Blue Advantage Notices
Blue Cross and Blue Shield of Alabama, Licensee of the Blue Cross and Blue Shield Association, has a contract with the Centers for Medicare & Medicaid Services (CMS) that is renewed annually, and availability of coverage beyond the end of the current contract year is not guaranteed.
You may only enroll in our Blue Advantage (PPO) plans during specific times of the year. For more information about enrollment periods, call us toll free at 1-888-627-4715 (TTY 711) 8 a.m. to 8 p.m., 7 days a week. From February 15 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned on the next business day.
You may be enrolled in only one Part D plan at a time. Medicare beneficiaries who are enrolled in an MA Private Fee-for-Service (PFFS) plan that includes Medicare prescription drugs or any MA coordinated care (HMO or PPO) plan will be automatically disenrolled from the HMO, PPO or MA PFFS plan if they enroll in a Prescription Drug Plan (PDP). Medicare beneficiaries enrolled in a PFFS that does not include Medicare prescription drug coverage, an MA Medical Savings Account (MSA) plan or an 1876 Cost plan may enroll in a PDP and will not be automatically disenrolled from the PFFS, MSA or an 1876 Cost plan.
Medicare beneficiaries may also enroll in Blue Advantage through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
To qualify for enrollment in Blue Advantage, individuals must have both Medicare Part A and Part B, and live in the service area. You must continue to pay your Medicare Part B premium. If you request premiums withheld, elect to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for the change to take effect and you will be held responsible for those premiums.
Out-of-network/non-contracted providers are under no obligation to treat Blue Advantage (PPO) members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
A sales person will be present with information and applications. For accommodation of persons with special needs at sales meetings call 1-888-543-9212.
The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and my change from one year to the next.
You can get prescription drugs shipped to your home through our network mail order delivery programs; PrimeMail Home Delivery Service or Walgreens Mail. You also have the choice to sign up for automated mail order delivery.
For PrimeMail, you should typically expect to receive your prescription drugs in five or eight business days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact us at PrimeMail. 1-800-731-3588, TTY: 711, 24 hours a day, 7 days a week website: www.MyPrime.com.
For Walgreens Mail, you should typically expect to receive your prescription drugs in seven or 10 business days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact us at 1-800-489-2197 and TTY: 1-800-573-1833. website: www.WalgreensMail.com.
Pharmacies are to obtain consent prior to shipping or delivering any prescriptions that the you did not personally initiate.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. To the extent of any discrepancy between this web site and your Evidence of Coverage/Contract Booklet, your Evidence of Coverage/Contract Booklet takes priority.