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We are pleased to offer you the following quote for your Medicare supplement coverage.  We represent  Wellmark Blue Cross and Blue Shield of South Dakota who offers the Plan F Medicare supplement coverage at a monthly premium of $PlanF$.  The premium quoted is based on you being eligible for the coverage and your age of $Age$ . 

The Wellmark Blue Cross Blue Shield coverage called "Senior Blue" could be just right for you, for a variety of reasons. Medicare supplement plans are standardized, which means you get the same plan with the same benefits from any insurer. But Senior Blue is more than just standard benefits.  It is the security you can find with The Blues®.  It is outstanding customer service from dedicated service representatives.  The benefits are easy to understand, easy to use, and has worldwide acceptance. Your Senior Blue coverage goes where you go.

Here's what current Wellmark Blue Cross and Blue Shield customers are buying during the open enrollment period.   The monthly premium is shown for each plan based on you being eligible for the coverage and your age of $Age$.

Plan A - less than 1%  Premium: $PlanA$ Plan F - 87%   Premium: $PlanF$   
Plan C - 1%   Premium: $PlanC$ Plan G - less than 1%  Premium: $PlanG$
Plan E - 2%  Premium: $PlanE$ Plan J - 10%  Premium: $PlanJ$

Thank you for reviewing our Senior Blue Medicare Supplement proposal.  We think you will get the most coverage for your money with Plan F at the monthly premium of $PlanF$ for your age $Age$.  

Please stop by the office to purchase the policy, or simply follow directions on the enclosed application.  If you have any questions or need help filling out the application, call me or $ProducerHelper$ at $AgencyPhone1$.  

If you want one of us to stop by your office or home to discuss the coverage or complete the application, please call for an appointment.

Sincerely,

 

$Producer$

 

What does Medicare Pay?    What does Plan F Pay?   What do you PaY  ?


Part A
is hospital insurance and covers costs associated with confinement in a hospital or skilled nursing facility.
 
When you are hospitalized for: Medicare Pays: Plan F Pays: You Pay:
1-60 days Most confinement costs AFTER the required Medicare Deductible. $840 Deductible $0
61-90 days All eligible expenses, AFTER the patient pays a per-day co-payment $210 per day Co-payment as much as $6,300 total $0
91-150 days All eligible expenses, AFTER patient pays a per-day co-payment. (these are Lifetime Reserve days which may never be used again) $420.00 per day Co-payment as much as $25,200 total $0
Once lifetime reserve days are used.  Additional 365 days $0 100% of Medicare Eligible Expenses $0
Beyond the additional 365 days $0 $0 You pay all costs
At least 3 days in a hospital and then enter a Medicare approved Skilled Nursing Facility within 30 days after hospital discharge.  
1-20 days All approved amounts $0 $0
21-100 days All but $105 per day Up to $105 per day $0
101st day and after $0 $0 You pay all costs
Blood  
First 3 pints $0 3 pints $0
Additional amounts 100% $0 $0
Hospice Care - as long as your doctor certifies you are terminally ill and you elect to receive these services All but very limited coinsurance for outpatient drugs and inpatient respite care $0 You pay the Balance

 

Part B covers costs associated with medical services and some preventive services. 
 
When you require services for:  Medicare Pays: Plan F Pays: You Pay:
Doctor Office Visits
Lab Tests Outside Hospitals
Surgeon's Fee
Anesthesiologist's Fee
Doctor Visits in Hospitals
Doctor Visits in Nursing Facilities
Ambulance
Speech Therapy
Mammography Screening
 
