stay in network — coverage at home: your...your highmark coverage go-to guide in-network coverage...
TRANSCRIPT
Your Highmark Coverage Go-To Guide
In-network coverage from coast to coast
The Visitor/Travel Program will include Blue Medicare Advantage PPO network coverage of all Part A, Part B, and Supplemental benefits offered by your plan outside your service area in 31 states and 1 territory: Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Maine, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, North Carolina, New York, Ohio, Oregon, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, and Wisconsin. For some of the states listed, MA PPO networks are only available in portions of the state.
Under Medicare Advantage rules, if you are absent from the service area for more than six (6) months, you must be disenrolled. However, in areas where we offer the Visitor/Travel Program you may remain in the plan while out of our service area for 6 months. Members who see Medicare Advantage PPO providers in any geographic area where the Visitor/Travel Program is offered will pay the same cost-sharing level (in-network cost-sharing) they would pay if they received covered benefits from in-network providers in their service area.
Highmark, Inc. is a Health plan with a Medicare contract. Highmark Health Insurance Company is a Health plan with a Medicare contract. Highmark is a registered mark of Highmark Inc. Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. Blue Shield and the Shield symbol are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Highmark Health Insurance Company is an independent licensee of the Blue Cross and Blue Shield Association. Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Freedom Blue is a service mark of the Blue Cross and Blue Shield Association.
Stay in network — even when you’re out of town.As a Highmark member, you have the same
in-network benefits and low costs at home and
across the country. Whether you’re heading
where it’s warm for the winter or just taking a
weekend trip, you’ll receive in-network level
benefits in all counties listed in this booklet.
Wherever you go, it’s easy to find a provider.Go online to the “Doctor and Hospital Finder” at
http://provider.bcbs.com and follow the simple
search instructions.
If you’re enrolled in a Highmark Medicare
Advantage PPO plan, you can call Member
Service using the phone number that’s
printed on the back of your Freedom Blue PPO
Member ID card.
If you have your enrollment forms and are
thinking about becoming a member, you
can find nationwide providers by calling
the phone or TTY number listed on your
enrollment materials.
Coverage at home:• Access to participating doctors and
hospitals wherever you go in Pennsylvania,
West Virginia, New York, Ohio and New Jersey.
• More choice through one of the largest
Medicare Advantage PPO networks in
the state.
• Over 34,000 doctors, specialists and
hospitals in Pennsylvania and West Virginia.
• High standards of quality — Every
participating Freedom Blue PPO provider
is carefully screened before admission
to the network. Then each is reviewed
regularly to ensure you continue to receive
the highest quality of care.
Coverage when you travel:• The same level of care and coverage
nationwide from any participating Blue
Cross and/or Blue Shield Medicare
Advantage PPO provider or hospital.
• Coverage in 31 states and 1 territory,
including Florida, California, the Carolinas,
New York, Texas, Puerto Rico and more.
The highest level of emergency benefits — anywhereNo matter where you are, emergency and
urgent care are always covered at the highest
level of coverage.
H3916_H5106_12_0576 Accepted 2189DP
Your Highmark Coverage Go-To Guide
In-network coverage from coast to coast
The Visitor/Travel Program will include Blue Medicare Advantage PPO network coverage of all Part A, Part B, and Supplemental benefits offered by your plan outside your service area in 31 states and 1 territory: Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Maine, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, North Carolina, New York, Ohio, Oregon, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, and Wisconsin. For some of the states listed, MA PPO networks are only available in portions of the state.
Under Medicare Advantage rules, if you are absent from the service area for more than six (6) months, you must be disenrolled. However, in areas where we offer the Visitor/Travel Program you may remain in the plan while out of our service area for 6 months. Members who see Medicare Advantage PPO providers in any geographic area where the Visitor/Travel Program is offered will pay the same cost-sharing level (in-network cost-sharing) they would pay if they received covered benefits from in-network providers in their service area.
Highmark, Inc. is a Health plan with a Medicare contract. Highmark Health Insurance Company is a Health plan with a Medicare contract. Highmark is a registered mark of Highmark Inc. Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. Blue Shield and the Shield symbol are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Highmark Health Insurance Company is an independent licensee of the Blue Cross and Blue Shield Association. Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Freedom Blue is a service mark of the Blue Cross and Blue Shield Association.
