These policies may not apply to all lines of business such as the Federal Employee Program, Medicare Advantage, and certain self-insured groups. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. If you need assistance with other documents please call a Customer Advocate toll free at 1-888-494-2583 (TTY 711). When a drug requires prior authorization, Blue Cross of Idaho may determine the most appropriate method of benefit administration (Major Medical vs. Pharmacy) through the authorization process. 2022 Secure Blue Courage (PPO) - Blue Cross of Idaho Medicare Drugs requiring step therapy can be identified by the ST that follows the drug name. Or call Blue Cross of Idaho Customer Service at 1-888-494-2583. You may also refer to the Medical Policies section of the website for information regarding criteria for certain prescription drugs. Today, Blue Cross of Idaho and Regence BlueShield of Idaho remain separate companies, operating independently of each other. We require prior authorizations for selected high risk and/or high cost medications to promote appropriate use and maintain affordability of Blue Cross of Idaho plans. If you don't have an insurance agent, you can search using our Find a Broker tool. Generic drugs are equivalent to brand-name drugs in dosage, safety, strength, route of administration, quality, performance characteristics and intended use. Powered by Blue Cross of Idaho Care Plus . 2023 Documents. Please select Continue if you agree to these guidelines. Take a look at our plans to get started. Benefits and Coverage Overview | Blue Cross of Idaho - bcidaho.com Blue Cross of Idaho Customer Service can assist with prior authorization questions and concerns. Secure Blue No Rx (PPO) is not available for new enrollments in 2021. An Employee Assistance Program is available as a value added benefit through Symetra. Blue Cross of Idaho's Summary of Benefits and Coverage (SBC) provides detailed information about your health coverage options and benefits. blue cross blue shield ppo emergency room coverage Please contact Medicare.gov or 1-800- MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Blue Cross of Idaho members now have access to Sharecare, an app to help you eat better, lower stress and get more active! Dental plans for you and your family | Blue Cross of Idaho - bcidaho.com For drugs approved for self-administration and covered under the member's pharmacy benefit, refer to the appropriate formulary(see the current year "Formulary Information" section above)to determine if the drug prescribed requires prior authorization. We understand when to step in and help you through the health insurance process. Whether you are new to Medicare or returning as a valued member, we will show you how to get the most out of your health plan. These include but are not limited to certain prenatal supplements, contraceptives, fluoride for children and tobacco cessation aids. Our dental plans boost your overall health and protect your pocketbook: Competitively priced plans Innovative plans cover services that members need and value Pharmacy | Blue Cross of Idaho - bcidaho.com Vision Benefit | Office of Group Insurance The medical policies contained in this manual are the property of Blue Cross of Idaho. First tier drugs have the lowest cost, with costs increasing as the tiers increase. Medicare Supplement (Medigap) | Blue Cross of Idaho Medicare Plans in Idaho | Blue Cross of Idaho - bcidaho.com You deserve a Medicare plan that not only supports your continued good health but also your financial peace of mind. Refer to the appropriatepage to locate prior authorization requirements for drugs typically administered in an outpatient setting. Most employer groups use one of three formularies. We're in your neighborhood. Members Portal | Blue Cross of Idaho Blue Cross of Idaho may require members to purchase a specialty drug through IngenioRX Specialty Pharmacy and have the medication shipped to their physician for administration OR physician may be required to buy-and-bill under Major Medical. Limitations and exclusions may apply. Medicare Made SimpleLearn the ABCs of Medicare in an animated video.If you find Medicare a little confusing, youre not alone. Access Plan Formulary - 6 Tier for Access Plans - for individual plans that are available directly through Blue Cross of Idaho. Certain medications may require step therapy, the trial of one or more cost-effective medications, prior to approval for a higher cost therapeutic treatment plan. These benefits include coverage of self-administered medications, as well as some vaccines and specialty medications. The use of generic medications is a valuable way to reduce overall prescription drug costs without sacrificing quality. Enrollment in plans depends on contract renewal. Powered by Blue Cross of Idaho Care Plus, Inc. Blue Cross of Idaho Care Plus, Inc. is a Medicare Advantage plan with a Medicare contract. You can verify which formulary to use by checking the Prescription Drug Program section of your plan's Benefit Description, located under Beneftis & Coverage after logging in. Select a Medicare approved doctor, specialist or hospital without a referraleven when you travel. Follow these steps to find an in-network provider. Kit de inscripcin combinado Secure Blue Courage, Nondiscrimination Notice and Language Assistance, $0 in-network primary care physician visits, No cost for most annual preventive screenings, Telehealth services, including virtual physical therapy, Hearing exams and deeply discounted hearing aids. For more details, download the Secure Blue Courage (PPO) Enrollment KitESPAOL: Kit de inscripcin combinado Secure Blue Courage. They are independent, certified, knowledgeable