First $100 of Medicare approved amounts $0 $100 Part B Deductible $0
Remainder of Medicare approved amounts Generally 80% 20% $0
Part B Excess Charges (above the Medicare approved amounts) $0 100% $0
Blood  
First 3 pints $0 All Costs $0
Next $100 of Medicare approved amounts $0 $100 Part B Deductible $0
Remainder of Medicare approved amounts Generally 80% 20% $0
Clinical Laboratory Services  
Blood tests for diagnostic services Generally 100% $0 $0
Home Health Care  
Medically necessary skilled care services and medical supplies Generally 100% $0 $0
Durable medical equipment  
  First $100 of Medicare approved amounts $0 $100 Part B Deductible $0
  Remainder of Medicare approved amounts Generally 80% 20% $0
Foreign Travel Not Covered By Medicare  -  Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA  
First $250 each calendar year $0 $0 $250
Remainder of charges $0 80% to a lifetime maximum benefit of $50,000 20% and all amounts over the $50,000 lifetime maximum benefit

and there's more.........

When you enroll in the Senior Blue Medicare supplement, you are automatically a member of the Blue Plus Club.  Just another reason “You Just Can’t Beat the Blues.®"

Blue Plus Club membership-it's automatic and free for Senior Blue® members. You don't have to fill out an enrollment form and your membership in the club doesn't cost a thing.

As a Blue Plus Club member you can enjoy the following benefits:
 

WellScript SM Prescription Drug Discount Program

What is it?
Most seniors need to fill prescriptions at least occasionally during the year-and many use prescription drugs consistently. Therefore, Wellmark has contracted with Advance PCS to provide the WellScript Prescription Drug Discount Program. Advance PCS manages the Advance Rx network of pharmacies, which has more than 58,000 pharmacies nationwide.

How does it work?
Just present your Blue Plus Club and Wellmark ID cards at participating Advance Rx pharmacies and you'll receive the lower of the WellScript discount price or the current retail sale price. It is important that you show your Wellmark ID card and your Blue Plus Club card to the pharmacist. Your Blue Plus Club card shows the Advance PCS logo-something your pharmacist will look for to know you are eligible for a discount.

It's more than just a discount
Pharmacies who participate in the Advance Rx network have access to Advance PCS's up-to-date computer information system. Using this system, pharmacists can review prescriptions dispensed to you by other Advance Rx pharmacies to check for known allergic reactions, duplicative therapies or drug interactions. Remember, the following two criteria must be met for a prescription to be tracked by the computer system: you must show the pharmacist your Wellmark and Blue Plus Club ID cards when you order the prescription, and the prescription must be filled by an Advance Rx pharmacy.


Mail Order Prescriptions
Senior Blue and Senior Blue Select members can have their prescriptions mailed to their homes by following these simple steps.

1. Call or visit your doctor and ask that he or she prescribe up to the maximum supply (a 90-day supply) of your prescription.

2. Call AdvancePCS-one of the nation's largest pharmacy benefit managers-toll free at 1-800-929-2524 to find out the cost of your prescription.

3. Complete the AdvancePCS Mail Order Form found in your New Member package (call 1-888-335-1197 if you need a Mail Order Form).

4. Mail your prescription, order form and payment to AdvancePCS. You may pay with MasterCard, Visa, check or money order.

You'll receive your prescription approximately 10 to 14 days from the date you mail your order. You'll also receive another order form and a refill notice. The notice will tell you how many refills are left on your prescription.

This mail-order service is not designed for customers with health conditions that require immediate medication. Mail-order service is best used for maintenance (long-term) and other regularly taken prescription medications. 

Eye Care and Eyewear Discounts   Save 10% to 60%

Through the Blue Plus Club, you'll have access to eye care professionals nationwide, including independent optical locations, national and regional chains, and department store locations. Here are a few examples of the many participating providers:

Lenscrafters
Pearle Vision
Midwest Vision Center (Iowa only)
Service Optical
Vogue Vision
Whylie Eye Care
Sears
JC Penney
Shopko (South Dakota only)
Vista Optical (South Dakota only)

Qualified Providers
Coast to Coast Vision, the eye care and eyewear vendor with whom we contract, reviews all providers to ensure they are able to provide you with the best service possible. Periodic member satisfaction surveys, conducted by Coast to Coast, help maintain a high level of quality and service. At some time you may be asked to complete a member satisfaction survey about your experiences.

