Platinum Blue(SM) is a Medicare-approved Cost plan providing benefits that reduce deductible, copayment and coinsurance costs for Medicare-eligible services and supplies.
Eligibility
You are eligible to enroll in Platinum Blue if you are entitled to coverage under Medicare Part A and enrolled in Medicare Part B (or enrolled in Medicare Part B only) and reside in Minnesota. Download the important Platinum Blue disclaimers below for additional details.
2010 Plan highlights
- No referrals needed
In Minnesota, see any provider in the Platinum Blue network. You can also go to providers outside the network, although you may only have Original Medicare benefits available and may pay more for those services. Providers may change during the year. Search for network providers.
- Peace of mind when you travel
Outside of Minnesota, travel throughout the United States for up to nine (9) months and receive plan benefits from any provider that accepts Medicare. You’re also covered for emergency care worldwide.
Three options to meet your needs
You can choose the Platinum Blue plan option that works best for you. Here are highlights for each option. Review the benefits overview, the Summary of Benefits or Evidence of Coverage for additional details about coverage and limitations. You can download these documents below.
| | Platinum Blue
Core Plan
member pays: | Platinum Blue
Choice Plan
member pays: | Platinum Blue
Complete Plan
member pays: |
|---|
| Monthly plan premium | $29 | $79 | $99 |
| Annual deductible | No deductible | No deductible | No deductible |
| Office visits (primary care and specialists) | 20% coinsurance | $10 copay | $0 |
| Inpatient hospital | $400 copay per stay; plan covers 90 days each benefit period plus any 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 room visits in the United States and worldwide | $50 copay | $50 copay | $0 |
| Annual out-of-pocket maximum | $3,000 | $3,000 | $3,000 |
You must continue to pay your Medicare Part B premium. Benefits, premiums and/or cost-sharing amounts may change on January 1, 2011. 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.
Healthy extras at no charge
- SilverSneakers® Fitness Program – Receive free access to amenities such as treadmills, weights, heated pool and fitness classes that are included with a basic fitness membership. You can also participate in health education seminars and fun social events with others who share your interest in a healthy lifestyle.
- 24-Hour Nurse Advice Line – Friendly, knowledgeable nurses are available seven days a week.
The products and services described below 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 Platinum Blue grievance process.
- Stop-Smoking Support – Want to kick tobacco? Then take advantage of this proven, successful program. The trained phone counselors and support materials can help you quit.
- Vision and Hearing Discounts – Save on eyewear and hearing aids.
- Health Guides – When you have questions about your benefits, finding a provider or deciding on the right type of care, our specially trained health guides can help.
- Online Member Center – The myBlueCross online member center has tools and information to help you manage your health and your health plan. When you sign in to this secure site, you can search for a doctor, see the status of your recent claims, research provider cost and quality information, and much more.
- Online Wellness Center – Includes health calculators, quizzes, exclusive articles and other helpful information.
Prescription drug coverage
Pair this medical plan with MedicareBlue(SM) Rx (PDP), a stand-alone prescription drug plan with a Medicare contract. Three plan options offer different levels of cost-sharing with access to a nationwide network of pharmacies.
Grievances, initial determinations and appeals
Platinum Blue members have the right to file a grievance, request an initial determination and file appeals. Detailed information about these rights can be found in the following documents which you can download below:
- 2010 Platinum Blue Summary of Benefits: See Section III
- 2010 Evidence of Coverage booklets: See Chapter 7
You can also contact Customer Service for information about these rights and to request the status of a grievance, initial determination request or appeal that you have filed:
Platinum Blue
Blue Cross and Blue Shield of Minnesota
P.O. Box 64024
St. Paul, MN 55164-0024
(651) 662-5654 or toll free at 1-866-340-8654
TTY users call (651) 662-8700 or toll free at 1-888-878-0137
Monday – Thursday, 8 a.m. to 5 p.m. Central Time
Friday, 9 a.m. to 5 p.m. Central Time
Fax (651) 662-2745
Appoint a representative
You may name a relative, friend, advocate, doctor or anyone else to act for you. The person you name would be your "appointed representative." Other persons may already be authorized under State law to act for you. If you want someone to act for you who is not already authorized under State law, then you and that person must complete Medicare's appointment of representative form.
Appointment of Representative form (CMS-1696) (PDF)
Be sure to sign and date the form and then mail or fax it to the address or fax number listed above.
If you have questions about how to name your appointed representative, please call Customer Service at the number above.
Download detailed information
Plans are available to residents of the service area. Blue Cross, Blue Shield, and the cross and shield symbols are registered marks of the Blue Cross and Blue Shield Association. Platinum Blue and MedicareBlue are service marks of the Blue Cross and Blue Shield Association. SilverSneakers® is a registered mark of Healthways, Inc., an independent company that provides fitness benefits.
Last updated December 2009
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