Stay in network — even when you’re out of town.As a Highmark member, you have the same
in-network benefits and low costs at home and
across the country. Whether you’re heading
where it’s warm for the winter or just taking a
weekend trip, you’ll receive in-network level
benefits in all counties listed in this booklet.
Wherever you go, it’s easy to find a provider.Go online to the “Doctor and Hospital Finder” at
http://provider.bcbs.com and follow the simple
search instructions.
If you’re enrolled in a Highmark Medicare
Advantage PPO plan, you can call Member
Service using the phone number that’s
printed on the back of your Freedom Blue PPO
Member ID card.
If you have your enrollment forms and are
thinking about becoming a member, you
can find nationwide providers by calling
the phone or TTY number listed on your
enrollment materials.
Coverage at home:• Access to participating doctors and
hospitals wherever you go in Pennsylvania,
West Virginia, New York, Ohio and New Jersey.
• More choice through one of the largest
Medicare Advantage PPO networks in
the state.
• Over 34,000 doctors, specialists and
hospitals in Pennsylvania and West Virginia.
• High standards of quality — Every
participating Freedom Blue PPO provider
is carefully screened before admission
to the network. Then each is reviewed
regularly to ensure you continue to receive
the highest quality of care.
Coverage when you travel:• The same level of care and coverage
nationwide from any participating Blue
Cross and/or Blue Shield Medicare
Advantage PPO provider or hospital.
• Coverage in 31 states and 1 territory,
including Florida, California, the Carolinas,
New York, Texas, Puerto Rico and more.
The highest level of emergency benefits — anywhereNo matter where you are, emergency and
urgent care are always covered at the highest
level of coverage.
H3916_H5106_12_0576 Accepted 2189DP
Your Highmark Coverage Go-To Guide
In-network coverage from coast to coast
The Visitor/Travel Program will include Blue Medicare Advantage PPO network coverage of all Part A, Part B, and Supplemental benefits offered by your plan outside your service area in 31 states and 1 territory: Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Maine, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, North Carolina, New York, Ohio, Oregon, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, and Wisconsin. For some of the states listed, MA PPO networks are only available in portions of the state.
Under Medicare Advantage rules, if you are absent from the service area for more than six (6) months, you must be disenrolled. However, in areas where we offer the Visitor/Travel Program you may remain in the plan while out of our service area for 6 months. Members who see Medicare Advantage PPO providers in any geographic area where the Visitor/Travel Program is offered will pay the same cost-sharing level (in-network cost-sharing) they would pay if they received covered benefits from in-network providers in their service area.
Highmark, Inc. is a Health plan with a Medicare contract. Highmark Health Insurance Company is a Health plan with a Medicare contract. Highmark is a registered mark of Highmark Inc. Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. Blue Shield and the Shield symbol are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Highmark Health Insurance Company is an independent licensee of the Blue Cross and Blue Shield Association. Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Freedom Blue is a service mark of the Blue Cross and Blue Shield Association.
Stay in network — even when you’re out of town.As a Highmark member, you have the same
in-network benefits and low costs at home and
across the country. Whether you’re heading
where it’s warm for the winter or just taking a
weekend trip, you’ll receive in-network level
benefits in all counties listed in this booklet.
Wherever you go, it’s easy to find a provider.Go online to the “Doctor and Hospital Finder” at
http://provider.bcbs.com and follow the simple
search instructions.
If you’re enrolled in a Highmark Medicare
Advantage PPO plan, you can call Member
Service using the phone number that’s
printed on the back of your Freedom Blue PPO
Member ID card.
If you have your enrollment forms and are
thinking about becoming a member, you
can find nationwide providers by calling
the phone or TTY number listed on your
enrollment materials.
Coverage at home:• Access to participating doctors and
hospitals wherever you go in Pennsylvania,
West Virginia, New York, Ohio and New Jersey.
• More choice through one of the largest
Medicare Advantage PPO networks in
the state.
• Over 34,000 doctors, specialists and
hospitals in Pennsylvania and West Virginia.
• High standards of quality — Every
participating Freedom Blue PPO provider
is carefully screened before admission
to the network. Then each is reviewed
regularly to ensure you continue to receive
the highest quality of care.
Coverage when you travel:• The same level of care and coverage
nationwide from any participating Blue
Cross and/or Blue Shield Medicare
Advantage PPO provider or hospital.
