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Blue Cross Freedom Blue PPO 2009
New To Anthem Blue Cross ? , please call (818) 654-4548 Oleg Skurskiy

Freedom Blue PPO Online Application

Enrollment Application 2009 year printable

You also can fax complete application to Fax # : 1-818-776-9865

 

Freedom Blue PPO

Freedom Blue PPO Summary of Benefits 2009

Blue Cross Freedom Blue Application

Freedom Blue PPO Application 2009 YEAR


Freedom Blue PPO (RPPO) Details 2009


 
Plan Brochure
Summary of Benefits
Evidence of Coverage
Freedom Blue Plan I 
PDF Format 
PDF Format 
PDF Format 
 
Unlike an HMO, Freedom Blue is a PPO plan that allows you the freedom to see any physician or specialist from our large network of participating providers without a referral.
 
ORIGINAL MEDICARE
FREEDOM BLUE PLAN 1

  Premium

In 2008, the monthly Part B Premium was $96.40 and will change for 2009, and the yearly Part B deductible amount was $135 and will change for 2009.

$0 monthly plan premium in addition to your monthly Medicare Part B premium

 

  Primary Care Copay 20% coinsurance $10 copay for each primary care doctor visit for Medicare-covered services
  Specialist   Copay 20% coinsurance $20 copay for each specialist visit for Medicare-covered benefits
  Inpatient   Hospital Days 1-60: an initial deductible of $1024

Days 61-90: $256 per day

Days 91-150: $512 per day
10% of the cost for each Medicare-covered hospital stay

$0 copay for additional hospital days
  Part D prescription drug coverage, including coverage for formulary generic drugs   through the Part D coverage gap
  Not included YES!

Freedom Blue Enrollment Application 2009 year

Freedom Blue PPO Online Application 2009 year
Limited Income Subsidy (LIS)
Freedom Blue PPO Prescription Drug Formulary
Formulary Transition Notice
Grievance & Appeals Information (for plans with prescription drug benefits)
Request Form – Coverage Determination, Formulary Exception or Tiering Exception
Quality Assurance (for plans with prescription drug benefits)
Appointment of Representative Form
Prescription Drug Claim Form
Submit the complete application by Fax # : 1-818-776-9865
 
Mail Application to:

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

 

You also can fax complete application to Fax # : 1-818-776-9865
 
 

*There may be a late-enrollment penalty.

 

® Anthem is a registered trademark. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association © 2007 Anthem Blue Cross. Serving California. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association
 
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Copyright © 2005 Oleg Skurskiy Authorized Independent Agent, CA License 0E50389