Your health is our priority, which is why we offer several programs to help you live your healthiest life. Discover preventive services, fitness programs, health coaches, and other resources included in your membership.
Medicare and HIPAA Forms
Find all the resources you need to manage your health care. These forms are useful for your Medicare membership, and include subscriber claims forms, coverage determination, Health Insurance Portability and Accountability Act (HIPAA) information, and much more.
Prescription Drug Information
Our Medicare Advantage plans are offered with or without a prescription drug benefit. Search for a pharmacy, review the Formulary, Quantity Limits, Step Therapy, Medication Therapy Management guidelines, and more.
Summary of Benefits
The Summary of Benefits provides a look at what we cover and what you are responsible for paying with each plan option.
Evidence of Coverage
The evidence of coverage booklet explains your member rights and responsibilities, what is covered, and what you pay as a member of one of our Medicare Advantage plans.
Out-of-Network Coverage Rules
Learn how choosing between in-network and out-of-network doctors and facilities can affect how much you pay for your health care services.
Exceptions and Appeals
If you want to request a coverage decision or make an appeal related to benefits and coverage for medical services and prescription drugs, including problems related to payment, this guide will walk you through the process.
BlueShield of Northeastern New York is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal.This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or coinsurance may change January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.You must continue to pay your Medicare Part B Premium.Out-of-network/non-contracted providers are under no obligation to treat BlueShield of Northeastern New York 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 customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network 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. A division of HealthNow New York Inc., an independent licensee of the BlueCross BlueShield Association. A salesperson will be present with information and applications. For accommodations of persons with special needs at sales meetings, please call 1-800-258-7453 (TTY 711). BlueShield of Northeastern New York complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-833-735-4515 (TTY: 711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-833-735-4515 (TTY: 711).
Content Last Updated June 18, 2018