Welcome to your 2017 plan!

This is your Anthem MediBlue Essential (HMO) Welcome Kit. It contains important documents and useful information related to your plan.

Useful Tips to Navigate Your Plan
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Getting Started

Your member ID card

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Your ID card will come in the mail separately, typically within 10 days of confirmation from Medicare of your enrollment. In rare cases, it may arrive by the end of the month in which you are enrolled. If that happens and you need to visit a doctor, just call us. Be sure to share your card with all of your providers. If you ever lose your card, call Customer Service.

Your member ID card

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Your ID card will come in the mail separately, typically within 10 days of confirmation from Medicare of your enrollment. In rare cases, it may arrive by the end of the month in which you are enrolled. If that happens and you need to visit a doctor or pick up a prescription, just call us. Be sure to share your card with all of your providers. If you ever lose your card, call Customer Service.

Paying your monthly premium

Automatic bank or Social Security deductions are great ways to pay your bill. Remember it can take up to three months to set up. If you get a bill in the mail during that time, do pay it. If we get a duplicate payment, we’ll give you a refund. If you miss a payment, we will contact you. If we don’t get a payment in 60 days, you may be dropped (disenrolled) from your plan. You may change the way you pay by calling Customer Service. For more information on plan premium payments, see Chapter 1 of the EOC.

Prevent health care fraud

It’s fraud when someone else uses your insurance card or member ID number to get prescription drugs or medical care. Help prevent health care fraud:

  • Never let anyone use your insurance card.
  • Keep your personal information safe.
  • Call us right away if you lose your insurance card or suspect fraud.
  • After your claims are processed, review your monthly Explanation of Benefits (EOB) to ensure the services listed are correct.
 
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Know your plan coverage

You have two options for viewing your plan benefits:

  • Benefits at-a-Glance - a snapshot of some of your key benefits, such as monthly premium, deductible and doctor visits.
  • Evidence of Coverage (EOC) - a comprehensive document that contains the complete details of what your plan covers and how much you'll pay for health care services.

You can find both in the Plan Documents and Resources section on this page.

Know your plan coverage

You have two options for viewing your plan benefits:

  • Benefits at-a-Glance - a snapshot of some of your key benefits, such as monthly premium, deductible and doctor visits.
  • Evidence of Coverage (EOC) - a comprehensive document that contains the complete details of what your plan covers and how much you'll pay for health care services and prescribed drugs.

You can find both in the Plan Documents and Resources section on this page.

Know your plan coverage

You have two options for viewing your plan benefits:

  • Benefits at-a-Glance - a snapshot of some of your key benefits, such as monthly premium, deductible, doctor and nephrologist visits.
  • Evidence of Coverage (EOC) - a comprehensive document that contains the complete details of what your plan covers and how much you'll pay for health care services and prescribed drugs.

You can find both in the Plan Documents and Resources section on this page.

Prescription drug coverage

Your plan covers prescription drugs. Talk to your doctor about choosing drugs from our Formulary (List of Covered Drugs). The Formulary, included in this Welcome Kit, tells you:

  • If your drug has any rules, such as quantity limits or step therapy.
  • Which drugs need preapproval from your plan.
  • Which cost-sharing tier your drug is in.

To find out what you might pay:

  1. Look up the drug in the Formulary and write down the tier.
  2. Look in your EOC to find the cost that applies to the tier, the supply (30 or 90 days) and the type of pharmacy (standard vs. preferred cost sharing).
  3. Take note of any special rules like those mentioned above. Call your doctor or Customer Service if special rules apply.]"

Prescription drug coverage

Your plan covers prescription drugs. Talk to your doctor about choosing drugs from our Formulary (List of Covered Drugs). The Formulary, included in this Welcome Kit, tells you:

  • If your drug has any rules, such as quantity limits or step therapy.
  • Which drugs need preapproval from your plan.
  • Which cost-sharing tier your drug is in.
  • Drugs in Tier 1 and Tier 6 have NO copays.

To find out what you might pay:

  1. Look up the drug in the Formulary and write down the tier.
  2. Look in your EOC to find the cost that applies to the tier, the supply (30 or 90 days) and the type of pharmacy (standard vs. preferred cost sharing).
  3. Take note of any special rules like those mentioned above. Call your doctor or Customer Service if special rules apply.

