Blue Medicare SupplementSM Policy Rates
L1098, 1/08
6 This is only a summary of benefits describing the policies’ most important features. The policy is the insurance contract. Members must read the policy itself to understand all the rights and duties of both the member and their insurance company. These policies may not fully cover all of their medical costs. Neither Blue Cross and Blue Shield of North Carolina nor its agents are affiliated with Medicare.
7 After 90 days of hospitalization, Medicare benefits are paid from a one-time, lifetime reserve of 60 additional days, which are not renewable each benefit period.
8 If blood is donated to replace what the member uses, there is no charge.
9 Members must have been in a hospital for at least three days and enter a Medicare-approved facility generally within 30 days after hospital discharge, no benefits after 100 days.
10 On all plans offered except PLANS F, I and J, members may be responsible for charges higher than the amount approved by Medicare unless the provider agrees to accept Medicare’s approved amount as full payment. Plans F, I and J are covered at 100% for these charges.
11 Pays up to $40 a visit for home care certified by a physician as necessary for personal care during recovery from an injury or sickness for which Medicare approved a treatment plan for home health care. Treatment must be received within 8 weeks of the last Medicare approved home health care visit and is limited to 7 visits a week up to $1,600 annually.
12 80% of medically necessary emergency care services beginning during the first sixty days of trip outside of USA, after $250 annual deductible, up to $50,000 lifetime maximum.
13 Preventive care benefits are limited to $120 per year.
14 Rates are effective until April 1, 2009 for Plans A-J.
15 Medicare supplement rates are for individuals who are on Medicare due to disability.
16 Plan B under 65 rate is only available to current Blue Cross and Blue Shield of North Carolina subscribers who qualify for Medicare due to disability.
1-800 New Health provides outstanding health care insurance service to the entire State of North Carolina including the NC metropolitan areas of Apex, Asheboro, Asheville, Beaufort, Burlington, Cary, Chapel Hill, Charlotte, Concord, Durham, Elizabeth City, Fayetteville, Fort Bragg, Garner, Gastonia, Goldsboro, Greensboro, Greenville, Havelock, Hickory, High Point, Huntersville, Jacksonville, Kannapolis, Kernersville, Kinston, Lexington, Lumberton, Matthews, Monroe, Morehead City, New Bern, Newport, Raleigh, Rocky Mount, Salisbury, Sanford, Shelby, Statesville, Thomasville, Wilmington, Wilson, and Winston Salem.
*2005 BCBSNC Internal data
**BCBSNC reserves the right to discontinue or change this programs at any time
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