Our $0 premium plan allows you more time to enjoy your life. Medicare Made SimpleLearn the ABCs of Medicare in an animated video.If you find Medicare a little confusing, youre not alone. First tier drugs have the lowest cost, with costs increasing as the tiers increase. Additional formulary information coming soon. Generic drugs are equivalent to brand-name drugs in dosage, safety, strength, route of administration, quality, performance characteristics and intended use. The policies are used for the express purpose of assisting physicians and other healthcare providers in providing evidence based cost effective care. The formularies include brand name as well as generic drugs that have undergone rigorous testing and are approved by the Food and Drug Administration (FDA). Hours of operation: October 1 to March 31: 8 a.m. to 8 p.m., seven days a week, April 1 to September 30, 8 a.m. to 8 p.m., Monday through Friday. Please contact Medicare.gov or 1-800- MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. 2. Every year, Medicare evaluates plans based on a 5-star rating system. We give you the tools you need to make informed decisions. Enrollment in Blue Cross of Idaho Care Plus, Inc. depends on contract renewal. We do not offer every plan available in your area. policies & procedures overview. Medicare Supplement insurance plans do not include prescription drug coverage. Drugs requiring step therapy can be identified by the ST that follows the drug name. company history. For drugs approved for self-administration and covered under the member's pharmacy benefit, refer to the appropriate formulary(see the current year "Formulary Information" section above)to determine if the drug prescribed requires prior authorization. Requests must be submitted with supporting clinical documentation to substantiate medical necessity. Some, but not all, ACA drugs are listed in the formularies. These benefits include coverage of self-administered medications, as well as some vaccines and specialty medications. 2022 Blue Cross of Idaho Care Plus, Inc. (Blue Cross of Idaho Care Plus), an Independent Licensee of the Blue Cross Blue Shield Association, with services provided by Blue Cross of Idaho Health Service, Inc. Your local agent is there for you. Our medical policies are designed for informational purposes only and are not an explanation of benefits, or a contract. For information specific to Medicare members, visit the Medicare Advantage Informationpage. PA requests may also be submitted by fax using thePharmacy Prior Authorization Form. (under age 19) Pediatric vision benefits are now covered by the plan at 100% when using a participating provider. Some employers may purchase this expanded list of preventive drugs at a specified preventive benefit. You can identify if Blue Cross of Idaho Rx administers benefits as the Blue Cross of Idaho Rx Customer Service phone number is on the back of the ID card, below the main Blue Cross of Idaho Customer Service number. Tier assignment can be determined utilizing the appropriate formulary. Enrollment in Blue Cross of Idaho Care Plus, Inc. depends on contract renewal. When you see an in-network provider, you get the most out of your health benefits. Members with ACA compliant plans also have the option to request coverage of an alternate contraceptive product at no cost, that would normally result in costs for the member. These plans provide all of the benefits you are entitled to under Medicareplus extra benefits, INCLUDING Medicare Part D prescription drug coverage. Give your employees access to preventive, basic and major dental services with Blue Cross of Idaho dental coverage. The Blue Cross of Idaho formularies list drugs approved for coverage under your policy. Register for an educationalMedicare meeting near you. Refer to the appropriatepage to locate prior authorization requirements for drugs typically administered in an outpatient setting. Preventive medications are generally prescribed for people who may be at risk for certain illness or condition, but are not yet showing symptoms. Our dental plans boost your overall health and protect your pocketbook: Competitively priced plans Innovative plans cover services that members need and value The Secure Blue Courage (PPO) plan is available in 31 counties in Idaho. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically. Qualified Health Plan Formulary - 6 Tier for Metal Level Plans - For individual and small group Affordable Care Act plans that are available through the healthcare exchange at Your Health Idaho or directly through Blue Cross of Idaho. Blue Cross of Idaho Medical Policy for determination of medical necessity versus investigational care are only applicable to Blue Cross of Idaho members. Powered by Blue Cross of Idaho Care Plus, Inc. Blue Cross of Idaho Care Plus, Inc. is a Medicare Advantage plan with a Medicare contract. An Independent Licensee of the Blue Cross and Blue Shield Association . For more details, download the Secure Blue Courage (PPO) Enrollment KitESPAOL: Kit de inscripcin combinado Secure Blue Courage. Medicare - Medicare Advantage Information, Commercial - Medical Drugs Requiring Prior Authorization. You have the option to require a prescription be filled for the brand name medication when a generic equivalent exists, by ordering the prescription with a Dispense as Written (DAW) condition. Today, Blue