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Enrollment Instructions

If you are becoming eligible for Medicare, please note that in 2011, the Annual Enrollment Period (AEP) begins October 15th and runs through December 7th. During AEP, Medicare beneficiaries may join or switch Medicare Prescription Drug or Medicare Advantage plans.
 
There are a few things to go over before you begin the enrollment process.
 
Know for sure you’re eligible for a Medicare Advantage or Medicare Advantage with Prescription Drug plan (MA-PD):
If you have Medicare Part A and Part B (or will have Medicare Part A and Part B as of the effective date) and you enroll during one of the enrollment periods, you’re eligible to join a Medicare Advantage plan. To be eligible for our plan, you must also reside in our service area. Generally, you are not eligible if you have End-Stage Renal Disease. 
 
If you already have a Medicare Advantage plan and are looking to switch plans, please keep the following in mind when you are ready to enroll:
  • As an Anthem Blue Cross member, if you inadvertently sign up for Medicare Part D prescription drug coverage from any other plan, you will be automatically dis-enrolled from your Medicare Advantage plan or your current Part D plan.  If you choose to, you can go back to Original Medicare and get a Medicare Supplement policy or a Part D policy.  But keep in mind that you can only join or leave a plan at certain times during the year.  
  • There is a Medicare Advantage Disenrollment Period (MADP). The next MADP is January 1, 2012, through February 14, 2012. If you choose to dis-enroll from a Medicare Advantage plan during the MADP and your plan includes a drug plan, you will be allowed to sign up for a stand-alone Part D plan to replace the drug coverage that was in your Medicare Advantage plan and go back to Original Medicare. This means that if you shop around for another Medicare Advantage plan, you will need to consider changing your plan during AEP (October 15, 2011 through December 7, 2011) because after January 1, 2012, you will not be able to change from your current Medicare Advantage plan to another Medicare Advantage plan unless you qualify for a Special Election Period.
 
To complete and mail a print copy of your Blue Cross Senior Secure Plan 1 (HMO) or Anthem Medicare Preferred Standard (PPO) Enrollment Form:
 
Download and print the enrollment form. Be sure to complete all information on the form, sign the form, and date the enrollment form. In Section I, please be sure that when you enter the Permanent Residence, you enter a Street Address. You cannot enter a P.O. Box.
  1. If you would like the convenience of having your premium deducted from your Social Security check, be sure to check “Yes” for “Deduct my premium from my Social Security benefit check each month” located in Section 3 “Paying Your Plan Premium”. If you want to use our other convenient payment options, select the option in Section 3 “Paying Your Plan Premium”. If you choose automatic monthly payment, enter the additional required information.
  2. Return the form(s) by mail to the address listed below. We will contact you, in writing, after we receive your enrollment application.
    Enrollment Processing Center
    P.O. Box 659404
    San Antonio, TX 78265-9863
    Fax #: 1-877-391-3877
 

 
Know for sure if you are eligible for a Medicare Prescription Drug plan (PDP):
Anyone who meets the following criteria is eligible for Medicare Prescription Drug coverage, and membership in our plan:
  • You are entitled to Medicare Part A or are enrolled in Part B.
  • Your permanent residence is within our service area.
  • You are not enrolled or do not plan to stay enrolled in another Medicare Prescription Drug plan.
Please keep this in mind: Eligible individual may only enroll in one Medicare prescription drug plan at a time and may not be enrolled in a standalone Medicare Advantage Plan (HMO, PPO) at the same time, unless they are a member of a Medicare Private-Fee-For-Service plan or are enrolled in a 1876 Cost Plan which does not have Part D coverage built in. If you are enrolled in a Medicare Advantage HMO or PPO plan without prescription drug coverage, you'll be dis-enrolled if you join a Medicare Part D prescription drug plan.
 