Savings and Satisfaction
We're not satisfied until you are. If for any reason you aren't happy with any covered eyewear you purchase from a participating retail location or through the mail, you may return the merchandise within 30 days for an exchange or complete refund. Coast to Coast's low price guarantee specifies that if you find a lower price anywhere else for the exact same complete pair or prescription eyeglasses purchased at a participating location, the difference will be cheerfully refunded. Just contact Coast to Coast at 1-800-800-3937. It's Easy to Save

Prescription Eyewear

1. Call 1-800-800-EYES (3937) for a list of the participating eye care providers in your area. Be prepared to provide the representative your zip code and member number (this is the same as your Senior Blue/Senior Blue Select member number, shown on your Wellmark identification card).

2. You may also contact a customer service representative at 1-800-245-6106 in Iowa; or 1-800-831-4818 in South Dakota.

3. When you visit participating providers, just show them your Blue Plus Club card, that shows the "Coast to Coast" logo, to receive your discount.

Replacement Contacts

1. Call America's Eyewear at 1-800-878-3901 for a price quote or to place an order. Please call Monday through Friday from 8:30 a.m. to 5:30 p.m. Central Standard Time.

2. You must give the service representative the brand name and type of lenses you wish to order.

3. Federal law requires that you mail or fax a copy of your prescription to the contact lens company before you place an order. Once the prescription is on file, you can order as needed until the prescription expires.           

America's Eyewear                        Fax: 1-972-503-5671
P.O. Box 810255
Farmers Branch, TX 75381                                         

4. Most of your orders will be shipped within 48 hours via overnight delivery. You may pay by Visa, MasterCard, Discover, American Express, check or money order.

Non-prescription Sunglasses

1. Call America's Eyewear at 1-800-878-3901 for a price quote or to place an order. Please call Monday through Friday from 8:30 a.m. to 5:30 p.m.

2. Provide the representative with the brand name and model number of the sunglasses you wish to order. This information is listed on the tags attached to most sunglasses at retail locations.

3. Most of your orders will be shipped within 48 hours. You may pay by Visa, MasterCard, Discover, American Express, money order, or check.

Vitamins, Nutritional Supplements, Over-the-Counter Medicine, Health and Beauty Items

You can expect to save up to 60 percent off the suggested retail price which is usually 10 to 20 percent lower than prices in most discount stores, chain drug stores and health food stores. In addition, you'll receive an extra discount with your first order.   To Use:

1. Call 1-800-838-4584 to request a free catalog or to place an order.
2. Orders are usually filled within 48 hours.
3. A $3.50 shipping and handling charge applies to all orders under $60.
4. You may pay with Visa, MasterCard, American Express, check or money order.

Your Satisfaction Is Important
If you are not satisfied, for any reason, just return the unused portion to Healthcare Product Distributors who will send you a complete refund.
 

Home Medical Equipment Discounts

Use the Blue Plus Club medical equipment discount to lower your out-of-pocket expenses on home medical equipment. You can purchase home medical equipment and supplies, health and fitness supplies*, and orthopedic supplies that are not covered by Medicare or your Medicare supplement at a discount of 20 percent off the current retail price.

You can receive the 20 percent discount just by presenting your Blue Plus Club ID card at any participating medical equipment company. The discount applies only to supplies that are not covered by Medicare or your Medicare supplement plan, and does not apply to fixed custom equipment items.

No matter where you live--across the street from one of the locations or across the state--free delivery may be available. Just check with the participating vendor of your choice.

Professional home medical equipment experts are available to help you make the right decision when you need to purchase or rent medical equipment and supplies. If you have any questions, just call one of the Blue Plus Club participating vendors.

