January 2022 – May 2022 Outline of Coverage - Blue Cross NC

January 2021 May 2021. Outline of Coverage D98, 11/20. Benefits Benefit Chart of medicare supplement Plans Effective On or After January 1, 2021. This chart shows the benefits included in each of the standard medicare supplement plans. Every company must make Plan A available. Some plans may not be available in your state. Attained-Age Plans1. High Plan A 2. Plan G 2. Deductible Plan K Plan N. Plan G3. Basic, including 100%. Hospitalization and Part B coinsurance, Basic, including Basic, including Basic, including preventive care paid except up to $20. 100% 100% 100%. at 100%; other basic copayment for office Part B coinsurance Part B coinsurance Part B coinsurance benefits paid at 50% visit, and up to $50. copayment for ER. Skilled nursing Skilled nursing 50% Skilled nursing Skilled nursing facility coinsurance facility coinsurance facility coinsurance facility coinsurance Part A deductible Part A deductible 50% Part A deductible Part A deductible Part B Part B.

Attention: Blue Medicare Supplement Enrollment, P.O. Box 17168, Winston-Salem, NC 27116. If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all of your payments.

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  Supplement, Medicare, Blue, Medicare supplement blue

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