2014 A nonprofit independent licensee of the Blue Cross Blue Shield Association For residents in Livingston, Monroe, Ontario, Seneca, Wayne and Yates Counties, NY. Y0028_3565_0 Accepted Choose a Medicare Plan That’s Perfect for You Our plans provide for your health and peace of mind. New Picture FPO Empower your body. Enhance your health. Energize your mind. 24-hour Health Coaching Managing your health is all about teamwork. That’s why our Health Coaches are available 24/7 to provide member-only access to specially trained Health Coaches ready to assist you in managing your health and wellness goals. You can work with them to tailor a wellness program specifically designed for you. Manage chronic health conditions (e.g., heart disease, diabetes, arthritis), get the latest information on nutrition, weight management and more. Silver&Fit ® Fitness Program Get fit, have fun,and be happy! The Silver&Fit program allows members to choose from a variety of fitness programs sure to fit your physical needs and lifestyle. Become a member at one of our participating fitness facilities to access available classes, meet other Silver&Fit members, and join in on the fun! Select the Silver&Fit home fitness program to choose from a wide range of in-home fit- ness kits such as Yoga, Chair Exercise, and Aqua Aerobics. Or join a non-participating facility and take advantage of our annual fitness allowance. Preventive Care Services Excellus BlueCross BlueShield covers many preventive services to protect, promote and maintain the health and well-being of our members. Some of our covered preventive services include a routine physical exam each year, mammography, prostate, and colorectal screenings. These are just a few examples, so feel free to call us for additional information. Opt-in to Wellness Sign up for our monthly e-mails and get healthy recipes, information about preventive health tools, web resources and tips about talking to your doctor. ExcellusMedicare.com/Email. Get Member Discounts with Blue365 ® When you become a part of the BlueCross BlueShield family, you gain exclusive member-only access to leading national companies that provide special savings on a wide variety of health-related products and services including vision, hearing, fitness and nutrition products. You’ll receive discounts on health and fitness clubs, weight-loss programs, healthy travel experiences and more! We offer several Medicare Supplement plans, also known as “Medigap” plans. Medicare Supplement plans work hand-in-hand with Original Medicare to help pay costs that Original Medicare does not, such as copayments, coinsurance, and deductibles. Please call us for more information. Stand-alone Medicare Prescription Drug Coverage For people that only need Medicare Prescription Drug Coverage, we offer our BlueCross BlueShield Rx PDP prescription drug plan. This plan gives you the benefit of lower drug costs through our extensive list of covered generic and brand name drugs (formulary). We also have a network of over 64,000 pharmacies nationwide, including major chains you’ll find right in your neighborhood! Please call us for more information. Medicare Supplement Plans Eligibility and Service Area: To be eligible for enrollment, individuals must have both Part A and Part B and reside in the service area of the Plan. (see counties on cover) Medicare Advantage (PPO) Plans: For our PPO Plans, with the exception of an emergency or urgent care situation, it may cost more to get care from out-of-network providers. Medicare Advantage (HMO) Plans: You must use plan providers except in emergency or urgent care situations, or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor Excellus BCBS will be responsible for the costs. For Part D (prescription drug) Plans: In general, you must use network pharmacies to access your prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day / 7 days a week; The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or Your State Medicaid Office. Enrollment and Benefit Information: Individuals may enroll in our plan only during specific times of the year. Contact Excellus BCBS for more information. This product brochure is an overview of the benefits available under our Medicare Advantage Plans. To the extent of any discrepancy between this document and your Evidence of Coverage, your Evidence of Coverage terms take priority. *Blue Medicare Advantage PPO Visitor/Traveler Program is available in 34 states and 1 territory (in some states only portions of the state are available). You must live in our service area for 6 months out of the year to remain in our plan. Excellus Health Plan, Inc. contracts with the federal government and is an HMO plan, PPO plan and PDP plan with a Medicare contract. Enrollment in Excellus Health Plan, Inc. depends on contract renewal. The Silver&Fit ® program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). All programs and services are not available in all areas. Silver&Fit is a federally registered trademark of ASH. Access to the Doctors & Hospitals You Want You gain access to a robust network of doctors and hospitals dedicated to providing affordable, quality health care services. With our PPO plan, you have the flexibility to see any Medicare-approved provider, anytime. There’s no need to select a Primary Care Physician, and no referrals are required. With our HMO plans, you select a Primary Care Physician who will assume all of your medical care, including referrals to specialists. Additionally, our HMO-Point of Service plans give you the freedom to receive select services from doctors and hospitals that are not in our network, without having to pay the full cost yourself! Urgent and Emergency Coverage Rest assured that whenever and wherever you travel, we offer coverage if you ever need urgent care (U.S. only) or emergency care (worldwide). Travelers & Snow Birds: A Plan for Every Traveler With our PPO plan, you can use either in-network or out-of-network benefits to get care. See any Medicare-approved doctor, have lab work or diagnostic tests done, use hospital services and more. If you choose to get care from an in-network provider, your costs are usually lower. We also have a Visitor/Traveler Program with our PPO plan which provides coverage while traveling outside of your service area. You pay the same in-network costs that you pay at home when you use a Blue Medicare Advantage PPO provider in any geographic area where the Visitor/Traveler Program is offered. Go to http://provider.bcbs.com or call 1-800-810-Blue (2583) to find a participating provider out of the area.* For the occasional traveler, our HMO-Point of Service plans provide members with limited out of area coverage. With our HMO-Point of Service plans, you have some routine out-of- network coverage, such as doctor visits, diagnostic tests or lab services, hospital services and more. An annual dollar limit applies to this benefit. You can review our Summary of Benefits for a complete list of covered services. If you have questions, please call us. B-3702Y14 / 7377-13MedM LIFE HAS A PLAN SM Questions? Call TOLL-FREE: 1-800-659-1986 TTY/TDD users: 1-800-421-1220 Hours: 8:00 a.m.– 8:00 p.m., Monday–Friday. From October 1 – February 14, representatives are available seven days a week from 8:00 a.m.– 8:00 p.m. Or visit ExcellusMedicare.com. Exclusive Member Advantages