WAYS TO GET FIT | RX SAVINGS | CONVENIENCE | DENTAL OPTIONS

2019 BLUECHIP FOR MEDICARE PLANS

You Asked for Exciting Changes—and

H E R E T H E Y A R E !

• An over-the-counter CVS Pharmacy® allowance (for plans that include pharmacy), where you can choose from a wide range of health-related items

• Trusted dental coverage to pair with your medical plan

• $0 copay for routine hearing and vision office visits and exams

• An allowance for glasses and other vision hardware

• $0 mail order on many generic drugs

• $5/month Living Fit gym membership benefit at more than 45 local fitness centers

• The Doctors Online benefit, which allows you to visit with a doctor 24/7 through your smartphone, tablet, or computer

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Almost anywhere I go in Rhode Island—from Narragansett Town Beach to the soccer field in Smithfield—I have the chance to chat with Blue Cross & Blue Shield of Rhode Island members. I love hearing firsthand what you value and how we can continue to best serve your needs.

That’s why I’m so excited to introduce this year’s Blue Cross & Blue Shield of Rhode Island Medicare Advantage plans. The plan benefits are designed based on your feedback and ideas, and I am grateful for all the input you shared with us.

Many of you asked for a plan that could keep up with your active life. BlueCHiP for Medicare Value HMO-POS is that plan—and it has a lower monthly premium for 2019. In addition to comprehensive coverage and preventive care, this plan offers great new features to help you take care of your health (and have fun doing it). You can use your complimentary Max BuzzTM to track your steps and calories while you’re walking, golfing, shopping, or doing yoga. Plus, you can now earn a $100 annual wellness reimbursement for participating in many of your favorite healthy activities.

While those benefits are specifically for BlueCHiP for Medicare Value HMO-POS, all of our plans offer new and innovative features, which you can learn more about in the Enrollment Book. Here are some highlights:

Have questions about which plan is right for you? Give us a call, visit bcbsri.com/Medicare, or stop by a Your Blue Store locationSM in East Providence, Lincoln, or Warwick. Our Sales and Medicare Concierge Teams enjoy being with you as much as I do. I look forward to seeing you around Rhode Island and thank you for considering Blue Cross & Blue Shield of Rhode Island.

Be well,

Melissa B. Cummings Executive Vice President and Chief Customer Officer

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I T ’S T H E N E W VA LU E O F B LU E

This guide gives you everything you need to learn about the value that you get from BlueCHiP for

Medicare. For 2019, we’re introducing some new, innovative, and value-packed benefits to

our Medicare Advantage plans that will show you how Blue means more: more rewards,

more savings, more convenience, and more extras to help you stay healthy and active.

WHAT YOU GET FROM BLUECHIP FOR MEDICARE, AT A GLANCE:

BlueCHiP for Medicare Value (HMO-POS)

is a really good fit if you’re already

active and healthy.

No matter which BlueCHiP for Medicare

plan you choose, you’ll find lots of

to help you and

.

And of course, as a BlueCHiP for Medicare

member, you’ll get a great local company

that’s here for you, where and when you

need us, from the

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pages

15-16

pages

5-7

page

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You want a plan that can keep up with your busy life. If you’re already active, the BlueCHiP for Medicare Value Plan could be a great choice for you. Besides the coverage and preventive care you need to stay well, it gives you extras that help you save money and stay healthy.

What’s new: The BlueCHiP for Medicare Value Plan

A new, lower premium for 2019:

$13*

per month!

$100 annual wellness reimbursement

A no-cost

Max BuzzTM

activity

monitoring device

Use it to participate in your favorite healthy activities, like fitness classes, sports lessons, weight-loss-programs, golf, and so much more.

Track your steps and calories and monitor your sleep with this easy-to-use device that syncs with the Virgin Pulse®** wellness program.

Choose from more than 45 local fitness centers, including YMCA locations.

$5

Get Living Fit for less! Our monthly gym

membership is now only

FPOFPO

*$23 premium for Newport County **Virgin Pulse® is an independent welllness company, contracted by Blue Cross & Blue Shield of Rhode Island to provide wellness services.

