Group MedicareBlue PPO, a Medicare-approved regional PPO plan, is a fully insured Medicare Advantage plan. You have a choice of four medical plans and five prescription drug options. This allows flexibility and convenience allowing you to build a benefit program that meets the needs of your retirees and your organization.

Reduce administration

When you choose this plan, you’re participating in a single plan for medical and drug coverage. Your retirees will have one member ID card and one point of contact.

Plan highlights

• Combines medical and prescription drug coverage
• Four medical options and five prescription drug options
• Access to a seven-state regional medical provider network
• No annual deductible and unlimited lifetime maximum
• No provider referrals required
• Worldwide coverage for emergency care
• In-network coverage when traveling or temporarily living outside the region
• More than 62,000 participating pharmacies nationwide
• Coverage for generic and brand-name drugs
• Additional discounts through our MedicareBlue Values discount program

Additional plan features

With Group MedicareBlue(SM) PPO, your retirees are offered additional benefits and programs, including:

Online member self-service
If your retirees have questions about their plan, YourMedicareSolutions.com is a great place for them to start. Here are just a few of the helpful features available:

• Locate network doctors, hospitals or pharmacies
• Find out how to order a replacement member ID card
• Sign up for mail order prescriptions
• Search the drug formulary

Case management
Group MedicareBlue PPO case managers are registered nurses who can offer medical education and knowledge of insurance. They also promote independent self-care, coordinate health plan benefits, refer members to community resources, find quality providers and help members understand their treatment. If members need long-term or complex health care services from a variety of providers, they may receive a call from a case manager.

Specialty drug coverage
Medicare classifies specialty drugs as certain unique and high-cost medications that are complex to dispense and involve patient education. Specialty drugs include injectable antibiotics, transplant drugs, certain chemotherapy drugs and other self-injectable or administered drugs. Specialty drug coverage with this plan gives members access to these medications while helping your company control costs.

Supplemental drug coverage
This plan also has coverage to help pay for select drugs that Medicare does not cover and are not on our formulary. Members can purchase these drugs for a 25 percent coinsurance payment. Money spent on supplemental drugs does not count toward your members’ out-of-pocket maximum for catastrophic coverage.

90-day supplies
Members can get a 90-day supply of their prescription drugs by mail order and at select retail pharmacies. If a member chooses mail order or a Preferred Extended Supply pharmacy, they pay only two copayments or coinsurance. A list of participating pharmacies is available online at YourMedicareSolutions.com .

Medication therapy management program
This program can help improve a member's health through education, counseling and timely interventions which may reduce potential prescription drug risks. Members must meet specific criteria for this program. Qualifying members will automatically be contacted and enrolled in the program. Members can choose not to participate. We encourage them to take full advantage of this free service.

MedicareBlue Values discount program
This program offers members access to vision and hearing discounts.

The products and services described as part of the MedicareBlue Values discount program above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Group MedicareBlue PPO grievance process.

How to learn more

To find out more about Group MedicareBlue PPO, talk with your Blue Cross licensed sales representative or ask your agent/broker to contact Blue Cross to discuss your needs.