• Coverage in 31 states and 1 territory,
including Florida, California, the Carolinas,
New York, Texas, Puerto Rico and more.
The highest level of emergency benefits — anywhereNo matter where you are, emergency and
urgent care are always covered at the highest
level of coverage.
H3916_H5106_12_0576 Accepted 2189DP
Access in-network benefits across the country
PR
WASeattle
MilwaukeeOlympia
Portland
Boise
Salt Lake City
Denver
Dallas
Springfield
St. Louis
Little Rock
Jonesboro
Boston
RichmondRoanokeGreensboroRaleigh
Savannah
Atlanta
Fort LauderdaleMiami
OrlandoJacksonville
St. Petersburg
Pensacola
Las Vegas
MTID
OR
NV
CAUT
AZ
AK
NM
CO
WY
ND
SD
NE
KS
IA
MNWI
IN
MI
OH
TNNC
SC
VAWV
PA
NY
VTNH
MA
RICT
NJ
DEMDDC
ME
KY
ILMO
AR
MS AL GA
OK
TXHouston
Austin
San Antonio
LA
FL
2013 Medicare Advantage PPO Network-Sharing Counties
Participating Counties
HI
See yourCounty-by-County Coverage Listing
ALABAMA (EVERY COUNTY)AUTAUGA HOUSTONBALDWIN JACKSONBARBOUR JEFFERSONBIBB LAMARBLOUNT LAUDERDALEBULLOCK LAWRENCEBUTLER LEECALHOUN LIMESTONECHAMBERS LOWNDESCHEROKEE MACONCHILTON MADISONCHOCTAW MARENGOCLARKE MARIONCLAY MARSHALLCLEBURNE MOBILECOFFEE MONROECOLBERT MONTGOMERYCONECUH MORGANCOOSA PERRYCOVINGTON PICKENSCRENSHAW PIKECULLMAN RANDOLPHDALE RUSSELLDALLAS SAINT CLAIRDEKALB SHELBYELMORE SUMTERESCAMBIA TALLADEGAETOWAH TALLAPOOSAFAYETTE TUSCALOOSAFRANKLIN WALKERGENEVA WASHINGTONGREENE WILCOXHALE WINSTONHENRY
CALIFORNIA (CONT.)CALAVERAS PLUMASCOLUSA RIVERSIDECONTRA COSTA SACRAMENTODEL NORTE SAN BENITOEL DORADO SAN BERNARDINOFRESNO SAN DIEGOGLENN SAN FRANCISCOHUMBOLDT SAN JOAQUINIMPERIAL SAN LUIS OBISPOINYO SAN MATEOKERN SANTA BARBARAKINGS SANTA CLARALAKE SANTA CRUZLASSEN SHASTALOS ANGELES SIERRAMADERA SISKIYOUMARIN SOLANOMARIPOSA SONOMAMENDOCINO STANISLAUSMERCED SUTTERMODOC TEHAMAMONO TRINITYMONTEREY TULARENAPA TUOLUMNENEVADA VENTURAORANGE YOLOPLACER YUBA
CALIFORNIA (EVERY COUNTY)ALAMEDA AMADORALPINE BUTTE
COLORADOADAMS EL PASOARAPAHOE FREMONTBROOMFIELD JEFFERSONDENVER PUEBLODOUGLAS
ARKANSASCRAIGHEAD POINSETTGREENE PULASKI
CONNECTICUT (EVERY COUNTY)FAIRFIELD NEW HAVENHARTFORD NEW LONDONLITCHFIELD TOLLANDMIDDLESEX WINDHAM
County-by-County Coverage Listing
HAWAII (EVERY COUNTY)HAWAII KAUAIHONOLULU MAUIKALAWAO
FLORIDAALACHUA LEEBRADFORD LEONBROWARD LEVYCHARLOTTE MANATEECITRUS MARIONCLAY MARTINCOLLIER MIAMI-DADECOLUMBIA OKALOOSADESOTO ORANGEDUVAL OSCEOLAESCAMBIA PALM BEACHFLAGLER PASCOFRANKLIN PINELLASGULF POLKHARDEE SAINT JOHNSHENDRY SANTA ROSAHERNANDO SARASOTAHIGHLANDS SEMINOLEHILLSBOROUGH SUMTERINDIAN RIVER SUWANNEEJACKSON VOLUSIALAKE WALTON
GEORGIA (CONT.)LONG SCHLEYMERIWETHER SPALDINGMILLER STEWARTMONROE TALBOTMONTGOMERY TATTNALLMORGAN TOOMBSMUSCOGEE TWIGGSNEWTON WALKERPAULDING WALTONPEACH WARRENPIKE WASHINGTONRICHMOND WAYNEROCKDALE WEBSTER
