2014 SecureBlue(SM) (HMO SNP) - health and prescription drug benefits in one easy plan

About the 2014 SecureBlue plan

SecureBlue, from Blue Plus, combines your Medicare and Medical Assistance health care benefits in one plan. The plan covers medical services such as doctor visits, vision and hearing exams and hospital stays. It also includes Part D prescription drug coverage. Members have little to no out-of-pocket costs for most health care services. SecureBlue also includes:

  • 24-Hour Nurse Advice Line – When you or someone in your family is sick, you can call a nurse to ask questions 24 hours a day, seven days a week.
  • BlueRide transportation – Rides to and from covered health care appointments at no charge using the BlueRide transportation service.
  • Care coordinator services — A professional nurse or social worker works with your doctors and clinics to get you the health care you need. Your care coordinator will take the time to get to know you and your health and safety concerns. He or she can help with your medications, answer health plan questions, support your health care decisions, and arrange home meal delivery (and other services) for you.
  • Dedicated Clinician – If you’re living with an ongoing health condition or you have had a major illness or injury, a Dedicated Clinician can help you understand your medical condition and treatment options. He or she will help you make the best choices for your care, and help you follow your treatment plan.
  • Dental care – Your plan includes annual dental services such as X-rays, fillings, checkups and teeth cleaning.

Drug coverage and pharmacy information

SecureBlue includes Part D prescription drug coverage that helps you pay for brand-name and generic drugs. There are no copays for prescription drugs covered by Medical Assistance. You will still pay copays for some Part D drugs.

The Blue Plus formulary includes over 2,700 prescription drugs. Prescription drugs are available through our nationwide network of 64,000 pharmacies.

More information

Evidence of Coverage (PDF)

Plan ratings (PDF)

Prescription drug formulary (PDF)

Provider and pharmacy directory (PDF)

Summary of Benefits (PDF)

Get Acrobat Reader ExternalLink


SecureBlue is an HMO-SNP plan with a Medicare contract and a contract with the Minnesota Medical Assistance program. Enrollment in SecureBlue depends on contract renewal. This is a voluntary program offered in conjunction with the Minnesota Senior Health Options (MSHO) program.

Last updated October 1, 2013
H2425_001_110413_N05 CMS Approved 11/22/2013

Networks and wellness features for 2014 SecureBlue

You must use network providers except in emergency or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers, neither Medicare nor Blue Plus will be responsible for those costs. See if your health care provider is in the network (PDF) .

Surgeons and doctors who treat things like allergies and cancer are examples of specialists. You do not need a referral from Blue Plus to see any specialist in the provider network.

Some medical services still require a special review between your doctor and health plan. This is called prior authorization. Prior authorization helps make sure certain medical services and procedures are necessary and covered by your plan.

American Indians can continue or begin to use tribal and Indian Health Services (IHS) clinics. We will not require prior approval or impose any conditions for you to get services at these clinics. For enrollees age 65 years and older this includes Elderly Waiver (EW) services accessed through the tribe. If a doctor or other provider in a tribal or IHS clinic refers you to a provider in our network, we will not require you to see your health plan primary care provider prior to the referral.

Dental services

Basic dental care services, including X-rays, fillings, checkups and teeth cleaning, are provided by Delta Dental of Minnesota using the CivicSmiles network. ExternalLink

Mental health care, drug and alcohol abuse services

Your mental health is important. SecureBlue members have access to services for mental health care and drug and alcohol abuse through the Behavioral Health network. Call member services for more information.

Pharmacies

Get prescriptions filled at one of over 64,000 pharmacies and drug stores in the SecureBlue network. For more on pharmacy locations and to see a list of drugs that are covered by this plan, visit the Prime Therapeutics website. ExternalLink You can also review the formulary and provider and pharmacy directory.

Wellness features

More information

Summary of Benefits (PDF)

Get Acrobat Reader ExternalLink

Delta Dental of Minnesota is independent from Blue Cross and Blue Shield of Minnesota and Blue Plus. Delta Dental provides administrative services for dental benefits, including access to the CivicSmiles network.

Prime Therapeutics LLC is an independent company providing pharmacy benefit management services.

Last updated October 1, 2013
H2425_001_110413_N05 CMS Approved 11/22/2013

Enroll today in 2014 SecureBlue

Am I eligible?

You can enroll in this plan if you:

  • are at least 65 years old
  • have Medical Assistance
  • have Medicare Part A and Part B
  • live in the service area (see list of Minnesota counties below)

Aitkin, Anoka, Becker, Benton, Carlton, Carver, Cass, Chippewa, Chisago, Clay, Cook, Cottonwood, Crow Wing, Dakota, Faribault, Fillmore, Houston, Isanti, Jackson, Kandiyohi, Kittson, Koochiching, Lac qui Parle, Lake, Lake of the Woods, LeSueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Polk, Ramsey, Red Lake, Redwood, Rice, Rock, Roseau, Scott, Sherburne, St. Louis, Stearns, Swift, Todd, Wadena, Washington, Watonwan, Wilkin, Winona, Wright and Yellow Medicine

Learn more

Contact your county or apply online ExternalLink to see if you meet income and program guidelines for the plan. If you do, your county will send you information on the health plans that offer benefits for MSHO members in your county. If you know you’re eligible you can also contact Blue Plus at the number below. Enrolling in this plan is voluntary.

