Welcome!

2010

Excellus BlueCross BlueShield Fall Member Meeting

A nonprofit independent licensee of the Blue Cross Blue Shield Association

Excellus BlueCross BlueShield contracts with the Federal Government and is a Medicare Advantage Organization with a Medicare contract.

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Our Vision

“…to be a best in class Medicare Program, providing Medicare

beneficiaries with a range of products and services that meet their needs for

health coverage at an affordable price.”

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As the health care landscape evolves, Excellus BlueCross BlueShield continues to provide low cost, benefit-rich Medicare health plans

No Change To Most Benefits

Valuable Extras

2010 Highlights

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Why Excellus BlueCross BlueShield?

Power of Blue – One of the most recognized health care insurers

More than 3,000 participating providers

In business for over 70 years

Commitment to serving our local communities

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Agenda

Plan Changes

What’s New?

Valuable Extras

What Do You Need to Do?

Questions

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HMO vs. PPO

HMOHealth Maintenance Organization

PPOPreferred Provider Organization

Primary Care Physician (PCP) is required.

Primary Care Physician (PCP) not required

Referrals required to see specialists No referrals required to see specialists

Must use In-Network providers(You must receive all routine care from plan

providers)

Can use In-Network & Out-of-Network providers*

(Out-of-pocket costs may be higher when you use an Out-of-Network provider, except in cases such as

emergency care, urgently needed care, or out-of-area renal dialysis)

*Excellus BlueCross BlueShield provides reimbursement for all covered benefits regardless of whether they are received In-Network, as long as they are medically necessary.

You are eligible to join a Medicare Advantage Plan if you have Medicare

Part A and B, live in our service area, and don’t have end stage renal disease.

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Medicare Advantage Plan Options

HMO Plans Medicare Blue Choice ValueSM (HMO) Medicare Blue Choice Value PlusSM (HMO) Medicare Blue Choice OptimumSM (HMO) Medicare Blue Choice PlatinumSM (HMO)

PPO Plan Medicare Blue PPOSM Plan 201 (PPO)

For full information on Medicare Blue Choice and/or Medicare Blue PPO benefits, call our Customer Service Department at 1-877-883-9577 for Medicare Blue Choice or 1-866-846-8643 for Medicare Blue PPO , TTY/TDD 1-800-421-1220 Monday – Friday, 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are available weekends from 8:00 a.m. – 8:00 p.m.

Our contract with CMS is renewed annually and the availability of coverage beyond the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2011. Please contact Excellus BlueCross BlueShield for details.

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Medicare Blue Choice ValueMedicare Blue Choice ValueSMSM (HMO)(HMO)

PCP Office VisitSpecialist Office VisitAmbulance ServicesEmergency RoomInpatient HospitalOutpatient Hospital

Physical TherapySkilled Nursing Facility (SNF)Chiropractic $650 GoGetters® Fitness Benefit

…and more!

No changes to the following benefits or cost-sharing in 2010:

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Medicare Blue Choice ValueMedicare Blue Choice ValueSM SM

(HMO)(HMO)

2009 2010

$0* $5.50*

Monthly Premium

* You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

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Medicare Blue ChoiceMedicare Blue Choice ValueValueSMSM (HMO)(HMO)

Benefit 2009 2010

Outpatient Mental Health Care (per visit)

50% coinsurance 45% coinsurance

Durable Medical Equipment 30% coinsurance 20% coinsurance

Prosthetic Devices 30% coinsurance 20% coinsurance

Diabetic Supplies 30% coinsurance 20% coinsurance

Part D Deductible $175 $150

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Medicare Blue Choice Value PlusMedicare Blue Choice Value PlusSMSM (HMO)(HMO)

No changes to the following benefits or cost-sharing in 2010:

PCP Office VisitSpecialist Office VisitAmbulance ServicesEmergency RoomInpatient HospitalOutpatient Hospital

Physical TherapySkilled Nursing Facility (SNF)Chiropractic $650 GoGetters® Fitness Benefit

…and more!

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Medicare Blue Choice Value PlusMedicare Blue Choice Value PlusSMSM (HMO)(HMO)

Monthly Premium

2009 2010

$35* $41*

* You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

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Medicare Blue Choice Value PlusMedicare Blue Choice Value PlusSMSM (HMO)(HMO)

Benefit 2009 2010

Outpatient Mental Health Care (per visit)

50% coinsurance 45% coinsurance

Durable Medical Equipment

30% coinsurance 20% coinsurance

Prosthetic Devices 30% coinsurance 20% coinsurance

Diabetic Supplies 30% coinsurance 20% coinsurance

Part D Deductible $175 $150

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Medicare Blue ChoiceMedicare Blue Choice OptimumOptimumSMSM (HMO)(HMO)

No changes to the following benefits or cost-sharing in 2010:

PCP Office VisitSpecialist Office VisitAmbulance ServicesEmergency RoomInpatient HospitalOutpatient Hospital

Physical TherapySkilled Nursing Facility (SNF)Chiropractic $650 GoGetters® Fitness Benefit

…and more!

