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.
Search for medical and dental providers, pharmacies and other True Blue network providers.
Below is a brief overview and summary of benefits. For a complete list of benefits and other resources, please review the 2017 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
$10 annually for two at home fitness kits
*All cost sharing on this plan is based on the particiant's level of Medicaid eligibility.
|$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||
||$100 plan coverage limit for supplemental eyewear every year|
|$0 copay for:||$0 copay for:||$0 copay for:|
|True Blue Special Needs Plan (HMO SNP) In-Network Dental Services||Preventive Dental Services:
||Restorative Dental Services:
||Dentures: Once every 84 months|
2017 & 2018 Tools, Resources & Other Information
- True Blue RX & SNP Formulary (Printable Drug List)
- Find a Pharmacy
- True Blue Rx & SNP Formulary Step Therapy Drugs
- True Blue Rx & SNP Formulary Prior Authorization Drugs
- How to use a Drug List (formulary)
- Notice of Drug List (formulary) Changes
- Prescription Drug Utilization
- Coverage Limits and Additional Requirements
- Medication Therapy Management Program (MTMP)
- What is Part D transition and how does it affect you?
- Member Submitted Part D Claim Form
- How to request an exception if your drug is not on our list
- How to request a Part D Drug Appeal
- Rights and Responsibilities
- How to ask for an organizational determination (coverage decision)
- Grievances or Complaints
- Civil Rights Complaint Form
- How to make a Medicare appeal based on a coverage decision
- How to appeal the state (Medicaid) based on a medical decision
- How to Name a Representative to Help with an Appeal
- Naming a Representative Form
- Customer Service
- When can you join a Medicare Advantage health plan
- Ending Your Membership
Centers for Medicare and Medicaid Services (CMS) occasionally makes a change or revision in Medicare coverage. We are required to notify you in our member newsletter when a National Coverage Determination (NCD) occurs.
You can review decisions using Medicare's Coverage Database. Visit www.cms.gov/medicare-coverage-database to get started.
Medicare beneficiaries may enroll in Blue Cross of Idaho Medicare Advantage plans through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
Last updated 10-01-2017