GEORGIAAPPLING DADEBALDWIN DEKALBBARTOW DOUGLASBIBB EARLYBRYAN EFFINGHAMBUTTS EMANUELCANDLER EVANSCATOOSA FAYETTECHATHAM FORSYTHCHATTAHOOCHEE FULTONCHEROKEE GWINNETTCLAYTON HARRISCOBB HENRYCOFFEE JEFF DAVISCOLQUIT JONESCOLUMBIA LAURENSCRAWFORD LIBERTY
IDAHOADA GOODINGADAMS JEFFERSONBANNOCK JEROMEBENEWAH KOOTENAIBINGHAM LATAHBLAINE MADISONBOISE MINIDOKABONNER NEZ PERCEBONNEVILLE ONEIDABOUNDARY OWYHEECANYON PAYETTECARIBOU POWERCASSIA SHOSHONECLARK TETONELMORE TWIN FALLSFREMONT VALLEYGEM WASHINGTON
INDIANA (EVERY COUNTY)ADAMS BARTHOLOMEWALLEN BENTON
County-by-County Coverage Listing
INDIANA (CONT.)BLACKFORD LAPORTEBOONE LAWRENCEBROWN MADISONCARROLL MARIONCASS MARSHALLCLARK MARTINCLAY MIAMICLINTON MONROECRAWFORD MONTGOMERYDAVIESS MORGANDEARBORN NEWTONDECATUR NOBLEDEKALB OHIODELAWARE ORANGEDUBOIS OWENELKHART PARKEFAYETTE PERRYFLOYD PIKEFOUNTAIN PORTERFRANKLIN POSEYFULTON PULASKIGIBSON PUTNAMGRANT RANDOLPHGREENE RIPLEYHAMILTON RUSHHANCOCK SAINT JOSEPHHARRISON SCOTTHENDRICKS SHELBYHENRY SPENCERHOWARD STARKEHUNTINGTON STEUBENJACKSON SULLIVANJASPER SWITZERLANDJAY TIPPECANOEJEFFERSON TIPTONJENNINGS UNIONJOHNSON VANDERBURGHKNOX VERMILLIONKOSCIUSKO VIGOLAGRANGE WABASHLAKE WARREN
KENTUCKY (EVERY COUNTY)ADAIR FLOYDALLEN FRANKLINANDERSON FULTONBALLARD GALLATINBARREN GARRADBATH GRANTBELL GRAVESBOONE GRAYSONBOURBON GREENBOYD GREENUPBOYLE HANCOCKBRACKEN HARDINBREATHITT HARLANBRECKINRIDGE HARRISONBULLITT HARTBUTLER HENDERSONCALDWELL HENRYCALLOWAY HICKMANCAMPBELL HOPKINSCARLISLE JACKSONCARROLL JEFFERSONCARTER JESSAMINECASEY JOHNSONCHRISTIAN KENTONCLARK KNOTTCLAY KNOXCLINTON LARUECRITTENDEN LAURELCUMBERLAND LAWRENCEDAVIESS LEEEDMONSON LESLIEELLIOT LETCHERESTILL LEWISFAYETTE LINCOLNFLEMING LIVINGSTON
INDIANA (CONT.)WARRICK WELLSWASHINGTON WHITEWAYNE WHITLEY
County-by-County Coverage Listing
KENTUCKY (CONT.)LOGAN PENDLETONLYON PERRYMADISON PIKEMAGOFFIN POWELLMARION PULASKIMARSHALL ROBERTSONMARTIN ROCKCASTLEMASON ROWANMCCRACKEN RUSSELLMCCREARY SCOTTMCLEAN SHELBYMEADE SIMPSONMENIFEE SPENCERMERCER TAYLORMETCALFE TODDMONROE TRIGGMONTGOMERY TRIMBLEMORGAN UNIONMUHLENBERG WARRENNELSON WASHINGTONNICHOLAS WAYNEOHIO WEBSTEROLDHAM WHITLEYOWEN WOLFEOWSLEY WOODFORD
MASSACHUSETTSBARNSTABLE HAMPDENBRISTOL HAMPSHIREESSEX MIDDLESEXFRANKLIN NORFOLK
MICHIGAN (EVERY COUNTY)ALCONA ISABELLAALGER JACKSONALLEGAN KALAMAZOOALPENA KALKASKAANTRIM KENTARENAC KEWEENAWBARAGA LAKEBARRY LAPEERBAY LEELANAUBENZIE LENAWEEBERRIEN LIVINGSTONBRANCH LUCECALHOUN MACKINACCASS MACOMBCHARLEVOIX MANISTEECHEBOYGAN MARQUETTECHIPPEWA MASONCLARE MECOSTACLINTON MENOMINEECRAWFORD MIDLANDDELTA MISSAUKEEDICKINSON MONROEEATON MONTCALMEMMETT MONTMORENCYGENESEE MUSKEGONGLADWIN NEWAYGOGOGEBIC OAKLANDGRAND TRAVERSE OCEANAGRATIOT OGEMAWHILLSDALE ONTONAGONHOUGHTON OSCEOLAHURON OSCODAINGHAM OTSEGOIONIA OTTAWAIOSCO PRESQUE ISLEIRON ROSCOMMON
