anthem blue cross Anthem Blue Cross Freedom Blue PPO California  

Oleg Skurskiy an Authorized Independent Agent for Anthem Blue Cross

Life Annuity

Medicare products on this web site is not connected with or endorsed by the United States government or the federal Medicare

Freedom Blue Regional PPO

plans offered in California ( Outside of California Click here )
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Open enrollment dates between November 15th through December 31, your new coverage will start January 1, 2011

  
online application
online application
  • Enrollment Application Freedom Blue - Online Application (Online applicaiton takes about 10 - 15 minutes. If you have any technical difficulty with the online application or questions ,please call me 1-818-654-4548 Oleg Skurskiy )
  • Freedom Blue Classic (Regional PPO) ** does NOT cover Medicare Part D prescription drugs. You CAN NOT apply for separate stand alone Rx part D plan.

If you have any enrollment questions , please call (818) 654-4548 Oleg Skurskiy or We can call you see below.

Click here to Apply Online

Plan Name
Monthly premium.
Summary of Benefits
Evidence of Coverage

Freedom Blue Plan 1 (Regional PPO) with this plan You can purchase the optional benefits Click Here

• 2011 Comprehensive Formulary drugs list


$0.00

Apply now

Summary of Benefits

Evidence of Coverage

Freedom Blue Classic (Regional PPO) 

** does NOT cover Medicare Part D prescription drugs. You CAN NOT apply for separate stand alone Rx part D plan.

$0.00

Apply now

Summary of Benefits

Evidence of Coverage

Please keep this in mind: Eligible individual may only enroll in one Medicare prescription drug plan at a time and may not also be enrolled in a Medicare Advantage Plan (HMO, PPO) at the same time, unless they are a member of a Medicare Private-Fee-For-Service plan or are enrolled in a 1876 Cost Plan which does not have Part D coverage built in. If you are enrolled in a Medicare Advantage HMO or PPO plan without prescription drug coverage, you'll be disenrolled if you join a Medicare Part D prescription drug plan.

 

Plus with Freedom Blue Plan 1 (Regional PPO)

you can purchase the following optional benefits:

Preventive Dental Package - $9

  • In-Network and Out-of-Network
    • $500 plan coverage limit for preventive dental benefits
  • In-Network
    • $0 copay for preventive dental benefits:
  • Out-of-Network
    • 20% of the cost for preventive dental services
Comprehensive Dental and Vision Package - $25
Dental Services
  • In- and Out-of-Network
    • $1,000 plan coverage limit for dental benefits
  • In-Network
    • $0 copay for preventive dental benefits.
    • 20% of the cost for covered restorative dental services (amalgam restorations)
    • 50% of the cost for covered endodontic, periodontic, and oral surgery dental services.
  • Out-of-Network
    • 30% of the cost for preventive dental services.
    • 60% of the cost for covered restorative dental services (amalgam restorations)
    • 75% of the cost for covered endodontic, periodontic, and oral surgery dental services.
Vision Services
  • In-Network and Out-of-Network
    • $130 maximum benefit coverage amount for eye glasses
    • $80 maximum benefit coverage amount for contact lenses
  • $0 copay for:
    • one routine eye exam
    • one pair of eye glasses (lenses and frames)
    • one pair of contacts lenses
Combination Package - $39
Dental Services
  • In- and Out-of-Network
    • $1,000 plan coverage limit for dental benefits
  • In-Network
    • $0 copay for preventive dental benefits.
    • 20% of the cost for covered restorative dental services (amalgam restorations)
    • 50% of the cost for covered endodontic, periodontic, and oral surgery dental services.
  • Out-of-Network
    • 30% of the cost for preventive dental services.
    • 60% of the cost for covered restorative dental services (amalgam restorations)
    • 75% of the cost for covered endodontic, periodontic, and oral surgery dental services.
Vision Services
  • In-Network and Out-of-Network
    • $200 maximum benefit coverage amount for eye glasses
    • $80 maximum benefit coverage amount for contact lenses
  • $0 copay for:
    • one routine eye exam
    • one pair of eye glasses (lenses and frames)
    • one pair of contacts lenses
Acupuncture Services
  • In-Network and Out-of-Network
    • The service specific benefit maximum is $60 per visit.
    • Up to 10 routine acupuncture visits each year
  • In-Network
    • $20 copay per visit.
  • Out-of-Network
    • $30 copay per visit.

