Extended Basic Blue 2013 — our most complete plan
About the Extended Basic Blue plan
Extended Basic Blue provides first-dollar coverage for Medicare-eligible services and supplies. Plus, your out-of-pocket costs are limited to $1,000 of eligible charges each year. Extended Basic Blue benefits automatically renew each year as long as you pay your premium and follow the terms of the contract.
Extended Basic Blue offers you support by:
- Covering Medicare coinsurance, copayments and deductibles
- Covering preventive screenings and services not covered by Medicare (up to $120 maximum per calendar year)
- Covering 20 extra days in a skilled-nursing facility and additional home health care benefits
- Providing worldwide emergency care — eligible services outside of the United States are covered at 80 percent
See the Summary of Coverage and Disclosure of Information (PDF) for additional details.
Prescription drug coverage
Extended Basic Blue does not include coverage for Part D prescription drugs and can be paired with a stand-alone plan. Visit
MedicareBlue (SM) Rx (PDP) 
to learn about prescription drug coverage options
Dental coverage
An optional
dental plan
is available separately for Medicare supplement plan members at special rates.
More plan information
Network, discounts and travel benefits for Extended Basic Blue
Is your doctor in the network?
Live or travel anywhere in the United States and receive plan benefits from any provider that accepts Medicare. No referrals needed.
Discounts on health & wellness
- Earn up to a $20 credit toward monthly health club fees when you exercise at a participating fitness center at least 12 times per month.
- Save on eyewear and hearing aids.
- Find answers to your medical questions using our health & wellness online resources. You’ll get access to health calculators, quizzes, exclusive articles and more.
Travel benefits
Travel anywhere in the United States and receive plan benefits. You have coverage for emergency care outside the United States too.
Extended Basic Blue is also portable, which means once you’re a member you can move anywhere in the United States and keep your coverage.
Enroll today in 2013 Extended Basic Blue
We’re available to make enrolling fast and easy. We’ll help you fill out your enrollment form and answer your questions.
1-855-579-7658
8 a.m. to 8 p.m. Central Time, daily
TTY users call 711
Send mail to:
Blue Cross and Blue Shield of Minnesota
P.O. Box 64560
St. Paul, MN 55164-0560
Choose how you’d like to enroll:
Download enrollment materials
1. Review this information:
Summary of Coverage and Disclosure of Information (PDF)
Guide to choosing a medigap policy (PDF)
2. Complete these forms:
Insurance Suitability form (PDF)
– This form is required. It has three sections. Please review, sign and date each section that applies to you. Keep a copy for your records. You do not need to mail it to us.
Medicare supplement application (PDF) or Medicare supplement application with health history (PDF) – Use the first application if you are applying within 6 months of your Medicare Part B effective date or have “guaranteed issue” rights for another reason. Otherwise, complete the application with health history (second option above). Please complete all required information, sign and date the application. Keep a copy for your records.
Monthly automatic withdrawal form (PDF) – This form is optional. It is a convenient way to pay your premium. If you choose this option, return this completed form with your enrollment form to the address below.
3. Mail your form(s) to:
Blue Cross and Blue Shield of Minnesota
PO Box 64560
St. Paul, MN 55164-00560
4. Relax! We’ll be in touch.
Blue Cross will send you an acknowledgement letter that will let you know your plan effective date or other information.
Request an enrollment kit
It will include all the forms you need to enroll.
Order a kit now.
Once you become a member, you can apply for optional
dental coverage
. And, if you’re interested in prescription drug coverage, learn more about
MedicareBlue SM Rx (PDP)
Minnesota’s only Part D plan to get 5 stars and the highest rating of excellent from the Medicare Program for plan quality, performance and member satisfaction.1
1 2013 CMS Plan Ratings released 10/12/2012. Plan performance Star Ratings are assessed each year and may change from one year to the next.
Member resources for Extended Basic Blue
Discounts and special programs
24-Hour Nurse Advice Line
Friendly, knowledgeable nurses are available seven days a week.
Sign in or register
for myBlueCross to learn more.
Fitness center discounts
Exercise at a
participating fitness center
at least 12 times a month to earn up to a $20 credit toward your monthly health club fees. The fitness center you can help you enroll in the program.
Health Guides
Our guides are there to answer benefit questions, help you find a provider and more.
Sign in or register
for myBlueCross to learn more.
Hearing aids
Visit any Beltone Hearing Aid Center to receive a 25 percent discount off the price of any hearing aid. Find a location near you (PDF).
*
myBlueCross online member center
The myBlueCross online member center can help you manage your health and your health plan. Sign into this secure site to search for a doctor, see the status of your recent claims, compare provider cost and quality information and much more.
Sign in or register
for myBlueCross.
Stop-Smoking Support
Take advantage of this proven, successful program. Trained phone counselors and support materials can help you quit.
Sign in or register
for myBlueCross to learn more.
Vision and eyewear
Visit a network optician (PDF)
* and receive a 20 percent discount on frames, lenses and contacts not covered under the medical portion of your benefits, plus get
LASIK discounts.
Weight Watchers
Save $10 on a three-month membership to
Weight Watchers
online.
* Providers may join or leave the network at any time. To find out if a provider is still in the network, call customer service at the number on the back of your member ID card.
Complaints & appeals
For a complete description of the complaint, coverage determination (including exceptions) and appeals process, see the Complaint Process section of your Certificate of Coverage (PDF).
You can also call us or send a letter to:
Blue Cross and Blue Shield of Minnesota
P.O. Box 64560
St. Paul, MN 55164
How to find more information
For more information about your rights and responsibilities, the service area, premiums and cost-sharing, out of network coverage and information about filing a grievance, coverage determination or appeal, review the Certificate of Coverage (PDF).
You can also call or write to us:
1-800-531-6686
8 a.m. to 8 p.m. daily
TTY users call 711
Blue Cross and Blue Shield of Minnesota
P.O. Box 64560
St. Paul, MN 55164-0560
Or, visit Medicare.gov or call toll-free
1-800-MEDICARE
(1-800-633-4227)
24 hours a day, 7 days a week
TTY users call 1-877-486-2048
Helpful resources and materials
Learn about your plan choices at a free "Prepare for Medicare" meeting.
(651) 662-9949
Toll free 1-855-579-7658
(TTY users call 711)
8 a.m. to 8 p.m. Central Time, daily