company history. Please contact Medicare.gov or 1-800- MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Infusion drugs may apply to the pharmacy benefit or the major medical benefit. 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. For our Host members, the determination of medical necessity versus investigational care is determined by the Home Plan Medical Policy, as related to its administration of the Members benefits and coverage. The use of generic medications is a valuable way to reduce overall prescription drug costs without sacrificing quality. Blue Cross of Idaho has been in Idaho for over 75 years and our Customer Advocates are located right here in Idaho. We also know when to get out of the way and let you work with your healthcare provider to take control of your health. Some policies cover preventive vaccines at 100 percent; therefore a member does not have copayment. We understand the important questions you may have about Medicare coverage. Please refer to the back of your patients Blue Cross of Idaho ID card to determine if their benefits are administered by Blue Cross of Idaho Rx. Blue Cross of Idaho goes beyond original Medicare to offer a range of comprehensive plans to meet your needs and budget, as well as the expertise to step in and help you through the Medicare process if you ever need a hand. Monthly Drug Premium *Included in Monthly Plan Premium. If you're looking to make a change, you may save money by staying blue. You deserve a Medicare plan that not only supports your continued good health but also your financial peace of mind. Enrollment in Blue Cross of Idaho Care Plus, Inc. depends on contract renewal. Blue Cross of Idaho will send you a member ID card with your policy after we approve your application. (Parts A and B) Original Medicare consists of Part A and Part B. Blue Cross of Idaho Care Plus, Inc. is a Medicare Advantage plan with a Medicare contract. Basic Plans. Any reproduction or dissemination of policies is expressly prohibited other than for the assistance in the care of our members. Our medical policies are designed for informational purposes only and are not an explanation of benefits, or a contract. The Blue Cross of Idaho formularies list drugs approved for coverage under your policy. policies & procedures overview. Every year, Medicare evaluates plans based on a 5-star rating system. Refer to the appropriatepage to locate prior authorization requirements for drugs typically administered in an outpatient setting. We do not offer every plan available in your area. Specialty medications help patients manage rare and complex conditions, are typically high-cost, and require strict compliance and patient support. Today, Blue Cross of Idaho and Regence BlueShield of Idaho remain separate companies, operating independently of each other. Whether you are new to Medicare or returning as a valued member, we will show you how to get the most out of your health plan. 2023 Documents. We work with healthcare providers who agree to provide services at discounted rates to help save you money. The Secure Blue Courage (PPO) plan is available in 31 counties in Idaho. And with one of Idahos largest provider networks, chances are your provider is already working with us. Most employer groups use one of three formularies. Blue Cross of Idaho may require members to purchase a specialty drug through IngenioRX Specialty Pharmacy and have the medication shipped to their physician for administration OR physician may be required to buy-and-bill under Major Medical. Enrollment in plans depends on contract renewal. These include but are not limited to certain prenatal supplements, contraceptives, fluoride for children and tobacco cessation aids. These benefits include coverage of self-administered medications, as well as some vaccines and specialty medications. Blue Cross of Idaho has been in Idaho for over 75 years and our Customer Advocates are located right here in Idaho. Out of network services are covered at 50%. These plans provide all of the benefits you are entitled to under Medicareplus extra benefits, INCLUDING Medicare Part D prescription drug coverage. Please reference the "Formulary Information" section on this page to find the appropriate formulary. First tier drugs have the lowest cost, with costs increasing as the tiers increase. Find an agentCall 1-888-492-2583 (TTY 711)8 a.m. - 6 p.m. Monday to Friday, Powered by Blue Cross of Idaho Care Plus, Inc.Y0010_MK23219_M. Call 1-888-492-2583 (TTY 711) 8 a.m. - 6 p.m. Monday to Friday Your Friend, the Health Insurance Agent Find a Certified Agent Find a Doctor Drug & Pharmacy Finder Blue Cross of Idaho Care Plus, Inc. is a Medicare Advantage plan with a Medicare contract. An Independent Licensee of