MAINE (EVERY COUNTY)ANDROSCOGGIN OXFORDAROOSTOOK PENOBSCOTCUMBERLAND PISCATAQUISFRANKLIN SAGADAHOCHANCOCK SOMERSETKENNEBEC WALDOKNOX WASHINGTONLINCOLN YORK
MASSACHUSETTS (CONT.)PLYMOUTH WORCESTERSUFFOLK
County-by-County Coverage Listing
MICHIGAN (CONT.)SAGINAW TUSCOLASAINT CLAIR VAN BURENSAINT JOSEPH WASHTENAWSANILAC WAYNESCHOOLCRAFT WEXFORDSHIAWASSEE
MISSOURIBARRY NEWTONBARTON OZARKCEDAR POLKCHRISTIAN SAINT CHARLESDADE SAINT LOUISDALLAS SAINT LOUIS CITYDOUGLAS STONEGREENE TANEYJASPER WARRENLAWRENCE WEBSTERLINCOLN WRIGHTMCDONALD
NEW HAMPSHIRECARROLL ROCKINGHAMHILLSBOROUGH
NEVADACLARK WASHOE
NEW JERSEY (EVERY COUNTY)ATLANTIC MIDDLESEXBERGEN MONMOUTHBURLINGTON MORRISCAMDEN OCEANCAPE MAY PASSAICCUMBERLAND SALEMESSEX SOMERSETGLOUCESTER SUSSEXHUDSON UNIONHUNTERDON WARRENMERCER
County-by-County Coverage Listing
NEW YORK (EVERY COUNTY)ALBANY NIAGARAALLEGANY ONEIDABRONX ONONDAGABROOME ONTARIOCATTARAUGUS ORANGECAYUGA ORLEANSCHAUTAUQUA OSWEGOCHEMUNG OTSEGOCHENANGO PUTNAMCLINTON QUEENSCOLUMBIA RENSSELAERCORTLAND RICHMONDDELAWARE ROCKLANDDUTCHESS SAINT LAWRENCEERIE SARATOGAESSEX SCHENECTADYFRANKLIN SCHOHARIEFULTON SCHUYLERGENESEE SENECAGREENE STEUBENHAMILTON SUFFOLKHERKIMER SULLIVANJEFFERSON TIOGAKINGS TOMPKINSLEWIS ULSTERLIVINGSTON WARRENMADISON WASHINGTONMONROE WAYNEMONTGOMERY WESTCHESTERNASSAU WYOMINGNEW YORK YATES
NORTH CAROLINAALAMANCE BERTIEALEXANDER BLADENALLEGHANY BRUNSWICKANSON CABARRUSASHE CALDWELLAVERY CARTERETBEAUFORT CASWELL
OHIO (EVERY COUNTY)ADAMS ATHENSALLEN AUGLAIZEASHLAND BELMONTASHTABULA BROWN
OHIO (CONT.)BUTLER MADISONCARROLL MAHONINGCHAMPAIGN MARIONCLARK MEDINACLERMONT MEIGSCLINTON MERCERCOLUMBIANA MIAMICOSHOCTON MONROECRAWFORD MONTGOMERYCUYAHOGA MORGANDARKE MORROWDEFIANCE MUSKINGUMDELAWARE NOBLEERIE OTTAWAFAIRFIELD PAULDINGFAYETTE PERRYFRANKLIN PICKAWAYFULTON PIKEGALLIA PORTAGEGEAUGA PREBLEGREENE PUTNAMGUERNSEY RICHLANDHAMILTON ROSSHANCOCK SANDUSKYHARDIN SCIOTHARRISON SENECAHENRY SHELBYHIGHLAND STARKHOCKING SUMMITHOLMES TRUMBULLHURON TUSCARAWASJACKSON UNIONJEFFERSON VAN WERTKNOX VINTONLAKE WARRENLAWRENCE WASHINGTONLICKING WAYNELOGAN WILLIAMSLORAIN WOODLUCAS WYANDOT
County-by-County Coverage Listing
NORTH CAROLINA (CONT.)CATAWBA MITCHELLCHATHAM MONTGOMERYCHOWAN NASHCLEVELAND NEW HANOVERCOLUMBUS NORTHAMPTONCUMBERLAND ONSLOWDAVIDSON ORANGEDAVIE PAMLICODUPLIN PENDERDURHAM PERQUIMANSEDGECOMBE PERSONFORSYTH PITTFRANKLIN POLKGASTON RANDOLPHGATES RICHMONDGRANVILLE ROBESONGREENE ROCKINGHAMGUILFORD ROWANHALIFAX SAMPSONHARNETT SCOTLANDHAYWOOD STANLYHENDERSON STOKESHERTFORD SURRYHOKE TYRRELLHYDE UNIONIREDELL VANCEJOHNSTON WAKEJONES WARRENLEE WASHINGTONLINCOLN WATAUGAMADISON WAYNEMARTIN WILKESMCDOWELL WILSONMECKLENBURG YADKIN
