Blue Care Network of Michigan: UAW-GM Hourly Retirees

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UAW Retiree Medical Benefits Trust (GM Population)

New to Medicare? Looking to change your current Medicare plan?

Whether you’ve just turned 65 and are choosing a Medicare plan for the first time or you’re currently enrolled in a plan but are exploring other options, we want to help you pick the plan that meets your needs and fits your budget.

Consider BCN Advantage HMO^SM, a Medicare-approved health maintenance organization plan offered by Blue Care Network. BCN Advantage is the Medicare Advantage HMO backed by Blue Cross Blue Shield of Michigan.

Why choose BCN Advantage?

We’re proud of the popularity of our plan, and we think you’ll like it too. After all, you’ll get all the benefits of Original Medicare and much more — more coverage, more savings and more peace of mind. And you’ll have the security and recognition of the Blue Cross and Blue Shield on your side.

Our plan is easy to use

You’ll choose a primary care physician from our network of more than 3,000* doctors. Your PCP will be your health care partner and help coordinate your care. And you’ll have one ID card for all covered services. Just show your BCN Advantage ID card each time you visit your network physician, and you’re assured that your coverage will always be accepted.

Our Customer Service team is dedicated to you

The BCN Advantage Customer Service team is specially trained to serve you. They’re dedicated to BCN Advantage members, and they’re available to answer your Medicare questions.

You’ll like our benefits**

As a UAW Retiree Medical Benefits Trust (GM Population) BCN Advantage member, you’ll enjoy:

Benefits for routine and follow-up care while on extended stays outside of Michigan — great for snowbirds!
Prescription drug coverage
No deductible
Low-cost coverage that includes hospital and doctor visits
Coverage for preventive tests, immunizations and annual physical exams
Hearing care coverage
Your choice of thousands of contracted doctors and other health care providers
Access to care management programs for certain chronic medical conditions
Special members-only discounts

Please contact us at 1-866-966-2583 to inquire about other benefits or to receive an enrollment kit containing a Summary of Benefits. Representatives are available 8 a.m. to 5 p.m., Monday through Friday. TTY users should call 1-800-431-7944.

Your retiree status determines the benefit plan available to you. If you have questions about your retiree status, please contact the Retiree Health Care Connect Service Center at 1-866-637-7555 for assistance. TTY users should call the Michigan Relay Service at 711. Representatives are available 8:30 a.m. to 4:30 p.m., Monday through Friday.

Are you eligible?

You may enroll in BCN Advantage if:

You are eligible for Medicare Part A and enrolled in Medicare Part B.
You live in one of the following counties: Bay, Clinton, Eaton, Genesee, Ingham, Jackson, Lapeer, Livingston, Macomb, Midland, Monroe, Oakland, Saginaw, Shiawassee, St. Clair, Tuscola, Washtenaw and Wayne. View GM service area map (PDF).

Note: If you enroll in BCN Advantage as part of the rolling enrollment process and complete a paper application, dependent members on your contract who are not eligible for Medicare must enroll in a Blue Care Network plan. Please contact the Retiree Health Care Connect Service Center at 1-866-637-7555 to add these dependents.

How to enroll

If you have questions about BCN Advantage or would like to request an enrollment kit, please call:

BCN Advantage

1-866-966-2583
TTY users may call 1-800-431-7944.
Representatives are available from 8 a.m. to 5 p.m. Monday through Friday.

You may also print and complete the enrollment form.

Mail your completed enrollment form to:
Blue Care Network of Michigan
Mail Code C411
P.O. Box 5043
Southfield, MI 48086-5043

Here are some tips to completing the paper enrollment form:

Read through the entire application.
Use blue or black ink.
Print your answers, except where your signature is required.
Choose an emergency contact who is aware of your medical history.
Include your Medicare number from your Medicare card (This may also be referred to as health insurance claim number or HIC number.)
Copy the information from your Medicare card directly onto the picture of the card on the enrollment form when filling out the Medicare section.

If you have any questions when completing the form, please call BCN Advantage Sales and Marketing at 1-866-966-2583 for assistance.

If you have questions about when you can enroll, or need to update your address, please call:

Retiree Health Care Connect Service Center

1-866-637-7555 (TTY 711)
Representatives are available 8:30 a.m. to 4:30 p.m., Monday through Friday.

* Source: BCN Provider Count Report, December 2009
** Limits and copays apply.

Important information about this plan

BCN Advantage Group HMO is available in these counties: Allegan, Barry, Bay, Calhoun, Clinton, Eaton, Genesee, Gratiot, Ingham, Ionia, Jackson, Kalamazoo, Kent, Lapeer, Livingston, Macomb, Midland, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ottawa, Saginaw, Shiawassee, St. Clair, Tuscola, Van Buren, Washtenaw and Wayne. Premiums vary by county. You must continue to pay your Medicare Part B premium.

You must use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor BCN Advantage Group HMO will be responsible for the costs. Out-of-network services authorized by BCN Advantage Group HMO will be covered.

If you are enrolled in BCN Advantage Group HMO Option 2 or Option 3, you must use a network pharmacy to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use a network pharmacy. Our pharmacy network includes the majority of chain pharmacies, mail order through Medco or Walgreens, as well as long-term care and home infusion pharmacies. For additional information on network pharmacies, please call Customer Service at 800-450-3680, 8 a.m. to 8 p.m., seven days a week. TTY users should call 800-430-3211. You may also write to: BCN Advantage Group HMO, 2311 Green Road, Ann Arbor, MI 48105.

The BCN Advantage Group HMO benefit information provided is not comprehensive. Additional information should be requested before making a decision about your coverage. For full information on BCN Advantage Group HMO benefits, current members should call our Customer Service department at 800-450-3680, from 8 a.m. to 8 p.m., seven days a week. TTY users should call 800-430-3211. Prospective group members should call 866-966-2583, from 8 a.m. to 8 p.m., seven days a week. TTY users should call 800-431-7944.

Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1, 2011. Please contact BCN Advantage Group HMO for details.

If you decide to have your BCN Advantage HMO premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.

BCN Advantage Group HMO is issued by Blue Care Network, which contracts with the federal government. BCN Advantage Group HMO’s contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed.

BCN Advantage Group HMO is a health plan with a Medicare contract.

H5883_BCNAdvantageWebR4 CMS Approved 07012010

page modified 06/04/2010