Blue Shield 2024

How long does it take to receive a decision for an expedited request for a coverage determination?

24 hours

Erectile Dysfunction Drug Coverage of generic Viagra (sildenafil) on Tier 2 (Generic Tier) for Blue Shield of California Plans participating in Erectile Dysfunction Drug Coverage for 2024 is a quantity limit of

4 pills per mo

What is the timeframe for a Health Plan to render a decision about payment for medical care or services that a member has already received

60 days

Formulary Requirements include

A list of drugs covered by the plan.

All Blue Shield Medicare Advantage Prescription Drug (MAPD) plans with the SSBCI Independence and Safe Mobility with AAA benefit include

AAA Roadside Assistance, Roadwise Driver, and educational driving resources

Blue Shield offers Independence and Safe Mobility with AAA

As a special Supplemental Benefit for the Chronically Ill (SSBCI) with select Medicare Advantage Plans (MAPD)

Non-Medicare covered vision benefits are

Available as additional plan buy-up options on

The optional supplemental dental HMO plan is not available for

Blue Shield AdvantageOptimum Plan (HMO)

A member can appeal if:

Both

An example of a grievance is expressing dissatisfaction with

Both

Which form field(s) are critical when completing an enrollment?

Both answers are correct

For 2023, all Blue Shield Medicare Advantage Prescription Drug (MAPD) plans have non-Medicare covered embedded dental benefits

False

The timeframe for a Health Plan to render a standard decision about a Part D drug that includes a request to reimburse the member for a Part D drug they have already paid for and received is 7 days

False

The following drug categories are covered by the Plan

Immunosuppressive drugs

Blue Shield transportation services (non-Medicare covered) are offered

In select Blue Shield Medicare Advantage Plans (MAPD)

The home meal delivery benefit is offered

In select Blue Shield Medicare Advantage Plans (MAPD)

What is Blue Shield of California's Mission

Our mission is to ensure all Californians have access to high-quality health care at an affordable price. We strive to offer a product that we would be proud to put our families and loved ones on

Medicare marketing material must have

Relevant approval/ tracking codes

What document is included in the pre-enrollment package

Summary of Benefits

A Sales Agent may correct anything on a signed enrollment form prior to submission to the Plan by initialing next to the change, EXCEPT for

The applicant's date of signature

Which of the following is NOT an example of when a beneficiary may file an appeal

The beneficiary's inquiry was not resolved during the first call

Appeal or request for reconsideration, Independent Review Entity, Administrative Law Judge Hearing, Medicare Appeals Council Review, and Judicial Review are the five levels of appeals

True

Blue Shield offers a personal emergency response system as benefit to selected plans

True

Blue Shield's Medicare Advantage HMO and HMO Dual Special Needs Plans (HMO D-SNP) require that beneficiary select a contracted network Primary Care Physician (PCP) from one of the contracted network physician groups listed in our Provider Directory.

True

Contacting a beneficiary at his or her home is door-to-door solicitation unless an appointment at the beneficiary's home at the applicable date and time was previously scheduled.

True

For 2023, the Special Supplemental Benefit for the Chronically Ill (SSBCI) Independence and Safe Mobility with AAA benefit is included with all northern California Blue Shield Medicare Advantage Prescription Drug (MAPD) plans.

True

If the Health Plan denies a member's formulary exception request, the member has the right to appeal the decision

True

Blue Shield TotalDual Plan (HMO D-SNP) is offered in:

​​Southern California in select counties

Beneficiaries who are enrolled in Medicare and receive full coverage from Medi-Cal are considered

​​​Full Dual