Name of Manual - Blue Cross and Blue Shield of Minnesota

Health Care Options
Medicare Basic Blue ® Medicare Basic Blue is our low-cost Medicare Supplement plan.
Members can enroll in the base plan and then select from a number
of additional coverage options to suit their needs.
The base plan for Medicare Basic Blue covers the Medicare
coinsurance for Part A and B, but does not cover the annual
deductibles. When the deductible has been met, coverage is
provided for the Medicare Part B coinsurance amount up to
Medicare’s approved charge and for the cost of the first three pints
of blood per calendar year. Additional coverage is furnished for
residential and nonresidential treatment programs, cancer
screening and temporomandibular joint syndrome (TMJ). It also
covers 80 percent of emergency care received in a foreign country.
The plan also offers four separate additional coverage options,
which include: Preventative care coverage, coverage of Medicare
Part A inpatient hospital deductible, coverage of Medicare Part B
annual deductible, and coverage of 100 percent of eligible medical
expenses and supplies not covered by Medicare Part B that exceed
Medicare approved charges. These options can be purchased to
supplement coverage available through the base plan according to
the needs of the member.
Under this plan, Medicare is the primary payer. Claims must be
submitted to Blue Cross with a copy of the Medicare Remittance
Advice (RA) form.
Extended Basic Blue ® The Extended Basic Medicare supplement plan is the most
comprehensive plan that Blue Cross offers. Coverage is furnished
Medicare coinsurance, deductibles, preventive care up to $120 of
eligible charges annually, 20 extra days in a skilled nursing facility
and extra home health care expenses. Member out of pocket is
limited to $1,000 of eligible charges each year.
Members who were enrolled in this plan with optional drug prior
to January 1, 2006 are able to retain their 80 percent prescription
drug coverage. That prescription coverage plan is creditable
according to CMS guidelines.
Under this plan, Medicare is the primary payer. Claims must be
submitted to Blue Cross with a copy of the Medicare RA form.
5-10 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10)