Prescription drug coverage

Your plan covers prescription drugs. You pay a $0 copay for some of these medications. Talk to your doctor about choosing drugs from our Formulary (List of Covered Drugs). The Formulary, included in this Welcome Kit, tells you:

  • If your drug has any rules, such as quantity limits or step therapy.
  • Which drugs need preapproval from your plan.
  • Which cost-sharing tier your drug is in.

To find out what you might pay:

  1. Look up the drug in the Formulary and write down the tier.
  2. Look in your EOC to find the cost that applies to the tier, the supply (30 or 90 days) and the type of pharmacy (standard vs. preferred cost sharing).
  3. Take note of any special rules like those mentioned above. Call your doctor or Customer Service if special rules apply.]"

Manage out-of-pocket costs

Some health plan benefits have cost shares. A cost share is what you pay as your share of the cost for each health care service. Cost sharing may include copays, coinsurance and/or deductibles. If your health plan benefits have cost shares, check your EOC to figure out what you have to pay for services like an office visit. When you get more than one type of service from your doctor, even if it seems like one procedure, you may pay a cost share for each one (unless a service has no cost shares). Ask your doctor for an estimate of your cost share before you get any service.

Manage out-of-pocket costs

Some health plan benefits have cost shares. A cost share is what you pay as your share of the cost for each health care service. Cost sharing may include copays, coinsurance and/or deductibles. Visits to your nephrologist are always a $0 copay. If your health plan benefits have cost shares, check your EOC to figure out what you have to pay for services like an office visit. When you get more than one type of service from your doctor, even if it seems like one procedure, you may pay a cost share for each one (unless a service has no cost shares). Ask your doctor for an estimate of your cost share before you get any service.

Get approvals in advance

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Sometimes you need to get our OK first for certain types of care. This is called preapproval (preauthorization). For example, we would need to approve hospital stays or other facility care. Check Chapters 3 and 4 of the EOC to see if preapproval is needed. If so, ask your doctor or call Customer Service. If you have an emergency, you don’t need to call us. Go to the nearest emergency room or hospital.

 
How to Find Care

DaVita VillageHealth care team

The highly trained team of DaVita VillageHealth care management professionals is committed to helping you better manage your kidney disease and improve your overall health. Your own personal DaVita VillageHealth nurse will contact you to learn more about your health needs and design a care plan that’s right for you. Your nurse will work with you, your loved ones, and your health care team to:

  • Keep track of your health care services, like medications and medical equipment.
  • Understand your preventive care options.
  • Monitor changes in your health.
  • Create plans of care to help you keep your health status and quality of life.
  • Find helpful resources and information.
  • Support you after a hospital discharge.

Find a primary care doctor

To help you stay as healthy as possible, we recommend you choose a primary care physician (PCP). Choosing a PCP and a nephrologist who work with your DaVita VillageHealth care team can help you get the right care. Your costs might be lower if you use a doctor in your plan's network. Visits to your primary care doctor and nephrologist are always a $0 copay. To find a network doctor or nephrologist, log in or call Customer Service.

In-network providers can change. To confirm they are in your plan's network, log in and select Find a Doctor, call them or call Customer Service. When calling doctors, ask if they are contracted with your specific plan for your Medicare Advantage plan.

Find a primary care doctor

You must choose an in-network doctor to be your primary care provider (PCP). Your PCP will be your main doctor. You may need to get your PCP's OK first to see a specialist. This is called a referral.

Your plan will only pay for services when you use an in-network doctor but may cover these exceptions:

  • You have an emergency or need urgent care and a network provider is not an option.
  • You need dialysis outside of our service area.
  • Your plan tells you that you can use other providers.

In-network providers can change. To confirm providers are in your plan's network, log in and select Find a Doctor, call them or call Customer Service. When calling doctors, ask if they are contracted with Anthem Blue Cross and Blue Shield for your Medicare Advantage plan.

Find a primary care doctor

To make sure you get your covered benefits, you will need to:

  • Choose a primary care provider (PCP) in your plan's network.
  • Go to your PCP. Your PCP is your main health care provider. If you get sick, your PCP will be the first person to care for you. Your PCP also will:
    • Refer you to an Emory Coordinated Care Center or other providers.
    • Get an OK ahead of time (prior authorization) from your plan for some types of care.