Chiropractic Services
  • In-Network and Out-of-Network
    • The service specific benefit maximum is $60 per visit.
    • Up to 10 routine chiropractic visits each year
  • In-Network
    • $20 copay per visit.
  • Out-of-Network
    • $30 copay per visit.
See the Summary of Benefits and Evidence of Coverage for a detailed review of the benefits provided by a Freedom Blue Plan 1 (Regional PPO).

.

Stand alone prescription coverage Anthem Blue Cross Medicare Rx - (PDP) - Plans

Do Freedom Blue plans Cover Medicare Part B or Part D Drugs?

  • * Freedom Blue Plan I (Regional PPO) and Freedom Blue Plus (Regional PPO) do cover both Medicare Part B prescription drugs and Medicare Part D prescription drugs.


  • ** Freedom Blue Classic (Regional PPO) does cover Medicare Part B prescription drugs. Freedom Blue Classic (Regional PPO) does NOT cover Medicare Part D prescription drugs.

Enrollment Steps

Step 1: Download the application for your California state below, print it and then fill it out.

Freedom Blue Plan 1 (RPPO) Enrollment Form – 2011
Freedom Blue Classic (RPPO) Enrollment Form – 2011

 

or Click here to Apply Online


Step 2: Mail your enrollment application to the address below:

Oleg Skurskiy
18375 Ventura Blvd. # 226
Tarzana , CA 91356


Or can fax complete application to Fax: (818) 776-9865


Also, be sure to complete the Working Aged Survey and return it along with your completed enrollment form.

 

Turning 65 ? Looking for reliable Medigap Insurance? or Looking to get better rates to the plan you have like plan F ?

Compare Medigap insurance online Click Here

Medicare products on this web site is not connected with or endorsed by the United States government or the federal Medicare program

 

 
 
Mail Application to:

Oleg Skurskiy
18375 Ventura Blvd. # 226
Tarzana , CA 91356

 
You also can fax complete application to Fax # : 1-818-776-9865
 
 
Freedom Blue Classic (Regional PPO) Summary of Benefits – SCASB2289BM
Freedom Blue Plan I (Regional PPO) and Freedom Blue Plus (Regional PPO)
Summary of Benefits – SCASB2286BM

Current members should contact Customer Service for process or status questions or to file a verbal grievance:

 

Customer Service Hours for Medicare Advantage plans: 
7 days a week, 8 a.m. to 8 p.m.  

Medicare Advantage: Toll Free: TTY/TDD: Address:
Anthem Senior Advantage
Anthem Medicare Preferred
Blue Medicare Access  
1-800-467-1199  
1-888-853-7754  
P.O. Box 37180 
Louisville, KY 
40233-7180 
Nevada - Anthem Medicare Preferred  
1-866-754-3077  
1-888-877-5378  
P.O. Box 60007 
Los Angeles, CA 
90060-0007 
Virginia - Anthem Medicare Preferred  
1-866-827-9866  
1-800-828-1120  
P.O. Box 37180 
Louisville, KY 
40233-7180 
Freedom Blue   
1-877-811-3107  
1-877-247-1657  
P.O. Box 60007 
Los Angeles, CA  
90060-0007 
Connecticut - MediBlue HMO   
1-866-673-4157  
1-800-241-6894  
P.O. Box 1407 Church Street Station 
New York, NY 10008-1407 
Senior Secure   
1-888-230-7338  
1-877-247-1657  
P.O. Box 60007 
Los Angeles, CA 90060-0007 
SmartValue   
1-888-445-8916  
1-800-425-5705  
P.O. Box 795180 
San Antonio, TX 78279 
SureValue   
1-866-408-7086  
1-877-247-1657  
P.O. Box 60007 
Los Angeles, CA 90060-0007 
 
Customer Service Hours for Medicare Part D plans: 
7 days a week, 8 a.m. to 8 p.m. 

