2013 Getting care at home and when you travel | BCN Advantage

Getting care at home and when you travel

HMO-POS: Elements, Basic, Classic and Prestige
HMO: Focus

Your BCN Advantage℠ HMO-POS coverage travels with you. Some services require prior authorization from BCN Advantage.

In Michigan, members must seek services in the BCN Advantage network. If you choose to go to a doctor outside of our network, you must pay for these services yourself. Neither BCN Advantage nor the Original Medicare plan will pay for these services, except for emergency medical or urgent care services.

With BCN Advantage HMO-POS and HMO plans you are covered worldwide for urgent and emergency medical services.

Inside the service area

Within the service area, you are covered for your medical and pharmacy services when using our network providers for both BCN Advantage HMO-POS and HMO. The BCN Advantage HMO plan network is not the same network as the BCN Advantage HMO-POS plans. Coordinate all your care through your primary care physician.

The service area for HMO-POS includes 42 counties in Michigan: Allegan, Barry, Bay, Calhoun, Clare, Clinton, Crawford, Eaton, Genesee, Gladwin, Grand Traverse, Gratiot, Huron, Ingham, Ionia, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lapeer, Livingston, Macomb, Mecosta, Midland, Missaukee, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ottawa, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, Tuscola, Van Buren, Washtenaw and Wayne.

View Map of the BCN Advantage Service Area (PDF)

The service area for HMO is Wayne County.

Outside the service area within Michigan

BCN Advantage HMO-POS and HMO covers you for urgent and emergency medical services from any provider. Contact your primary care doctor as soon as possible so he or she can coordinate your follow-up care when you return home.

Outside of Michigan and within the United States

BCN Advantage HMO-POS uses the BlueCard^® Program to allow you to travel and stay well. The BlueCard Program is a national network of Blues plans. Talk with your primary care physician before you leave so that you can arrange for care away from home while you are traveling or temporarily living outside of Michigan. You must reside in Michigan 6 months out of the year in order to remain in our plan.

To locate a doctor:

Visit BlueCard or call BlueCard at 1-800-810-BLUE (2583) 24 hours a day, seven days a week. TTY users should call 711.

BCN Advantage HMO Focus plan does not have travel benefits.

H5883_BCNAdvantageWebR5.4 Pending CMS Approval

Important Plan and Benefit Information

Important information for BCN Advantage HMO-POS℠ plans

BCN Advantage HMO-POS℠ is available in these counties: Allegan, Barry, Bay, Calhoun, Clare, Clinton, Crawford, Eaton, Genesee, Gladwin, Grand Traverse, Gratiot, Huron, Ingham, Ionia, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lapeer, Livingston, Macomb, Mecosta, Midland, Missaukee, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ottawa, Roscommon, Saginaw, St. Clair, Sanilac, Shiawassee, Tuscola, Van Buren, Washtenaw and Wayne. Premiums vary by county. You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Medicare beneficiaries may also enroll in BCN Advantage through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. BCN Advantage's contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed. Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1 of each year.

You must use plan providers except in emergency medical or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers without prior authorization from the plan, neither Medicare nor BCN Advantage will be responsible for the costs. Out-of-network services authorized by BCN Advantage will be covered. Our point-of-service benefit allows you to get care from providers not in our network under certain conditions. If you're traveling outside of Michigan, you're covered under our point-of-service BlueCard benefit and can access out-of-network doctors, specialists or hospitals that participate with Blues plans. You may receive most plan-covered services at in-network out-of-pocket cost sharing. You may need to pay higher cost-sharing for routine care from non-network providers.

If your plan includes Part D prescription drug coverage, 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 Pharmacy® (now a part of the Express Scripts family of pharmacies) or Walgreens, as well as long-term care and home infusion pharmacies. For more information, call the Customer Service number on the back of your ID card from 8 a.m. to 8 p.m., Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users should call 711. Certain services are available 24/7 through our automated telephone response system. You may also write to: BCN Advantage, 2311 Green Road, Ann Arbor, MI 48105.

The BCN Advantage benefit information provided on this website is not complete. Additional information should be requested before making a decision about your coverage. For full information on BCN Advantage benefits, call the Customer Service number on the back of your ID card from 8 a.m. to 8 p.m., Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users should call 711. Certain services are available 24/7 through our automated telephone response system. If you decide to have your BCN Advantage 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. For more information, contact BCN Advantage at 1-877-469-2583. TTY users call 711. Hours are: 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30; 8 a.m. to 9 p.m. Eastern time, seven days a week, from Oct. 1 to Feb. 14.

BCN Advantage HMO-POS℠ is a health plan with a Medicare contract.

Important information for the BCN Advantage HMO Focus℠ plan

BCN Advantage HMO Focus℠ is available only to residents of Wayne County. You must use BCN Advantage Focus plan providers except in emergency medical or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers without prior authorization from the plan, neither Medicare nor BCN Advantage will be responsible for the costs. You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Medicare beneficiaries may also enroll in BCN Advantage through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. BCN Advantage's contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed. Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1 of each year.

BCN Advantage HMO Focus℠ plan members must use a network pharmacy to access their prescription drug benefit, except under non-routine circumstances when they cannot reasonably use a network pharmacy. Our pharmacy network includes the majority of chain pharmacies, mail order through Medco Pharmacy® (now a part of the Express Scripts family of pharmacies) or Walgreens, as well as long-term care and home infusion pharmacies. For more information call the Customer Service number on the back of your ID card from 8 a.m. to 8 p.m., Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users should call 711. Certain services are available 24/7 through our automated telephone response system. You may also write to: BCN Advantage, 2311 Green Road, Ann Arbor, MI 48105.

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

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2013 Individual plan coverage

Getting care