Drugs noted as “Select Insulin” are covered under Part D Senior Savings Model Program. You will pay a maximum of $35 for a 1-month supply of insulin during the deductible, initial coverage, and coverage gap or “donut hole” stages of your benefit. You will pay 5% of the cost of your insulin in the catastrophic stage. LIS members are excluded from the Senior Savings Model (PDSS insulin program). Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association. Premera Blue Cross is an HMO plan with a Medicare contract. Enrollment in Premera Blue Cross depends on contract renewal. This information is not a complete description of benefits. Call 888-868-7767 (TTY/TDD: 711) 7 days a week, 8 a.m. to 8 p.m. for more information. To join a Premera Blue Cross Medicare Advantage Plan, you must have Medicare Part A and Part B and live in the Premera Blue Cross Medicare Advantage service area (Cowlitz, Island, King, Kitsap, Pierce, Lewis, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla and Whatcom counties in Washington). Members must select a Primary Care Provider (PCP) from the Premera Blue Cross Medicare Advantage Plans provider network. For accommodation of persons with special needs at sales meetings, call 888-868-7767 (TTY/TDD: 711) 7 days a week, 8 a.m. to 8 p.m. To request a copy of the Premera Blue Cross Medicare Advantage Evidence of Coverage, Formulary, or Provider and Pharmacy Directory, please call 888-850-8526 (TTY/TDD: 711) Monday – Friday, 8 a.m. to 8 p.m. (7 days a week, 8 a.m. to 8 p.m., October 1 – March 31). Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January 1, 2022, and from time to time during the year.
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Premera Blue Cross complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex
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