HOME - ARKANSAS BLUE CROSS AND BLUE SHIELDSIGN INSHOPMEMBERSMEDICAREPROVIDERSSUPPORT Download the My Blueprint Mobile app to sign into your account and pay from your mobile phone. Eligible 1 members can make payments using a check, credit or debit card by calling 800-354-9904. Visit an Arkansas Blue Cross location to pay your bill in person. Send a check or money order to us. Remember to include your member ID or account number.

PAYMENT OPTIONS

For all other members (including dental and non-Metallic medical plans): Arkansas Blue Cross and Blue Shield. P.O. Box 954722. St. Louis, MO 63195-4772. 1 Medicare Advantage and Prescription Drug plan product members can mail their monthly payment or set up an automatic monthly bank draft. If there are questions, please call customer

service to

HEALTHY BLUE REWARDS If you have other questions, please call Healthy Blue Rewards Customer Service at 800-960-6360 from Monday through Friday 8:00 a.m. to 8:00 p.m. Central Time. HealthMine, Inc., is an independent company that contracts with Arkansas Blue Medicare to provide Medicare Advantage member rewards programs. Y0083_MA Website. MY BLUEPRINT MEMBER PORTAL: ARKANSAS BLUE CROSS AND BLUE Access your member portal to review claims, see your ID card, find care and estimate costs, review personal health records, pay premiums

and more.

BLUE CHOICE ESSENTIAL VALUE FORMULARY APRIL 2021 INTRODUCTION We are pleased to provide the 2021 Arkansas Blue Cross and Blue Shield Blue Choice Formulary as a useful reference and informational tool. This document can assist practitioners in selecting clinically appropriate and cost-

COVERAGE POLICY

The medical director of Arkansas Blue Cross and Blue Shield has established specific coverage policies addressing certain medical procedures or technologies. The purpose of a Coverage Policy is to inform members and their physicians why certain medical procedures may or may not be covered under Arkansas Blue Cross and Blue Shield health

plans.

PRE-CERTIFICATION / PRE-AUTHORIZATION INFORMATION Pre-certification / Pre-notification: Preadmission certification or pre-certification is a process where a member must call and receive prior approval for an admission into any hospital. Failure to receive preadmission certification usually involves a penalty payment by the member of a specified dollar amount – varies by plan design.

2021 OTC BENEFITS

2021 OTC Benefits. Over-the-counter benefits catalog

H9699_21HA_MOTCC_C

REQUEST TO CANCEL POLICY Request to cancel policy Please cancel my individual policy through Arkansas Blue Cross and Blue Shield or Health Advantage. Current ID number Current group number COVERAGE POLICY MANUAL The network must maintain a log of connections, with time, date, and duration. An example of a compliant network is Arkansas e-Link. (To connect to the Arkansas e-Link network, healthcare professionals may call the Center for Distance Health at 501-686-6998 or enroll online at arkansaselink.com.) 7. HOME - ARKANSAS BLUE CROSS AND BLUE SHIELDSIGN INSHOPMEMBERSMEDICAREPROVIDERSSUPPORT Download the My Blueprint Mobile app to sign into your account and pay from your mobile phone. Eligible 1 members can make payments using a check, credit or debit card by calling 800-354-9904. Visit an Arkansas Blue Cross location to pay your bill in person. Send a check or money order to us. Remember to include your member ID or account number.

PAYMENT OPTIONS

For all other members (including dental and non-Metallic medical plans): Arkansas Blue Cross and Blue Shield. P.O. Box 954722. St. Louis, MO 63195-4772. 1 Medicare Advantage and Prescription Drug plan product members can mail their monthly payment or set up an automatic monthly bank draft. If there are questions, please call customer

service to

HEALTHY BLUE REWARDS If you have other questions, please call Healthy Blue Rewards Customer Service at 800-960-6360 from Monday through Friday 8:00 a.m. to 8:00 p.m. Central Time. HealthMine, Inc., is an independent company that contracts with Arkansas Blue Medicare to provide Medicare Advantage member rewards programs. Y0083_MA Website. MY BLUEPRINT MEMBER PORTAL: ARKANSAS BLUE CROSS AND BLUE Access your member portal to review claims, see your ID card, find care and estimate costs, review personal health records, pay premiums

and more.

BLUE CHOICE ESSENTIAL VALUE FORMULARY APRIL 2021 INTRODUCTION We are pleased to provide the 2021 Arkansas Blue Cross and Blue Shield Blue Choice Formulary as a useful reference and informational tool. This document can assist practitioners in selecting clinically appropriate and cost-

COVERAGE POLICY

The medical director of Arkansas Blue Cross and Blue Shield has established specific coverage policies addressing certain medical procedures or technologies. The purpose of a Coverage Policy is to inform members and their physicians why certain medical procedures may or may not be covered under Arkansas Blue Cross and Blue Shield health

plans.

