Please note, this communication applies to Healthy Blue + MedicareSM (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
Annual benefit changes for Medicare plan members under Blue Cross NC will be effective January 1, 2022.
Annual benefit changes for Medicare plan members under Blue Cross NC will be effective January 1, 2022. The following is a summary of these changes. Complete details are in the member’s Evidence of Coverage (EOC).
Visit https://medicare.bluecrossnc.com/medicare/find-plan for EOC, formularies, and benefit summaries, or contact Provider Services at the number on the back of the member’s ID card. Changes may include medical and Part D benefits, copays, coinsurance, deductibles, formulary coverage, pharmacy network, premiums, and out-of-pocket maximums.
Not all benefits listed below are available to all Medicare members. Complete details are in the member’s EOC:
Healthy Groceries (Grocery Card) benefit:
- Members can receive a debit card with a monthly allowance to spend on healthy food items at participating retailers. Funds will not be rolled over from one month to the next.
- Some items including tobacco and alcohol products are excluded.
- Precertification may be required to qualify for this benefit on some plans.
- This could be offered as an embedded benefit or an option that members can pick from.
2022 Service Area Changes
- The existing Healthy Blue + Medicare (HMO D-SNP) plan will expand into many new counties in 2022.
|Healthy Blue + Medicare (HMO D-SNP)||Alexander, Alleghany, Anson, Ashe, Avery, Beaufort, Bertie, Bladen, Brunswick, Burke, Caldwell, Caswell, Catawba, Chatham, Chowan, Cleveland, Columbus, Duplin, Edgecombe, Franklin, Gates, Graham, Granville, Greene, Halifax, Haywood, Henderson, Hertford, Hoke, Hyde, Iredell, Jackson, Johnston, Jones, Lee, Lenoir, Lincoln, Macon, Madison, Martin, McDowell, Mitchell, Montgomery, Moore, Nash, New Hanover, Northampton, Pamlico, Pender, Person, Pitt, Polk, Randolph, Richmond, Robeson, Rockingham, Rutherford, Sampson, Scotland, Stanly, Swain, Transylvania, Tyrrell, Union, Vance, Warren, Washington, Watauga, Wayne, Wilkes, Wilson, Yancey|
Formulary and Pharmacy
Encourage your patients to review the 2022 formulary information within their Annual Notice of Change (ANOC) mailing, their new member kit, or online. Ask your patients if the coverage for any of their prescriptions has been changed. If your patient has been impacted by changes to prescription coverage, consider alternative medications in a lower cost-sharing tier.
Prior Authorization for Medicare Plans
Prior authorization requirements are available at https://www.availity.com. Contracted and non-contracted providers who are unable to access Availity* may call Provider Services at the phone number on the back of the member’s ID card for prior authorization requirements.
Please check the member’s ID card for any identification and/or group number changes that may affect claim submissions. Sample 2022 member ID cards will be available at https://www.bluecrossnc.com/providers/blue-medicare-providers/healthy-blue-medicare.
NOTE: Availity, LLC is an independent company providing administrative support services for Healthy Blue + Medicare providers on behalf of Blue Cross and Blue Shield of North Carolina.
BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is an independent licensee of the Blue Cross and Blue Shield Association.
SABUCR-0060-21 October 2021