2013 Using and managing your plan | Blue Care Network Advantage

Information for current individual plan members.

Evidence of Coverage and Summary of Benefits

Essential information to understand and use your benefits is included in your Evidence of Coverage booklet. Your Evidence of Coverage is an important legal document that explains how to get your Medicare services through BCN Advantage℠. It also explains your rights, benefits, and responsibilities as a member of the plan.

View Evidence of Coverage for Individual Members: BCN Advantage Elements (PDF)
View Evidence of Coverage for Individual Members: BCN Advantage Basic, Classic and Prestige (PDF)
View Evidence of Coverage for Individual Members: BCN Advantage HMO Focus (PDF)

Find out how to get the most from your coverage

Member benefits seminars
Learn more and RSVP (PDF)

The Summary of Benefits is a chart of your plan benefits compared to Original Medicare. It is a shorter reference and provides you with a brief description of your coverage.

Extra Help: Low-Income Subsidy

People with limited incomes may qualify for extra help to pay for their prescription drug costs. For more information about this extra help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.

Forms

For additional forms and resources, such as mail order pharmacy forms, advanced directive forms, Healthy Advantage Rewards program forms, reimbursement forms and more, visit our forms library.
View forms

Formulary

A formulary is a list of drugs covered by the plan. It covers both generic and brand-name drugs. Formulary Updates is a list of drugs that has been added to, removed from, or updated in our formulary.

For more information on how to fill your prescriptions, please refer to your Evidence of Coverage.

Member discounts and wellness programs

We offer a variety of programs to promote good health, safety and savings.
View discounts and programs

Member publications

View Your Health Advantage magazine

Provider/Pharmacy Directory

The BCN Advantage network includes many primary care physicians, hospitals, pharmacies and other providers.

Online Health Care Provider Search for BCN Advantage

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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Individual plan coverage

Using and managing your plan