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 Advantage65 E

Products and Plans
 
Alpha Prefix: XJM (Individual) / XJS (Group)
In-Network: Hospital - participating in Advantage 65/Medicare Select
Inpatient/Outpatient – physician must have admitting privileges at an Advantage 65/Medicare Select Hospital
Office Visits – Any physician
Out-of-Network: Hospital inpatient/outpatient services are only covered in cases of emergency or accident.
Additional Information: This product covers the member based on the hospital network for inpatient/outpatient. Member can choose any physician, but for the physician to treat a member in a hospital setting, the provider must have admitting privileges to an Advantage 65/Medicare Select participating hospital.
Hospitals participating with Medicare and BCBSF have agreed to waive the Part A deductible and accept Medicare’s payment as payment in full for covered services.
Has a 20 percent gap coverage to complement Medicare payment after satisfaction of Part B deductible.
Benefit
 
Availity: Part A inpatient deductible and/or coinsurance based plans. Access Availity for member specific details.
Utilization Management
 
Utilization Management is not applicable for Medicare Supplement plans. Plan follows Medicare for covered services.
Plan effective prior to 6/1/2010
The Manual is not intended to be a complete statement of all BCBSF polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and BCBSF or Health Options the terms of such agreement(s) shall govern.

The Manual is not intended to be a complete statement of all Florida Blue polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and Florida Blue or Health Options the terms of such agreement(s) shall govern.

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