Benefits

True Blue Special Needs Plan (HMO SNP) Overview and Benefits

Ready to enroll in True Blue SNP?

Click the Enroll Now link below to go to the online enrollment, or call 888-495-2583 or TTY 800-377-1363. Our trained customer service representatives are available from 8 a.m. to 8 p.m., seven days a week, or fill out this contact request form to have Customer Service call you.

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Below is a brief overview and summary of benefits. For a complete list of benefits and other resources, please review the 2015 Tools and Resources section on this page.

Health Plan Overview

Premium PCP Office Visit Part D Deductible Specialist Office Visit Inpatient Hospital Care Out-of-Pocket Maximum Fitness Options
True Blue Special Needs (HMO SNP) Includes Part D Prescription Coverage $0* $0* $0* $0* $0* $3000 per calendar year includes all plan services $50 annual gym membership
OR
$10 annually for two at home fitness kits

*All cost sharing on this plan is based on the particiant's level of Medicaid eligibility.

Vision Coverage

$0 copay for: $0 copay for: $0 copay for: Supplemental Eyewear Coverage
True Blue Special Needs (HMO SNP) In-Network Vision Services Medicare-covered diagnosis and treatment for diseases and conditions of the eye, including an annual glaucoma screening for people at risk Up to 1 supplemental routine eye exam(s) every year
  • one pair of Medicare-covered eyeglasses (lenses and frames) or contact lenses after cataract surgery*
  • eyeglasses (lenses and frames)
  • eyeglass lenses
  • eyeglass frames
$100 plan coverage limit for supplemental eyewear every year

Dental Coverage

$0 copay for: $0 copay for: $0 copay for:
True Blue Special Needs Plan (HMO SNP) In-Network Dental Services Preventive Dental Services:
  • Up to one oral exam every 12 months
  • Up to one cleaning every six months
  • Up to one flouride treatment every 12 months
  • Up to one dental x-ray every 12 months
  • Up to one full mouth series or panoramic x-ray every 36 months
Restorative Dental Services:
  • Fillings once in a 24-month period per tooth/surface
  • Simple and surgical extractions
  • Endodontic services including therapeutic pulpotomy and pulpa debridement
  • Periodontic services including scaling and root planning full mouth debridement
  • Periodontal maintenance up to two visits every 12 months
Dentures: Once every 84 months

Tools, Resources & Other Information

Drug List (Formulary) & Prescription Drug Resources

Membership Information

Member Handbook

Summary of Benefits

Evidence of Coverage

Annual Notice of Change

Other Plan and Benefit Information

Medicare beneficiaries may enroll in Blue Cross of Idaho Medicare Advantage plans through the CMS Medicare Online Enrollment Center located at www.medicare.gov.

H1350_MK 14352 Approved 4-7-2014
Last updated 3-26-2014