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Exclusions for BlueMedicare Supplement Plans

All of the following exceptions apply to all standard BlueMedicare Supplement plans (Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M and Plan N) unless otherwise stated:

Services or supplies not covered or approved by Medicare, and not considered eligible as a Medicare- Eligible Expense; Services or supplies in excess of what Medicare determines or would have determined is a covered Service and a Medicare-Eligible Expense; Services or supplies which would duplicate what Medicare has paid or would have paid had a claim for Services been submitted to Medicare; Services for which there is no charge or for which you have no legal liability to pay; Mental or nervous disorders, alcoholism and drug addiction in excess of what Medicare allows.; Illness, treatment or medical conditions arising out of: War or act of war (whether declared or undeclared); participation in a felony, riot or insurrection, engaging in an illegal occupation, service in the armed forces or auxiliary units thereto; suicide or attempted suicide, whether sane or insane, or intentionally self-inflicted injury; coverage for air related accidents which occur outside of the United States; being intoxicated or under the influence of any narcotic unless taken on the advice of a Physician.; Cosmetic surgery, except that “cosmetic surgery” does not exclude benefits for reconstructive surgery when such Service is incidental to or follows surgery resulting from trauma, infection or other diseases of the involved part, or to restore normal bodily function; Hearing aids and eyeglasses and examinations for prescription fitting; Rest cures, custodial care, transportation and routine physical examinations.

Unless specifically stated, these Policies do not cover any service that is not a Medicare-Eligible Expense. These Plans do not contain limitations or exclusions on coverage that are more restrictive than those of Medicare.


The following exclusions apply ONLY to the plans indicated and not to other BlueMedicare Supplement plans.

Applies only to Plan A: Medicare Part A Inpatient deductible; Medicare Part B deductible; Care received outside of the United States.

Applies only to Plan A and Plan B: Care received at a skilled nursing facility.

Applies only to Plan B, Plan K and Plan L: Medicare Part B deductible; Care received outside of the United States.

Applies only to Plan C and Plan F: Care received outside of the United States that is not a Medically Necessary Medical Emergency/Accident Service.

Applies only to Plan D, Plan G, Plan M and Plan N: Medicare Part B deductible; Care received outside of the United States that is not a Medically Necessary Medical Emergency/Accident Service.


Exclusions for BlueMedicare Supplement Select Plans

All of the following exceptions apply to all BlueMedicare Supplement Select plans (Plan B, Plan C, Plan D, and Plan M) unless otherwise stated:

Services or supplies not covered or approved by Medicare, and not considered eligible as a Medicare- Eligible Expense; Services or supplies in excess of what Medicare determines or would have determined is a covered Service and a Medicare-Eligible Expense; Services or supplies which would duplicate what Medicare has paid or would have paid had a claim for Services been submitted to Medicare; Services for which there is no charge or for which you have no legal liability to pay; Network Hospital: you are responsible for only 50% of the Medicare Part A deductible for Inpatient Hospital benefits. Non-Network Hospital: you are responsible for 100% of the inpatient Medicare Part A deductible EXCEPT as indicated in the Network Hospital Restrictions; Mental or nervous disorders, alcoholism and drug addiction in excess of what Medicare allows; Illness, treatment or medical conditions arising out of: War or act of war (whether declared or undeclared); participation in a felony, riot or insurrection, engaging in an illegal occupation, service in the armed forces or auxiliary units thereto; suicide or attempted suicide, whether sane or insane, or intentionally self-inflicted injury; coverage for air related accidents which occur outside of the United States; being intoxicated or under the influence of any narcotic unless taken on the advice of a Physician; Cosmetic surgery, except that “cosmetic surgery” does not exclude benefits for reconstructive surgery when such Service is incidental to or follows surgery resulting from trauma, infection or other diseases of the involved part, or to restore normal bodily function; Hearing aids and eyeglasses and examinations for prescription fitting; Rest cures, custodial care, transportation and routine physical examinations; Hospital confinements in a Non- Network Hospital, EXCEPT as indicated in the Network Hospital Restrictions.