PCPs in the network can change. Call them to ask if they take Medicare as well as your BCBSHP MediBlue Prime Select HMO plan. Your plan may cover certain exceptions. See Section 2.4, Chapter 3 of the EOC. To find a network PCP in your area, log in or call Customer Service.

Find a doctor

Your costs will be lower if you use a doctor in our network. To find a network provider, log in and select Find a Doctor.

In-network providers can change. To confirm providers are in your plan's network, log in and select Find a Doctor, call them or call Customer Service. When calling doctors, ask if they are contracted with Anthem Blue Cross and Blue Shield for your Medicare Advantage plan.

Emory Coordinated Care Centers

The Emory Coordinated Care Centers are more than just a doctor's office. They combine medical supervision with nutrition to help improve your health and well-being. To get care at the Emory Coordinated Care Centers other than the Healthy Start™ visit, you will need a referral from your PCP. You don't have a copay for covered services provided at the Emory Coordinated Care Centers, which may include:

  • Healthy Start™ and Healthy Journey (annual wellness visits)
  • Fall Prevention program
  • Diabetes Management program
  • Hypertension program
  • Wound care program
  • Anticoagulation Therapy program
  • Congestive Heart Failure (CHF) program
  • Chronic Obstructive Pulmonary Disease (COPD) program
  • Remote Monitoring Program
  • Chronic Kidney Disease program

Refer to your Evidence of Coverage for a list of services available to you at the following Emory Coordinated Care Centers:

  • Emory Coordinated Care Center
    484 Irvin Court, Suite 240
    Decatur, GA 30030
    1-404-251-1950 (TTY: 711)
  • Emory Coordinated Care Center
    3515 Hwy 138 SE
    Stockbridge, GA 30281
    1-404-251-1980 (TTY: 711)

Find a pharmacy

Your costs will be lower if you use a pharmacy in our network. You may save even more money if you visit a preferred cost-sharing pharmacy. Keep in mind that in-network pharmacies can change. Log in to search for pharmacies near you. If you have questions, call Customer Service.

Pharmacies with preferred cost sharing include:
Bartell Drugs, CVS Pharmacy, Food Lion, Giant Eagle Pharmacy, Hannaford, Harris Teeter Pharmacy, H-E-B PHARMACY, Kroger, Roundy's, Shopko, Walmart, their affiliates and some independent pharmacies, including more than 5,000 Access Health pharmacies.

Other pharmacies are available in our network.

Note: If you are receiving Medicare's Extra Help, your costs will be the same at any network retail pharmacy (standard or preferred cost sharing).

Care when you need it

For medical advice or care, call your doctor. If your doctor can't see you right away, you have other covered care options. Of course, if you require emergency care, please call 911.

24/7 Nurse HelpLine
You may call to talk for free with a registered nurse (RN) for non-emergencies any time of the day or night, year-round. HelpLine RNs can answer basic health questions and help you decide what to do next. Call 1-855-658-9249 (TTY: 711).

Retail Health Clinic
You can get preventive care or treatment for minor ailments at a retail health clinic in retail stores, supermarkets or drugstores. To find a retail health clinic near you, log in or call Customer Service.

Urgent care center or walk-in doctor's office
You can be treated for non-emergency ailments or injuries at an urgent care center or walk-in doctor's office. To find an urgent care center near you, log in or call Customer Service.

LiveHealth Online
See a board-certified doctor on your computer or mobile device. When your doctor can't see you, you can choose to see a doctor online for minor health issues such as colds, flu or allergies. You can also see a psychologist or therapist by appointment. Enter your member ID when you register to get $0 copays for online doctor visits as part of your plan! Sign up for LiveHealth Online for free or download the mobile app.*