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Medicare Blue Choice OptimumMedicare Blue Choice OptimumSM SM

(HMO)(HMO)

Monthly Premium

2009 2010

$90* $101*

* You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

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Medicare Blue Choice OptimumMedicare Blue Choice OptimumSMSM (HMO)(HMO)

Benefit 2009 2010

Durable Medical Equipment

25% coinsurance

20% coinsurance

Prosthetic Devices25%

coinsurance20% coinsurance

Diabetic Supplies30%

coinsurance20% coinsurance

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No changes to the following benefits or cost-sharing in 2010:

PCP Office VisitSpecialist Office VisitAmbulance ServicesEmergency RoomInpatient HospitalOutpatient Hospital

Physical TherapySkilled Nursing Facility (SNF)Durable Medical Equipment (DME)Chiropractic $650 GoGetters® Fitness Benefit …and more!

Medicare Blue Choice PlatinumMedicare Blue Choice PlatinumSMSM (HMO)(HMO)

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Monthly Premium

2009 2010

$45* $61*

Medicare Blue Choice PlatinumMedicare Blue Choice PlatinumSMSM (HMO)(HMO)

* You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

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Benefit 2009 2010

Diabetic Supplies30%

coinsurance20% coinsurance

Medicare Blue Choice PlatinumMedicare Blue Choice PlatinumSMSM (HMO)(HMO)

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PCP Office VisitSpecialist Office VisitAmbulance ServicesEmergency RoomInpatient HospitalOutpatient Hospital

Physical TherapySkilled Nursing Facility (SNF)Chiropractic $650 GoGetters® Fitness Benefit

…and more!

Medicare Blue PPOMedicare Blue PPOSMSM Plan 201 Plan 201 (PPO)(PPO)

No changes to the following benefits or cost-sharing in 2010:

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Monthly Premium

2009 2010

$25* $36*

Medicare Blue PPOMedicare Blue PPOSMSM Plan 201 Plan 201 (PPO)(PPO)

* You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

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Benefit 2009 2010

Radiology Services (per visit) 10% coinsurance In-Network20% coinsurance

In-Network

Outpatient Mental Health Care(per visit)

50% coinsurance In-Network45% coinsurance

In-Network

Durable Medical Equipment30% In-Network

40% Out-of-Networkcoinsurance

20% In-Network30% Out-of-Network

coinsurance

Prosthetic Devices30% In-Network

40% Out-of-Networkcoinsurance

20% In-Network30% Out-of-Network

coinsurance

Seasonal flu/pneumonia vaccines 30% Out-of-NetworkCovered in full Out-of-Network

Diabetic Supplies 30% coinsurance In-Network20% coinsurance

In-Network

Part D Deductible $175 $150

Medicare Blue PPOMedicare Blue PPOSMSM Plan 201 Plan 201 (PPO)(PPO)

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Medicare Prescription Drug Plan (Part D)

You pay $2.50 for generics and $6.30 for brand name drugs, or 5% of the price (whichever is

greater)

Catastrophic Coverage

Excellus BlueCross BlueShield pays the balance

Coverage GapAll costs are out-of-pocket

You PayYour

copays/coinsurance

Initial Coverage PeriodExcellus BlueCross BlueShield pays the

balanceDeductible is out-of-pocket

$0 or $1502

Medicare Drug BenefitOut Of Pocket

4 Coverage PhasesCatastrophic Coverage begins when you or others on your behalf have spent $4,5501.

No coverage when total drug spend exceeds $2,8301 until your true out of pocket spending reaches $4,5501.

You must pay your deductible (if applicable) before you start getting your prescription coverage.

1 Coverage limits for all phases of the Part D benefit change annually.

2 Benefits, formulary, pharmacy network, premium, copayment/coinsurance may change on January 1, 2011. Contact Excellus BlueCross BlueShield for details.

Initial Coverage starts after you have met your deductible, if applicable, and continues until your total drug costs reach $2,830.1

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Medicare Prescription Drug Plan (Part D)

Formulary Changes• Review the drugs you are taking• Consult with your doctor if your drug will no longer be covered.

Network• About 60,000 pharmacies nationwide• Retail, mail order, long-term care, home infusion,

Indian/Tribal/Urban pharmacies included• For additional information regarding our pharmacy network,

quantity limits, and mail order prescription drug service, call: 1-877-883-9577 TTY/TDD 1-800-421-1220 Monday-Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1 representatives are also available weekends from 8:00 a.m. – 8:00 p.m.

• You may write us at: Excellus BlueCross BlueShield, PO Box 546, Buffalo, NY 14201

You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use network pharmacies.

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Medicare Prescription Drug Plan (Part D)

You may be able to get Extra Help to pay for your prescription drug premiums and costs.

