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.
BlueMedicare Supplement Plans C and F and BlueMedicare Supplement Select Plan C may not be
offered to any newly eligible Medicare beneficiary. Newly eligible Medicare beneficiary
means anyone who attains age 65 on or after January 1, 2020, or who first becomes eligible
for Medicare benefits due to age, disability or end-stage renal disease on or after January
Florida Blue Medicare Supplement Insurance policies are not connected with or endorsed by the
U.S. Government or the Federal Medicare Program. The amount of benefits provided depends
upon 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: Policy Numbers: BlueMedicare Supplement Plan A – [30147-0717 SU] |
BlueMedicare Supplement Select Plan B – [30166-0717 SU] | BlueMedicare Supplement Plan C –
[30149-0717 SU] | BlueMedicare Supplement Plan D – [30150- 0717 SU] | BlueMedicare
Supplement Plan F – [30151-0717 SU] | BlueMedicare Supplement Plan G – [30152-0717 SU] |
BlueMedicare Supplement Plan K – [30154-0717 SU] | BlueMedicare Supplement - Plan L –
[30155-0717 SU] | BlueMedicare Supplement Plan M – [30156-0717 SU] | BlueMedicare Supplement
Plan N – [30157-0717 SU] | BlueMedicare Supplement Select Plan B – [30166-0717 SU] |
BlueMedicare Supplement Select Plan C – [30167-0717 SU] | | BlueMedicare Supplement Select
Plan D – [30168-0717 SU] | BlueMedicare Supplement Select Plan M – [30159-0717 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 1-800-955-8770.
BlueMedicare Supplement and BlueMedicare Supplement Select Plans are guaranteed renewable.
Florida Blue will only terminate your coverage for nonpayment of premiums or material
Exclusions for BlueMedicare Supplement and BlueMedicare Supplement Select Plans
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.
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 or BlueMedicare Supplement Select 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, Plan B and Select Plan B: Care received at a skilled nursing
- Applies only to Plan B, Select 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, Select Plan D, Plan G, Plan M Select 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.
Applies only to BlueMedicare Select Plans:
- Network Hospital - 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.
SilverSneakers is a separate fitness program and not part of Florida Blue’s Medicare Supplement Insurance Policy. To enroll in SilverSneakers, you must be enrolled in a Medicare Supplement Insurance Policy through Florida Blue. Your SilverSneakers fitness membership will automatically cancel when you are no longer enrolled in a Florida Blue Medicare Supplement Insurance policy. You may cancel your SilverSneakers membership at any time.
Tivity Health, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarks of Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries. © 2021 Tivity Health, Inc. All rights reserved.