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Legal

CMS Disclaimer

Empire BlueCross BlueShield is an LPPO plan and an HMO plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal.

The Medicare contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed. You are eligible to enroll if you are entitled to Medicare Part A and enrolled in Medicare Part B and you live in the service area. You must continue to pay your Medicare Part B premium.

Medicare beneficiaries may enroll in Medicare Advantage Prescription Drug (MA-PD) plans and Medicare Part D (PDP) plans through the CMS Medicare Online Enrollment Center, located at www.medicare.gov. For more information please contact Customer Service.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply.

Benefits, formulary, pharmacy network, provider network, premium and or co-payments/co-insurance may change on January 1 of each year.

All Medicare Advantage plans and Medicare Part D plans agree to stay in the program for a full calendar year at a time. Plan benefits and cost-sharing my change from calendar year to calendar year. Each year, plans can decide whether to continue to participate with Medicare Advantage or Medicare Part D. A plan may continue in their entire service area (geographic area where the plan accepts members) or choose to continue only in certain areas. Also, Medicare may decide to end a contract with a plan. Even if your Medicare Advantage plan or Medicare Part D plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue for an additional calendar year, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.

Grievances and Appeals Disclaimer

Information on the Grievances and Appeals Process:
For information on our Grievance and Appeals Process, please see the section of your Evidence of Coverage (EOC) document titled "What to Do If You Have a Problem or Complaint (Coverage Decisions, Appeals, Complaints)".This section of your EOC document explains how to ask for coverage decisions and make appeals if you are having trouble getting the medical care or prescription drugs you think are covered by our plan. This includes asking us to make exceptions to the rules or extra restrictions on your coverage for prescription drugs, and asking us to keep covering hospital care and certain types of medical services if you think your coverage is ending too soon. The EOC document also explains how to make complaints about quality of care, waiting times, customer service, and other concerns.

 

Current members who wish to file a written grievance should submit their information to Grievances & Appeals.

 

To obtain an aggregate number of grievances, appeals and exceptions filed or for full information on benefits, please call Customer Service.

 

If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for it take effect and you will ultimately be held responsible for those premiums.

Evidence of Coverage Disclaimer

Evidence of Coverage:

Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits. If you have special needs, our Plan documents may be available in other formats. Please call Customer Care for details.

For information on provisions for non routine access to covered Part D drugs at out-of-network pharmacies, including limits and financial responsibility for access to these drugs please reference your Evidence of Coverage, or call Customer Care.

Customer Service

Disclaimer for the "Find a Pharmacy" search tool:

If you are not a member, you can use this "Find a Pharmacy" search tool to locate the pharmacies in your area that participate in our Medicare Advantage Prescription Drug (MA-PD) or Medicare Part D (PDP) Plans.

If you are already a plan member with Medicare Part D coverage, you can use this "Find a Pharmacy" search tool to search for participating pharmacies and obtain contact information and driving directions.

Our plans feature more than 69,000 pharmacies in our network. Generally, you must use network pharmacies to receive plan coverage. Our network includes both preferred retail and network retail pharmacies. You are never far from one of our network pharmacies; but to pay a lower amount, you should go to one of the preferred pharmacies. Network retail pharmacies are still in our network but do not offer the discounted prices available at preferred pharmacies. 

Members: Please note that our plans have contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. In addition, even though a pharmacy is listed in network, this does not guarantee that the pharmacy is still in the network.

The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed. You are eligible to enroll if you are entitled to Medicare Part A and/or enrolled in Medicare Part B and you live in the service area. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. With some exceptions you can only enroll during certain times of the year.

If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for it to take effect and you will ultimately be held responsible for those premiums.

Medicare beneficiaries may enroll in Medicare Advantage Prescription Drug (MA-PD) plans and Medicare Part D (PDP) plans through the CMS Medicare Online Enrollment Center, located at www.medicare.gov. For more information please contact Customer Service.

To obtain an aggregate number of grievances, appeals and exceptions filed or for full information on benefits, please call Customer Service. Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits.

If you have special needs, our Plan documents may be available in other formats. Please call Customer Service for details.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778;
  • or Your State Medicaid Office.

