Enroll today in BlueSecure SM and Blue Cross Group MedicareRx SM

What’s inside:• Details about your medical and prescription drug benefits

• How BlueSecure and Medicare Part D work

• What happens after you enroll

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Introducing your Medicare optionsNow you can have the freedom and security of medical and prescription drug coverage that goes wherever you go. Your employer is offering you the chance to enroll in BlueSecure and Blue Cross Group MedicareRx (PDP). These plans work together with Original Medicare to cover your medical, hospital and prescription costs.

We’re here to help you understand the benefits of each plan, how to get started, and what to expect after you enroll.

Cover out-of-pocket costs not paid for by MedicareWhen you’re under 65, health insurance plans usually include medical and prescription drug coverage. Plans through your employer may also have dental and vision coverage.

With Original Medicare, basic coverage includes hospital and medical benefits from Medicare Parts A and B. But Medicare only covers about 80% of those costs. BlueSecure fills in the gaps that Medicare doesn’t cover, like coinsurance, copayments, and deductibles. And, Blue Cross Group MedicareRx helps to cover your prescription drugs.

You’re covered anywhere you travel in the U.S. You can see any doctor who accepts Medicare, and you never need a referral to see a specialist.

Enroll in your Medicare plans today!

It only takes a few minutes to get covered. Just follow these simple steps:1. Review the plan documents.

2. Fill out the enrollment forms and return them as directed.

3. Watch your mailbox for your enrollment confirmation letters and member ID cards. There will be one card for each plan; two cards in total.

4. Your Welcome Kits with plan documents and Formulary will arrive shortly after that.

Talk to your employer if you have questions about your plans.

How does BlueSecure work?

BlueSecure does not replace Medicare Part B. You must be enrolled in Part A or Part B first, then you are eligible to enroll.

Medicare will cover its share of your doctor and hospital bills. Then your BlueSecure plan will cover the remaining deductible and coinsurance.

Each year Medicare can change the copayments and deductibles that they cover, but BlueSecure always adjusts to cover the remaining deductible and coinsurance. Your BlueSecure plan will renew every year as long as you pay your premium and the plan is available. See the plan documents in this enrollment kit for details about your coverage and any out-of-pocket costs.

* Covers up to 515 consecutive days of hospitalization† Covers 21st through 100th day of skilled nursing care ‡ Pays 80% after $250 annual deductible up to a Lifetime Max. of $50,000.

Services must be rendered within 60 days of travel outside the U.S.

Medicare Part A Pays for

Medicare Part B Pays for

BlueSecure Pays for

Inpatient Hospital *

Skilled Nursing †

Hospice Care

Inpatient Physician Visits

Preventive Care

Blood

X-Rays

Laboratory Services

Speech & Physical Therapy

Medical Equipment & Supplies

Foreign Travel Emergency Care

‡

Part B Excess Charges

Part B Deductible Depends on your plan

Get help paying for your prescription drugsBlue Cross Group MedicareRx helps you stay healthy and protects you against high pharmacy costs. Also known as Medicare Part D, this plan has low copayments on commonly used medications, like those used to treat diabetes, high blood pressure, high cholesterol, depression, and osteoporosis. Your benefits include:

• A comprehensive drug list (formulary)

• Convenient mail order and online ordering

• A nationwide network of pharmacies

• The confidence of knowing your coverage is backed by one of the state’s leading health insurers

Part D plans are not part of Original Medicare, but they are often used with BlueSecure to provide prescription drug coverage. Combining BlueSecure with a prescription drug plan can help you lower your out-of-pocket costs.

How does Medicare Part D work?Prescription drug plans help pay for covered drugs not covered by Original Medicare. To enroll, you must qualify for Part A and/or be enrolled under Part B. If you don’t enroll in Part D when you first qualify, you may have to pay a penalty later.

Part D coverage has four stages

1. Annual Deductible Some plans have a deductible you will need to meet before benefits start. This is the amount you have to pay for your prescriptions before the plan starts to pay.

2. Initial Coverage Limit The plan pays until your total costs reach the Initial Coverage Limit. This is an amount determined by the Centers for Medicare and Medicaid Services (CMS). It may change each year. Only the retail cost of a prescription drug goes toward the Initial Coverage Limit.

3. Coverage Gap Also called the “donut hole,” this stage starts after you and the plan have spent up to the Initial Coverage Limit. What you pay for generic and brand drugs may change, based on your Part D plan.

4. Catastrophic Coverage When your out-of-pocket costs reach an amount set by CMS each year, you will enter Catastrophic Coverage. During this phase, you will pay a small copay or coinsurance for covered drugs for the rest of the calendar year.

What medications are covered?Your plan’s list of covered drugs (formulary) may be different from what you’re used to. In Medicare Part D plans, prescription drugs are placed into tiers. The costs for drugs in each tier may be different. Tier 1 includes drugs used to treat common conditions. These drugs will cost less than Tier 5 drugs.

You may have to follow rules for Prior Authorization, Quantity Limits and Step Therapy. Some drugs have requirements or limits on coverage. But there can be exceptions to these rules. Please read the formulary for details.

Tier 1 Preferred Generic

Drugs

Tier 2 Non-Preferred Generic Drugs

Tier 3 Preferred Brand

Drugs

Tier 4 Non-Preferred Brand Drugs

Tier 5 Specialty Drugs

$ (Lowest cost)

$$ $$$ $$$$$$$$$

(Highest cost)

This information is a solicitation for insurance. Not connected with or endorsed by the U.S. Government or Federal Medicare Program.BlueSecure SM Plan Notice: BlueSecure plan is offered by Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Not connected with or endorsed by the U.S. Government or Federal Medicare Program. Medicare Part D Plan Notice: Blue Cross Group MedicareRx is a prescription drug plan provided by HCSC Insurance Services Company (HISC), an Independent Licensee of the Blue Cross and Blue Shield Association. A Medicare-approved Part D sponsor. Enrollment in HISC’s plan depends on contract renewal.

Enroll in coverage today!Follow the directions in this enrollment kit:

• Review the plan documents.

• Fill out and return the enrollment forms OR talk to your employer about enrollment.

Get more from your Medicare

Here’s what you can expect after you return your enrollment forms

Questions about the plans?Talk to your employer or refer to the plan documents for details.

BlueSecure This plan does not need Medicare approval. You should receive your member ID card 7 to 14 days before your eligibility date.

Blue Cross Group MedicareRx Medicare must approve your Blue Cross Group MedicareRx enrollment form before you are officially a member. You will receive an acknowledgment letter with your member ID number. You can use this number for services until you get your member ID card. This card will arrive about 10 days after Medicare approves your enrollment.

Be sure to show your new ID cards to your primary care provider (PCP) and pharmacist.

You will also receive a Welcome Kit in the mail with important information about your new medical and prescription drug benefits. It will include a welcome brochure, evidence of coverage, and formulary.