2014 Senior Gold(SM) (Medicare supplement) — Minnesota’s leading Medicare supplement plan

About the 2014 Senior Gold plan

Senior Gold provides a basic level of health care coverage, and you decide which options to add for the most comprehensive plan. Senior Gold benefits automatically renew each year as long as you pay your premium and follow the terms of the contract.

  • Additional coverage options include:
     
  • Coverage for Medicare Part A inpatient hospital deductible
  • Coverage for Medicare Part B annual deductible
  • Coverage for 100 percent of eligible medical expenses and supplies not covered by Medicare Part B that exceed Medicare-approved charges
  • Coverage for preventive hearing and vision screenings not covered by Original Medicare


Health Plan benefits

  Member pays:
Monthly plan premium
(You must also pay your Part B premium)

Tobacco-free: $170.35
Standard: $204.35

Option 1: Coverage for Medicare Part A inpatient hospital deductible: $28

Option 2: Coverage for Medicare Part B annual deductible: $12.65

Option 3: Coverage for 100% of eligible medical expenses and supplies not covered by Medicare Part B that exceed Medicare-approved charges: $1

Preventive: Screenings and services (see below): $4
 

Total monthly premium when you select all options

Tobacco-free: $216.00
Standard: $250.00
 

Plan coverage shown below is Senior Gold with all four coverage options selected:  
Deductible $0
Doctor office visits
(Includes primary care, specialists, chiropractic and podiatry services)
$0
Emergency care

$0 for emergency care in the United States
20% coinsurance for eligible emergency care worldwide

Inpatient hospital care

$0; no limit to the number of days covered each benefit period

Preventive screenings and services
(Includes vision, hearing and other routine screenings)
$0 for services not covered by Medicare (up to $120 maximum per calendar year)
 
Annual out-of-pocket maximum No maximum; minimal to no cost-sharing for eligible services and supplies

This chart provides a snapshot of some of the benefits of Senior Gold. For information about Original Medicare benefits and additional details, refer to the benefits overview (PDF) or the Summary of Coverage and Disclosure of Information (PDF) .

 

Find a doctor in the network

In Minnesota and bordering counties, see any provider in our  Aware® network.  Anywhere else in the country, see any provider that accepts Medicare. No referrals needed.


Prescription drug coverage

Senior Gold does not include coverage for Part D prescription drugs and can be paired with a stand-alone plan. Visit MedicareBlue(SM) Rx (PDP) ExternalLink to learn about prescription drug coverage options.


Dental coverage

An optional dental plan ExternalLink is available separately for Medicare supplement plan members at special rates.


More plan information

Benefits overview (PDF)

Summary of Coverage and Disclosure of Information (PDF)

Get Acrobat Reader ExternalLink

Networks, discounts and travel benefits for 2014 Senior Gold

Find a doctor in the network

In Minnesota and bordering counties, see any provider in our Aware® network. Anywhere else in the country, see 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 and 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.

Senior Gold 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 2014 Senior Gold

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

Eligibility
You must be a resident of Minnesota to enroll in Senior Gold. You must also be entitled to Medicare Part A and enrolled in Medicare Part B. If you have been enrolled in Medicare Part B for more than six months, you may need to answer health questions and could be denied coverage. 

Generally, you may apply for a Medicare supplement 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 Select/Supplement Plans” (on the first screen) to see the Senior Gold plan. Be sure to review the Summary of Coverage and Disclosure of Information when prompted.

Enroll online

Download enrollment materials

1. Review this information:
Benefits overview (PDF)
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 six 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.

Pay-O-Matic 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.

Enroll by phone

8 a.m. to 8 p.m. Central Time, daily
 

Request an enrollment kit

It will include all the forms you need to enroll. Order a kit ExternalLink
 

 

 

 

Once you become a member, you can apply for optional dental coverage. ExternalLink And, if you’re interested in prescription drug coverage, learn more about MedicareBlue(SM) Rx (PDP). ExternalLink

Member resources for 2014 Senior Gold

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 ExternalLink at least 12 times a month to earn up to a $20 credit toward your monthly health club fees. The fitness center 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 to learn more.

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. ExternalLink

Weight Watchers
Save $10 on a three-month membership to Weight Watchers ExternalLink 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 ExternalLink 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

Certificate of Coverage (PDF)

Discharge Preparation Checklist (PDF) – What to do before you leave the hospital

Personal Health Record ExternalLink – Prepare for your next medical visit

Privacy notice (PDF)

Get Acrobat Reader ExternalLink
 

Blue Cross® and Blue Shield® and the Cross and Shield Symbols are registered marks of the Blue Cross and BlueShield Association, an association of independent Blue Cross and/or Blue Shield Plans.

Weight Watchers is the registered trademark of Weight Watchers International, Inc. and is used under license.