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What’s new: All BlueCHiP for Medicare plans

No matter which BlueCHiP for Medicare plan you choose (except where noted), you’ll get these new and innovative ways to save money, add convenience, or stay healthy:

CVS Pharmacy® over-the-counter (OTC) benefit – Get between $25-$100 each quarter (depending on your plan) to use on a wide range of OTC health-related items such as cold remedies and personal care items. Redeem your reward online at a virtual rewards store, over the phone, or one of 14* retail locations. (Available with all plans except BlueCHiP for Medicare Core (HMO).)

Healthy discounts from CVS Pharmacy® – BlueCHiP for Medicare members save 20%** in-store on thousands of CVS Pharmacy Brand health-related items. (This discount cannot be combined with the OTC benefit.)

Quality dental coverage, built into your plan – Taking care of your teeth is just as important as the rest of you…that’s why most BlueCHiP for Medicare plans now include dental coverage. (See coverage details on page 14.) (Available with all plans except BlueCHiP for Medicare Advance (HMO) and Core.)

$0 copay for routine hearing and vision – To help you get important hearing and vision tests regularly, there’s now no copay for routine office visits and exams.

Annual allowance for glasses and vision hardware – Get a $100-$200 allowance (depending on your plan) if you need glasses or vision hardware.

Virtual doctors’ visits 24/7 – Sometimes you have medical questions when the doctor’s office is closed. Our new online service gives you access to quality care anytime. Talk to a top-rated, board-certified doctor from anywhere using your smartphone, tablet, or computer.

*This list is current as of August 31, 2018. For the most updated information, visit bcbsri.com/Medicare. ** The 20% CVS discount is not a plan benefit and is restricted to items purchased for the health care of cardholder and applies to

regularly priced CVS Pharmacy Brand health-related items valued at $1 or more. Excludes prescriptions and any items reimbursed by federal healthcare programs. Products and services subject to the Extra Care Health Card discount are neither offered nor guaranteed under Blue Cross & Blue Shield of Rhode Island’s contract with Medicare. In addition, they are not subject to the Medicare appeals process. Purchases eligible for the ExtraCare Health Card discounts will not count toward your true-out-of-pocket (TrOOP) costs under our plan. Any disputes regarding these products and services may be subject to Blue Cross & Blue Shield of Rhode Island’s grievance process. Other pharmacies are available in our network. You are not obligated to fill your prescriptions at CVS Pharmacy by using this Value Added Service.

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Besides great benefits, BlueCHiP for Medicare gives you exclusive extras at no cost. That’s even more value from your plan!

• Medicare Concierge Team – This dedicated team of representatives are your Medicare experts, ready to help with any questions you have about your plan or your benefits.

• $0 mail order copay* – Pay no copay for a 90-day supply of many generic drugs in Tiers 1 and 2 and have them delivered right to your door.

• Virgin Pulse wellness program – This program, available on your phone, tablet, or computer, helps you get healthy and active! Sync your activity device and use the activity trackers, fun challenges, customized nutrition tools, and more.

• Talk to a Blue Cross healthcare professional about your health, at no cost – They can work with you and your doctor to improve your health. Call (401) 459-2273 or 1-800-637-3718, ext. 2273 (TTY: 711), or stop in to one of our Your Blue StoresSM.

• Nutrition counseling – Learn more about healthy eating and meet with a registered dietitian.

• Second Act volunteer program – This program matches our Medicare members with volunteer opportunities to make a difference and give back to our community.

$0 means more value

* Available with all plans except BlueCHiP for Medicare Core

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STAY INFORMED WITH EVEN MORE EXTRAS

The Rhode Ahead for Medicare Members – This print and online newsletter—just for our members—is packed with plan updates, health tips, info on events, recipes, and more.

Taking care of your teeth is just as important as taking care of the rest of you. That’s why most of our BlueCHiP for Medicare plans* now include dental coverage at no cost! This gives you:

• Peace of mind of having your medical and dental coverage together

• Convenience with just one ID card

• Low premium with no membership fees or deductibles

DENTAL COVERAGE: NOW INCLUDED!