OREGONBENTON LANECLACKAMAS LINCOLNCLATSOP LINNCOLUMBIA MARIONCOOS MULTNOMAHCURRY POLKDOUGLAS TILLAMOOKHOOD RIVER WASCOJACKSON WASHINGTONJOSEPHINE YAMHILL
PENNSYLVANIA (EVERY COUNTY)ADAMS GREENEALLEGHENY HUNTINGDONARMSTRONG INDIANABEAVER JEFFERSONBEDFORD JUNIATABERKS LACKAWANNABLAIR LANCASTERBRADFORD LAWRENCEBUCKS LEBANONBUTLER LEHIGHCAMBRIA LUZERNECAMERON LYCOMINGCARBON MCKEANCENTRE MERCERCHESTER MIFFLINCLARION MONROECLEARFIELD MONTGOMERYCLINTON MONTOURCOLUMBIA NORTHAMPTONCRAWFORD NORTHUMBERLANDCUMBERLAND PERRYDAUPHIN PHILADELPHIADELAWARE PIKEELK POTTERERIE SCHUYLKILLFAYETTE SNYDERFOREST SOMERSETFRANKLIN SULLIVANFULTON SUSQUEHANNA
PUERTO RICO (EVERY COUNTY)ADJUNTAS HATILLOAGUADA HORMIGUEROSAGUADILLA HUMACAOAGUAS BUENAS ISABELAAIBONITO JAYUYAANASCO JUANA DIAZARECIBO JUNCOSARROYO LAJASBARCELONETA LARESBARRANQUITAS LAS MARIASBAYAMON LAS PIEDRASCABO ROJO LOIZACAGUAS LUQUILLOCAMUY MANATICANOVANAS MARICAOCAROLINA MAUNABOCATANO MAYAGUEZCAYEY MOCACEIBA MOROVISCIALES NAGUABOCIDRA NARANJITOCOAMO OROCOVISCOMERIO PATILLASCOROZAL PENUELASCULEBRA PONCEDORADO QUEBRADILLASFAJARDO RINCONFLORIDA RIO GRANDEGUANICA SABANA GRANDEGUAYAMA SALINASGUAYANILLA SAN GERMANGUAYNABO SAN JUANGURABO SAN LORENZO
PENNSYLVANIA (CONT.)TIOGA WAYNEUNION WESTMORELAND
VENANGO WYOMINGWARREN YORKWASHINGTON
County-by-County Coverage Listing
SOUTH CAROLINA (EVERY COUNTY)ABBEVILLE GREENWOODAIKEN HAMPTONALLENDALE HORRYANDERSON JASPERBAMBERG KERSHAWBARNWELL LANCASTERBEAUFORT LAURENSBERKELEY LEECALHOUN LEXINGTONCHARLESTON MARIONCHEROKEE MARLBOROCHESTER MCCORMICKCHESTERFIELD NEWBERRYCLARENDON OCONEECOLLETON ORANGEBURGDARLINGTON PICKENSDILLON RICHLANDDORCHESTER SALUDAEDGEFIELD SPARTANBURGFAIRFIELD SUMTERFLORENCE UNIONGEORGETOWN WILLIAMSBURGGREENVILLE YORK
TENNESSEE (EVERY COUNTY)ANDERSON CARROLLBEDFORD CARTERBENTON CHEATHAMBLEDSOE CHESTERBLOUNT CLAIBORNEBRADLEY CLAYCAMPBELL COCKECANNON COFFEE
TENNESSEE (CONT.)CROCKETT MARSHALLCUMBERLAND MAURYDAVIDSON MCMINNDECATUR MCNAIRYDEKALB MEIGSDICKSON MONROEDYER MONTGOMERYFAYETTE MOOREFENTRESS MORGANFRANKLIN OBIONGIBSON OVERTONGILES PERRYGRAINGER PICKETTGREENE POLKGRUNDY PUTNAMHAMBLEN RHEAHAMILTON ROANEHANCOCK ROBERTSONHARDEMAN RUTHERFORDHARDIN SCOTTHAWKINS SEQUATCHIEHAYWOOD SEVIERHENDERSON SHELBYHENRY SMITHHICKMAN STEWARTHOUSTON SULLIVANHUMPHREYS SUMNERJACKSON TIPTONJEFFERSON TROUSDALEJOHNSON UNICOIKNOX UNIONLAKE VAN BURENLAUDERDALE WARRENLAWRENCE WASHINGTONLEWIS WAYNELINCOLN WEAKLEYLOUDON WHITEMACON WILLIAMSONMADISON WILSONMARION
County-by-County Coverage Listing
PUERTO RICO (CONT.)SAN SEBASTIAN VEGA ALTASANTA ISABEL VEGA BAJATOA ALTA VIEQUESTOA BAJA VILLALBATRUJILLO ALTO YABUCOAUTUADO YAUCO