Cross of Idaho and Regence BlueShield of Idaho remain separate companies, operating independently of each other. This documenation should include current clinical chart notes, applicable laboratory results, and documentation of any trial or failure of other pharmacological therapies. We're in your neighborhood. We work with healthcare providers who agree to provide services at discounted rates to help save you money. Any reproduction or dissemination of policies is expressly prohibited other than for the assistance in the care of our members. Call 1-888-492-2583 (TTY 711) 8 a.m. - 6 p.m. Monday to Friday Your Friend, the Health Insurance Agent Find a Certified Agent Find a Doctor Drug & Pharmacy Finder Blue Cross of Idaho Care Plus, Inc. is a Medicare Advantage plan with a Medicare contract. With plans that offer a range of benefits, you can find an option that fits the needs of your employees and their families. True Blue No Rx HMO without Part D Drug Coverage; Secure Blue PPO. 2023 Documents. When a drug requires prior authorization, Blue Cross of Idaho may determine the most appropriate method of benefit administration (Major Medical vs. Pharmacy) through the authorization process. Refer to the Provider Administrative Policiesfor information about the prior authorization process and timeframes. We also know when to get out of the way and let you work with your healthcare provider to take control of your health. Find an agentCall 1-888-492-2583 (TTY 711)8 a.m. - 6 p.m. Monday to Friday. Kit de inscripcin combinado Secure Blue Courage, Nondiscrimination Notice and Language Assistance, $0 in-network primary care physician visits, No cost for most annual preventive screenings, Telehealth services, including virtual physical therapy, Hearing exams and deeply discounted hearing aids. There are a lot of choices to make and you get to start making those choices when you near the age of 65, or when you retire at 65 and no longer get health insurance from your employer.Common myths about medicare|Medicare FAQs. Government Programs Membership: 833-377-4266, An Independent Licensee of the Blue Cross and Blue Shield Association, BlueCard Pre-Service Review for Out-of-Area Members, Medicare Medicaid Coordinated Plan / Idaho Medicaid Plus, Prior Authorization Procedure Code Lookup, Medical Drugs Requiring Prior Authorization, Prior Authorization and/or Step Therapy requirements. Your local agent is there for you. The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. You must be logged-in to view this page. Not all plans offer all of these benefits. Not affiliated with or endorsed by any government agency. Specialty prescriptions may be submitted by phone to FastStart at 833-203-1742 or faxed to 833-263-2871. VIEW YOUR SBC Coordination of Benefits The Secure Blue Courage (PPO) plan is available in 31 counties in Idaho. Some policies cover preventive vaccines at 100 percent; therefore a member does not have copayment. In addition to Part C and Part D benefits, our Secure Blue Courage plan offers a lot of supplemental benefits that you can take advantage of to stay your healthiest. Medication specific quantity limits are searchable in the formulary. This exclusive arrangement helps to facilitate lower costs on specialty medications and provide patient support through the treatment process. If you're looking to make a change, you may save money by staying blue. These vaccines include: For members on a Qualified Health Plan, physicians may submit a Formulary Exception Request with complete clinical documentation to request coverage for a non-formulary drug when all therapeutically equivalent generic drugs within the same class have been tried and are contraindicated for use. Please select Continue if you agree to these guidelines. Blue Cross of Idaho goes beyond original Medicare to offer a range of comprehensive plans to meet your needs and budget, as well as the expertise to step in and help you through the Medicare process if you ever need a hand. 800-627-1188 Blue Extras! How this plan performs in coverage of conditions, screenings, customer service and more. Some medications may have limits on how many doses are covered under your patient's policy. The use of generic medications is a valuable way to reduce overall prescription drug costs without sacrificing quality. Staying Healthy: Screenings, Tests and Vaccines, Ease of Getting Needed Care and Seeing Specialists, Health Plan Provides Information or Help when Members Need It, Coordination of Members' Health Care Services, Diagnostic radiology services (e.g., MRI), Prosthodontics, other oral/maxillofacial surgery, other services, Outpatient group therapy visit with a psychiatrist, Outpatient individual therapy visit with a psychiatrist, Physical therapy and speech and language therapy visit, Durable medical equipment (e.g., wheelchairs, oxygen), Prosthetics (e.g., braces, artificial limbs). Members with plans compliant with the Affordable Care Act (ACA) have a ccess to a list of drugs mandated by the ACA at no cost. Any drug prescribed for off-label use indication also requires prior authorization. Out of network services are covered at 50%. Blue Cross of Idaho may require members to purchase a specialty drug through IngenioRX Specialty Pharmacy and have the medication shipped to their physician for administration OR physician may be required to buy-and-bill under Major Medical.