To complete and mail a print copy of your Blue Cross MedicareRxSM Rewards (PDP) Enrollment Form:
  1. Download and print the enrollment form. Be sure to complete all information on the form, sign the form, and date the enrollment form. In Section I, please be sure that when you enter the Permanent Residence, you enter a Street Address. You cannot enter a P.O. Box.
  2. If you would like the convenience of having your premium deducted from your Social Security check, be sure to check “Yes” for “Deduct my premium from my Social Security benefit check each month” located in Section 3 “Paying Your Plan Premium”. If you want to use our other convenient payment options, select the option in Section 3 “Paying Your Plan Premium”. If you choose automatic monthly payment, enter the additional required information.
  3. Return the form(s) by mail to the address listed below. We will contact you, in writing, after we receive your enrollment application.
    Enrollment Processing Center
    P.O. Box 659404
    San Antonio, TX 78265-9863 
    Fax #: 1-877-391-3877

  
Beneficiaries interested in available Medicare Part D subsidies may contact Blue Cross MedicareRx  (PDP) customer service toll-free at 1-800-928-6201 and TTY/TDD – 711, 1-800-MEDICARE (TTY/TDD USERS CALL 877-486-2048), their State Medicaid Office, or your local Social Security Administration Office. If you have a Medicare Supplement (Medigap) policy that includes prescription drug coverage, you must contact your Medigap Issuer to let them know that you have joined a Medicare Prescription Drug Plan.
 
 
For information on provisions for non routine access to covered Part D drugs at out-of-network pharmacies, including limits and financial responsibility for access to these drugs please reference your Evidence of Coverage or call Customer Service.
 
 
PDP and MAPD Contract Renewal
Our prescription drug plan (PDPs) and Medicare Advantage prescription drug (MAPD) plans have a Medicare contract. Since contracts with Medicare are renewed annually, both the Prescription Drug Plans and the Medicare Advantage prescription drug (MAPD) plans cannot guarantee availability of coverage beyond the end of their current contract year.

If our Medicare contract is terminated or if we stop offering PDP or MAPD benefits, we will give you written notice of when that change will be effective. We will also provide you with information about alternative Prescription Drug Plans or Medicare Advantage prescription drug (MAPD) plans in your area, and the steps you need to take to continue your prescription drug coverage with Medicare. At that time, you would be eligible for a Special Enrollment Period, and could choose a new PDP sponsor or MAPD sponsor without being subject to a late enrollment penalty. Again, you cannot have a standalone Medicare Advantage plan and a standalone PDP plan at the same time unless as specified above.
 
PDP and MAPD Contract Termination Procedures
All Medicare Prescription Drug Plans and Medicare Advantage prescription drug (MAPD) plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Prescription Drug Plan or Medicare Advantage prescription drug (MAPD) plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 60 days before your coverage will end. The letter will explain your options for Medicare prescription drug coverage in your area.
 
After you enroll: 
  1. Shortly after we receive your application, we will send you a letter confirming receipt. The letter will include your proposed effective date. You may use the letter as proof of membership until your member identification (ID) card arrives. 
  2. We will send your application to the Centers for Medicare and Medicaid Services (CMS) for approval.  
  3. When approved, you will receive a welcome letter confirming your effective date with us. You will also receive your member identification (ID) card and other new member materials.
 
Please note: You must continue to pay your Medicare Part B premium as well as any Part D IRMAA (Income Related Medicare Adjustment Amount) premium if CMS has notified you that you owe a Part D IRMAA premium.
 
Materials may be available in alternative formats. Please call Customer Service at if you need information in another format.
 
 
Paying your monthly premium:
If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take two or more months for the change to take effect and you will be responsible for those premiums.
 
Network of Pharmacies
With thousands of pharmacies across the country, you have an extensive network to choose from. Most major pharmacy chains are included in our network. To find a network pharmacy, click here or contact your sales representative or independent agent.
 
You will receive an Evidence of Coverage which will provide more detail on your benefits.
It will also tell you about some exclusions to the plan, which include:
  • Services that are not reasonable and necessary under Original Medicare program standards
  • Experimental or investigational medical and surgical procedures, equipment and medications, unless covered by Original Medicare or under an approved clinical trial.
    • Custodial care, which is not covered unless it is provided in conjunction with skilled nursing care and/or skilled rehabilitation services.
    • Charges imposed by immediate relatives or members of your household
Remember, if you ever disagree with a claim decision, a denial, a prior authorization request for prescription drug coverage or have a concern, you have options.

We will do our best to give you all the information you need and listen to your concerns. That’s why we have both appeals and grievance procedures. We review complaints about grievances, including quality of care within 30 days from the receipt date of the grievance. Issues about payment for services (appeals) will be addressed within 60 days from the receipt date of the appeal. If the appeal is for a denied service, the reconsideration decision must be made no later than 30 days after receipt date of the appeal. However, if your health is at stake, we are required to respond to the appeal within 72 hours. Under certain circumstances, you also have the right to file an expedited grievance, which we must respond to within 24 hours from the grievance receipt date.