Eligibility requirements For the Senior Blue Medicare Supplement Program

To be eligible for coverage, those enrolling must:

Be a South Dakota resident

Be enrolled in Medicare Part A and Part B

If you enroll within the first six months of Medicare enrollment, you do not have to answer health questions and are qualified for whichever plan you desire.

If you are past the six-month open enrollment and lost other health insurance you are eligible for Plan A, B, C or F without answering health questions if you apply within 63 days from the date your old policy expires.

If you do not enroll within the first six months after electing Medicare Part A and Part B,  you have to answer the health questions, which determines which plan you will qualify for. 

For your age $Age$, the guarantee issue Plan C has a monthly premium of $PlanCG$ for those who missed the open enrollment and do not qualify for standard plans because of health problems.

If you are covered by another Medicare supplement policy at the time this policy is issued, you do not qualify unless you intend to replace your other policy.  You can only have one Medicare supplement policy.

 

Wellmark Blue Cross and Blue Shield does not provide benefits for:
  • Services not allowed by Medicare as benefits, except as specified in the policy
  • Services denied by Medicare, except as specified in the policy
  • Services which would duplicate benefits provided by Medicare.

 

Please note: This information is only a summary of the benefits of Senior Blue Medicare Supplement coverage from Wellmark Blue Cross and Blue Shield; it is to be used for descriptive purposes only. Benefits and general provisions described here are subject to terms of the actual benefits policy.  Discounts and services through Blue Plus Club are not insurance.  They are available through contracts with named vendors.

Summary of all six plans with current premiums for your age $age$ 

Medicare Does Not Cover:

Senior Blue Plans Cover:   
 

A

C

E

F

G

J

Part A Hospital Services            
Initial hospital deductible each benefit period  

X

X

X

X

X

Co-payment for days 61-90 in a hospital

X

X

X

X

X

X

Co-payment for days 91-150 in a hospital

X

X

X

X

X

X

100% of Medicare-allowable expenses for additional 365 days after Medicare hospital benefits stop completely

X

X

X

X

X

X

Calendar year blood deductible (first 3 pints of blood) if the deductible is not met by the replacement of blood

X

X

X

X

X

X

Copayment for days 21-100 in a skilled nursing facility  

X

X

X

X

X


Part B Physician and Medical Services
           
$100 Part B deductible  

X

 

X

 

X

20% of Medicare-approved amount after $100 Part B deductible is met

X

X

X

X

X

X

100% of Medicare Part B excess charges      

X

 

X

80% of Medicare Part B excess charges        

X

 

Additional Benefits Not Covered by Medicare
           
At-home recovery benefits (up to $1,600 per calendar year)        

X

X

Benefits for medically necessary emergency care received in a foreign country (80% up to $50,000 lifetime maximum after $250 deductible)  

X

X

X

X

X

Outpatient prescription drug benefits per year (50% of up to $6,000 in charges after $250 deductible)          

X

Preventive care services including an annual clinical examination and preventive tests, up to $120 per year    

X

   

X

             
Monthly Premium for each plan at your age $Age$  $PlanA$ $PlanC$ $PlanE$ $PlanF$ $PlanG$ $PlanJ$
Guaranteed Issue Medicare Supplement
at your age $Age$
 na $PlanCG$ na na na na

 

Explanation of Medicare from the Handbook
"Medicare & You 2003"
 

The Original Medicare Plan is a "fee-for-service" plan. This means you are usually charged a fee for each health care service or supply you get. This plan, managed by the Federal Government, is available nationwide.  If you are happy getting your health care this way, you do not have to change. You will stay in the Original Medicare Plan unless you choose to join a Medicare Managed Care Plan or Medicare Private Fee-for-Service Plan.  Your medicare office will have complete information on choices available to you.

How does the Original Medicare Plan work?

You may go to any doctor, specialist, or hospital that accepts Medicare. Generally, a fee is charged each time you get a service. 

If you have Part A, you get all the Medicare Part A covered services. 

If you pay the monthly Part B premium ($58.70 in 2003), you get all the Medicare Part B covered services. 

