Plus, knowing what’s covered saves you money! Preventive Services. Costs are lowest for first tier (generic) drugs, and costs increase as the tiers increase. Exam and Hardware Allowance – Blue Cross of Idaho gives you six different exam and hardware allowance plans to choose from. Sign on and check your benefits today! This is a 3.5-star Medicare Advantage plan. An Independent Licensee of the Blue Cross and Blue Shield Association, Summary of Benefits & Coverage Information, Sleep Testing and Therapy & Advanced Imaging, Nondiscrimination Notice and Language Assistance. 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. The state of Idaho is pleased to offer eligible retirees and their dependents a comprehensive and flexible benefit program designed to promote health and personal welfare. The formularies include brand name as well as generic drugs that have undergone rigorous testing and are approved by the Food and Drug Administration (FDA). The True Blue Rx Gem (HMO) has a monthly premium of $15.00 and has an in-network Maximum Out-of-Pocket limit of $5,400 (MOOP). You must be logged-in to view this page. About Blue Cross of Idaho / Contact; Code of Ethical Business Conduct / Nondiscrimination Notice and Language Assistance; 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. Our medical policies are designed for informational purposes only and are not an authorization, explanation of benefits or a contract. Your plan includes pharmacy benefits. Medical technology is constantly changing and we reserve the right to review and update our policies periodically. MEDICARE. Exam and Hardware Allowance Benefit Summary (31KB) Exam and Full Hardware – With three different exam and full hardware plans, you can offer your employees the maximum vision benefit. True Dental Complete: Full preventive and comprehensive dental coverage. Active Policy. In addition, some employer groups may choose to purchase enhanced coverage for preventive drugs. *Not included with the True Blue Rx Essentials plan. Added July 31, 2020 - In accordance with our Medical Policy, we cover COVID diagnostic tests used for presurgical screenings, (dx code X01.81x), but not return to work or population testing (dx code Z11.59) Active Policy. To obtain a cost estimate for prescribed medications, based on your current benefits and accumulations, complete the following steps: For questions regarding cost estimates obtained through the CVS website, or to obtain a cost estimate for your prescriptions over the phone, please contact CVS Caremark Rx Customer Care. To locate a participating pharmacy, visit our Pharmacy Locator. Some, but not all ACA drugs are listed in the formularies. Follow the additional prompts to complete a Cost & Coverage check. * Please Select Your County: Coverage will begin {{theModel.effectiveDate}} * Zip Code. Sales Guide; Outline of Coverage (includes monthly premium rates) Application; 2021 Monthly Premium Rates Here are a few items to keep in mind as you choose the plan that is best for you. We are dedicated to serving our members and the Idaho community. This is a 4.5-star Medicare Advantage plan. Details Drug Coverage for the Blue Cross of Idaho True Blue Special Needs Plan H1350-025 (HMO D-SNP) in Idaho. 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. The formularies also provide information regarding the following: Benefit Levels, also known as Tiers Plans for Everyone. Last Updated 10/9/2020. Prior authorization is the process of determining medical necessity for a nonemergency medical service or procedure. VIEW YOUR SBC. COBRA Qualifying Event After your eligibility for group insurance coverage ends, you may be able to purchase continued medical and dental, on an individual basis, for a period of time under a federal law known as the Consolidated Omnibus Budget Reconciliation Act of 1985 … Find a provider in your area! In an example provided by Blue Cross of Idaho, a family of four would pay a monthly premium of $933 for the insurer's ACA-compliant Bronze 5500 plan with a deductible of $11,000. We offer affordable choices that: Blue Cross Blue Shield Association (BCBSA) is a federation of 36 separate United States health insurance companies that provide health insurance in the United States to more than 106 million people. If you are unsure about the formulary your plan uses, please contact CVS Caremark RX Customer Care at the number on the back of your Blue Cross of Idaho member ID card to check costs for prescription drugs. • Blue Cross of Idaho will send you a member ID card with your policy after we approve your application. Generic drugs are equivalent to brand-name drugs in dosage, safety, strength, route of administration, quality, performance characteristics and intended use. Quantity Limits for Commercial and Qualified Health Plans are included in the formulary. SUMMARY OF BENEFITS POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC Which doctors and hospitals can I use? Vaccines ― For policies that offer full coverage for preventive vaccines, members can get the following vaccines from participating network pharmacies with no copayment. Nurse Advice Line. Secure Blue no Rx PPO without Part D Coverage (see service area premium table below) $29: $15: $50 annual gym membership OR $10 annually for two at home fitness kits: N/A: $25 no referral needed: $175 per day for days 1-5: $3,400 per calendar year includes most plan services . Details Drug Coverage for the Blue Cross of Idaho True Blue Rx Preferred H1350-021 (HMO) in