blue cross of california Blue Cross Freedom Blue PPO - California

Oleg Skurskiy an Authorized Independent Agent for Blue Cross of California

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Blue Cross Freedom Blue PPO 2007
Enrollment questions or assistance please call (818) 654-4548
add to my favorite FAQ's

Freedom Blue PPO

Freedom Blue PPO Summary of Benefits 2007

Blue Cross Freedom Blue Application

Freedom Blue PPO Application 2007 year
NEW > Compare Freedom Blue PPO Side -by - Side - 2007
 
Freedom Blue PPO I & II Vs. Kaiser Permanente Senior HMO
 

Submit application Express by fax today.

Fax : 818-776-9865

The drug benefit has been improved!!!

Freedom Blue Plan I and Plan II both include MedicareRx Part D prescription drug coverage, for no additional cost! and cover the "donut hole" See the Summary of Benefits

 
Freedom Blue Plan I (R9943-001) Freedom Blue Plan II (R9943-002)
Total Premium $0.00/month Total Premium $50.00/month ($600.00/year)

You pay $10 for each in-network primary care doctor office visit for Medicare-covered services. You pay $10 for each in-network specialist visit for Medicare-covered services.

You pay 20% of cost for services received from an out-of-network provider. View full benefits for more details

You pay $10 for each in-network primary care doctor office visit for Medicare-covered services. You pay $10 for each in-network specialist visit for Medicare-covered services.

You pay 20% of cost for services received from an out-of-network provider View full benefits for more details
$ 1000 yearly deductible $ 500 yearly deductible

Freedom Blue PPO Application -2007-Downloadable / Printable

Freedom Blue Plan I and Plan I includes Medicare Part D Prescription Drug Coverage.
Total annual deductible $0 Total annual deductible $0

Generic: $10
Preferred Brand: $30
Non-Preferred Brand: $60
Non-Specialty Injectables: 30%
Specialty Injectables: 30%

Generic: $10
Preferred Brand: $30
Non-Preferred Brand: $60
Non-Specialty Injectables: 30%
Specialty Injectables: 30%
Prescription Drug List -2007 - Downloadable / Printable

Freedom Blue PPO Application -2007-Downloadable / Printable

Request the Application Now!

( New Enrollment only . If you are current member with Blue Cross on any Medicare Supplement, Advantage or Rx plans please call the number on your card.)

(You must continue to pay your Medicare Part B premiums no matter which plan you choose.)

* This is just a brief summary of the plan benefits.

Blue Cross Freedom Blue PPO 2007

  • Blue Cross Freedom Blue Provider Finder is your online resource for finding doctors, hospitals and other health professionals that participate in your current plan or a different Blue Cross plan. Follow the step-by-step instructions to find providers that match your custom search criteria. Blue Cross of California
As a person with Medicare, you have choices in how you get your Medicare Prescription Drug coverage Select below
UniCare Rx Health Net Orange Rx Cigna CIGNATURE Rx Blue Cross Medicare Rx Freedom Blue PPO
 
Learn About New Blue Cross Medicare Rx - California only
Final Expense Insurance - No Medical Exam
 
    Blue Cross Final Expense Whole Life Insurance - California only
  • Benefits from $3,000 to $25,000
  • Policies may be issued to individuals between the ages of 45 and 80
  • No medical exam and no waiting period required
  • To view Brochure with Application and Rates Click Here Printable
 
 
If you have any questions, please call (818) 654-4548 or Contact Us
 
 
Mail Application to:

Oleg Skurskiy
18375 Ventura Blvd. # 226
Tarzana , CA 91356

 
You also can fax complete application to Fax # : 1-818-776-9865
 
  Compare Freedom Blue PPO side -by - side - 2007
 

Freedom Blue I

$0 monthly plan premium

BC LIFE & HEALTH INSURANCE COMPANY
Freedom Blue Plan I (R9943 - 001)

Freedom Blue II

$50 monthly plan premium

BC LIFE & HEALTH INSURANCE COMPANY
Freedom Blue Plan II (R9943 - 002)

   
 
Download Summary of Benefits Download Application
 
1 Premium and Other Important Information 2
 
 
 
 
blue cross freedom blue

Blue Cross Freedom Blue Application

Freedom Blue PPO

Application 2007

Download Application

 

 
 

Freedom Blue PPO

Freedom Blue PPO Brochure

Download Brochure

General
in addition to your $93.50 monthly Medicare Part B premium.

