The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 drugs. If you are currently eligible for Medicare Part B coverage, the Program will coordinate with Medicare Part B. If you wish to submit prescriptions for Medicare Part B-eligible drugs to Medicare, you will need to go to a Retail Pharmacy that is a “Medicare supplier” and present your Medicare card. The Retail Pharmacy will need to submit these claims to Medicare on your behalf as noted below: • At Retail: When using a Retail Pharmacy, you will be asked to present your Medicare ID card. The Retail Pharmacy will work with you to bill Medicare on your behalf. The Retail Pharmacy will also submit any other claims that may be eligible for additional coverage. Most independent pharmacies and national chains are Medicare suppliers. • At Mail: Medco Pharmacy (Medco’s mail order service) is not a Medicare supplier; therefore if you submit your prescription to Medco Pharmacy, the Program will not coordinate your benefit with Medicare. Cost of your medication: You will be required to pay your copayment/coinsurance as determined by your pharmacy option. If you go to a “Medicare supplier” and Medicare pays your claim, you could also be reimbursed for additional costs not paid by Medicare. To determine if your option will pay any additional costs not paid by Medicare, ask your pharmacist to electronically submit the additional costs to Medco for processing under your U.S. Bank Program option. If using a Retail Pharmacy you must use a Medco participating Retail Pharmacy that will submit your secondary claim electronically to determine if you are eligible for additional benefits. Paper claims sent to Medco will not be eligible for any additional reimbursement. If it is determined that the medication or product is not eligible for coverage under Medicare Part B, normal provisions associated with your option will apply. Refer to the “Mail Order Maintenance Drug Provision” section and the “Specialty Drug Provision” section in this SPD for more information. Any prescription excluded from coverage is also excluded under the Medicare Part B Program. This program is subject to change. If you have any questions, please contact Medco at 1-800- 864-1404. Health Management Program Health Management Program participants generally receive educational mailings and toll-free phone access to registered pharmacists. In some programs, participants may also receive followup calls from Medco’s pharmacists. Medco develops these voluntary programs to support your doctor's care and may contact your doctor regarding your eligibility for, or participation in, these programs. 82
Retiree Health Care SPD Effective January 1, 2012 BCBS OF MN OPTIONS – GENERAL INFORMATION The information in this section applies to the Early Retiree Medical and Comprehensive options. Special rules that apply to the different options are noted. Note: This section does not apply to the Kaiser Colorado, UnitedHealthcare or Medica Plan options. If you are enrolled in the Kaiser, UnitedHealthcare or Medica Plan options, you should refer to the materials provided to you by Kaiser, UnitedHealthcare or Medica to determine the provisions and requirements of those benefit options. Your ID Card After you enroll for coverage, you will generally receive two ID cards (medical and pharmacy) from your Claims Administrator, sent directly to your home address. You must present the applicable ID card when receiving services, so your claim will be handled promptly. If you do not, you may need to pay for services yourself and file a claim for reimbursement. Additional or replacement cards can be obtained by contacting the applicable Claims Administrator. Bariatric Surgery Coverage is limited to bariatric surgery for severe or morbid obesity. To be eligible, certain requirements must be met and prior approval from BCBS must be received. For severe obesity, the Body Mass Index (BMI) must be 35-40 and will only be considered when there is documentation of a co-morbid condition such as hypertension refractory to standard drug regimens, cardiovascular disease, degenerative joint disease or diabetes. For morbid obesity, the BMI must be 40 or greater. All bariatric surgeries must be performed at a hospital or facility that participates in the Bariatric Centers of Excellence program associated with BCBS. Services performed at nonparticipating bariatric centers are not covered even if the services are medically necessary and/or referred. Other benefit limits and restrictions apply. For members age 18 and older, all bariatric surgeries must be received at a Blue Distinction Centers for Bariatric Surgery ® . You may view a listing of designated centers at www.bluecrossmn.com/usb. Once you locate a designated center, you need to confirm the designated center is participating in your applicable network. To do this, choose your applicable network from the drop down menu under “Network” and search for the designated center to make sure it displays. You may also get information by calling BCBS Customer Service at 651-662-5550 or 1-800-729-3039 for more information. Expenses for Travel and Lodging Expenses for travel and lodging for the patient and a companion are available as follows: • Transportation of the patient and one companion who is traveling on the same day(s) to and/or from the site of the surgery for the purposes of an evaluation, the surgical procedure or necessary post-discharge follow-up. 83
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The eligibility and enrollment rules for the U

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