VIRGINIA (CONT.)NORFOLK CITY RICHMOND CITYNORTHAMPTON ROANOKENORTHUMBERLAND ROANOKE CITYORANGE ROCKBRIDGEPAGE SALEMPETERSBURG CITY SHENANDOAHPOQUOSON CITY SUFFOLKPORTSMOUTH CITY SURRYPOWHATAN VIRGINIA BEACH CITYPRINCE GEORGE WARRENPULASKI WILLIAMSBURG CITYRADFORD YORKRICHMOND
WASHINGTONASOTIN PIERCECLALLAM SAN JUANCLARK SKAGITCOLUMBIA SKAMANIACOWLITZ SNOHOMISHISLAND THURSTONKING WAHKIAKUMKITSAP WALLA WALLAKLICKITAT WHATCOMLEWIS YAKIMA
TEXASBASTROP HARRISBURNET HAYSCALDWELL LEECOLLIN MONTGOMERYDALLAS TARRANTDENTON TRAVISFAYETTE WILLIAMSONFORT BEND
UTAHBOX SUMMITCACHE TOOELEDAVIS UTAHIRON WASATCHMORGAN WASHINGTONRICH WEBERSALT LAKE
VIRGINIAALBEMARLE FRANKLINAMELIA GILESAPPOMATTOX GLOUCESTERBEDFORD GOOCHLANDBEDFORD CITY GREENSVILLEBOTETOURT HAMPTON CITYBUENA VISTA CITY HANOVERCAROLINE HENRICOCHARLES CITY HOPEWELL CITYCHARLOTTE JAMES CITYCHARLOTTESVILLE CITY KING AND QUEENCHESAPEAKE CITY LANCASTERCHESTERFIELD LEXINGTON CITYCOL. HEIGHTS CITY LOUISACRAIG LUNENBURGCULPEPER MADISONCUMBERLAND MATHEWSDINWIDDIE MIDDLESEXEMPORIA CITY MONTGOMERYFLOYD NEW KENTFLUVANNA NEWPORT NEWS CITY
County-by-County Coverage Listing
WEST VIRGINIA (EVERY COUNTY)BARBOUR HANCOCKBERKELEY HARDYBOONE HARRISONBRAXTON JACKSONBROOKE JEFFERSONCABELL KANAWHACALHOUN LEWISCLAY LINCOLNDODDRIDGE LOGANFAYETTE MARIONGILMER MARSHALLGRANT MASONGREENBRIER MCDOWELLHAMPSHIRE MERCER
County-by-County Coverage Listing
WISCONSINBROWN OUTAGAMIECALUMET OZAUKEECOLUMBIA PORTAGEDODGE RACINEFOND DU LAC ROCKGREEN LAKE SHAWANOJEFFERSON SHEBOYGANKENOSHA WALWORTHMANITOWOC WASHINGTONMARATHON WAUKESHAMARINETTE WAUPACAMILWAUKEE WAUSHARAOCONTO WINNEBAGO
WEST VIRGINIA (CONT.)MINERAL RITCHIEMINGO ROANEMONONGALIA SUMMERSMONROE TAYLORMORGAN TUCKERNICHOLAS TYLEROHIO UPSHURPENDLETON WAYNEPLEASANTS WEBSTERPOCAHONTAS WETZELPRESTON WIRTPUTNAM WOODRALEIGH WYOMINGRANDOLPH
Your Highmark Coverage Go-To Guide
In-network coverage from coast to coast
The Visitor/Travel Program will include Blue Medicare Advantage PPO network coverage of all Part A, Part B, and Supplemental benefits offered by your plan outside your service area in 31 states and 1 territory: Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Maine, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, North Carolina, New York, Ohio, Oregon, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, and Wisconsin. For some of the states listed, MA PPO networks are only available in portions of the state.