In-Network
$3000 out-of-pocket limit every year for benefits.

Out-of-Network
View the Summary of Benefits  for more details on what is covered out of network.

In and Out-of-Network
$1000 yearly deductible for all benefits. This deductible applies to benefits you get in-network or out of network.
Yearly deductible applies to the following benefits:

  • Inpatient Hospital Care
  • Inpatient Mental Health Care
  • Skilled Nursing Facility
  • Home Health Care
  • Chiropractic Servicesblue cross freedom blue
  • Podiatry Services
  • Outpatient Mental Health Care
  • Outpatient Substance Abuse Care
  • Outpatient Services/Surgery
  • Ambulance Services
  • Outpatient Rehabilitation Services
  • Durable Medical Equipment
  • Prosthetic Devices
  • Diabetes Self-Monitoring Training and Supplies
  • Diagnostic Tests, X-Rays, and Lab Services
  • Hearing Servicesblue cross freedom blue
  • Transportation
  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Partial Hospitalization
  • Other Health Care Professional
  • Cardiac Rehabilitation Services
  • Renal Dialysis
  • Blood
  • Medicare Part B Rx Drugs

 		 General
$50 monthly plan premium in addition to your $93.50 monthly Medicare Part B premium.

In-Network
$3000 out-of-pocket limit every year for benefits.

Out-of-Network
View the Summary of Benefits  for more details on what is covered out of network.

In and Out-of-Network
$500 yearly deductible for all benefits. This deductible applies to benefits you get in-network or out of network.
Yearly deductible applies to the following benefits:

  • Inpatient Hospital Care
  • Inpatient Mental Health Care
  • Skilled Nursing Facility
  • Home Health Care
  • Chiropractic Servicesblue cross freedom blue
  • Podiatry Services
  • Outpatient Mental Health Care
  • Outpatient Substance Abuse Care
  • Outpatient Services/Surgery
  • Ambulance Services
  • Outpatient Rehabilitation Services
  • Durable Medical Equipment
  • Prosthetic Devices
  • Diabetes Self-Monitoring Training and Supplies
  • Diagnostic Tests, X-Rays, and Lab Services
  • Hearing Servicesblue cross freedom blue
  • Transportation
  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Partial Hospitalization
  • Other Health Care Professional
  • Cardiac Rehabilitation Services
  • Renal Dialysis
  • Blood
  • Medicare Part B Rx Drugs

 
2 Doctor and Hospital Choice In-Network
No referral required for network doctors, specialists, and hospitals.
You may have to pay a separate copay for certain doctor office visits.

In and Out-of-Networkblue cross freedom blue
You can go to doctors, specialists, and hospitals in or out of the network. It will cost more to get out of network benefits.
 		 In-Network
No referral required for network doctors, specialists, and hospitals.
You may have to pay a separate copay for certain doctor office visits.blue cross freedom blue

In and Out-of-Network
You can go to doctors, specialists, and hospitals in or out of the network. It will cost more to get out of network benefits.
 
Inpatient Care
3 Inpatient Hospital Care In-Network
10 % of the cost for each Medicare-covered hospital stay
$0 copay for additional hospital days
No limit to the number of days covered by the plan each benefit period.blue cross freedom blue

Out-of-Network
10 % of the cost for each hospital stay.
 		 In-Network
10 % of the cost for each Medicare-covered hospital stay
$0 copay for additional hospital days
No limit to the number of days covered by the plan each benefit period.blue cross freedom blue

Out-of-Network
10 % of the cost for each hospital stay.
 
Outpatient Care
8 Doctor Office Visits General
See Section 32, "Routine Physical Exams," for more information.

In-Network
$10 copay for each primary care doctor visit for Medicare-covered benefits.
$10 copay for each specialist visit for Medicare-covered benefits.

Out-of-Network
20 % for each primary care doctor visit.
20 % for each specialist visit.blue cross freedom blue
 		 General
See Section 32, "Routine Physical Exams," for more information.