the Blue Cross and Blue Shield Association . Providers may submit the Contraceptive Exception Request Form along with documentation showing the need for this alternate product instead of one already covered with no member cost share. Medical Policy overview Use and Disclosure of Data The medical policies contained in this manual are the property of Blue Cross of 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. This plan is offered in the following counties: Powered by Blue Cross of Idaho Care Plus . Preventive care does not include medications prescribed for treatment of an existing illness or condition. Download the freeMedicare for Idaho booklet today to find all of the information you need to get started.ESPAOL: Medicare para Idaho. These vaccines include: For members on a Qualified Health Plan, physicians may submit a Formulary Exception Request with complete clinical documentation to request coverage for a non-formulary drug when all therapeutically equivalent generic drugs within the same class have been tried and are contraindicated for use. Learn all about your Medicare options so you are prepared when you are ready to enroll. Summary of Benefits (spanish version) 800-627-1188; . How this plan performs in coverage of conditions, screenings, customer service and more. Our dental plans boost your overall health and protect your pocketbook: Competitively priced plans Innovative plans cover services that members need and value last updated: 01/03/2022. Please visit the form for additional details. This page is a general reference for Blue Cross of Idaho plan members with pharmacy benefits administered by Blue Cross of Idaho, with our PBM partner IngenioRx. Blue Cross of Idaho Customer Service Department at (208) 331-8897 or (866) 804-2253 for assistance in locating a Provider. Please reference the Formulary Information section for the current year on this page to find the appropriate formulary. Blue Cross of Idaho Customer Service can assist with prior authorization questions and concerns. Blue Cross of Idaho remains Idaho's oldest health insurer, with approximately one quarter of the state's population enrolled in its traditional, PPO, and managed care programs. In most cases, members must purchase their specialty medications through IngenioRX Specialty Pharmacy. Access Plan Formulary - 6 Tier for Access Plans - for individual plans that are available directly through Blue Cross of Idaho. These policies may not apply to all lines of business such as the Federal Employee Program, Medicare Advantage, and certain self-insured groups. Whether you are new to Medicare or returning as a valued member, we will show you how to get the most out of your health plan. 2022 Plan Sales Guide Medicare Supplement Plan Extras (for plans effective after 3/1/2022) Outline of Coverage (includes monthly premium rates) 2022 Application Call 800-365-2345 or visit your local office if you have additional questions. Enrollment in Blue Cross of Idaho Care Plus, Inc. depends on contract renewal. And with one of Idaho's largest provider networks, chances are your current healthcare providers are already working with us. Drugs requiring prior authorization can be identified by the PA that follows the drug name. Some employers may purchase this expanded list of preventive drugs at a specified preventive benefit. 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). This plan is offered in the following counties: Ada, Adams, Bannock, Bingham, Blaine, Boise, Bonner, Bonneville, Boundary, Canyon, Cassia, Clark, Elmore, Fremont, Gem, Gooding, Jefferson, Jerome, Kootenai, Latah, Lincoln, Madison, Minidoka, Nez Perce, Owyhee, Payette, Power, Shoshone, Twin Falls, Valley and Washington counties. What your patient pays for prescription medications is subject to the prescription benefits available for each specific tier. Blue Cross of Idaho's Summary of Benefits and Coverage (SBC) provides detailed information about your health coverage options and benefits. If you don't have an insurance agent, you can search using our Find a Broker tool. For drugs approved for self-administration and covered under the member's pharmacy benefit, refer to the appropriate formulary(see the current year "Formulary Information" section above)to determine if the drug prescribed requires prior authorization. Blue Cross of Idaho Rx Customer Care can assist members and providers with questions and can provide detailed explanations regarding pharmacy benefits and claims. 