To see if you qualify for getting Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227), TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week;

• The Social Security Administration at 1-800-772-1213 between 7:00 a.m. – 7:00 p.m.,

Monday through Friday, TTY/TDD users should call 1-800-325-0778; or

• Your State Medicaid office.

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People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for:

seventy-five percent of drug costs including monthly prescription drug premiums,

annual deductibles, and coinsurance.

Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty.

Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social

Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

Medicare Prescription Drug Plan (Part D)

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Summary of 2010 Benefit Changes

No Change To Most Benefits

Valuable Extras

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GoGetters® Fitness Benefit• Up to $650 per calendar year* • Qualified fitness facility membership fees • Qualified weight management program

membership fees• Can be used in conjunction with Blue365

* This benefit does not cover any ancillary services or items that are not part of a membership fee.

Health and Wellness

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Blue365 offers access to savings and discounts on items that members may purchase directly from independent vendors. Blue365 may also be used in conjunction with the GoGetters® Benefit.

Fitness- save on membership, monthly fees and other services at Gold’s Gym®, Curves®, Snap FitnessTM and Global FitTM

Nutrition- Save on programs, products and consultations at eDiets®, Kronos Optimal Health® and Jenny Craig®

Elective procedures- Save on vision products and services at Davis Vision®, QualSight LASIK ®, LasikPlus® and TruVisionTM

Hearing aids- Save on products from BeltoneTM and TruHearing

The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Excellus BlueCross BlueShield grievance process.

Note: Not all vendors that have provided discounts for Blue365 are qualified fitness

facilities or weight management programs for purposes of our GoGetters benefit.

What’s New

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What’s New

Side by side comparisons of: Your plan options & Estimated out-of-pocket costs.

2010 plan changes Learn more about cost-cutting options Research health topics Change your doctor Request ID cards Access health coaching information

www.excellusbcbs.com/medicare

Enhanced Web Tools

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Valuable Extras

Medicare Dedicated Customer Service Unit Knowledgeable and friendly staff dedicated to

answering any questions you may have timely, accurately, and professionally.

24-hour Personal Health Coaching Line Provides education and programs on nutrition,

weight management and much more.

Disease & Case Management Clinical staff work with you to make informed

choices on your health care and prescriptions

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What To Expect

Whether changing your coverage or not, you will receive new: ID cards GoGetters® card (if you already have a card

that you’re using for this benefit)

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What Do You Need To Do?

If you want to stay in your current plan, there is nothing you need to do.

If the plan you are in no longer suits your needs, we have many other plan options.

Complete an option transfer form if switching from an HMO plan to another HMO plan within our organization.

Complete an application if switching between HMO, PPO or Medicare Supplement Plans.

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Medicare Advantage Plan Enrollment Periods

Annual Enrollment Period (AEP)• Runs from November 15 – December 31, each year• Can change Medicare Advantage plan or stand-

alone Prescription Drug Plan• Can add or drop prescription drug coverage• Can return to Original Medicare• Enrollment changes take effect on January 1

Open Enrollment Period (OEP)• Runs from January 1 – March 31, each year• Can change Medicare Advantage plans• Cannot add or drop prescription drug coverage• One opportunity to change to a similar plan

(No-drug plan to no-drug plan – OR – drug plan to drug plan)

• Enrollment or disenrollment becomes effective the month after the application is received

There are only certain times during the year when you may change or voluntarily end your membership in a Medicare Advantage Plan.

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Special Enrollment Period (SEP)• Change of residence into or out of the

service area• Loss of employer coverage• Qualify for Low Income Subsidy

Medicare Advantage Plan Enrollment Periods

To obtain more information regarding Medicare Advantage Plan enrollment periods you can call our Customer Service Department at 1-877-883-9577 for Medicare Blue Choice or 1-866-846-8643 for Medicare Blue PPO TTY/TDD 1-800-421-1220 Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends 8:00 a.m. – 8:00 p.m.

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How to Contact us

Call us:• Medicare Blue Choice® (HMO)

• 1-877-883-9577

• Medicare Blue PPOSM

• 1-866-846-8643

• TTY/TDD 1-800-421-1220

Monday – Friday 8:00 a.m. – 8:00 p.m.From November 15 – March 1, representatives are also

available weekends from 8:00 a.m. – 8:00 p.m.

Write us:• Excellus BlueCross BlueShield P.O. Box 546

Buffalo, NY 14201

Visit us on the Web at www.excellusbcbs.com/medicare

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Interested in Receiving Emails?

Fill out our simple form provided by your sales representative or call us to

receive some information such as health and wellness from Excellus BlueCross BlueShield in your Email!

Call: 1-800-659-1986 (TTY/TDD 1-800-421-1220), Monday – Friday, 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m.

Interested in Becoming an Ambassador?

Ask your Medicare representative about our exciting Ambassador program.

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We Value Your Opinion

Tell Us How We Are Doing!

Call Our Confidential Voice Message System

1-800-230-709224 Hours a day, 7 days a week

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Questions ?

Thank You!

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