  • In an emergency, go to the nearest emergency room (ER). Your emergency care will be covered even if the provider is not in your plan's network. Please let your own provider know if you had emergency care so he or she can plan your follow-up care.
  • If you don't have an emergency, call your PCP first. Your PCP or the physician on call will assist or direct you for care as needed.
  • Call the 24/7 Nurse HelpLine at any time day or night at 1-855-658-9249 (TTY: 711). A registered nurse will assess your symptoms and help you figure out what to do next.
  • You can be treated for non-emergency ailments or injuries at an urgent care center or walk-in doctor's office. To find an urgent care center near you, log in call Customer Service.
  • LiveHealth Online
    See a board-certified doctor on your computer or mobile device. When your doctor can't see you, you can choose to see a doctor online for minor health issues such as colds, flu or allergies. You can also see a psychologist or therapist by appointment. Enter your member ID when you register to get $0 copays for online doctor visits as part of your plan! Sign up for LiveHealth Online for free or download the mobile app.*

Get a ride to your covered care center visits

For routine (non-emergency) rides to or from a place approved by the plan and in the local service area, call LogistiCare Medical Transportation at 1-866-913-4508 (TTY: 1-800-201-7165). You need to book your ride at least two days before you need it. When you call to set up your ride, please have the information below:

  • Name of the doctor or medical provider
  • Address
  • Telephone number
  • Time of visit
  • Type of ride needed (such as regular car, van with wheelchair access).

For limits, check the transportation benefit in Chapter 4 of the EOC.

Mail-order drugs

Our in-network mail-order pharmacy can ship prescriptions to your home. You can fill a new prescription or switch your existing maintenance prescriptions to mail delivery. Log in for benefits information and navigate to Pharmacy tools.

Typically, you should expect to receive your prescription drugs within 10 business days from the time that the mail-order pharmacy receives the order.

 
Wellness Benefits

"Welcome to Medicare" visit at no cost

Are you new to Medicare? Your "Welcome to Medicare" visit is at no cost to you when you see an in-network provider during your first year in the plan. After that, your plan covers an Annual Routine Physical every 12 months. See Chapter 4 of the EOC. Please be aware that some services may have cost shares. You may ask your doctor's office to check possible costs before you receive a service.

Preventive care at no cost

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When you use an in-network doctor, you can get many preventive services at no cost! They include:

  • Your annual health exams and flu or pneumonia shots.
  • Screenings for breast cancer (mammograms), prostate cancer, diabetes, colorectal cancer and heart problems.
  • Help to quit smoking.

For a full list of covered preventive care, see Chapter 4 of the EOC. Please be aware that some services may have cost shares. You may ask your doctor's office to check possible costs before you receive a service.

Preventive care at no cost

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When you use an in-network doctor, you can get many preventive services at no cost! They include:

  • Diabetes screenings and monitoring.
  • Your annual health exams and flu or pneumonia shots.
  • Screenings for breast cancer (mammograms), prostate cancer, colorectal cancer and heart problems.
  • Help to quit smoking.

For a full list of covered preventive care, see Chapter 4 of the EOC. Please be aware that some services may have cost shares. You may ask your doctor's office to check possible costs before you receive a service.

Jump-start your care with a Healthy Start™ visit.

Have you set up your Healthy Start™ visit yet? You don't need your primary care provider's referral or OK to schedule it. This important 60- to 90-minute visit will take place at your local Emory Coordinated Care Center. Your care team will get to know you and work with you to help make a care plan to meet your needs. Your care team will:

  • Do a complete history and physical exam.
  • Review your medicines.
  • Conduct screening labs for diabetes, kidney disease, liver function and more.
  • Do a fall risk assessment.
  • Recommend preventive and/or needed follow-up care.

Your PCP will receive a copy of the results of your Healthy Start™ visit.

After your Healthy Start™ visit, you may be able to take part in the chronic disease management programs at the Emory Coordinated Care Center. To schedule your Healthy Start™ appointment, please call the Emory Coordinated Care Center at 1-404-251-1950.

SilverSneakers®

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SilverSneakers is a complete wellness program that gives you access to:

  • More than 13,000 fitness locations.
  • Basic amenities, fitness classes and social events.
  • FLEX™ Community Fitness classes.

Your SilverSneakers ID card will come in the mail soon.

Find a convenient fitness center location.**

Discounts

Who doesn't like to save money? We all do. That's why SpecialOffers is a great deal. You can save money on health-related products and services. Once you get your member ID card, log in to access Discounts.

 

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