January 1, 2020 – December 31, 2020. /StructParents 0 2021 summary of beneits . Summary of Benefits Blue Cross Medicare Advantage Basic (HMO) SM. /AvgWidth 441 [833 556] /ToUnicode 848 0 R /ColorSpace << /Descent -212 0 0 0 306 252 0 507 507 507 507 /Flags 32 /Type /Catalog Florida Blue HMO works with Medicare to provide significant coverage beyond Part A and Part B benefits. << [840 0 R] 500 500 500 500 500 500 500 500 277 277 It doesn’t list every service that we cover or list every limitation or exclusion. /FontDescriptor 858 0 R /FontBBox [-182 -210 1000 728] >> /FontFile2 869 0 R 840 0 obj /Font << 500 500 500 500 333 389 277 500 500 722 563 563 563 443 920 722 666 666 722 610 /FontFile2 859 0 R /StemV 80 1 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2020 –12/31/2020 CareFirst BlueChoice: HealthyBlue Advantage HDHP Coverage for: Self Only, Self Plus One or Self and Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. >> << 843 0 obj 845 0 obj << x���? 0000003531 00000 n 0000006709 00000 n Medicare Advantage HMO plans (HMO stands for Health Maintenance Organization) approved by Medicare and run by a private company. 666 777 722 666 610 722 666 943 666 666 /FontBBox [-568 -306 2045 1039] 556 722 666 556 610 722 722 943 722 722 277 277 277 277 0 0 0 0 0 0 /CA 1 endobj 0000006261 00000 n /FontDescriptor 849 0 R 583 583 583 556 1015 666 666 722 722 666 [500] 0 0 250 333 408 500 500 833 777 180 857 0 obj endstream /Type /XObject /FontBBox [-664 -324 2000 1039] /Type /Font << /Descent -212 0000001813 00000 n /Root 828 0 R 592 547 501 592 547 774 547 547 0 0 /Type /FontDescriptor Thank you for your interest in Blue Cross and Blue Shield of Texas. 333 500 443 1000 500 500 333 1000 556 333 177 It doesn’t list every service that we cover or list every /Group << 500 500 500 500 500 500] /FontName /BCDFEE+Calibri /ImageC /Descent -210 /F2 11.808 Tf 722 666 666 610 556 556 556 556 556 556 0 0 0 0 544 533 0 0 0 0 endobj 0000004298 00000 n endobj Enrollment in Blue Advantage depends on contract renewal. /Type /FontDescriptor 610 277 277 277 469 556 333 556 556 500 842 0 obj S 851 0 obj 1 0 0 1 -0.24 -8.6774 Tm /ItalicAngle 0 endobj /FontDescriptor 851 0 R 500 500 500 333 259 333 583 350 556 350 /L 532074 0000003594 00000 n >> endobj /Subtype /TrueType endobj 556 556 556 556 556 556 556 556 277 277 /BaseFont /BCDEEE+ArialNarrow >> /Leading 150 860 0 R] endstream /Leading 150 /Type /Font Blue Shield 65 Plus Los Angeles County/Orange County January 1, 2020 – December 31, 2020. January 1, 2019 – December 31, 2019. Summary of Benefits and Coverage As part of the Patient Protection and Affordable Care Act, the Summary of Benefits and Coverage (SBC) provides additional information regarding coverage specifications and limitations that apply to the health insurance … /Subtype /Image 889 350 610 350 350 333 333 443 443 350 endobj >> >> /BaseFont /KKYTOQ+Arial-BoldMT /Flags 34 Blue Cross Medicare Advantage Premier Plus (HMO-POS) SM. /ColorSpace << 500 1000 333 979 389 333 722 350 443 722 @{��Bw�HɄ %C�J6%�����:����]'o�&��̨&�����>�K�Tu9U�r��[0[�"_�bW�Hr(}Y��������-� /Type /Font /FirstChar 0 premera blue cross medicare advantage core plus (hmo) h7245-008 333 333 500 563 250 333 250 277 500 500 /GS8 835 0 R This booklet has information about the cost and benefits of the BCN Advantage HMO-POS Region 3 plan. /Subtype /TrueType /BM /Normal 19 >> /Subtype /TrueType 0000004125 00000 n /Descent -250 666 443 443 443 443 443 277 277 277 277 610 556 333 610 610 277 277 556 277 889 841 0 obj /Type /FontDescriptor /Pages 59 0 R 370 556 583 333 736 552 399 548 333 333 /CapHeight 728 /CapHeight 662 889 556 556 556 556 556 277 277 277 277 Summary of benefits (cont’d) Blue Shield 65 Plus (HMO) Los Angeles and Orange Counties Effective January 1, 2021 - December 31, 2021 . 827 38 333 576 453 333 333 299 310 500 750 750 /FontFile2 857 0 R /BaseFont /UTPWUD+Arial-BoldMT /ToUnicode 846 0 R This Summary of Benefits booklet gives you a summary of what Blue Cross Medicare Advantage Basic (HMO), Blue Cross Medicare Advantage Basic Plus (HMO-POS), or Blue Cross Medicare Advantage Premier Plus (HMO-POS) covers and what you pay. /ExtGState << endobj Blue Cross Blue Shield of Arizona Advantage is an HMO plan with a Medicare contract. /Height 238 /Leading 33 /BaseFont /JOVPPX+TimesNewRomanPSMT endobj Enrollment in the Plan depends on contract renewal. >> << 277 333 556 556 556 556 259 556 333 736 %ABCpdf 11200 0000253036 00000 n Blue Advantage (HMO) | Blue Advantage (PPO) Summary of Benefits This document is available in other formats such as Braille and large print. 500 443 333 500 500 277 277 500 277 777 /Encoding /WinAnsiEncoding /Widths 844 0 R /StemV 52 - Fri. /Ascent 891 /CapHeight 716 >> << Medicare HMO Blue FlexRx also offers Medicare Part D prescription drug coverage—making it easy for you to get your medical and prescription benefits from one plan. /LastChar 255 850 0 obj /CS /DeviceRGB /Ascent 905 /FontName /UTPWUD+Arial-BoldMT This HMO-POS plan is only available in these counties: << 583 583 583 610 975 722 722 722 722 666 /Prev 515472 /DefaultRGB [/ICCBased /DestOutputProfile 861 0 R >> endobj endobj 250 333 500 500 500 500 200 500 333 759 /ItalicAngle 0 0000005791 00000 n (PW) NV BA HMO BD NGF $25_$400Ded (15_45_75_30%Rx).s0116 . /FontDescriptor 853 0 R << /Ascent 936 610 333 277 333 583 556 333 556 610 556 /ItalicAngle 0 /StemV 44 /Length 224 endobj /Length 957 828 0 obj 750 443 722 722 722 722 722 722 889 666 SEI - U SUMMARY OF BENEFITS The benefit formaon pved is aummary of what coveand what you pay. /Encoding /WinAnsiEncoding /Length 366 277 277 277 277 0 0 0 0 0 0 /T 515484 And Blue Shield 65 Plus Los Angeles County/Orange County january 1, 2020 Advantage HMO. 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