The following exclusions apply ONLY to the plans indicated and not to other BlueMedicare Supplement Select plans:

Applies only to Plan B: Medicare Part B deductible; Care received outside of the United States; Care received at a skilled nursing facility.

Applies only to Plan D: Medicare Part B deductible; Care received outside of the United States that is not a Medically Necessary Medical Emergency/Accident Service.

Applies only to Plan M: Medicare Part B deductible; Care received outside of the United States that is not a Medically Necessary Medical Emergency/Accident Service; You are responsible for only 50% of the Medicare Part A deductible for each Medicare Benefit Period. Non-Network Hospital, you are responsible for 100% of the inpatient Medicare Part A deductible EXCEPT as indicated in the Network Hospital Restrictions.

Unless specifically stated, these Policies do not cover any service that is not a Medicare-Eligible Expense. These Plans do not contain limitations or exclusions on coverage that are more restrictive than those of Medicare.

Florida Blue Medicare Supplement Insurance policies are not connected with or endorsed by the U.S. Government or the Federal Medicare Program. These policies have limitations and exclusions. The amount of benefits provided depends on the plan selected and the premium may vary with the amount of benefits selected. While medical cost increases and inflation could increase our premiums, your premium will always remain the lowest we offer, according to your age at enrollment. Medical Underwriting will apply to all BlueMedicare Supplement and BlueMedicare Supplement Select products unless the applicant is eligible for guaranteed issue. Networks are comprised of independent contracting healthcare providers.

Policy Numbers: BlueMedicare Supplement Plan K - 30154-1014 SU | BlueMedicare Supplement - Plan L - 30155-1014 SU | BlueMedicare Supplement Plan A -
 30147-1014 SU | BlueMedicare Supplement Select Plan B - 30166-1014 SU | BlueMedicare Supplement Select Plan M - 30159-1014 SU | BlueMedicare
Supplement Select Plan D - 30168-1014 SU | BlueMedicare Supplement Plan N - 30157-1014 SU | BlueMedicare Supplement Plan M - 30156-1014 SU |
BlueMedicare Supplement Plan B - 30148-1014 SU | BlueMedicare Supplement Select Plan C - 30167-1014 SU | BlueMedicare Supplement Plan D - 30150-
1014 SU | BlueMedicare Supplement Plan G - 30152-1014 SU | BlueMedicare Supplement Plan C - 30149-1014 SU | BlueMedicare Supplement Plan F -
30151-1014 SU

If this policy is replacing current health insurance coverage that has been in effect for at least three months, there is no waiting period required for pre-existing conditions.
However, if this policy does not replace current health insurance coverage, a condition treated three months before the effective date may not be covered until three months after the effective date of this policy. Additionally, coverage for this condition may not begin for patients in a hospital or skilled nursing facility the day before the effective date until they have been released, or six months passed the effective date of the policy. For special circumstances or questions, please call 1-855-601-9465 or TTY 800-955-8770. BlueMedicare Supplement and BlueMedicare Supplement Select Plans are guaranteed renewable. Florida Blue will only terminate your coverage for nonpayment of premiums or material misrepresentation.

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., an Independent Licensee of the Blue Cross and Blue Shield Association

David McBride
State License Number: P027737

FBM PPC 001 032018

 

 

 

 

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Generally, the pronouns "our," "we" and "us" used throughout this website are intended to refer collectively to Blue Cross and Blue Shield of Florida, Inc. and its subsidiaries and affiliates. However, where appropriate, the content may identify a particular company; there, any pronouns refer to that specific entity.

Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue. HMO coverage is offered by Health Options Inc., DBA Florida Blue HMO, an HMO affiliate of Blue Cross and Blue Shield of Florida, Inc. Dental, Life and Disability are offered by Florida Combined Life Insurance Company, Inc., DBA Florida Combined Life, an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association.

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© 2017 Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. All rights reserved.

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