In-Network
$10 copay for each primary care doctor visit for Medicare-covered benefits.
$10 copay for each specialist visit for Medicare-covered benefits.

Out-of-Network
20 % for each primary care doctor visit.
20 % for each specialist visit.blue cross freedom blue
 
13 Outpatient Services/Surgery In-Network
10 % of the cost for each Medicare-covered ambulatory surgical center visit.
10 % of the cost for each Medicare-covered outpatient hospital facility visit.

Out-of-Network
20 % of the cost for ambulatory surgical center benefits.
 		 In-Network
10 % of the cost for each Medicare-covered ambulatory surgical center visit.
10 % of the cost for each Medicare-covered outpatient hospital facility visit.

Out-of-Network
20 % of the cost for ambulatory surgical center benefits.
 
14 Ambulance Services In-Network
10 % of the cost for Medicare-covered ambulance benefits.

Out-of-Network
20 % of the cost for ambulance benefits.blue cross freedom blue
 		 In-Network
10 % of the cost for Medicare-covered ambulance benefits.

Out-of-Network
20 % of the cost for ambulance benefits.blue cross freedom blue
 
Outpatient Medical Services and Supplies
18 Durable Medical Equipment In-Network
10 % of the cost for Medicare-covered items.

Out-of-Network
20 % of the cost for durable medical equipment.
 		 In-Network
10 % of the cost for Medicare-covered items.

Out-of-Network
20 % of the cost for durable medical equipment.
 
21 Diagnostic Tests, X-Rays, and Lab Services In-Network
10 % of the cost for Medicare-covered clinical/diagnostic lab benefits.
10 % of the cost for for Medicare-covered radiation therapy benefits.blue cross freedom blue
10 % of the cost for Medicare-covered X-rays.

Out-of-Network
20 % of the cost for clinical/diagnostic lab benefits.
20 % of the cost for radiation therapy benefits.
20 % of the cost for X-rays.
 		 In-Network
10 % of the cost for Medicare-covered clinical/diagnostic lab benefits.
10 % of the cost for for Medicare-covered radiation therapy benefits.blue cross freedom blue
10 % of the cost for Medicare-covered X-rays.

Out-of-Network
20 % of the cost for clinical/diagnostic lab benefits.
20 % of the cost for radiation therapy benefits.
20 % of the cost for X-rays.
 
Additional Benefits
28 Prescription Drugs General
This plan uses a formulary. A formulary is a list of drugs covered by the plan. If a plan takes a drug off the list; changes a drug on its list to a more expensive tier; or places a prior authorization, step therapy or quantity limit requirement on a drug, the plan will tell you at least 60 days before the change is effective. The plan will send you the formulary. You can also see the formulary at www.bluecrossca.com on the web.
Different out-of-pocket costs may apply for people who

  • have limited incomes,
  • live in long term care facilities, or
  • have access to Indian/Tribal/Urban (Indian Health Service).

Some drugs have quantity limits.blue cross freedom blue

In-Network
10 % of the cost of Part B-covered drugs.
$0 deductible.
Your provider must get prior authorization from Freedom Blue Plan I for certain drugs.
Some of the drugs covered by this plan do not count toward your out-of-pocket expenses.

Initial Coverage
You pay the following until total yearly drug costs reach $2400:

Retail Pharmacy
  • $10 copay for a one-month (30-day) supply of Generic drugs
  • $30 copay for a one-month (30-day) supply of Preferred Brand drugs
  • $60 copay for a one-month (30-day) supply of Non-Preferred Brand drugs
  • 30 % coinsurance for a one-month (30-day) supply of Non-Specialty Injectables drugs
  • 30 % coinsurance for a one-month (30-day) supply of Specialty Injectables drugs
  • $30 copay for a three-month (90-day) supply of Generic drugs
  • $90 copay for a three-month (90-day) supply of Preferred Brand drugs
  • $180 copay for a three-month (90-day) supply of Non-Preferred Brand drugs
  • 30 % coinsurance for a three-month (90-day) supply of Non-Specialty Injectables drugs
  • 30 % coinsurance for a three-month (90-day) supply of Specialty Injectables drugs

