BlueChoice Tennessee, an Independent Licensee of the Blue Cross Blue Shield Association. BlueCross BlueShield of Tennessee, Inc is a PPO plan with a Medicare contract. Enrollment in BlueCross BlueShield of Tennessee, Inc. BlueChoice Tennessee is an HMO plan with a Medicare contract. Enrollment in BlueChoice℠ Tennessee depends on contract renewal. The information is not a complete description of be
nefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premium, copayments and coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. BlueCross BlueShield of Tennessee's Medicare contract is renewed annually. The availability of coverage beyond the end of this contract year is not guaranteed. Members may enroll in the plan only during specific times of the year. Contact BlueCross BlueShield of Tennessee for more information. Individuals must have both Part A and Part B to enroll. All services must be covered by Medicare or your plan and received from network providers for these cost sharing amounts to apply. With the exception of emergencies or urgent care, it will cost more to get care from out-of-network providers. For detailed information on a BlueAdvantage℠ or BlueChoice plan and its limitations, copayments and restrictions, please review the Evidence of Coverage. BlueChoice members must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor BlueChoice will be responsible for the costs. BlueAdvantage and BlueChoice cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs. You must use network pharmacies to access your prescription drug benefits, except under non-routine circumstances; quantity limitations and restrictions may apply. BlueAdvantage and BlueChoice has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Premium, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Out-of-network/non-contracted providers are under no obligation to treat BlueAdvantage members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our member service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. TruHearing® is a registered trademark of TruHearing, Inc. All other trademarks, product names, and company names are the property of their respective owners. TruHearing is an independent company that provides hearing services for BlueCross BlueShield of Tennessee. TruHearing does not provide BlueCross branded products and services. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
