Name of Manual - Blue Cross and Blue Shield of Minnesota

Platinum Blue SM (Cost)
(continued)
MedicareBlue PPO
(Regional PPO)
Health Care Options
The Plan C employer group option requires copays for most
services, including inpatient hospital, mental health services and
emergency room visits. The Plan B option requires similar copays,
but does not require a copay for inpatient hospital care and
inpatient mental health.
No referrals are needed for in-network doctors, specialists or
hospitals. It is important to note that both individual and group
Platinum Blue members can receive plan benefits for services
received outside of Minnesota when traveling for up to nine
months per year. This differs from out of network coverage while
in Minnesota. If, while in Minnesota, members go to a provider
outside of the Platinum Blue (Cost) network who accepts Medicare
patients, members are covered under Original Medicare and would
pay the Part A and Part B deductibles and coinsurance.
Claims administration for Platinum Blue is shared by Blue Cross
and Medicare. Medicare is the primary claim processing entity for
most Medicare Part A eligible services, with some exceptions.
Claims for services eligible under Medicare Part B will generally
be administered by Blue Cross, again, with some exceptions.
This product is also available for fully insured employer groups to
purchase for their Medicare eligible members. The logo on the
member ID card for any such group members will be prefaced
with “Group”. Benefits may vary by group.
A more recent introduction in the Blue Cross Medicare product
expansion is MedicareBlue PPO. This is a regional Medicare
Advantage product offered through the coordination of six Blue
Cross plans covering seven states.
The service area for this plan encompasses Iowa, Minnesota,
Montana, Nebraska, North Dakota, South Dakota and Wyoming.
The plan was introduced across the region with a first effective
date of January 1, 2006.
This product offers one medical benefit level option with Medicare
Part D (prescription drug) coverage included. The plan covers the
full range of basic Medicare covered services, with expanded
coverage levels and additional benefits. Additional benefits
include: hearing services, vision services, physical exams,
health/wellness education (newsletter, nurse hotline, and disease
management).
MedicareBlue PPO members are free to receive care either in or
out of network, however; while in-network care is generally
subject to a copay, out-of-network care is generally subject to
coinsurance.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10) 5-13