2018 Secure Blue PPO

2018 Secure Blue PPO

2018 Benefits

Silver & Fit, VSP, TrueHearing Select

Secure Blue no Rx PPO offers low office visit copays! Only $15 when you see in-network primary care providers, or $25 to see in-network specialists. Plus a gym membership, and the freedom to see providers in- or out-of-network. When you travel, you have access to in-network providers in over 30 states and Puerto Rico with Blue Cross and Blue Shield Medicare Advantage PPO plans. You are eligible to enroll in Secure Blue no Rx PPO if you are:

  • Entitled to Medicare benefits under Part A
  • Enrolled in Medicare Part B
  • Reside in the plan's service area

The benefit information provided below is a brief summary, not a comprehensive description of benefits. For more information contact us

2018 PLAN OVERVIEW

  Premium In-Network PCP Office Visit Fitness Options Part D Deductible In-Network Specialist Office Visit In-Network Inpatient Hospital Care Out-of-Pocket Maximum
Secure Blue no Rx PPO
without Part D Coverage
(see service area premium table below)
$30 $15 $50
annual gym membership


OR

$10
annually for two at home fitness kits
N/A $25
no referral needed
$175
per day for days 1-5
$3,400
per calendar year includes most plan services
 

SECURE BLUE PLAN PREMIUM TABLE

Secure Blue no Rx (PPO) Plan H1302-004-0 Service Area
Ada, Bannock, Bingham, Boise, Bonner, Bonneville, Boundary, Cassia, Canyon, Clark, Elmore, Fremont, Gem, Jefferson, Kootenai, Madison, Minidoka, Nez Perce, Owyhee, Payette, Power, and Twin Falls counties.
$30.00 monthly plan premium in addition to your monthly Medicare Part B premium

SUMMARY OF BENFITS

EVIDENCE OF COVERAGE

ANNUAL NOTICE OF CHANGE

Y0010_MK19182_M Accepted 10/1/2018
Last updated 10/01/2018