*Included with all plans except BlueCHiP for Medicare Advance and Core

Access to 90% of Rhode Island dentists as part of our network

Secure messaging service – Get personalized messages about your health and health plan on your phone or mobile device with Your Blue Wire RI.

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GOOD HEALTH—AND GOOD HEALTHCARE—TAKES A TEAM.

That’s why we’ve partnered with the state’s top doctors to create the state’s largest Medicare Advantage network, including more than 95% of providers in Rhode Island.

Our BlueCHiP for Medicare plans include a provider network built on a coordinated care ap-proach that puts you at the center of your care.

Your primary care provider (PCP) coordinates all of your care with specialists, labs, hospitals, and any other providers you might need. This type of coordinated care makes it easier for you to find your way through the healthcare system so you can focus on getting or staying healthy.

PCP coordinated care: Designed to keep you healthy

* See a complete list, as well as important information regarding referrals, in your plan’s Evidence of Coverage or under “My Account” on bcbsri.com/Medicare.

YOUPRIMARY CARE PROVIDER (PCP)

Your doctor will coordinate all the care you need, making sure your providers

are sharing important information.

SPECIALISTS

HOSPITALS

PHARMACIES

PCP REFERRALS - GOOD FOR YOUR HEALTH

A strong relationship with your PCP leads to better outcomes and results for you, helping to keep you healthier. Your PCP is uniquely qualified to understand the “big picture” of your health, and can help make it easier for you to understand it, too.

Your PCP coordinates referrals for specialists, tests, and other services. While your PCP will help you make many important healthcare decisions by giving you referrals, some covered services* don’t require a referral, including:

• Hearing and vision office visits and exams

• Behavioral health/substance abuse services

• Emergency/urgent care services

• Retail health clinics

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Two networks, same local relationship!

TRADITIONAL NETWORK

(Includes all plans except BlueCHiP for Medicare Advance)

ADVANCE NETWORK (BlueCHiP for Medicare Advance)

All PCPs in BlueCHiP for Medicare network

All hospitals in RI and 4 in Southeastern MA

RI Primary Care Physicians Corp., Care New England, Prospect/Charter CARE,

Lifespan, and Coastal Medical

Butler, Kent, Landmark Medical Center, Miriam, Newport, Our Lady of Fatima,

RI Hospital, Roger Williams Medical Center, South County, and Women & Infants

Is choice more important to you?

Then the Traditional Network might be the right option for you. It offers a wider provider and hospital network in Rhode Island and Massachusetts.

Is cost more important to you? Then the Advance Network might be the right option for you. BlueCHiP for Medicare Advance has a $0 monthly premium and a focused provider and hospital network, all working together to ensure quality, integrated care.

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DO YOU FREQUENTLY SEE DOCTORS OR GET CARE IN OTHER STATES?

Relax, you're covered no matter where you go when you choose one of our plans that include a Point-of-Service (POS) benefit: BlueCHiP for Medicare Value (HMO-POS), BlueCHiP for Medicare Extra (HMO-POS), and BlueCHiP for Medicare Preferred (HMO-POS).

Coverage wherever you are!

A 20% coinsurance applies for the POS benefit.

93% of providers nationwide

accept Medicare

Our POS plans:

• Provide even more access

• Have no network restrictions

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PLAN OPTIONS AT-A-GLANCE

Medical and Prescription Drug Plans Medical and Prescription Drug Plans Medical Plan Only

BlueCHiP for Medicare Advance (HMO)*

BlueCHiP for Medicare Value (HMO-POS)

BlueCHiP for Medicare Standard with Drugs (HMO)

BlueCHiP for Medicare Extra (HMO-POS)

BlueCHiP for Medicare Plus (HMO)

BlueCHiP for Medicare Preferred (HMO-POS)

BlueCHiP for Medicare Core (HMO)

