True Blue Special Needs Plan (HMO SNP) is good for the ones you care for
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.
Blue Cross of Idaho is proud to offer a health plan for Full Benefit Dual Eligible (FBDE) beneficiaries who are enrolled in Medicare Parts A, B, D and Idaho Medicaid services. Beneficiaries must also be at least 21 years of age and live within our service area.
Our True Blue plan covers long term services and support, while providing one membership card used for all their healthcare needs including medical, dental and vision coverage. An annual gym membership is also included for a one-time cost share of $50 annually.
A Trusted Network of Doctors, Dentists and Specialists
True Blue has one of the largest networks of doctors, dentists, specialists and hospitals across the state ready to provide first-class care to eligible members. You'll feel confident referring your clients to known and trusted care providers that you may already work with.
How does True Blue SNP Benefit my Business?
You probably help many people who hold two, three or even four different health insurance plans. All these plans with different policies and procedures may cause confusion for your staff.
Now imagine your clients holding one health insurance plan that covers all your unique needs while providing simplified billing. Plus, one customer service team ready to help your staff when necessary. We designed True Blue SNP not only around your client's needs, but your agency's needs as well.
Questions and Answers
Full Benefit Dual Eligible beneficiaries who are enrolled in Medicare Parts A, B, D and Idaho Medicaid services. Beneficiaries must also be at least 21 years of age and enrolled in the State of Idaho Medicaid program. The enrollee must also be eligible for Medicare Part A, enrolled in Medicare Part B, and reside in the service area.
Beneficiaries may have been notified of eligibility by the Idaho Department of Health and Welfare. Beneficiaries can also call Blue Cross of Idaho customer service at 888-495-2583 or TTY 800-377-1363, between the hours of 8 a.m. to 8 p.m. seven days a week for help determining eligibility.
There are three simple ways for beneficiaries, or a person acting on their behalf, to enroll in True Blue. Simply enroll online, or download the True Blue HMO SNP Enrollment Application, print out the form and mail it to Blue Cross of Idaho, P. O. Box 8406, Boise, ID 83707—2406; or call customer service at 888-495-2583 or TTY 800-377-1363, between the hours of 8 a.m. to 8 p.m. seven days a week for help enrolling over the phone.
Being a member of the True Blue plan is entirely voluntary. You can ask to leave True Blue at any time for any reason. To request True Blue disenrollment, call customer service at 1-888-495-2583 or TTY 1-800-377-1363. We are available from 8 a.m. to 8 p.m., seven days a week. You can also contact Medicare, at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week, and ask to be disenrolled. TTY users should call 1-877-486-2048.
If you decide to change to a new plan, you can choose any of the following types of Medicare plans:
- Another Medicare Advantage health plan. (You can choose a plan that covers prescription drugs or one that does not cover prescription drugs.)
- Original Medicare with a separate Medicare prescription drug plan. If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you have opted out of automatic enrollment.
Until your membership ends, you are still a member of our plan
- You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends.
- If you are hospitalized on the day that your membership ends, your hospital stay will usually be covered by our plan until you are discharged.
- If you disenroll from True Blue, your True Blue coverage ends on the last day of the month that you disenrolled. All Medicaid services will go back to Fee for Service. Any new Medicare plan you enroll in begins on the first day of the next month.
You will have to leave True Blue if:
- You do not stay continuously enrolled in Medicare Part A and Part B.
- You are no longer eligible for Medicaid.
- You move out of our service area.
- You go to prison.
- You lie about or withhold information about other insurance you have that provides prescription drug coverage.
- You gave True Blue false information when you signed up, we may ask Medicare for permission to have you leave the plan.
- You let someone else use your membership card to get medical care, we may ask Medicare for permission to have you leave the plan. If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
- You are supposed to pay the extra Part D prescription drug amount because of your income and you do not pay it, Medicare will disenroll you from our plan.
How can a beneficiary find out which LTSS and HCBS waiver services are covered by True Blue HMO SNP?
The easiest way to find out which long term services & support (LTSS) or home & community-based services (HCBS) are covered is to call customer service at 888-495-2583 or TTY 800-377-1363, between the hours of 8 a.m. to 8 p.m. seven days a week.