You pay a set amount for your health care (deductible) before Medicare pays its part. Then, Medicare pays its share, and you pay your share (coinsurance or co-payment). 

What you pay out-of-pocket depends on: 

How often you need health care. 

What type of health care you need. 

Whether you get services or supplies not covered by Medicare. 

Whether you have Part A and Part B. 

Whether your doctor or supplier agrees to accept assignment.    Assignment is an agreement between Medicare, and doctors, other health care providers, and suppliers of health care equipment and supplies (like wheelchairs, oxygen, braces, and ostomy supplies). Doctors, providers, and suppliers who agree to accept assignment accept the Medicare-approved amount as payment in full for Part B services and supplies. You pay the coinsurance and deductible amounts. In some cases (such as for Medicare-covered ambulance services), your health care providers and suppliers must accept assignment. 

If assignment is not accepted, charges are often higher. This means you may pay more. In addition, you may have to pay the entire charge at the time of service. Doctors and suppliers must submit your claim to Medicare. Medicare will then send you its share of the charge. 

For most services, there is a limit on the amount your doctors and providers can bill you. The highest amount of money you can be charged for a Medicare covered service by doctors and other health care providers who don't accept assignment is called the limiting charge. The limit is 15% over Medicare's approved amount. The limiting charge only applies to certain services and does not apply to supplies or equipment. 

Note: In most cases, Medicare does not pay for health care you get while traveling outside of the United States.

What does MEDICARE pay and what do YOU pay?

Medicare Part A (Hospital Insurance) Helps Pay For

Hospital Stays
Skilled Nursing Facility (SNF) Care
Home Health Care 
Hospice Care
Blood 

What hospital expenses YOU Pay in 2003 for Part A in the Original Medicare Plan 

For Hospital Stays  each benefit period YOU pay

A total of $840 for a hospital stay of 1-60 days. 

$210 per day for days 61-90 of a hospital stay. 

$420 per day for days 91-150 of a hospital stay. These are considered lifetime reserve days, and these 60 reserve days can be used only once during your lifetime.

All costs for each day beyond 150 days.

For Skilled Nursing Facility (SNF) Care  each benefit period YOU pay: 

Nothing for the first 20 days. 

Up to $105 per day for days 21-100. 

All costs beyond the 100th day in the benefit period. 

For Home Health Care YOU pay: 

Nothing for home health care services. 

20% of the Medicare-approved amount for durable medical equipment. 

For Hospice Care YOU pay:

a co-payment of up to $5 for outpatient prescription drugs and 5% of the Medicare-approved amount for inpatient respite care (short-term care given to a hospice patient so that the usual caregiver can rest). The amount you pay for respite care can change each year. Room and board are generally not payable by Medicare except in certain cases. For example, room and board are not covered if you receive general hospice services while a resident of a nursing home or a hospice's residential facility. However, room and board are covered for inpatient respite care and during short-term hospital stays. 

For Blood YOU pay:

for the first 3 pints of blood, unless you or someone else donates blood to replace what you use. 

 

Medicare Part B (Medical  Insurance)  

What Medical Expenses YOU Pay in 2003 for Part B in the Original Medicare Plan

For Medical and Other services each year YOU pay: 

$100 deductible (once per calendar year). 

20% of Medicare-approved amount after the deductible (if the doctor or provider accepts "assignment," see the note earlier). 

20% for all outpatient physical, occupational, and speech-language therapy services. 

50% for outpatient mental health care.

For Clinical Laboratory Services YOU pay:

nothing for Medicare-approved services. 

For Home Health Care YOU pay: 

Nothing for Medicare-approved services. 

20% of the Medicare-approved amount for durable medical equipment. 

For Outpatient Hospital Services YOU pay:

a coinsurance or co-payment amount, which may vary according to the service. 

For Blood YOU pay:

for the first 3 pints of blood, then 20% of the Medicare-approved amount for additional pints of blood (after the deductible), unless you or someone else donates blood to replace what you use. 