    Mail Order
  • $15 copay for a three-month (90-day) supply of Generic drugs from a preferred mail order pharmacy.
  • $75 copay for a three-month (90-day) supply of Preferred Brand drugs from a preferred mail order pharmacy.
  • $150 copay for a three-month (90-day) supply of Non-Preferred Brand drugs from a preferred mail order pharmacy.
  • 25 % coinsurance for a three-month (90-day) supply of Non-Specialty Injectables drugs from a preferred mail order pharmacy.
  • 25 % coinsurance for a three-month (90-day) supply of Specialty Injectables drugs from a preferred mail order pharmacy.blue cross freedom blue
  • $30 copay for a three-month (90-day) supply of Generic drugs from a non-preferred mail order pharmacy.
  • $90 copay for a three-month (90-day) supply of Preferred Brand drugs from a non-preferred mail order pharmacy.
  • $180 copay for a three-month (90-day) supply of Non-Preferred Brand drugs from a non-preferred mail order pharmacy.
  • 25 % coinsurance for a three-month (90-day) supply of Non-Specialty Injectables drugs from a non-preferred mail order pharmacy.
  • 25 % coinsurance for a three-month (90-day) supply of Specialty Injectables drugs from a non-preferred mail order pharmacy.

    Gap Coverage ("donut hole")

  • You pay the following:
  • $10 copay for a one-month (30-day) supply of Generic drugs
  • $30 copay for a three-month (90-day) supply of Generic drugs
  • $15 copay for a three-month (90-day) supply of Generic drugs from a preferred mail order
  • $30 copay for a three-month (90-day) supply of Generic drugs from a non-preferred mail order
    For all other covered drugs, after your total yearly drug costs reach $2400, you pay 100 % until your yearly out-of-pocket drug costs reach $3850.


    Catastrophic Coverage
    After your yearly out-of-pocket drug costs reach $ 3850, you pay the greater of:

    • $ 2.15 copay for generic (including brand drugs treated as generic) and $ 5.35 copay for all other drugs, or
    • 5 % coinsurance.

     
 General
This plan uses a formulary. A formulary is a list of drugs covered by the plan. If a plan takes a drug off the list; changes a drug on its list to a more expensive tier; or places a prior authorization, step therapy or quantity limit requirement on a drug, the plan will tell you at least 60 days before the change is effective. The plan will send you the formulary. You can also see the formulary at www.bluecrossca.com on the web.
Different out-of-pocket costs may apply for people who

  • have limited incomes,
  • live in long term care facilities, or
  • have access to Indian/Tribal/Urban (Indian Health Service).

Some drugs have quantity limits.blue cross freedom blue

In-Network
10 % of the cost of Part B-covered drugs.
$0 deductible.
Your provider must get prior authorization from Freedom Blue Plan II for certain drugs.
Some of the drugs covered by this plan do not count toward your out-of-pocket expenses.

Initial Coverage
You pay the following until total yearly drug costs reach $2400:

Retail Pharmacy
  • $10 copay for a one-month (30-day) supply of Generic drugs
  • $30 copay for a one-month (30-day) supply of Preferred Brand drugs
  • $60 copay for a one-month (30-day) supply of Non-Preferred Brand drugs
  • 30 % coinsurance for a one-month (30-day) supply of Non-Specialty Injectables drugs
  • 30 % coinsurance for a one-month (30-day) supply of Specialty Injectables drugs
  • $30 copay for a three-month (90-day) supply of Generic drugs
  • $90 copay for a three-month (90-day) supply of Preferred Brand drugs
  • $180 copay for a three-month (90-day) supply of Non-Preferred Brand drugs
  • 30 % coinsurance for a three-month (90-day) supply of Non-Specialty Injectables drugs
  • 30 % coinsurance for a three-month (90-day) supply of Specialty Injectables drugs