1-866-477-1584 (toll-free)
8 a.m. to 8 p.m. Central Time, daily
TTY users call 711

Send mail to:
Blue Plus
P.O. Box 64024
St. Paul, MN 55164-0179

Enrollment form (PDF)

Minnesota Health Care Programs ExternalLink

Plan ratings (PDF)

Summary of Benefits (PDF)

Get Acrobat Reader ExternalLink

Last updated October 1, 2013
H2425_001_110413_N05 CMS Approved 11/22/2013

Member resources for 2014 SecureBlue

SecureBlue members have access to these programs and services to help improve your health and keep you well. Sign in or register for myBlueCross to learn more about each of these services. You can also review the materials you received in your member welcome kit.

  • Specialty care — Access to services like chiropractic care, ob/gyn, vision care and more
  • 24-Hour Nurse Advice Line — if you or someone in your family is sick, you can call a nurse 24 hours a day, seven days a week
  • BlueRide transportation – If you need a ride to your appointment and you don’t live near a bus line or you can’t safely ride a bus, call BlueRide. Please call at least three days before your appointment.
  • Dedicated Clinician — If you’re living with an ongoing health condition or you have had a major illness or injury, a Dedicated Clinician can help you make the best choices for your care and help you follow your treatment plan
  • Falls prevention and safety — Your care coordinator can look for ways to make your home safer. You may be eligible for a risk assessment, follow-up support services and up to $750 per year toward home safety items that promote safety, injury prevention and encourage maximal function
  • Language services — Available for members who need help during a health care visit
  • Stop-Smoking Support — One-on-one phone counseling and tools to help you quit tobacco, at no cost to you

Appointing 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. ExternalLink If you have questions about how to name your appointed representative, call member services.

Be sure to sign and date the form and then mail or fax it to:
Blue Plus
P. O. Box 64179
St. Paul, MN 55164
Fax: (651) 662-6860

Prior authorization and coverage decisions

Some medical services require a special review between your doctor and your health plan. This is called prior authorization. Prior authorization helps make sure that certain medical services and procedures are necessary and covered by your plan.

If you have any questions about whether Blue Plus will pay for a service or item, including inpatient hospital services, you have the right to have a coverage decision made for the service. You may call member services and tell us you would like a decision on whether the service will be covered.

If you have questions about the prior authorization process or the status of a request, call customer service at 1-888-740-6013, 8 a.m. to 8 p.m. Central Time, daily. TTY users call 711. Your provider can also call provider services at 1-800-262-0820.

Part D utilization management, prior authorization and coverage determinations

Some Part D drugs are covered only if your doctor or other network provider gets prior authorization. Covered drugs that need prior authorization are marked in the formulary. If you have any questions about whether Blue Plus will pay for a drug prescribed for you, you have the right to have a coverage determination made. You may call member services and tell us you would like a decision on whether the drug will be covered and the amount, if any, you are required to pay for the prescription.

For more information about prior authorization, utilization management or coverage decisions (including exceptions) see the Evidence of Coverage (PDF).

Quality assurance, Medication Therapy Management and drug utilization

For information related to quality assurance, Medication Therapy Management and drug utilization, visit the Prime Therapeutics website. ExternalLink

Prescription transition process

For more information about the transition process for SecureBlue, refer to Chapter 5 of the Evidence of Coverage (PDF) or on the Prime Therapeutics website. ExternalLink

Prime Therapeutics LLC is an independent company providing pharmacy benefit management services.

Reconsiderations

You may ask for a reconsideration if you disagree with a prior authorization or coverage decision. Your provider will need to fill out the Provider Claim Adjustment / Status Check / Appeal Form (PDF).

Complaints, Appeals and State Fair Hearing process

If you disagree with a decision or have a complaint regarding medical or prescription drug benefits, you can write to or call member services to file a grievance or appeal.

Blue Plus
P. O. Box 64179
St. Paul, MN 55164

1-888-740-6013
8 a.m. to 8 p.m. Central Time, daily
TTY users call 711

If you disagree with a decision made by our plan, you can also write to the Minnesota Department of Human Services to request a State Fair Hearing. You must request a State Fair Hearing in writing.

Minnesota Department of Human Services
Appeals Office
P.O. Box 64249
St. Paul, MN 55164

For a complete description of the complaint, coverage determination (including exceptions), appeals processes and State Fair Hearing process for medical services, please see Chapters 8 and 9 of the Evidence of Coverage (PDF).

Disenrollment

You may end your membership in our plan at any time. Ending your membership in our plan may be voluntary (your own choice) or involuntary (not your own choice). Please refer to Chapter 10 of the Evidence of Coverage (PDF).

Potential for contract terminations

All health plans in the Medicare program agree to stay with the program for a full year at a time. Each year the plans decide whether to continue for another year. Even if a Medicare health plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for health care coverage in your area and give you information about your rights to other Medicare coverage. You can choose another health plan if one is available.

More information

Best Available Evidence policy ExternalLink

Evidence of Coverage (PDF)

LIS premium summary table (PDF)

Medicare Ombudsman ExternalLink

Privacy notice (PDF)

Visit the official Medicare site ExternalLink

Forms and coverage information

Medicare appointment of representative ExternalLink

Medicare complaint form ExternalLink

Medicare Prescription Drug Determination Request form (PDF)

Get Acrobat Reader ExternalLink

Last updated October 1, 2013
H2425_001_110413_N05 CMS Approved 11/22/2013