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Benefit Summary

If you want to pay less for your health coverage…if you want benefits you can't get with original Medicare…if you want to choose any licensed doctors and hospitals and still get benefits…ZERO in on these outstanding features:

$0 plan premium option available⁺
$0 copayment option for in-network doctor office visits⁺⁺
$0 deductible option for hospital and medical benefits
$0 deductible option for Medicare prescription drugs

For more details about Blue Medicare PPO, a preferred provider health insurance plan, please refer to the Summary of Benefits (PDF, 116KB). Or for more information, call our Customer Service at:

For current members - (800) 718-2031, Monday - Friday, 8 a.m. - 6 p.m. CST. For the hearing or speech impaired, please call (888) 844-5530

For prospective members - (866) 308-4781, 8 a.m. - 8 p.m., CST, 7 days a week. For the hearing or speech impaired, please call (800) 538-0380

The Blue Medicare PPO follows the same coverage policies of the Center for Medicare and Medicaid Services (CMS). The policies are posted on the CMS Web site. Get additional information on national and local medical policy from CMS.*

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FOOTNOTES

* By clicking this link, you will leave the Blue Medicare PPO Web site.

⁺ You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Premiums apply to residents of Texas.

⁺⁺ Deductibles, coinsurance and limitations apply to out-of-network benefits. Your responsibility may be greater since the coinsurance is based on the Medicare-allowed amount.

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Last updated 03/26/2008

FOOTER

^SM Service Mark of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans

® Registered Service Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

Blue Cross and Blue Shield of Texas refers to HCSC Insurance Services Company, which is a wholly owned subsidiary of Health Care Service Corporation, a Mutual Legal Reserve Company. These companies are independent licensees of the Blue Cross and Blue Shield Association and offer or provide services for Medicare Advantage and Medicare Part D products under HCSC Insurance Services Company's contract H4531 with the Centers for Medicare and Medicaid Services.

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