    Mail Order
  • $15 copay for a three-month (90-day) supply of Generic drugs from a preferred mail order pharmacy.
  • $75 copay for a three-month (90-day) supply of Preferred Brand drugs from a preferred mail order pharmacy.
  • $150 copay for a three-month (90-day) supply of Non-Preferred Brand drugs from a preferred mail order pharmacy.
  • 25 % coinsurance for a three-month (90-day) supply of Non-Specialty Injectables drugs from a preferred mail order pharmacy.
  • 25 % coinsurance for a three-month (90-day) supply of Specialty Injectables drugs from a preferred mail order pharmacy.blue cross freedom blue
  • $30 copay for a three-month (90-day) supply of Generic drugs from a non-preferred mail order pharmacy.
  • $90 copay for a three-month (90-day) supply of Preferred Brand drugs from a non-preferred mail order pharmacy.
  • $180 copay for a three-month (90-day) supply of Non-Preferred Brand drugs from a non-preferred mail order pharmacy.
  • 25 % coinsurance for a three-month (90-day) supply of Non-Specialty Injectables drugs from a non-preferred mail order pharmacy.
  • 25 % coinsurance for a three-month (90-day) supply of Specialty Injectables drugs from a non-preferred mail order pharmacy.

    Gap Coverage ("donut hole")

  • You pay the following:
  • $10 copay for a one-month (30-day) supply of Generic drugs
  • $30 copay for a three-month (90-day) supply of Generic drugs
  • $15 copay for a three-month (90-day) supply of Generic drugs from a preferred mail order
  • $30 copay for a three-month (90-day) supply of Generic drugs from a non-preferred mail order
    For all other covered drugs, after your total yearly drug costs reach $2400, you pay 100 % until your yearly out-of-pocket drug costs reach $3850.


    Catastrophic Coverage
    After your yearly out-of-pocket drug costs reach $ 3850, you pay the greater of:

    • $ 2.15 copay for generic (including brand drugs treated as generic) and $ 5.35 copay for all other drugs, or
    • 5 % coinsurance.

     
29 Dental Services In-Network blue cross freedom blue
Preventive Dental Benefits:
In general, preventive dental benefits (such as cleaning) not covered.

 		 In-Network blue cross freedom blue
Preventive Dental Benefits:
In general, preventive dental benefits (such as cleaning) not covered.

 
 
1Monthly Premiums and Estimated Annual Costs don't include any Medicare Part D (prescription drug) late enrollment penalty amounts that may apply to you.


2The Medicare Part B premium shown is the standard monthly Part B premium that most people will pay. Some people will pay a higher premium based on their modified adjusted gross income.

Medicare Part B Premium Information blue cross freedom blue

Starting January 1, 2007, most people will pay the standard monthly Part B premium listed in the chart below. However, some people will pay a higher premium based on their modified adjusted gross income.



If Your Yearly Income is You Pay
File Individual Tax Return File Joint Tax Return  
$80,000 or less $160,000 or less $93.50*
$80,001 - $100,000 $160,001 - $200,000 $105.80*
$100,001 - $150,000 $200,001 - $300,000 $124.40*
$150,001 - $200,000 $300,001 - $400,000 $142.90*
Above $200,000 Above $400,000 $161.40*
blue cross freedom blue

*There may be a late-enrollment penalty.

Page Last Updated: November 2, 2006
 
 
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Copyright © 2005 Oleg Skurskiy Authorized Independent Agent, CA License 0E50389
       
Blue CrossFreedom Blue PPO Blue Cross MediCareRx Health Net Orange Blue Shield Supplement
freedom blue
ACAMPO 95220
ACTON 93510
ADELAIDE 93446
ADELANTO 92301
ADIN 96006
AGUA DULCE 91350
AGUANGA 92536
AHWAHNEE 93601
ALAMO 94507
ALBANY 94706
ALBION 95410
ALHAMBRA 91801
ALHAMBRA 91803
ALISO VIEJO 92656
ALLEGHANY 95910
ALPINE 91901
ALTA 95701
ALTA LOMA 91701
ALTA LOMA 91737
ALTADENA 91001
ALTURAS 96101
ALVISO 95002
AMBOY 92304
AMERICAN CANYON 94589
ANAHEIM 92801
ANAHEIM 92802
ANAHEIM 92804 - 92808
ANDERSON 96007
ANGELS CAMP 95222
ANGELUS OAKS 92305
ANGWIN 94508
ANNAPOLIS 95412
ANTIOCH 94509
ANZA 92539
APPLE VALLEY 92307-92308
APPLEGATE 95703
APTOS 95003
ARBUCKLE 95912
ARCADIA 91006
ARCADIA 91007
ARGUS 93562
ARLETA 91331
ARMONA 93202