Platinum Blue (Cost) 2013 - great value in a comprehensive medical plan
About the Platinum Blue plan
Platinum BlueSM, a Medicare-approved Cost plan from Blue Cross and Blue Shield of Minnesota, can help pay for your medical costs and provide additional benefits and services as well.
The Platinum Blue plan includes:
- Access to a large
provider network
of doctors, clinics and hospitals
- Flexible coverage that allows you to change among three plan options at any time
- The SilverSneakers® Fitness Program at no additional cost
Choose from three plan options:
| Platinum Blue Core member pays: |
Platinum Blue Choice member pays: |
Platinum Blue Complete member pays: |
|
| Monthly plan premium | $29 | $74 | $109 |
| Deductible | $0 | $0 | $0 |
| Doctor's office visits | 20% coinsurance | $15 copay | $0 |
| Inpatient hospital care | $500 copay per stay; plan covers 90 days each benefit period plus 60 lifetime reserve days | $100 copay per stay; no limit to the number of days covered each benefit period | $0; no limit to the number of days covered each benefit period |
| Emergency care | $50 copay | $50 copay | $0 |
| Annual plan out-of-pocket maximum | $5,000 | $3,000 | $3,000 |
Prescription drug coverage
Platinum 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.
More plan information
SilverSneakers® Fitness Program (PDF)
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The benefit information provided is a brief summary not a complete description of benefits. For more information contact the plan. Limitations, copayments and restrictions may apply. You must continue to pay your Medicare Part B premium. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You can also view additional details in the benefits overview
(PDF) or the Summary of Benefits
(PDF).
SilverSneakers® is a registered mark of Healthways, Inc., an independent company that provides fitness benefits.
Last updated April 1, 2013
H2461_040113_N01 CMS Approved 04/29/2013
Networks, discounts and travel benefits for Platinum Blue
Find a doctor in the network
See any provider in the Platinum Blue network , no referral needed. You can also see doctors outside the network but you may only have Original Medicare benefits available and may pay more for those services.
Discounts on health & wellness
- 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 throughout the United States for up to nine months and receive plan benefits from any provider that accepts Medicare. No referrals needed. You’ll also receive emergency care nationwide.
Last updated April 1, 2013
H2461_040113_N01 CMS Approved 04/29/2013
Enroll today in Platinum Blue
Eligibility
You must be a resident of Minnesota to enroll in Platinum Blue. You must also be entitled to Medicare Part A and enrolled in Medicare Part B, or enrolled in Part B only. You may not be eligible if you have permanent end-stage renal disease (kidney disease requiring dialysis or a kidney transplant), unless you are currently enrolled in a Blue Cross and Blue Shield of Minnesota or Blue Plus plan.
Generally, you may enroll in a Cost plan at any time during the year. However, if you are a member of a Medicare Advantage plan, you may not be able to enroll if you are locked in to your current plan.
Choose how you’d like to enroll:
Enroll online
Select “Medicare Cost Plans” (on the first screen) to see Platinum Blue plans. Be sure to review the Summary of Benefits when prompted.
Download enrollment materials
1. Review this information:
Benefits overview (PDF)
Plan ratings (PDF)
Summary of Benefits (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.
Platinum Blue enrollment form (PDF)
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:
Platinum Blue
Blue Cross and Blue Shield of Minnesota
P.O. Box 64024
St. Paul, MN 55164-0024
4. Relax! We’ll be in touch.
We may call you after we receive your enrollment form. The purpose of the call is to help you understand how the plan works and answer your questions. If you get a call from us and have questions, please call 1-888-329-5302 (TTY users call 711), Monday through Friday, 9 a.m. to 5 p.m., Central Time.
You will also get at least two letters from us. The first will let you know that we received your enrollment request. The second will confirm whether CMS has approved your enrollment in Platinum Blue.
Enroll by phone
Call 1-855-579-7658
8 a.m. to 8 p.m. Central Time, daily
TTY users call 711
Request an enrollment kit
It will include all the forms you need to enroll. Order a kit now.
If you’re interested in prescription drug coverage, learn more about
MedicareBlueSM 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.
Last updated April 1, 2013
H2461_040113_N01 CMS Approved 04/29/2013
Member resources for Platinum Blue
Discounts and special programs
Complementary care and products
Enjoy discounts (up to 25 percent) on acupuncture and massage therapy at
ChooseHealthy.com.
You can also get discounts on health & wellness products from
Edgepark Medical Supplies
and
Rotech Healthcare.
Health Guides
When you have questions about your benefits, finding a provider or choosing the right type of care, our specially trained health guides will help.
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 has tools and information to help you manage your health and your health plan. By signing in to this secure site, you can 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 to learn more.
The SilverSneakers® Fitness Program
All Platinum Blue members receive free access to amenities such as treadmills, weights and fitness classes that are included with a basic fitness membership at
participating SilverSneakers facilities.
You can also participate in health education seminars and fun social events with others who share your interest in a healthy lifestyle.
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 Chapter 7 of your Evidence of Coverage: Core plan (PDF), Choice plan (PDF), or Complete plan (PDF).
You can also call member services or send a letter to:
Blue Cross and Blue Shield of Minnesota
Platinum Blue – Grievances
P.O. Box 64560
St. Paul, MN 55164-0560
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 Evidence of Coverage: Core plan (PDF), Choice plan (PDF), or Complete plan (PDF).
You can also call or write to us:
1-866-340-8654
8 a.m. to 8 p.m. Central Time, daily
TTY users call 711
Platinum Blue
P.O. Box 64024
St. Paul, MN 55164-0024
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
Evidence of Coverage for Core plan (PDF)
(see Chapter 6 for rights and responsibilities; see Chapter 7 for grievance, coverage determination and appeals information)
Evidence of Coverage for Choice plan (PDF)
(see Chapter 6 for rights and responsibilities; see Chapter 7 for grievance, coverage determination and appeals information)
Evidence of Coverage for Complete plan (PDF)
(see Chapter 6 for rights and responsibilities; see Chapter 7 for grievance, coverage determination and appeals information)
Forms and coverage information
Last updated April 1, 2013
H2461_040113_N01 CMS Approved 04/29/2013
Learn about your plan choices at a free "Prepare for Medicare" meeting.
Call us for help enrolling. We'll make it fast and easy.
1-855-579-7658
8 a.m. to 8 p.m.
Central Time, daily
TTY users call 711
Mail to:
Blue Plus
P.O. Box 64024
St. Paul, MN 55164-0024