2017 BlueCare Plus Plan Details

In-Network Benefits and Plan Information

Plan Name

Plan Type

Monthly Premium

Low Income Subsidy (Extra Help)

Out-of-Pocket Maximum

Plan Benefits

Plan Rating

BlueCare Plus (HMO SNP)

Health Maintenance Organization (HMO)

You pay: $0     Enroll Now

View Plan Premiums

$6,700

Summary of Benefits

BlueCarePlus Plan Rating

Provider Directory Is your doctor covered in our network?
Pharmacy and Prescription Drug Benefits

Find a Network Pharmacy

Formulary (Drug Search)
Click to see if your drugs are covered on the BlueCare Plus (HMO SNP) Formulary
2017 Formulary
Formulary Archive

Other Forms & Documents
Quantity Limit Criteria
Part D Prior Authorization Criteria
Part D Out of Network Coverage
Step Therapy Criteria
Quality Assurance P&P

Retail and Mail Order Pharmacy
Cost Tier 1 - Preferred Generic Drugs
Cost Tier 2 - Generic Drugs
Cost Tier 3 - Preferred Brand Drugs and includes some Generic Drugs
Cost Tier 4 - Non-preferred Brand Drugs and includes some Generic Drugs
Cost Tier 5 - Specialty Drugs that includes some Brand and Generic Drugs

Saving at the Pharmacy
BlueCross BlueShield of Tennessee often partners with suppliers to offer free and discounted necessities to help make staying healthy more affordable. To find a participating pharmacy, check your Plan directory.

Blood Sugar Monitors
Do you need a blood sugar monitor?
We offer free blood glucose monitors for our member. The program is easy to use, just click and print the coupon for either a free Bayer® or OneTouch® glucose monitor and take it to your pharmacy.

Additional Benefits*

Dental
Plan pays $250 per quarter for routine and comprehensive dental services. Any unused balance will roll over each quarter until 12/31.

Hearing Services
$0 copay for each routine hearing test. Plan pays $1,000 towards hearing aids.

Vision Care
$0 copay for each routine exam every year. Plan pays $200 towards glasses or contacts.

Silver Sneakers® Fitness Center Membership
Included

Over the Counter (OTC) Catalog
Plan covers $120 per quarter for items listed in the OTC catalog

Health Education and Wellness
Member Discount Program

Additional Resources

Important Forms and Documents
Evidence of Coverage 2017 (EOC)
Annual Notice of Changes 2017 (ANOC)
Transition Policy
Multi-Language Insert
Appointment of Representative Form
Best Available Evidence (BAE) Policy
Notices and Disclaimers

Member Rights

Coverage Decisions, Appeals & Complaints

*These additional supplemental benefits, non-covered by Medicare and Medicaid, are covered by BlueCare Plus

 

This page was updated on October 1, 2017