Monthly plan premium** $0 $13 or $23 Newport County*** $65 $99 $165 $255 $0

Medical deductible $0 $0 $0 $0 $0 $0 $0

PCP and virtual doctors’ visits $10 $0 PCMH or $35 non-PCMH $0 PCMH or $20 non-PCMH $0 PCMH or $10 non-PCMH $0 PCMH or $5 non-PCMH $0 PCMH or $5 non-PCMH $0 PCMH or $10 non-PCMH

Routine hearing and vision exams $0 $0 $0 $0 $0 $0 $0

Specialist office visits $45 $45 $35 $25 $25 $25 $40

Inpatient medical hospitalization $360 per day; Days 1-5 $325 per day; Days 1-5 $290 per day; Days 1-5 $250 per day; Days 1-5 $190 per day; Days 1-5 $180 per day; Days 1-5 $180 per day; Days 1-5

Skilled nursing facilityDays 1-20: $0 ;

Days 21-45: $160; Days 46-100: $0

Days 1-20: $0; Days 21-45: $150; Days 46-100: $0

Days 1-20: $0; Days 21-45: $140; Days 46-100: $0

Days 1-20: $0; Days 21-45: $135; Days 46-100: $0

Days 1-20: $0; Days 21-45: $135; Days 46-100: $0

Days 1-20: $0; Days 21-45: $130; Days 46-100: $0

Days 1-20: $0; Days 21-45: $130; Days 46-100: $0

Lab services $12 $5 $5 $0 $0 $0 $0

Diagnostic tests and X-rays $15 $5 $5 $0 $0 $0 $0

High-tech radiology services (MRIs, CT scans, etc.)

$200 $150 $125 $100 $150 $150 $150

Emergency room $90 $90 $90 $90 $75 $75 $90

Ambulance $150/trip $150/trip $150/trip $150/trip $75/trip $75/trip $150/trip

Out-of-pocket maximum (in-network)

$5,500 $5,000 $4,500 $3,500 $2,800 $2,250 $3,950

Prescription Drugs

Pharmacy deductible $200 for Tiers 3, 4 & 5 $200 for Tiers 3, 4 & 5 $100 for Tiers 3, 4 & 5 $0 $0 $0

Not covered

Pharmacy network Preferred Standard Preferred Standard Preferred Standard Preferred Standard Preferred Standard Preferred Standard

Tier 1 (preferred generic) $2 $10 $2 $10 $1 $9 $0 $8 $3 $11 $3 $11

Tier 2 (generic) $9 $17 $9 $17 $8 $16 $5 $13 $6 $14 $6 $14

Tier 3 (preferred brand) $47 $47 $47 $47 $47 $47 $47 $47 $47 $47 $47 $47

Tier 4 (non-preferred brand) $100 $100 $100 $100 $100 $100 $100 $100 $100 $100 $100 $100

Tier 5 (specialty tier) 29% 29% 29% 29% 31% 31% 33% 33% 33% 33% 33% 33%

Additional Benefits

Gym discount - Living Fit $5 per month $5 per month $5 per month $5 per month $5 per month $5 per month $5 per month

Over the Counter (OTC) benefit $25 per quarter $50 per quarter $75 per quarter $100 per quarter $100 per quarter $100 per quarter Not covered

Vision hardware allowance $100 every year $100 every year $125 every year $150 every year $150 every year $200 every year $100 every year

Wellness reimbursement $100 every year

Preventive services

Out-of-network (POS) benefit

Max Buzz fitness tracker

Hearing aid allowance

Dental Options

Dental included in medical

Dental rider (additional costs apply)

*Must receive care within the BlueCHiP for Medicare Advance network of providers. **You must continue to pay your Medicare Part B premium.***Newport County ZIP Codes: 02801, 02835, 02837, 02840, 02841, 02842, 02871, 02878

This information is not a complete description of benefits. Call the Medicare sales team at 1-800-505-BLUE (2583) (TTY: 711) for more information.

