Information for Members of Medicare Plus Blue Group PFFS^SM

Medicare Plus Blue Group PFFS^SM offers comprehensive coverage for hospital and medical care through a group plan sponsor. As a member of this plan, you still have Medicare coverage, but you now get all your hospital and medical services through our plan. Medicare Plus Blue Group PFFS^SM combines Original Medicare Part A (hospital) and Part B (medical) coverage and expands your coverage to include some preventive services (some group plans may also include Medicare Part D prescription drug coverage).

Medicare Plus Blue Group PFFS^SM is a Private Fee-for-Service plan. You can go to any doctor, hospital or other health care professional eligible to participate in Medicare and that accepts our plan's terms and conditions of payment and agrees to provide you with services

Limits and cost-sharing may apply. Consult your Evidence of Coverage for specific information about your benefits and cost-sharing responsibilities.

Call Medicare Plus Blue Group PFFS^SM for information:
866-684-8216 (TTY users should call 1-800-579-0235), 8:30 a.m. to 5 p.m, Eastern Standard Time, Monday through Friday.

To locate a network pharmacy, download the Medicare Plus Blue Group PFFS^SM Pharmacy Directory (PDF - 1.3 MB).

To look up covered drugs in our formulary, download the Medicare Plus Blue Group PFFS^SM Comprehensive Drug Formulary (PDF - 510K) or the Medicare Plus Blue Group PFFS^SM Abridged Drug Formulary (PDF - 989K).

Go back to Medicare home.

Medicare Plus Blue PFFS^SM is a health plan with a Medicare contract.

Important information about this plan

A Medicare Advantage private fee-for-service plan works differently than a Medicare supplement plan. Your doctor or hospital can continue to treat you if it agrees to accept our terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan's terms and conditions on our Web site at bcbsm.com/ma. You can also read more about how private fee-for-service plans work for you in our downloadable flyer (PDF 160K).

In Michigan, 86 percent of pharmacies are network pharmacies; nationwide, more than 80 percent of pharmacies are in the network, including the majority of chain pharmacies, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies (Source: 2010 Pharmacy Directory). 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. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Medicare Plus Blue PFFS^SM. For additional information on network pharmacies, please call Customer Service at 1-877-469-2583, 8 a.m. to 8 p.m., seven days a week. TTY users should call 1-800-481-8704. You may also write to: Medicare Plus Blue PFFS^SM, 600 E. Lafayette Blvd., Mail Code X435, Detroit, MI 48226.

If you decide to have your Medicare Plus Blue PFFS^SM 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.

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1, 2011. Please contact Blue Cross Blue Shield of Michigan for details.

In addition to enrolling through this Web site, Medicare beneficiaries may enroll in Medicare Plus Blue PFFS^SM through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at medicare.gov. For more information, please contact Medicare Plus Blue PFFS^SM at 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704. You may only enroll in Medicare Plus Blue PFFS^SM during specific times of the year. To learn more about enrollment periods, please contact Customer Service.

This document is available in alternate formats or languages. For more information, call 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704.

Medicare Plus Blue PFFS^SM is issued by Blue Cross Blue Shield of Michigan, which contracts with the federal government. Medicare Plus Blue PFFS's^SM contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed.

Medicare Plus Blue PFFS^SM is available to all Medicare beneficiaries who are Michigan residents entitled to Part A of Medicare and enrolled in Part B. Premiums vary by county. You must continue to pay your Medicare Part B premium.
A Medicare Advantage private fee-for-service plan works differently than a Medicare supplement plan. Your doctor or hospital can continue to treat you if it agrees to accept our terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan's terms and conditions on our Web site at bcbsm.com/ma. You can also read more about how private fee-for-service plans work for you in our downloadable flyer (PDF 160K).
In Michigan, 86 percent of pharmacies are network pharmacies; nationwide, more than 80 percent of pharmacies are in the network, including the majority of chain pharmacies, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies (Source: 2010 Pharmacy Directory). 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. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Medicare Plus Blue PFFS^SM. For additional information on network pharmacies, please call Customer Service at 1-877-469-2583, 8 a.m. to 8 p.m., seven days a week. TTY users should call 1-800-481-8704. You may also write to: Medicare Plus Blue PFFS^SM, 600 E. Lafayette Blvd., Mail Code X435, Detroit, MI 48226.
If you decide to have your Medicare Plus Blue PFFS^SM 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.
The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1, 2011. Please contact Blue Cross Blue Shield of Michigan for details.
In addition to enrolling through this Web site, Medicare beneficiaries may enroll in Medicare Plus Blue PFFS^SM through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at medicare.gov. For more information, please contact Medicare Plus Blue PFFS^SM at 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704. You may only enroll in Medicare Plus Blue PFFS^SM during specific times of the year. To learn more about enrollment periods, please contact Customer Service.
This document is available in alternate formats or languages. For more information, call 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704.
Medicare Plus Blue PFFS^SM is issued by Blue Cross Blue Shield of Michigan, which contracts with the federal government. Medicare Plus Blue PFFS's^SM contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:

1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day, seven days a week;
The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
Your State Medicaid Office.

H9572 H2319 S5584 Web17rev [CMS approval xx\xx] Pending CMS approval

Information for Members of Medicare Plus Blue Group PFFSSM

Information for Members of Medicare Plus Blue Group PFFS^SM