Utah Medicare Program | Blue Select

Regence BlueSelect Medicare Supplement Plans

• Description and Differences among Standard Plans
• Plan Highlights
• Regence HealthWise BlueSelect: A Medicare Select Program
• Network Hospitals
• What is Not covered
• Rates
• Apply for Coverage
• Regence Advantages
• Regence Life and Health Medicare Script™ Part D Prescription Drug Coverage

BlueSelect and Differences among Standard Plans
Regular Medicare Supplement (also called Medigap) Plans are designed to pay for the deductible and coinsurance amounts and certain other benefits which are not covered by Medicare. These "gaps" include such items as the Part A and Part B deductibles, the Part A and Part B coinsurance, coverage for certain preventive services, and additional coverage for care provided in the beneficiary's home and prescriptions. You can fill some or most of these gaps depending on the Medicare Supplement plan that you choose.

Under Regence BlueCross BlueShield of Utah's (Regence BCBSU) regular Medicare Supplement plans, you can seek care from any hospital or participating doctor of your choice, and the full benefits of your Medicare Supplement plan will be paid.

Regence BlueSelect is a Medicare Select plan also designed to fill many of the gaps not covered by Medicare. However, there are some major differences between regular Medicare Supplement plans and the Regence BlueSelect program. The main dffierence is that, in general, when you require Part A inpatient hospital services, you must use the services of the IHC network hospitals specified to receive the full value of the Regence BlueSelect program. Another difference is that fewer plans are available under Regence BlueSelect. Under Regence BlueSelect we offer Plans C and F only.

If the IHC hospitals named in the brochure are used for Part A hospital services, the benefits of Plan C and Plan F under our Regence BlueSelect program are virtually identical to the benefits of Plan C and Plan F under our regular Medicare Supplement plans.

Plan Highlights

Regence HealthWise offers Medicare Select plans C and F under the Regence BlueSelect program. Regence BlueSelect Plans C and F offer lower premium rates than Plans C and F under our standard Medicare Supplement plans. The following shows the benefits included in Regence BlueSelect plans C and F.

For detailed plan information, download Regence HealthWise BlueSelect: A Medicare Select Program.

BASIC BENEFITS

Hospitalization: Part A coinsurance plus coverage for 365 days after Medicare benefits end.*

Medical Expenses: Part B coinsurance (generally 20% of the Medicare-approved expenses) or, in the case of hospital outpatient department services under a prospective payment system, applicable copayments.

Blood: First three pints of blood each year.

*In most cases, Part A Deductible and Coinsurance amounts are paid only if specified IHC network hospitals are used for Part A hospital services.

Network Hospitals
The BlueSelect network of participating hospitals includes the following IHC hospitals:

What is Not Covered
If you are age 65 or older and you enroll within six months of your Medicare Part B effective date, you are not subject to any Regence HealthWise underwriting requirements.

No Benefits are Provided For:

• Inpatient care received in a non-network hospital unless on an emergency basis
• Private duty nursing
• Services excluded by Medicare
• Custodial nursing home costs
• Intermediate nursing home costs
• Home health care if the patient is not homebound
• Services considered not medically necessary
• Dental care, dentures, physicals, routine immunizations, cosmetic surgery, routine care examinations, the cost of hearing aids or eyeglasses except when eyeglasses are required following cataract surgery
• Injuries or disease covered under Workers Compensation or other liability insurance which is primary
• Services provided by an employer-sponsored program or service covered under federal, state or local laws
• Disease contracted or injury sustained as a result of war
• Services or supplies not ordered by an attending physician

Please refer to Regence HealthWise BlueSelect: A Medicare Select Program, Plans C and F for complete Plan Summaries.

Regence Life and Health Medicare Script™ Part D Prescription Drug Coverage
Need a separate plan for Medicare Part D prescription drug coverage? Learn more about our new plan, Regence Life and Health Medicare Script™. This plan is available in all Utah counties.

Rates

Rates for Regence BlueSelect
The rates (PDF) for all Regence Medicare Supplement plans are subject to change, typically effective August 1, and apply to all plans regardless of the date coverage begins. You may also experience a rate change when you move from one age category to another.
Effective August 1, 2009*

*Regence HealthWise can raise your premium only if we raise the premium for all BlueSelect policies like yours in the state.

Apply for Coverage
We offer four easy ways to apply for Medicare Supplement coverage:

1. Online shopping and application tool. This online application walks you through the application step-by-step so all required fields are completed and you can simply submit the application electronically. Once registered, you can check back and view your application status online.
   
   
2. Download the application. If you'd rather fill out the forms by hand, here's where you can find application instructions and links to download plan forms.
   
   
3. Stop by our Salt Lake City office or call us. Phone (801) 333-2510, or toll-free 1 (800) 662-9585. We'll be happy to mail the forms and brochures to you to complete.
   
   
4. Shop with one of our agents. We can have one of our local agents give you a call. They can help you determine the plan that's best for you and your family. There is no extra cost and an independent agent can often give you additional insights into the plan that may benefit you.