Benefit Features

Plan options At-a-Glance

✓

✓

✓✓✓✓

✓ ✓

Medical and Prescription Drug Plans Medical and Prescription Drug Plans Medical Plan Only

BlueCHiP for Medicare Advance (HMO)*

BlueCHiP for Medicare Value (HMO-POS)

BlueCHiP for Medicare Standard with Drugs (HMO)

BlueCHiP for Medicare Extra (HMO-POS)

BlueCHiP for Medicare Plus (HMO)

BlueCHiP for Medicare Preferred (HMO-POS)

BlueCHiP for Medicare Core (HMO)

Monthly plan premium** $0 $13 or $23 Newport County*** $65 $99 $165 $255 $0

Medical deductible $0 $0 $0 $0 $0 $0 $0

PCP and virtual doctors’ visits $10 $0 PCMH or $35 non-PCMH $0 PCMH or $20 non-PCMH $0 PCMH or $10 non-PCMH $0 PCMH or $5 non-PCMH $0 PCMH or $5 non-PCMH $0 PCMH or $10 non-PCMH

Routine hearing and vision exams $0 $0 $0 $0 $0 $0 $0

Specialist office visits $45 $45 $35 $25 $25 $25 $40

Inpatient medical hospitalization $360 per day; Days 1-5 $325 per day; Days 1-5 $290 per day; Days 1-5 $250 per day; Days 1-5 $190 per day; Days 1-5 $180 per day; Days 1-5 $180 per day; Days 1-5

Skilled nursing facilityDays 1-20: $0 ;

Days 21-45: $160; Days 46-100: $0

Days 1-20: $0; Days 21-45: $150; Days 46-100: $0

Days 1-20: $0; Days 21-45: $140; Days 46-100: $0

Days 1-20: $0; Days 21-45: $135; Days 46-100: $0

Days 1-20: $0; Days 21-45: $135; Days 46-100: $0

Days 1-20: $0; Days 21-45: $130; Days 46-100: $0

Days 1-20: $0; Days 21-45: $130; Days 46-100: $0

Lab services $12 $5 $5 $0 $0 $0 $0

Diagnostic tests and X-rays $15 $5 $5 $0 $0 $0 $0

High-tech radiology services (MRIs, CT scans, etc.)

$200 $150 $125 $100 $150 $150 $150

Emergency room $90 $90 $90 $90 $75 $75 $90

Ambulance $150/trip $150/trip $150/trip $150/trip $75/trip $75/trip $150/trip

Out-of-pocket maximum (in-network)

$5,500 $5,000 $4,500 $3,500 $2,800 $2,250 $3,950

Prescription Drugs

Pharmacy deductible $200 for Tiers 3, 4 & 5 $200 for Tiers 3, 4 & 5 $100 for Tiers 3, 4 & 5 $0 $0 $0

Not covered

Pharmacy network Preferred Standard Preferred Standard Preferred Standard Preferred Standard Preferred Standard Preferred Standard

Tier 1 (preferred generic) $2 $10 $2 $10 $1 $9 $0 $8 $3 $11 $3 $11

Tier 2 (generic) $9 $17 $9 $17 $8 $16 $5 $13 $6 $14 $6 $14

Tier 3 (preferred brand) $47 $47 $47 $47 $47 $47 $47 $47 $47 $47 $47 $47

Tier 4 (non-preferred brand) $100 $100 $100 $100 $100 $100 $100 $100 $100 $100 $100 $100

Tier 5 (specialty tier) 29% 29% 29% 29% 31% 31% 33% 33% 33% 33% 33% 33%

Additional Benefits

Gym discount - Living Fit $5 per month $5 per month $5 per month $5 per month $5 per month $5 per month $5 per month

Over the Counter (OTC) benefit $25 per quarter $50 per quarter $75 per quarter $100 per quarter $100 per quarter $100 per quarter Not covered

Vision hardware allowance $100 every year $100 every year $125 every year $150 every year $150 every year $200 every year $100 every year

Wellness reimbursement $100 every year

Preventive services

Out-of-network (POS) benefit

Max Buzz fitness tracker

Hearing aid allowance

Dental Options

Dental included in medical

Dental rider (additional costs apply)

*Must receive care within the BlueCHiP for Medicare Advance network of providers. **You must continue to pay your Medicare Part B premium.***Newport County ZIP Codes: 02801, 02835, 02837, 02840, 02841, 02842, 02871, 02878

This information is not a complete description of benefits. Call the Medicare sales team at 1-800-505-BLUE (2583) (TTY: 711) for more information.