What Covered Preventive Services YOU Pay in 2003 for Part B in the Original Medicare Plan

For Bone Mass Measurements, 20% of the Medicare-approved amount (or a co-payment amount) after the yearly Part B deductible. 

For Colorectal Cancer Screening, nothing for the fecal occult blood test. For all other tests, 20% of the Medicare approved amount after the yearly Part B deductible. For flexible sigmoidoscopy or colonoscopy, you pay 25% of the Medicare-approved amount if the test is done in a hospital outpatient department. 

For Diabetes Services and Supplies, 20% of the Medicare-approved amount after the yearly Part B deductible. 

For Glaucoma Screening, 20% of the Medicare-approved amount after the yearly Part B deductible. 

 

For Mammogram Screening, 20% of the Medicare-approved amount after the yearly Part B deductible.

For Pap Test, Clinical Breast Exam, and Pelvic Examination, nothing for the Pap lab test. For Pap test collection, and pelvic and breast exams,  20% of the Medicare-approved amount (or a co-payment amount) with no Part B deductible. 

For Prostate Cancer Screening, Generally, 20% of the Medicare-approved amount for the digital rectal exam after  the yearly Part B deductible. No coinsurance and no Part B deductible for the PSA (Prostate Specific Antigen) Test. 

For Shots (vaccinations), nothing for flu and pneumococcal pneumonia shots if the health care provider accepts assignment (see note earlier). For Hepatitis B shots, 20% of the Medicare approved amount (or a co-payment amount) after the yearly Part B deductible. 

What is not paid by Medicare  Part A  and  Part B ?

The Original Medicare Plan does not cover everything. Health care costs that are not covered include, but are not limited to:

Acupuncture
Deductibles, coinsurance, or co-payments when you get health care services
Dental care and dentures (with only a few exceptions)
Cosmetic surgery
Custodial care (help with bathing, dressing, using the bathroom, and  eating) at home or in a nursing home
Health care you get while traveling outside of the United States  (except in limited cases)
Hearing aids and hearing exams
Long-term care, such as most nursing home care
Orthopedic shoes (with only a few exceptions)
Outpatient prescription drugs (with only a few exceptions)
Routine foot care (with only a few exceptions)
Routine eye care and most eyeglasses
Routine or yearly physical exams
Screening tests except those permitted
Shots (vaccinations) except those permitted
Some diabetic supplies (like syringes or insulin unless it is used with  an insulin pump

The above information is from an 82 page handbook titled "Medicare & You - 2003" published by the U.S. Department of Health and Human Services.  The above information is not complete, but serves to provide an initial understanding of the Original Medicare Plan available to people age 65 or older.  For more complete information or to order your free copy of the handbook or other medicare publications, call your Medicare office at 1-800-633-4227 (option #4) or go to http://www.medicare.gov/ on the internet.

 

 

$FullName$ $FullAddress$ $CityStateZip$

Quoted on   $today$  by signing producer $Producer$ and helper producer of $ProducerHelper$

Quoted   Wellmark  Blue Cross  Blue Shield   Senior Blue Medicare Supplement

Issue age of  $Age$      

Plan A  premium  of  $PlanA$
Plan C  premium  of  $PlanC$
Plan E  premium  of  $PlanE$
Plan F  premium  of  $PlanF$
Plan G  premium  of  $PlanG$
Plan J  premium  of  $PlanJ$
Plan C Guaranteed Issue premium of $PlanCG$

_____PRINT THE CLIENT APPLICATION TO SEND WITH THE PROPOSAL. ALSO INCLUDE A POSTAGE FREE RETURN ENVELOPE.

$FullName$ $FullAddress$ $CityStateZip$

$FullName$ $FullAddress$ $CityStateZip$

$FullName$ $FullAddress$ $CityStateZip$

$FullName$ $FullAddress$ $CityStateZip$

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