Quantity limitations and restrictions may apply. Our pharmacy network includes the majority of chain pharmacies, mail order through Medco or Walgreens, as well as long-term care and home infusion pharmacies. For additional information on network pharmacies, please call Member Services at 1-800-450-3680, 8 a.m. to 8 p.m. seven days a week. TTY users call 1-800-430-3211. You may also write to: BCN Advantage HMO-POS, P.O. Box 5184, Mail Code A103, Southfield, MI 48086-5184.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on Jan. 1 of each year.

If you decide to have your BCN Advantage HMO-POS premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.

Medicare beneficiaries may enroll in BCN Advantage HMO-POS through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For more information, please contact Blue Cross Blue Shield of Michigan at 1-877-469-2583, 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30; 8 a.m. to 9 p.m. Eastern time, seven days a week, Oct. 1 through Feb. 14. TTY users call 711. To learn more about enrollment periods, please contact Member Services.