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Medicare Eligible vs Non Medicare Eligible

Your eligibility for Medicare determines which medical plan you are enrolled.

Neither plan requires a primary care physician, although it is important to keep your family doctor informed of your medical conditions and treatments.

Highmark Blue Shield maintains the formulary, or list of covered drugs, and the formulary applies to both retail and maintenance drug programs. If you choose to receive medication that is not included in the formulary, you are required to pay 70% of the cost.

Retirees Eligible for Medicare

  • You must continue your enrollment in Medicare Parts A and B. Since FreedomBlue provides prescription drug coverage, there is no need to enroll in Medicare Part D prescription coverage.
  • Use your Highmark ID card for access to all services, including doctor visits and pharmacies.
  • Your FreedomBlue PPO plan provides a fixed dollar co-payment for doctor office visits and for prescription drugs.
  • Prescription coverage will be available at local pharmacies. While a 30-day supply of a maintenance drug is available from your local pharmacy, a 90-day supply of a maintenance drug is available by mail-order the University Health Service Pharmacy or from Medco by Mail.
  • If you are a retiree who is Medicare-eligible, and you have questions regarding your health plan, please contact Highmark Blue Shield at the dedicated toll-free number for Penn State at 1-866-918-5285.
  • For complete coverage details, see the FreedomBlue PPO Overview of Coverage.
International Travel

While Out of the Country, you are covered up to 6 consecutive months in full, only for Urgent and Emergency Care, owing an applicable copayment of $20.00 for an Urgent office visit or $50.00 for the Emergency Room. The Emergency Room copayment is waived if you are admitted inpatient to the hospital for the same condition within 3 days and the admission is authorized by FreedomBlue PPO.

If you are admitted inpatient to the hospital out of the country due to a medical emergency, all medically necessary services are covered in full when pre-approved by FreedomBlue PPO. When urgent or emergent care is received, you should notify your Preferred Provider within 48 hours, or as soon as possible, for coordination of care.

If you pay up front for services, obtain an itemized bill (in English if possible) to submit to FreedomBlue PPO for a possible refund. Send the itemized bill with receipt to FreedomBlue PPO Member Service, PO Box 1068, Pittsburgh, PA 15230-1068. Once FreedomBlue receives the itemized bill with receipt, it will take time to process the foreign claim because we may need to negotiate payment with the foreign provider. Out of country, urgent and emergent claims are paid up to the negotiated amount agreed by the provider minus any applicable owed copayments that may apply. If the claims deny, the member will receive a denial letter with appeal rights.

If the member cannot obtain an itemized bill in English, the claim may take longer to process because the itemized bill will need to be translated.

Retirees Not Eligible for Medicare

  • Since the Highmark PPOBlue plan covers services provided both in and out of the Blue Shield network, you will not need to change doctors.
  • Fixed dollar co-payments apply for visits to doctors within the Blue Shield network.
  • Prescription coverage will be available at local pharmacies; a 50/50 co-payment applies. While a 30-day supply of a maintenance drug is available from your local pharmacy, a 90-day supply of a maintenance drug is available by mail-order from the University Health Service Pharmacy or from Medco by Mail. Your co-payment for maintenance drugs is 20%.
  • If you are a retiree who is not eligible for Medicare, and you have a question about your health plan, please call Highmark Blue Shield at 1-800-914-4384. This is a dedicated toll-free number for Penn State members.

 

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