If you have qualified for additional assistance for your Medicare Prescription Drug Plan costs, the amount of your premium and cost at the pharmacy will be less. Once you have enrolled in Blue MedicareRx (PDP), Medicare will tell us how much assistance you are receiving, and we will send you information on the amount you will pay. If you are not receiving this additional assistance, you should contact 1-800-MEDICARE (TTY/TTD users call 1-877-486-2048), your state Medicaid Office, or local Social Security Administration Office to see if you might qualify.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.

Limitations, copayments, and restrictions may apply.

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year.

Disclaimer for "Find your covered drugs" search tool:

What Prescription Drugs are Covered?
A drug list (also called a formulary) is a list of drugs selected by us in consultation with a team of health care providers, which represent prescription therapies believed to be a necessary part of a quality treatment program. Your plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy and other plan rules are followed.

The Medicare Advantage with Prescription Drug (MA-PD) plans and Medicare Prescription Drug plans (PDPs) cover both brand-name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs and are approved by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.

Note: The drug list may change during the year. All changes are subject to the policy issued by the Centers for Medicare and Medicaid Services (CMS) and can only occur when specific guidelines are met.

For information on how to obtain an exception to the plan’s drug list, utilization management tools, or tiered cost-sharing please reference your Evidence of Coverage or contact Customer Service.

The drug costs displayed represent a 30 day supply, and are only estimates. Actual costs may vary based on the specific quantity, strength and/or dosage of the drug.

For information on provisions for non routine access to covered Part D drugs at out-of-network pharmacies, including limits and financial responsibility for access to these drugs please reference your EOC, or call Customer Service.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan.

Limitations, copayments, and restrictions may apply.

Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.

Plan Documents Disclaimer

Additional Information about the Medicare Advantage (MA), Medicare Advantage Prescription Drug (MA-PD)  and Prescription Drug (PDP) Plan Documents:

For more information about receiving extra help to pay for your prescription drug coverage:
In certain cases, CMS systems do not reflect a beneficiary's correct low-income subsidy (LIS) status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan. In order to address these special situations, CMS has created the Best Available Evidence (BAE) policy. This policy requires Part D plans to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate. For more information about this CMS policy, click here 

Appointing a representative:
An appointed representative is a relative, friend, advocate, doctor or other person authorized to act on your behalf in obtaining a grievance, coverage determination or appeal.

Those not authorized under state law to act for you will need to sign an Appointment of Representative Form and mail or fax it to Customer Care.

Part D Contract Renewal
Our prescription drug plan (PDP) has a Medicare contract.  Since contracts with Medicare are renewed annually, Prescription Drug Plans cannot guarantee availability of coverage beyond the end of their current contract year.

If our Medicare contract is terminated or if we stop offering Prescription Drug Plan (PDP) benefits, we will give you written notice of when that change will be effective. We will also provide you with information about alternative Prescription Drug Plans in your area, and the steps you need to take to continue your prescription drug coverage with Medicare. At that time, you would be eligible for a Special Enrollment Period, and could choose a new PDP sponsor without being subject to a late enrollment penalty.

Part D Contract Termination Procedures
All Medicare Prescription Drug Plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Prescription Drug Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 60 days before your coverage will end. The letter will explain your options for Medicare prescription drug coverage in your area. 

Service Area Disclaimer - NY (Empire BlueCross BlueShield)

In New York, these are the Service Areas for Medicare Advantage (MA) plans and Medicare Advantage with Prescription Drug (MA-PD) plans offered by Empire BlueCross BlueShield:

Empire MediBlue Plus (HMO) – Contract H3370-001:
Our service area includes these counties in New York:
Bronx, Kings, New York, Queens, and Richmond

Empire MediBlue Select (HMO) – Contract H3370-002:
Our service area includes these counties in New York:
Putnam, Rockland, and Westchester

Empire MediBlue Plus (HMO) – Contract H3370-003:
Our service area includes this county in New York:
Nassau

Empire MediBlue Plus (HMO) – Contract H3370-004:
Our service area includes this county in New York:
Suffolk