Under Medicare Advantage rules, if you are absent from the service area for more than six (6) months, you must be disenrolled. However, in areas where we offer the Visitor/Travel Program you may remain in the plan while out of our service area for 6 months. Members who see Medicare Advantage PPO providers in any geographic area where the Visitor/Travel Program is offered will pay the same cost-sharing level (in-network cost-sharing) they would pay if they received covered benefits from in-network providers in their service area.
Highmark, Inc. is a Health plan with a Medicare contract. Highmark Health Insurance Company is a Health plan with a Medicare contract. Highmark is a registered mark of Highmark Inc. Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. Blue Shield and the Shield symbol are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Highmark Health Insurance Company is an independent licensee of the Blue Cross and Blue Shield Association. Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Freedom Blue is a service mark of the Blue Cross and Blue Shield Association.
Stay in network — even when you’re out of town.As a Highmark member, you have the same
in-network benefits and low costs at home and
across the country. Whether you’re heading
where it’s warm for the winter or just taking a
weekend trip, you’ll receive in-network level
benefits in all counties listed in this booklet.
Wherever you go, it’s easy to find a provider.Go online to the “Doctor and Hospital Finder” at
http://provider.bcbs.com and follow the simple
search instructions.
If you’re enrolled in a Highmark Medicare
Advantage PPO plan, you can call Member
Service using the phone number that’s
printed on the back of your Freedom Blue PPO
Member ID card.
If you have your enrollment forms and are
thinking about becoming a member, you
can find nationwide providers by calling
the phone or TTY number listed on your
enrollment materials.
Coverage at home:• Access to participating doctors and
hospitals wherever you go in Pennsylvania,
West Virginia, New York, Ohio and New Jersey.
• More choice through one of the largest
Medicare Advantage PPO networks in
the state.
• Over 34,000 doctors, specialists and
hospitals in Pennsylvania and West Virginia.
• High standards of quality — Every
participating Freedom Blue PPO provider
is carefully screened before admission
to the network. Then each is reviewed
regularly to ensure you continue to receive
the highest quality of care.
Coverage when you travel:• The same level of care and coverage
nationwide from any participating Blue
Cross and/or Blue Shield Medicare
Advantage PPO provider or hospital.
• Coverage in 31 states and 1 territory,
including Florida, California, the Carolinas,
New York, Texas, Puerto Rico and more.
The highest level of emergency benefits — anywhereNo matter where you are, emergency and
urgent care are always covered at the highest
level of coverage.
H3916_H5106_12_0576 Accepted 2189DP