and they won't cost you a thing! Not all plans offer all of these benefits. You must be logged-in to view this page. Medicare Advantage offers you the benefits you need with the affordable coverage you deserve. You have the option to require a prescription be filled for the brand name medication when a generic equivalent exists, by ordering the prescription with a Dispense as Written (DAW) condition. No referral is needed with a POS managed-care plan. We also know when to get out of the way and let you work with your healthcare provider to take control of your health. PDF Instructions for Group Health Plans and Health Insurance Issuers To determine if the member has preventive drug benefits, refer to the Prescription Drug section of the members Benefit Plan Summary, under Eligibility & Claims. Powered by Blue Cross of Idaho Care Plus, Inc. Blue Cross of Idaho Care Plus, Inc. is a Medicare Advantage plan with a Medicare contract. The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. 2022 Blue Cross of Idaho | Secure Blue Courage (PPO) | US News This plan is offered in the following counties: Monthly Drug Premium *Included in Monthly Plan Premium. PAP 101 - Blue Cross of Idaho Healthcare Coverage - bcidaho.com Out of network services are covered at 50%. This plan is offered in the following counties: Ada, Adams, Bannock, Bingham, Blaine, Boise, Bonner, Bonneville, Boundary, Canyon, Cassia, Clark, Elmore, Fremont, Gem, Gooding, Jefferson, Jerome, Kootenai, Latah, Lincoln, Madison, Minidoka, Nez Perce, Owyhee, Payette, Power, Shoshone, Twin Falls, Valley and Washington counties. $5,000 In and Out-of-network / $3,400 In-network Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) $5,000 In and Out-of-network / $3,400 In-network Optional. Blue Cross of Idaho Care Plus, Inc. is a Medicare Advantage plan with a Medicare contract. Providers may submit the Contraceptive Exception Request Form along with documentation showing the need for this alternate product instead of one already covered with no member cost share. Although generic drugs are chemically the same as their brand counterparts, they are typically sold at substantial discounts from the branded price. Our medical policies are designed for informational purposes only and are not an explanation of benefits, or a contract. Any drug prescribed for off-label use indication also requires prior authorization. Staying Healthy: Screenings, Tests and Vaccines, Ease of Getting Needed Care and Seeing Specialists, Health Plan Provides Information or Help when Members Need It, Coordination of Members' Health Care Services, Diagnostic radiology services (e.g., MRI), Prosthodontics, other oral/maxillofacial surgery, other services, Outpatient group therapy visit with a psychiatrist, Outpatient individual therapy visit with a psychiatrist, Physical therapy and speech and language therapy visit, Durable medical equipment (e.g., wheelchairs, oxygen), Prosthetics (e.g., braces, artificial limbs). Preventive medications are generally prescribed for people who may be at risk for certain illness or condition, but are not yet showing symptoms. Blue Cross of Idaho will send you a member ID card with your policy after we approve your application. Enrollment in Blue Cross of Idaho Care Plus, Inc. depends on contract renewal. Infusion drugs may apply to the pharmacy benefit or the major medical benefit. Medication specific quantity limits are searchable in the formulary. We understand the important questions you may have about Medicare coverage. Our $0 premium plan allows you more time to enjoy your life. Summary of Benefits | Blue Cross of Idaho - bcidaho.com Qualified Health Plan Formulary - 6 Tier for Metal Level Plans - For individual and small group Affordable Care Act plans that are available through the healthcare exchange at Your Health Idaho or directly through Blue Cross of Idaho. Drugs requiring prior authorization can be identified by the PA that follows the drug name. There are a lot of choices to make and you get to start making those choices when you near the age of 65, or when you retire at 65 and no longer get health insurance from your employer.Common myths about medicare|Medicare FAQs. For information specific to Medicare members, visit the Medicare Advantage Informationpage. What your patient pays for prescription medications is subject to the prescription benefits available for each specific tier. SHORT TERM PPO PLANS: (1 to 6 months) These plans provide all of the benefits you are entitled to under Medicareplus extra benefits, INCLUDING Medicare Part D prescription drug coverage. 2022 Blue Cross of Idaho Care Plus, Inc. (Blue Cross of Idaho Care Plus), an Independent Licensee of the Blue Cross Blue Shield Association, with services provided by Blue Cross of Idaho Health Service, Inc. Nondiscrimination Notice and Language Assistance. Government Programs Membership: 833-377-4266, An Independent Licensee of the Blue Cross and Blue Shield Association, BlueCard Pre-Service Review for Out-of-Area Members, Medicare Medicaid Coordinated Plan / Idaho Medicaid Plus, Prior Authorization Procedure Code Lookup, Medical Drugs Requiring Prior Authorization, Prior Authorization and/or Step Therapy requirements. Short-Term Health Insurance| Blue Cross of Idaho - bcidaho.com Specialty prescriptions may be submitted by phone to FastStart at 833-203-1742 or faxed to 833-263-2871. Good oral health is a key part of your overall health, so Blue Cross of Idaho offers flexible and affordable dental plans that enhance your medical coverage. Blue Cross of Idaho has been in Idaho for over 75 years and our Customer Advocates are located right here in Idaho.
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