How can a beneficiary find out if a Primary Care Provider (PCP), nursing facility and other providers are in the True Blue Provider network?
Simply use the Provider Search tool, select Medicare Advantage – True Blue (HMO SNP) under network type, and choose to search by provider name, provider specialty, city, zip code or county where you wish to find providers in the True Blue HMO SNP network.
For a brief description of covered services, review the True Blue (HMO SNP) Summary of Benefits, or for a complete description of covered and non-covered services, review the True Blue (HMO SNP) Evidence of Coverage.
It is important to know which providers are part of the True Blue network because, with limited exceptions, members must use network providers to get medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when members are out of the area), out-of-area dialysis services, and cases in which True Blue authorizes use of out-of-network providers. See Chapter 3 in the True Blue (HMO SNP) Evidence of Coverage (Using the plan’s coverage for your medical services) for more specific information about emergency, out-of-network, and out-of-area coverage.
True Blue has a list of covered drugs in the Formulary. It tells which Part D prescription drugs are covered by True Blue. The drugs on this list are selected by the plan with the help of a team of doctors and pharmacists. The list must meet requirements set by Medicare. Medicare has approved the True Blue Drug List.
In addition to the drugs covered by Part D, some prescription drugs are covered under the beneficiary’s Idaho Medicaid benefits. This Drug List called the Formulary Addendum tells you how to find out which drugs are covered under Idaho Medicaid.
The Drug List also tells you if there are any rules that restrict coverage for your drugs.
Our pharmacy directory provides a complete list of our network pharmacies – that means all of the pharmacies that have agreed to fill covered prescriptions for our plan members. Members can use the Pharmacy Directory to find the network pharmacy a member wants to use. This is important because, with few exceptions, members must get prescriptions filled at one of our network pharmacies to have our plan cover (help you pay for) them.
Upon enrollment in True Blue, the member will be assigned a Care Manager by Blue Cross of Idaho. The Care Manager’s role is to ensure the member’s care is effectively coordinated and appropriate for the member’s needs. Under some circumstances, it is possible to have a new Care Manager assigned to coordinate a member’s care. Call customer service at 888-495-2583 or TTY 800-377-1363, between the hours of 8 a.m. to 8 p.m. seven days a week for help with questions about care management.
In most cases, a member should either call their Care Manager or customer service with help in determining what questions should be directed to True Blue, or to Idaho Medicaid. Members may call customer service at 888-495-2583 or TTY 800-377-1363, between the hours of 8 a.m. to 8 p.m. seven days a week.
Please refer to Chapter 9, Section 11 in the Evidence of Coverage for instructions on filing a grievance or complaint.
You can name a relative, friend, attorney, doctor, or someone else to act as your representative. If you want someone else to act for you, call customer service at 888-495-2583 or TTY 800-377-1363, between the hours of 8 a.m. to 8 p.m. seven days a week for helping naming your representative. Both you and the person you want to act for you must sign and date a statement confirming this is what you want. You’ll need to mail or fax this statement to us.
Each year, starting on January 1, there will be some changes to True Blue’s costs and benefits. The booklet called the Annual Notice of Change (ANOC) tells about those changes. The most recent ANOC describes what changes were made from the 2016 plan year, to the current 2017 plan year.
Every fall, we will send members the ANOC that will impact the plan in the new contract year, beginning January 1.
Medicare allows beneficiaries to change Medicare health and drug coverage. It’s important to review coverage each fall to make sure it will meet the member’s needs the following year.
- Check the changes to our benefits and costs to see if they affect the member.
- Check the changes to our prescription drug coverage to see if they affect the member.
- Check to see if your doctors and other providers will be in our network next year.
- Think about the member’s overall health care costs.
- Think about whether the member is happy with our plan.
If members want to stay with us next year, it’s easy – they don’t need to do anything. If members don’t make a change by December 31, they will automatically stay enrolled in our plan.
If members decide other coverage will better meet their needs, they can switch at any time. If a member enrolls in a new plan, their new coverage will begin on the first day of the month after they requested the change. Look in Section 2.2 of the ANOC to learn more about coverage choices.
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