2010 Plan information
For more information call:
1-877-469-2583
TTY 1-800-481-8704
Seven days a week
8 a.m. to 8 p.m. Eastern Time
BCN Advantage HMO wants you to understand your plan and feel comfortable using it. Click a term from the following list for a definition of some commonly used terms that can be confusing.
A type of complaint you make when you want us to reconsider and change a decision we have made about what services are covered for you or what we will pay for a service.
The percentage of billed charges that you may have to pay after you pay any plan deductibles (same as copayment).
The amount patients pay at the time of service. Your copayment for a doctor’s office visit is likely to be lower than for an urgent care center visit. Your copayment for an emergency room visit is likely to be higher than for an urgent care center visit.
The total amount you must pay for health care before your health plan begins to pay.
A set time that a beneficiary can change Medicare plans or return to Original Medicare.
A regularly updated list of medications that have been approved by the Food and Drug Administration. We use the clinical judgment of Michigan physicians, pharmacists and other experts in health care diagnosis and treatment to organize our formulary into tiers based on each drug’s clinical effectiveness, safety and opportunity for cost savings.
A prescription drug that has the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration to be as safe and effective as brand-name drugs.
BCN Advantage is a Medicare Advantage Plan. We cover most of your health care needs for minimal copayments. You select a primary care physician from a list of doctors who participate in the plan’s network. Your doctor coordinates your care and refers you to specialists and hospitals if necessary. All of your care must be received in-network. There is no coverage outside the plan’s network of providers, unless it’s for an emergency.
A pharmacy that contracts with BCN Advantage, where members can receive covered prescription drug benefits.
Original Medicare is the national pay-per-visit program that lets you go to any doctor, hospital, or other health care provider that accepts Medicare. You must pay the deductible. Medicare pays its share of the Medicare-approved amount, and you pay your share. Original Medicare has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance) and is available everywhere in the United States. It is the way most people get their Medicare Part A and Part B health care.
Medicare hospital insurance that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.
Medicare medical insurance that helps pay for doctors’ services, outpatient hospital care, durable medical equipment, and some medical services that aren’t covered by Medicare Part A.
Health benefit coverage offered by a Medicare Advantage organization. You receive a specific set of health benefits at a uniform premium and uniform level of cost-sharing. Part C is available to all Medicare beneficiaries residing in a plan’s service area.
Optional Medicare Prescription Drug Plan that provides prescription drug coverage through private companies and organizations. You may choose any of the Medicare-approved drug plans or Medicare Advantage plans that offer drug coverage in your area.
The amount you or your employer pays each month for your health plan coverage.
Your primary care physician, or PCP, is the doctor you see first for most health problems. He or she makes sure you get the care you need to keep you healthy. He or she also may talk with other doctors and health care providers about your care and refer you to them.
Some in-network services are covered only if your doctor or other plan provider gets approval in advance from Blue Care Network. Covered services that need prior authorization are marked in the benefits chart.
A written OK from your primary care physician for you to see a specialist or to receive certain services.
BCN Advantage’s service area covers 29 counties: Allegan, Barry, Bay, Calhoun, Clinton, Eaton, Genesee, Gratiot, Ingham, Ionia, Jackson, Kalamazoo, Kent, Lapeer, Livingston, Macomb, Midland, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Ottawa, Saginaw, Shiawassee, St. Clair, Tuscola, Washtenaw and Wayne. This is where services are provided.
BCN Advantage HMOSM is a health plan with a Medicare contract.
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page modified 09/29/2009