2. Limitations and exclusions may apply. Group Dental Plans Optimal Dental plan Blue Cross of Idaho Medical Policy for determination of medical necessity versus investigational care are only applicable to Blue Cross of Idaho members. You can find the number on the back of your ID card, or you can write to us at the following address: Appeals and Grievance Coordinator Blue Cross of Idaho PO Box 7408 Boise, ID 83707 Secure Blue No Rx (PPO) is not available for new enrollments in 2021. Although generic drugs are chemically the same as their brand counterparts, they are typically sold at substantial discounts from the branded price. You have the option to require a prescription be filled for the brand name medication when a generic equivalent exists, by ordering the prescription with a Dispense as Written (DAW) condition. Any information we provide is limited to those plans we do offer in your area. Drugs requiring step therapy can be identified by the ST that follows the drug name. An Employee Assistance Program is available as a value added benefit through Symetra. Not all plans offer all of these benefits. Your local agent is there for you. We're in your neighborhood. Per benefit period, Insureds, under age 19, may receive: One (1) eye exam One (1) pair of spectacle Lenses or Contact Lenses One (1) Frame (selection may be limited by provider) Like us on Facebook Blue Cross Blue Shield is enacting this policy because it doesn't want people to use the emergency room as their primary health care. There are a lot of choices to make and you get to start making those choices when you near the age of 65, or when you retire at 65 and no longer get health insurance from your employer.Common myths about medicare|Medicare FAQs. If you need assistance with other documents please call a Customer Advocate toll free at 1-888-494-2583 (TTY 711). Government Programs Membership: 833-377-4266, An Independent Licensee of the Blue Cross and Blue Shield Association, BlueCard Pre-Service Review for Out-of-Area Members, Medicare Medicaid Coordinated Plan / Idaho Medicaid Plus, Prior Authorization Procedure Code Lookup, Medical Drugs Requiring Prior Authorization, Prior Authorization and/or Step Therapy requirements. 2022 Blue Cross of Idaho Care Plus, Inc. (Blue Cross of Idaho Care Plus), an Independent Licensee of the Blue Cross Blue Shield Association, with services provided by Blue Cross of Idaho Health Service, Inc. These benefits include coverage of self-administered medications, as well as some vaccines and specialty medications. For information specific to Medicare members, visit the Medicare Advantage Informationpage. Any drug prescribed for off-label use indication also requires prior authorization. SHORT TERM PPO PLANS: (1 to 6 months) The policies are used for the express purpose of assisting physicians and other healthcare providers in providing evidence based cost effective care. Medicare Advantage plans provide these benefits through a contract with the government, and are offered by companies like Blue Cross of Idaho Care Plus, Inc. With convenient Medicare Supplement coverage, you can visit any provider you choose. Tier assignment can be determined utilizing the appropriate formulary. VIEW YOUR SBC Coordination of Benefits True Blue No Rx HMO without Part D Drug Coverage; Secure Blue PPO. Certain medications may require step therapy, the trial of one or more cost-effective medications, prior to approval for a higher cost therapeutic treatment plan. They focus on the primary care provider (PCP) guiding treatment and managing the members' care. Get the flexibility you need in a health plan. The Secure Blue Courage (PPO) plan is available in 31 counties in Idaho. Secure Blue No Rx PPO without Part D Prescription Drug Coverage; Medicare-Medicaid Coordinated Plan. Members with plans compliant with the Affordable Care Act (ACA) have a ccess to a list of drugs mandated by the ACA at no cost. PA requests may also be submitted by fax using thePharmacy Prior Authorization Form. If you believe that Blue Cross of Idaho has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with Blue Cross of Idaho's Grievances and Appeals Department at: Manager, Grievances and Appeals 3000 East Pine Avenue, Meridian, Idaho 83642 Medicare Made SimpleLearn the ABCs of Medicare in an animated video.If you find Medicare a little confusing, youre not alone. No referral is needed with a POS managed-care plan. With plans that offer a range of benefits, you can find an option that fits the needs of your employees and their families. 