Empire MediBlue Essential (HMO) – Contract H3370-019:
Our service area includes these counties in New York:
Bronx, Kings, Queens, Richmond and Westchester

Empire MediBlue Freedom I (PPO) – Contract H3342 012:
Our service area includes these counties in New York:
Bronx, Kings, Nassau, Richmond, Rockland, and Suffolk

Empire MediBlue Freedom II (PPO) – Contract H3342-013:
Our service area includes these counties in New York:
Bronx and Richmond

Empire MediBlue Freedom III (PPO) – Contract H3342-001:
Our service area includes these counties in New York:
Bronx and Richmond

Enrollment Instructions

How to Enroll  in a Plan:     
You have three options for enrolling: online, by phone, or by mail or fax.
If you choose to print the enrollment form, and then apply by mail or fax, review the Enrollment Instructions for information on where to submit the form.

Legal Disclaimer Terms of Use - NY EBCBS

This online store is owned and operated by Empire BlueCross BlueShield. By using this online store, you acknowledge and agree to abide by all of these terms of use.  The insurance products described in this online store are offered only to persons over the age of 18 and who are residents of New York. You must be a resident of the state where the policy is offered.  The Medicare Supplement products are not connected with or endorsed by the U.S. Government or the federal Medicare program.  The purpose of this communication is the solicitation of insurance.  Contact will be made by an insurance agent or an insurance company if you submit a request for more information or an application. This site is intended for consumer and informational use only. We do not guarantee to provide you coverage and we reserve the right to reject your application based on applicable enrollment and eligibility criteria specific to Medicare Advantage, Part D or Medicare Supplement Products.  Do not cancel your existing insurance until you receive written confirmation from Empire BlueCross BlueShield that your application has been approved and your policy is in effect.  Your completion of the online enrollment process constitutes your acceptance of the applicable policy should we approve your application. Your enrollment/acceptance constitutes your authorization for the initial and recurring premium payment by credit card or automatic bank draft, should you select those methods. 

The insurance product that we offer to you through this online store is based, in part, on the zip code that you provide. You accept sole responsibility for entering the proper zip code into the shopping experience. You are responsible for maintaining the confidentiality of your username and password for this online store and for restricting access to your computer.  You acknowledge and agree that neither Empire BlueCross BlueShield nor any of its affiliates will have any liability to you for any unauthorized application, enrollment or credit card transaction made using your username and password if such transaction occurs before you have notified us of possible unauthorized use and we had a reasonable period of time to act on that notice. Further, we may suspend or cancel your account or your access to the Site at any time even without receiving notice from you if we suspect that your account and/or password is being used in an unauthorized or fraudulent manner. Empire BlueCross BlueShield may, in its sole discretion, change, suspend or terminate, temporarily or permanently, the online store (in part or in full), for any reason, without notice and without liability to you.  If another party is providing information on behalf of the consumer as part of the application or enrollment process, the party meets applicable laws regarding authorized representatives, and the party entering such information hereby agrees to accept all liability that may arise from providing us inaccurate information and/or selecting the proper/improper product.

DISCLAIMER OF WARRANTIES: YOU AGREE THAT ALL CONTENT PROVIDED ON OR THROUGH THIS ONLINE STORE IS PROVIDED “AS IS”.  EMPIRE BLUECROSS BLUESHIELD AND ITS AFFILIATES DISCLAIM ALL WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED.  NEITHER EMPIRE BLUE CROSS AND BLUE SHIELD, ITS AFFILIATES AND RELATED ENTITIES, NOR ANY OF THEIR RESPECTIVE EMPLOYEES, AGENTS, THIRD PARTY CONTENT PROVIDERS OR LICENSORS WARRANT THAT THIS ONLINE STORE WILL BE UNINTERRUPTED, TIMELY, SECURE OR ERROR FREE; THAT ANY DEFECTS OR ERRORS WILL BE CORRECTED; THAT THE CONTENT OR SERVICE IS FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS. LIMITATION OF LIABILITY: NEITHER EMPIRE BLUECROSS BLUESHIELD NOR ITS EMPLOYEES SHALL BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES RESULTING FROM THE USE OR INABILITY TO USE THIS SITE.