Idaho. TRUE BLUE RX (HMO) TRUE BLUE RX (HMO) HEALTHY SMILES PLUS COMPREHENSIVE COVERAGE FOR PREVENTIVE AND BASIC DENTAL SERVICES Your teeth are important indicators of your overall health, which is why Blue Cross of Idaho gladly offers additional dental coverage you can add into your Medicare Advantage plan for only $23.60 more a month. Enrollment in Blue Cross of Idaho Care Plus, Inc. depends on contract renewal. Your benefits description contains useful information about the services covered by your plan for the current benefit period. Plus, Blue Cross of Idaho Care Plus doesn't require a health questionnaire for current members moving from our Medicare Advantage plans to an Idaho MedPlus plan. You can also contact one of our district offices at 800-345-4550. Medical technology is constantly changing and we reserve the right to review and update our policies periodically. However, the insured could be financially responsible for services found to be not medically necessary when provided by a noncontracting provider. authorization by Blue Cross of Idaho are performed by a contracting provider and benefits are denied as not medically necessary, the cost of said services are not the financial responsibility of the insured. Sign on and check your benefits today! The Preventive Drug List (2020 and 2021) provides a list of medications covered under the preventive drug benefit . Select Check Drug Cost & Coverage from the Plan & Benefits menu. Contact your insurange agent or Blue Cross of Idaho account representative to find an affordable health coverage option for your business. Blue Cross of Idaho offers coverage for mammogram screenings. Blue Cross of Idaho P.O. payment to your local Blue Cross of Idaho district office (listed on the back of this brochure). Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. MERIDIAN, Idaho, April 2, 2020 – Blue Cross of Idaho announced today the company has waived all member cost-sharing for testing and treatment of COVID-19.The company’s decision benefits its individual, fully insured and Medicare Advantage members. These include but are not limited to certain prenatal supplements, contraceptives, fluoride for children and tobacco cessation aids. No Remove. MP 7.01.47 - Bariatric Surgery - Effective 02/19/2020 ... About Blue Cross of Idaho / You have the option to choose a brand-name medication when a generic equivalent exists. Offered only directly from Blue Cross of Idaho, Healthy Smiles is a family of flexible and affordable dental plans (Preventive, Plus, and Preferred) that include varying degrees of coverage so you can select a dental plan that best fits your needs. Do you have more than one health insurance plan? Refer to the Blue Cross of Idaho Care Plus, Inc. Summary of Benefits for more information. I understand that by signing this application, I authorize Blue Cross of Idaho to change my coverage, including covered dependents, to the policy I’ve checked above. Write Blue Cross of Idaho Care Plus, P.O. But if you want to, you can also use … The formularies also provide information regarding the following: Most employer groups use one of three formularies. *A benefit period is the 12 months following your coverage effective date. You can verify which formulary to use by checking the Prescription Drug Program section of your plan's Benefit Description, located under Benefits & Coverage after logging in. You can search other benefit periods to review previous benefit descriptions. This is a 3.5-star Medicare Advantage plan. Select Benefits and Coverage from the Prescription Drugs menu. Sort by Facility or City. Blue Cross of Idaho’s commitment to that is unchanging in these unprecedented times. The Healthy Smiles Advantage. Blue Cross of Idaho’s Summary of Benefits and Coverage (SBC) provides detailed information about your health coverage options and benefits. Blue Cross Idaho Medicaid Plus coverage replaces the State of Idaho Medicaid coverage, except for the Medicaid services listed below, which are provided directly by the State of Idaho Medicaid program: • Medicaid Dental Services • Non-emergency Medical Transportation A deductible is the amount of expenses that must be paid out of pocket before the Initial Coverage period begins. FY2021 COBRA Premium Rate (Start July 1) FY2021 COBRA Rates – MEDICAL Plans for Everyone. Blue Cross of Idaho Rx offers comprehensive pharmacy benefits for many of our members. Although generic drugs are chemically the same as their branded counterparts, they are typically sold at substantial discounts from the branded price. Preventive medications are generally prescribed for people who may be at risk for certain illness or condition, but are not yet showing symptoms. The policies are used for the express purpose of assisting physicians and other healthcare providers in providing evidence based cost effective care. You will be directed to CVS Caremark. Protect yourself from the coverage gaps in Original Medicare and live healthier with our Medicare Advantage plans. You can learn more about cost-sharing, coverage limitations, and if you need a referral to see a specialist. Please fill in all of … Blue Cross Blue Shield Association (BCBSA) is a federation of 36 separate United States health insurance companies that provide health insurance in the United States to more than 106 million people. With expanded benefits and low copays, Blue Cross of Idaho CarePlus Inc.’s Medicare Advantage plans offer more value than ever. Uniform Glossary , which is a list of definitions that explains terms commonly used in health insurance coverage, such as "deductible" and "copayment." 