600K+ People covered by Blue Cross of Idaho 1.4K+ Employees working at Blue Cross of Idaho to serve our members 100+ More than 100 partnerships with nonprofits across the state 4K+ Blue Cross of Idaho members now have access to Sharecare, an app to help you eat better, lower stress and get more active! This exclusive arrangement helps to facilitate lower costs on specialty medications and provide patient support through the treatment process. Medication specific quantity limits are searchable in the formulary. You can also contact one of our district offices at 800-345-4550. These plans include comprehensive medical and prescription drug coverage through Blue Cross of Idaho, life insurance coverage of $25,000 per employee, $5,000 for spouse and $5,000 for dependent (s), AD&D, and $125/week short-term disability coverage. Plus, you can lower your out-of-pocket expenses when you choose a provider from the Blue Cross of Idaho Care Plus PPO network. They are independent, certified, knowledgeable and they won't cost you a thing! The medical policies contained in this manual are the property of Blue Cross of Idaho. Contact your insurange agent or Blue Cross of Idaho account representative to find an affordable health coverage option for your business. Some, but not all, ACA drugs are listed in the formularies. (under age 19) Pediatric vision benefits are now covered by the plan at 100% when using a participating provider. Specialty prescriptions may be submitted by phone to FastStart at 833-203-1742 or faxed to 833-263-2871. 800-627-1188 Blue Extras! These plans have a POS benefit, in- and out-of-network benefit, and require members to select a PCP. Refer to the Provider Administrative Policiesfor information about the prior authorization process and timeframes. Give your employees access to preventive, basic and major dental services with Blue Cross of Idaho dental coverage. We're in your neighborhood. With the Secure Blue Courage plan youll have the flexibility of selecting your own Medicare-approved physician, while gaining access to more services than Original Medicare provides. Not affiliated with or endorsed by any government agency. If you have questions about becoming a contracting pharmacy, please use this link to initiate your request. In addition to Part C and Part D benefits, our Secure Blue Courage plan offers a lot of supplemental benefits that you can take advantage of to stay your healthiest. Some medications may have limits on how many doses are covered under your patient's policy. When you see an in-network provider, you get the most out of your health benefits. For more details, download the Secure Blue Courage (PPO) Enrollment KitESPAOL: Kit de inscripcin combinado Secure Blue Courage. This page is a general reference for Blue Cross of Idaho plan members with pharmacy benefits administered by Blue Cross of Idaho, with our PBM partner IngenioRx. Our $0 premium plan allows you more time to enjoy your life. Follow these steps to find an in-network provider. The prescribing physician should submit the PA request by logging on to our secure provider portal atproviders.bcidaho.com. 2021 Blue Cross of Idaho Care Plus, Inc. (Blue Cross of Idaho Care Plus), an Independent Licensee of the Blue Cross Blue Shield Association, with services provided by Blue Cross of Idaho Health Service, Inc. Powered by Blue Cross of Idaho Care Plus, Inc. Powered by Blue Cross of Idaho Care Plus, Inc.Y0010_MK23219_M. You can identify if Blue Cross of Idaho Rx administers benefits as the Blue Cross of Idaho Rx Customer Service phone number is on the back of the ID card, below the main Blue Cross of Idaho Customer Service number. Medicare Supplement insurance plans do not include prescription drug coverage. At its headquarters in . Albertsons companies, including Jewel-Osco and Safeway, you can find a provider here. When a drug requires prior authorization, Blue Cross of Idaho may determine the most appropriate method of benefit administration (Major Medical vs. Pharmacy) through the authorization process. Limits are established with the manufacturers and the U.S. Food and Drug Administrations (FDA) recommendations and accepted medical practices. Original Medicare only covers about 80 percent of most peoples medical expenses, and does not have an out-of-pocket maximum, leaving you exposed to unexpected out-of-pocket costs. To determine if the member has preventive drug benefits, refer to the Prescription Drug section of the members Benefit Plan Summary, under Eligibility & Claims. The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. You can learn more about cost-sharing, coverage limitations, and if you need a referral to see a specialist. If we deny your request for coverage or you have questions regarding your prior authorization, please call Blue Cross of Idaho's Customer Service. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. This documenation should include current clinical chart notes, applicable laboratory results, and documentation of any trial or failure of other pharmacological therapies. Drugs and medical injectables received in an outpatient setting may also require prior authorization. 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