The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
HOW COVERAGE WORKS IF YOU ARE UNDER
AGE 65 AND NOT MEDICARE ELIGIBLE
Read this section if you or any of your eligible dependents are under age 65 and not Medicare
eligible. If you have covered dependents age 65 or older or are pre-65 and Medicare eligible, also
read the section, “How Coverage Works If You Are Age 65 Or Older Or Pre-65 And Medicare
Eligible” and “Medicare Eligible Retirees And Dependents Turning Age 65.”
Note: If you are enrolled in Kaiser Colorado, this information does not apply to you. Please see
the separate Kaiser materials.
Which Network Providers to Use
Early Retiree Medical Option
This option lets you and your covered dependents choose where you receive eligible medical
services, including second opinions. If you use providers who participate in the BCBS BlueCard
PPO network, the Program pays a greater portion of the cost of covered services. The BCBS
BlueCard PPO network also applies to covered dependents not residing with you (such as noncustodial
dependents or dependents attending school away from home).
Blue Distinction Centers for Specialty Care ® – Select medical facilities that have been awarded
designation because they have demonstrated expertise in delivering quality health care, under
objective selection criteria. Except for transplants, Blue Distinction Centers are intended to treat
members age 18 and older. Although Blue Distinction Centers currently only exist for Bariatric
Surgery, Cardiac Care, Complex and Rare Cancers, Knee and Hip Replacements, Spine Surgery
and Transplants, additional centers may be added in the future. If new centers are added, they
can be found at http://www.bluecrossmn.com/usb.
In-network providers for BCBS are listed on the BCBS Web site* or are available by calling the
BCBS customer service department (see the “Important Resources” section in this SPD).
* Every effort is made to ensure that the list of providers on the BCBS Web site is up-to-date and accurate.
However, the network is subject to change throughout the year. It is your responsibility to verify that the provider
you or a covered family member uses is in the network associated with your health care option. You should call
BCBS’s customer service department or access their Web site before you receive care to find out if a specific
provider continues to be part of the network.
If you choose to receive covered treatment from a provider who is not in the BCBS network (an
out-of-network provider), you will pay a greater share of the cost. You are also responsible for
notifying BCBS prior to receiving certain services or being admitted to the hospital. (See the
section “Preadmission Notification and Prior Authorization for BCBS-Administered Benefits,”
in this SPD for more information.) In addition, you may need to file your own claim. See “Filing
Health Care Claims – BCBS” in this SPD for more information.
When you use “out-of-network,” but “participating” providers, the out-of network benefit level
will apply. However, you will not be responsible for charges in excess of BCBS allowed
amounts. If you use “non-participating providers,” you will be responsible for charges in excess
of BCBS allowed amounts and it won’t apply to your deductible or out-of-pocket maximum.
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