2018 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)

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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

Pharmacy Directory

Formulary (Drug Search)
Click on the Formulary link below to see if your drugs are covered.
2018 Formulary
Formulary Archive

Other Forms & Documents
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 Ascensia® or OneTouch® glucose monitor and take it to your pharmacy.

Additional Benefits*

Dental
Plan pays $1,000 annual coverage towards routine and comprehensive dental services.

Hearing Services
$1,000 annual coverage towards hearing exams, hearing aids, hearing aid fittings/evaluations and repairs/adjustments.

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

Silver Sneakers® Fitness Center Membership Included
SilverSneakers®

Over the Counter (OTC) Catalog
Plan covers $192 per quarter for items listed in the OTC catalog

Southeastrans
Plan covers 40 one-way (20 round-trip), non-emergent rides each year to your covered appointments. Contact Customer Service for more information about your transportation benefits.

Additional Resources

Important Forms and Documents
Evidence of Coverage 2018 (EOC)
Annual Notice of Changes 2018 (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