Secure Blue PPO is a Medicare Advantage Preferred Provider Organization plan offered by Blue Cross of Idaho. Secure Blue PPO offers you quality healthcare coverage with the freedom you"ve been looking for. Secure Blue PPO gives you the option to choose your healthcare providers from the plan"s network or to choose your doctors outside the network. And, Secure Blue PPO provides valuable protection from unexpected healthcare costs with low out of pocket limits and coverage beyond Medicare.
2010 Plan Overview
| Premium | Deductible | PCP Office Visit | Specialist Office Visit | Inpatient Hospital Care | Out-of-Pocket Maximum | ||||
|---|---|---|---|---|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | ||||
| Secure Blue PPO includes Part D Coverage |
$42 | $0 | $25 | 25% | $25
no referral needed |
25%
no referral needed |
$500
per inpatient admission |
$750
per inpatient admission |
$3,000 per calendar year
combined in- & out-of-network services |
| Secure Blue PPO without Part D Coverage |
$5 | ||||||||
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 |
 |
PDF Document Information Center
| Summary of Benefits | Evidence of Coverage | Formulary |
|---|---|---|
| Secure Blue PPO | Secure Blue PPO | Secure Blue PPO Formulary |
| Secure Blue PPO with Part D | Secure Blue PPO with Part D |
Eligibliity
You are eligible to enroll in Secure Blue PPO if you are:
- Entitled to Medicare benefits under Part A
- Enrolled in Medicare Part B
- And reside in our service area
Secure Blue PPO is available in the following counties: Ada, Bannock, Benewah, Boise, Bonner, Bonneville, Boundary, Canyon, Caribou, Cassia, Gem, Jefferson, Kootenai, Latah, Madison, Minidoka, Nez Perce, Oneida, Owyhee, Payette, Power, Shoshone, Twin Falls and Washington.
H1350 H1302 H5862 MK 10056 (XX/XX/XX)
Pending CMS Approval
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