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