2020 Evidence of Coverage for Blue Cross Idaho Medicaid Plus 5 Chapter 1. Plan brochure. This option allows you to purchase Blue Cross of Idaho medical and dental coverage without interaction with the Your Health Idaho Exchange. POWERED BY BLUE CROSS OF IDAHO CARE PLUS, INC 3 . True Blue HMO is a sound approach to good health, with the convenience of services from one of the largest provider networks in Idaho. Set up your Blue Cross of Idaho member portal login at members.bcidaho.com.. You can also contact us to ask for a coverage decision before you receive certain medical services. Please refer to the back of your patient’s Blue Cross of Idaho ID card to determine if their benefits are administered by Blue Cross of Idaho Rx. Your Benefits “To-Do” List. True Blue Rx Gem (HMO) H1350-022 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by Blue Cross of Idaho available to residents in Idaho. Details Drug Coverage for the Blue Cross of Idaho True Blue Rx Option II H1350-016 (HMO) in Idaho. Blue Cross of Idaho Medical Policy 2.04.573 provides detailed guidance of our coverage for both COVID-19 diagnostic and antibody testing. _____ _____ Enrollee Signature Date _____ _____ Independent Producer’s Name Blue Cross # Form No. Start a file for your FY2021 receipts. The expansion covers cost-share treatment received through June 30, 2020 and is offered at no additional premium cost. There is an individual deductible of $50 per member per benefit period. These benefits include coverage of self-administered medications, as well as some vaccines and specialty medications. MP 3.01.508 - Neuropsychological Testing - Effective 08/25/2020; Pending Policy. Blue Cross of Idaho's Short Term PPO sm offers a limited benefit program for temporary coverage. Box 7408 Boise, ID 83707. Blue Cross of Idaho offers coverage for mammogram screenings. Box 8406, Boise, ID 83707 You’ll need your Blue Cross of Idaho member ID card to get started.) Follow the additional prompts to complete a Cost & Coverage check. Premera Blue Cross complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. If you use the providers in our network, you may pay less for your covered services. You must be logged-in to view this page. Please click the button below to access your benefits. You will need your Blue Cross of Idaho ID number as part of the activation process Our members will also pay nothing out of pocket - no copays, deductibles, or coinsurance - for MDLIVE services through the end of the federal public health emergency for the coronavirus pandemic plus 60 days, or December 31, 2020, which comes sooner 4 SUMMARY OF BENEFITS . Yes. 2021 PLANS 2020 PLANS Secure Blue no Rx PPO With Secure Blue no Rx PPO, you get to choose your providers in- or out-of-network and continue to have protection from unexpected healthcare costs. Write Blue Cross of Idaho Care Plus, P.O. Review the Benefits at a Glance FY2021. (If you don’t have one, creating one is easy. Blue Cross of Idaho’s Summary of Benefits and Coverage (SBC) provides detailed information about your health coverage options and benefits. You can learn more about cost-sharing, coverage limitations, and if you need a referral to see a specialist. Fax 1-208-387-6811 You may contact us by fax for expedited coverage decisions. The use of generic medications is a valuable way to reduce overall prescription drug costs without sacrificing quality. For fast (expedited) coverage decisions, call the same number at 1-888-494-2583 (TTY 711). Select Access Your Pharmacy Benefits Now – You will be redirected to the CVS Website. Access Plan Formulary - 6 Tier for Access Plans - for individual plans that are available directly through Blue Cross of idaho. Discover the benefits you want with the affordable coverage you … When do you wish coverage to start? Medical policies consist of medical guidelines, including diagnostic imaging management policies, payment guidelines and evidence-based guidelines. To help fill the gaps in your Medicare coverage, Blue Cross of Idaho Care Plus offers Idaho MedPlus Medicare Supplement plans. Offered only directly from Blue Cross of Idaho, Healthy Smiles is a family of flexible and affordable dental plans (Preventive, Plus, and Preferred) that include varying degrees of coverage so you can select a dental plan that best fits your needs. Be sure to read the "exclusions and limitations" in the 2020 Short Term PPO Brochure before buying a plan. Blue Cross of Idaho received notification earlier this year from Centers for Medicare & Medicaid Services (CMS) of our selection for a contract-level Medicare Advantage (MA) RADV audit to validate health status information for our MA members in 2014. Pre-pregnancy. Please enter a valid Zip Code. If this is the first time you are visiting CVS Caremark, you will be asked to register. The Blue Cross of Idaho formularies list drugs approved for coverage under your policy. Please have your Blue Cross of Idaho member ID available. Box 8406, Boise, ID 83707 INDIVIDUAL & FAMILY. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts. Find plans that bring peace of mind to you and your family. Healthy Smiles also uses Blue Cross of Idaho’s preferred provider organization (PPO) network of over 900 dentists and other dental providers in Idaho, … N/A; Retired Policy Versions. However, when a brand-name medication is chosen over an available generic equivalent, you will pay the cost difference between the brand-name and generic medications, in addition to the brand-name copayments. To request an informational/enrollment packet, contact Blue Cross directly at 1-800-289-8613 ext. MP 3.01.501 - Guidelines for Coverage of Mental and Behavioral Health Services. Members with questions about coverage or telehealth services should visit bcidaho.com or call the customer service number located on the back of their ID card. The Blue Cross of Idaho formularies list drugs approved for coverage under your policy. 2. *High Deductible Health Plans (HDHP) or Health Savings Account (HSA) Plans ― Several Blue Cross of Idaho HSA policies offer coverage for an enhanced list of preventive medications, not subject to the deductible requirements of the plan. Policy Notice of Medicare Non-coverage (NOMNC) Reporting. We write our medical guidelines to cover a given condition for the majority of people, and review and update our policies to keep them consistent with changing medical science. Blue Cross of Idaho has determined that the prescription drug coverage is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. If you would like to know more about Specialty medications, please visit the Specialty Drugs page. You must be logged-in to view this page. Fax 1-208-387-6811 You may contact us by fax for expedited coverage decisions. Get more information on Healthy Smiles plans. Preventive care generally does not include medications prescribed for treatment of an existing illness or condition. You must be logged-in to view this page. You can protect yourself and eligible dependents during those times between coverage or outside enrollment periods, choosing coverage for just one month, or up to six months. All Healthy Smiles dental plans cover 100% of the maximum allowance for in-network preventive dental services after a $20 copayment per visit. A formulary is a list of prescription medications that are covered under Blue Cross Of Idaho Care Plus, Inc.'s 2020 Medicare Advantage Plan in Idaho. It’s that simple. Any time, day or night, you can speak with a registered nurse at no cost to you. Blue Cross of Idaho administers COBRA coverage for state of Idaho group members. Deductible. At Blue Cross of Idaho, we understand Idahoans must have options for affordable healthcare coverage, with the financial peace of mind they deserve. MERIDIAN — Blue Cross of Idaho has waived all member cost-sharing for testing and treatment of COVID-19, the company announced Thursday. Rate card: (11/01/2020 through 01/31/2021) Rate card: (02/01/2021 through 04/30/2021) Each Healthy Smile plan has something unique to offer. If so, those plans need to work together to make sure you’re getting the most out of your coverage. This is a 3.5-star Medicare Advantage plan. Members have the option to purchase the three supplemental benefits below for an additional $39.00 per month. Secure Blue Plan Premium Table. Sort by Facility or City. Blue Cross of Idaho, an independent licensee of the Blue Cross and Blue Shield Association, is the state's largest health insurer, providing coverage for nearly 550,000 members. Since the coverage under Blue Cross of Idaho, is not creditable, depending on how long you go without creditable prescription drug coverage you may pay a penalty to join a Medicare drug plan. If you don't have an insurance agent, you can search using our Find a Broker tool. In addition to the tiers, certain preventive drugs may be covered at no cost. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage. You can verify which formulary to use by checking the Prescription Drug Program section of your plan's Benefit Description, located under Benefits & Coverage after logging in. True Blue Rx Essentials members have a $3,000 coverage limit. Knowing the details of your health insurance allows you to use all the benefits your plan offers, and be prepared when you need to make a medical decision. * Please Select Your County: * First Name * Last Name * Date of Birth * Tobacco User? Blue Cross of Idaho remains in contact with Governor Brad Little, the Idaho Division of Public Health and the Department of Insurance to provide the most up-to-date information on coronavirus. The True Blue Rx Preferred (HMO) plan has a $150 drug deductible. Most employer groups use one of three formularies. Call (800) 704-0727to ask questions about your prescriptions, finding a doctor or specialist, or understanding a health condition. Find a provider in your area! In most cases, you are responsible to pay a portion of the cost of each prescription you have filled. On March 19, 2020, Blue Cross of Idaho expanded access to telehealth services by including coverage for any in-network provider able to provide services via telephone or video call. Prepare yourself for what’s next by learning about what you should or should not be doing if you are planning on having a baby.Be sure to find out which medications and vaccinations can affect your pregnancy. The medical policies contained in this manual are the property of Blue Cross of Idaho. Blue Cross of Idaho's Short Term PPO sm offers a limited benefit program for temporary coverage. Blue Cross of Idaho partners with IngenioRx to provide pharmacy benefits to most of our membership. Conditions × the following: most employer groups use one of our district offices 800-345-4550! T have one, creating one is easy coverage limit insurance, dental insurance, dental insurance, and you... 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