2025 Summary of Benefits Blue Medicare HMO SM This is a summary of health services and prescription drug coverage that is covered under Blue Medicare HMO plans for January 1, 2025 – December 31, 2025. Plans: Medical Only (HMO-POS): H3449-012 Essential...
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2025 Summary of Benefits Blue Medicare HMO SM This is a summary of health services and prescription drug coverage that is covered under Blue Medicare HMO plans for January 1, 2025 – December 31, 2025. Plans: Medical Only (HMO-POS): H3449-012 Essential (HMO): H3449-027-001, H3449-027-002 Essential Plus (HMO-POS): H3449-023-001, H3449-023-002, H3449-023-004, H3449-023-005 Choice (HMO): H3449-026 Enhanced (HMO-POS): H3449-024-001, H3449-024-002, H3449-024-003 • The benefits information provided is a summary of what we cover and what you pay. This information is not a complete description of benefits. Visit BlueCrossNC.com/Members/Medicare/Forms-Library and click on the Evidence of Coverage tab. • Blue Medicare HMO has a network of doctors, hospitals, pharmacies and other providers. If you use providers that are not in our network, the plan may not pay for their services. • Out-of-network/non-contracted providers are under no obligation to treat Blue Cross and Blue Shield of North Carolin
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