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| Medicare
products on this web site is not connected with
or endorsed by the United States government or
the federal Medicare program |
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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
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| 
Freedom
Blue PPO Summary of Benefits
2009
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Freedom
Blue PPO Application 2009
YEAR
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Freedom
Blue PPO (RPPO) Details 2009
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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. |
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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 |
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Not
included |
YES! |
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Formulary
Transition Notice |
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Submit the complete
application by Fax # : 1-818-776-9865 |
|
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| Mail
Application to: |
Oleg
Skurskiy
18375 Ventura Blvd. # 226
Tarzana , CA 91356
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| You
also can fax complete application to Fax
# : 1-818-776-9865 |
|
| |
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*There may be a late-enrollment
penalty.
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®
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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