Blue MedicareRx: Toll Free: TTY/TDD: Address:
California, Colorado, Nevada, Wisconsin  
1-800-928-6201  
1-877-247-1657  
P.O. Box 9282 
Oxnard, CA 93031-9282 
Connecticut, Indiana, Kentucky, Maine, Missouri, New Hampshire, Ohio, Virginia  
1-866-755-2776  
1-866-798-7026  
P.O. Box 34160 
Louisville, KY 40232-9732 
 
Current members who wish to file written grievances for any of the plans above*:
  The mailing address and fax number designated for receiving written grievances is:
Grievances & Appeals
P.O. Box 1975
Fond du Lac, WI 54936-1975
FAX: (888) 458-1406
*Note: For the MediBlue plans offered in Connecticut, use the following contact information: 
  The mailing address and fax number designated for receiving written grievances is:
Grievances & Appeals
P.O. Box 1407 Church Street Station
New York, NY 10008-1407
FAX: 888-458-1406

 

Providers should call
Please call the numbers listed below for process or status questions as well as Grievance & Appeals.  
Provider Service Hours are listed below. 

Medicare Advantage: Toll Free: TTY/TDD:
Anthem Senior Advantage
Anthem Medicare Preferred
Blue Medicare Access  
1-888-290-9160  
(Monday through Friday 8 a.m. to 8 p.m. ET)  
1-888-853-7754  
Nevada - Anthem Medicare Preferred  
1-866-754-3077  
(Monday through Friday 8 a.m. to 8 p.m. ET)  
1-888-877-5378  
Freedom Blue  
1-877-811-3107  
(Monday through Friday 8 a.m. to 8 p.m. ET) 
1-888-877-5378  
MediBlue HMO (Connecticut)  
1-866-673-4157  
(Monday through Friday 8 a.m. to 8 p.m. ET) 
1-800-241-6894  
Senior Secure  
1-888-230-7338  
(Monday through Friday 8 a.m. to 8 p.m. ET) 
1-888-877-5378  
SmartValue  
1-866-364-2374  
(Monday through Friday 8 a.m. to 8 p.m. ET)  
1-800-425-5705  
SureValue  
1-866-408-7086  
(Monday through Friday 8 a.m. to 8 p.m. ET)  
711  

 

*There may be a late-enrollment penalty.

 

Legal Disclaimers for Medicare Advantage Plans and Medicare Advantage with Prescription Drug Plans

HMO and PPO Plans:
Blue Cross of California, doing business as Anthem Blue Cross, is the legal entity that has contracted with the Centers for Medicare and Medicaid Services (CMS) to offer the Medicare Advantage plan noted above or herein. Independent licensee of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

RPPO plans:
Anthem Blue Cross Life and Health Insurance Company (Anthem) is the legal entity that has contracted with the Centers for Medicare and Medicaid Services (CMS) to offer the Medicare Advantage Regional PPO plan(s) (MAPD-RPPO) noted. Anthem is the risk bearing entity licensed under applicable state law to offer the MAPD-RPPO plan(s) noted. Anthem has retained the services of its related companies and the authorized agents/brokers/producers to provide administrative services and/or to make the MAPD-RPPO plan(s) available in this region. Anthem Blue Cross Life and Health Insurance Company is an independent licensee of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

PFFS plans:
Blue Cross of California, doing business as Anthem Blue Cross, is the legal entity that has contracted with the Centers for Medicare and Medicaid Services (CMS) to offer the Private Fee for Service plan(s) (PFFS) noted above or herein. Anthem is the risk bearing entity licensed under applicable state law to offer the PFFS plan(s) noted. Anthem has retained the services of its related companies and the authorized agents/brokers/producers to provide administrative services and/or to make the PFFS plan(s) available in this region. Independent licensee of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association

 
® 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
Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment, service areas and any applicable conditions associated with using the plan benefits.

Material Identification M0013_09_221, CMS Approved 09/25/2009
For Agents
Copyright © 2005 Oleg Skurskiy Authorized Independent Agent, CA License 0E50389