✓

✓

✓✓✓✓

✓✓

✓

✓✓✓

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Benefit FeaturesBlueCHiP for Medicare

Advance (HMO) Core (HMO)

BlueCHiP for Medicare Value

(HMO-POS)

BlueCHiP for Medicare Standard with Drugs (HMO)

BlueCHiP for Medicare

Extra (HMO-POS) Plus (HMO)

Preferred (HMO-POS)

Dental OptionOptional Supplemental

Dental RiderIncluded in medical

Monthly premium $21.60 Not applicable

Annual benefit maximum $1,000 $1,000 $1,500 $1,500

Preventive Services

Annual exam $0. One oral exam per calendar year

Cleanings $0. Two cleanings per calendar year

X-Rays

Bitewing X-rays $0. One set per calendar year

Full mouth set $0. One set every five years

Individual X-rays $0

Comprehensive Dental Services

- Fillings- Palliative treatment- Simple extractions- Denture repairs

50% 50% 20% $0

Root canals and oral surgery

Not covered Not covered 20% $0

Dental Plan options At-a-GlanceYou are covered for the following dental benefits. You must receive these services from one of our participating dentists. To get the most up-to-date information about participating providers, you can use the Find a Doctor tool on bcbsri.com/Medicare or call our Medicare Concierge Team at the number on the back page.

Sometimes you just want to talk to someone face-to-face. Luckily, we’re in your neighborhood! BlueCHiP for Medicare members can visit any of our three Your Blue Store locations—in East Providence, Warwick, and Lincoln—and take advantage of:

Members-only informational meetings

No-cost fitness classes, like yoga, salsa, and meditation

Nurse consultations for help with any questions you have about your health

Face-to-face service – we’re ready to help!

THERE’S MORE IN STORE AT YOUR BLUE STORE SM

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08/18 BMED-253628• 1417

Blue Cross & Blue Shield of Rhode Island is an HMO plan with a Medicare contract. Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal. An independent licensee of the Blue Cross and Blue Shield Association.

500 Exchange Street • Providence, RI 02903-2699 • bcbsri.com/Medicare

We’re here to help!

CALL

Contact the Medicare sales team at 1-800-505-BLUE (2583) (TTY: 711).

Hours: Monday through Friday, 8:00 a.m. to 8:00 p.m. (Open seven days a week, 8:00 a.m. to 8:00 p.m., from October 1 – March 31)

You can use our automated answering system outside of these hours.

Already a BlueCHiP for Medicare member?

Call the Medicare Concierge Team at (401) 277-2958 or 1-800-267-0439 (TTY: 711).

Hours: October 1 - March 31, seven days a week, 8:00 a.m. to 8:00 p.m. April 1 – September 30, Monday through Friday, 8:00 a.m. to 8:00 p.m.; Saturday & Sunday, 8:00 a.m. to noon

You can use our automated answering system outside of these hours.

CLICK

Visit bcbsri.com/Medicare to compare plans, get recommendations, and apply.

From choosing a plan, to enrolling, to answering your questions once you’re a member... we’re here for you. We’ll show you the value of BlueCHiP for Medicare!

Your Blue StoreSM retail locations

East Providence 71 Highland Avenue (Highland Commons - pictured above)

Lincoln 622 George Washington Highway (Lincoln Mall Shopping Center)

Warwick 300 Quaker Lane (Cowesett Corners)

Store hours: Monday and Thursday - 9:00 a.m. to 7:00 p.m., Tuesday, Wednesday, and Friday - 9:00 a.m. to 5:00 p.m., Saturday - 9:00 a.m. to 1:00 p.m. (Saturday hours during the Medicare Advantage Election Period only, from October 15 – December 7)

COME BY

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