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Hearing Eligibility & Enrollment Medical

COMPREHENSIVE MEDICARE SUPPLEMENT
The BlueCross BlueShield (BCBS) Comprehensive Medicare Supplement covers most (but not all) of the Medicare-eligible expenses that Medicare does not pay. A chart showing the coverage provided appears below.

It is very important to understand that benefits under the Plan will be modified to take Medicare into account, whether or not an individual enrolls in Medicare.

It is very important for a Participant and/or Eligible Dependent to enroll in Medicare Part A and Part B as soon as they are eligible.

However, you should NOT enroll in Medicare Part D prescription benefit coverage.

When you and/or your Eligible Dependent become Medicare Eligible, a copy of the Medicare Card must be furnished to the Fund Office.

Medicare periodically publishes a handbook called “Medicare & You” each year. This handbook details the Medicare benefits available to Medicare recipients and can be obtained directly from Medicare. You should contact Medicare to

obtain a copy of the handbook
If you have questions about the benefits provided by Medicare
If you have questions about your eligibility for Medicare
If you have questions about enrolling in Medicare

You can contact Medicare at 1-800-MEDICARE (1-800-633-4227) or on the internet at www.medicare.gov

COMPREHENSIVE MEDICARE SUPPLEMENT-BCBS GROUP # 50446
for Medicare Eligible Participants and/or their Medicare Eligible Dependents

Medicare Part A Supplement (Hospital/Facility Fees per Benefit Period)
*A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.
	Medicare Pays	Plan Covers	You Pay
Hospital Confinement (Semi-private room and board, general nursing, and miscellaneous services and supplies:
o First 60 days	All but Part A Deductible	Part A Deductible	$0
o 61st through 90th day	All but Part A Copayment	Part A Copayment	$0
o 91st day and after
o while using 60 Lifetime Reserve Days	All but Part A Copayment	Part A Co-Payment	$0
o Once Lifetime Reserve days are used: Additional 365 days	$0	100% of Medicare eligible expenses	$0
o Beyond the additional 365 days	$0	$0	All costs
Skilled Nursing Facility Care* (You must meet Medicare’s requirements including having been in a hospital for at least three days and entered a medicate approved facility within 30 days after leaving the hospital.)
o First 20 days	All approved amounts	$0	$0
o 21^st through 100^th day	All but Part A Copayment	Part A Copayment	$0
o 101^st day and after	$0	$0	All Costs
Blood
o First 3 pints	$0	Three Pints	$0
o Additional Amounts	100%	$0	$0
Hospice Care (Available as long as your doctor certifies you are terminally ill and you elect to receive these services.)	All but very limited coinsurance for outpatient drugs and inpatient respite care	$0	Balance
Medicare Part B Supplement (Professional Fees per Calendar Year)
*Once you have been billed $100 of Medicare-approved amounts for covered services (which are noted with a single asterisk), your Part B deductible will have been met for the calendar year.
Medical Expenses – In or Out of the Hospital and Outpatient Treatment, such as physician services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic test, durable equipment.
o First $100 of Medicare-approved amounts	$0	$0	$100 (Part B Deductible)
o Remainder of Medicare-approved amounts	80%	20%	$0
o Part B excess charges (above Medicare-approved amounts)	$0	$0	All Costs
Blood
o First three (3) pints	$0	All Costs	$0
o Next $100 of Medicare-approved amounts*	$0	$0	$100 (Part B Deductible)
o Remainder of Medicare approved amounts	80%	20%	$0
Clinical Laboratory Services – Blood Tests for Diagnostic Services	100%	$0	$0
Medicare (Parts A & B)
	Medicare Pays	Plan Covers	You Pay
Home Health Care
o Medically necessary skilled care services and medical supplies	100%	$0	$0
o Durable medical equipment
o Next $100 of Medicare approved amounts*	$0	$0	$100 (Part B Deductible)
o Remainder of Medicare-approved amounts	80%	20%	$0
At-Home Recovery Services (Home care certified by your doctor, for personal care during recovery from and injury or sickness for which Medicare approved a home care treatment plan)
o Each Visit	$0	Actual charges to $40 a visit	Balance
o Number of visits covered (must be received within eights weeks of last Medicare-approved visit)	$0	Up to the number of Medicare-approved visits, not to exceed seven each week	Balance
o Calendar Year Maximum	$0	$1,600	Balance
Foreign Travel (Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA.)
o First $250 each calendar year	$0	$0	$250
o Remainder of Charges	$0	80% to a lifetime benefit of $50,000	20% and amounts over the $50,000 lifetime maximum