PRE-CERTIFICATION / PRE-AUTHORIZATION INFORMATION Pre-certification / Pre-notification: Preadmission certification or pre-certification is a process where a member must call and receive prior approval for an admission into any hospital. Failure to receive preadmission certification usually involves a penalty payment by the member of a specified dollar amount – varies by plan design.

2021 OTC BENEFITS

2021 OTC Benefits. Over-the-counter benefits catalog

H9699_21HA_MOTCC_C

REQUEST TO CANCEL POLICY Request to cancel policy Please cancel my individual policy through Arkansas Blue Cross and Blue Shield or Health Advantage. Current ID number Current group number COVERAGE POLICY MANUAL The network must maintain a log of connections, with time, date, and duration. An example of a compliant network is Arkansas e-Link. (To connect to the Arkansas e-Link network, healthcare professionals may call the Center for Distance Health at 501-686-6998 or enroll online at arkansaselink.com.) 7. MEDICARE - ARKANSAS BLUE CROSS AND BLUE SHIELD The 2021 Plans That Give You More. Call now 888-754-0751. Shop plans Free plan information kit. Shop Find care COVID-19 Find forms Sign in.

MDL SETTLEMENT

In October 2020, Arkansas Blue Cross and Blue Shield was part of a class action settlement in a case brought by Blue Cross Blue Shield subscribers related to licensing agreements within the Blue Cross and Blue Shield System. While we reject claims made by the plaintiffs in the case, we agreed to provide monetary payments to eligible

individuals

GO PAPERLESS

How to go paperless: Sign in to My Blueprint. Go to the Settings link in the top right to add or verify your email address. Check the "Email Me" box in the Claims documents section. Select the Save button. You're all set! You'll now receive claims notifications by email. BLUEMEDICARE SAVER CHOICE (PPO) FORMULARY A formulary is a list of covered drugs selected by BlueMedicare Saver Choice (PPO) in consultation with a team of health care providers, which represents the prescription therapies believed VACCINES SAVE LIVES: STICK WITH ME In this article from the Arkansas Democrat-Gazette on June 10, Dr. Vic Snyder, corporate medical director for external affairs at Arkansas Blue Cross and Blue Shield, discusses the importance of immunizations. One of the curiosities that comes from being an old father with young children is that your household becomes its own science project. 2021 MEDI-PAK MEDICARE SUPPLEMENT MEDI-PAK ® MEDICARE SUPPLEMENT 2021 INSURANCE POLICIES For individuals newly eligible for Medicare on or after January 1, 2020.

MPI 8546.2 11/20

CAREER OPPORTUNITIES Internships. The Arkansas Blue Cross Summer Internship Program is a 10-week, full-time, paid learning experience. Arkansas Blue Cross and Blue Shield is proud to be an Equal Opportunity and Affirmative Action employer. We are subject to federal employment regulations and do not discriminate based on race, color, national origin, gender, gender BLUEMEDICARE PREMIER (HMO) FORMULARY A formulary is a list of covered drugs selected by BlueMedicare Premier (HMO) in consultation with a team of health care providers, which represents the prescription therapies believed PRIOR AUTHORIZATION REQUEST FORM 9. Previous services/therapy (Including medication, dose, duration) a. Date (mm/dd/yyyy) b. Date (mm/dd/yyyy) c. Date (mm/dd/yyyy) d. Reason for discontinuing previous therapy (e.g. contraindications, allergies, therapeutic failure) Additional Information: Please attach and submit any progress notes, lab data, discharge summaries, or other relevant documentation to support discontinuation of COVERAGE POLICY MANUAL The network must maintain a log of connections, with time, date, and duration. An example of a compliant network is Arkansas e-Link. (To connect to the Arkansas e-Link network, healthcare professionals may call the Center for Distance Health at 501-686-6998 or enroll online at arkansaselink.com.) 7. HOME - ARKANSAS BLUE CROSS AND BLUE SHIELDSIGN INSHOPMEMBERSMEDICAREPROVIDERSSUPPORT Download the My Blueprint Mobile app to sign into your account and pay from your mobile phone. Eligible 1 members can make payments using a check, credit or debit card by calling 800-354-9904. Visit an Arkansas Blue Cross location to pay your bill in person. Send a check or money order to us. Remember to include your member ID or account number.

PAYMENT OPTIONS

For all other members (including dental and non-Metallic medical plans): Arkansas Blue Cross and Blue Shield. P.O. Box 954722. St. Louis, MO 63195-4772. 1 Medicare Advantage and Prescription Drug plan product members can mail their monthly payment or set up an automatic monthly bank draft. If there are questions, please call customer

service to

MEDICARE - ARKANSAS BLUE CROSS AND BLUE SHIELD The 2021 Plans That Give You More. Call now 888-754-0751. Shop plans Free plan information kit. Shop Find care COVID-19 Find forms Sign in. HEALTHY BLUE REWARDS If you have other questions, please call Healthy Blue Rewards Customer Service at 800-960-6360 from Monday through Friday 8:00 a.m. to 8:00 p.m. Central Time. HealthMine, Inc., is an independent company that contracts with Arkansas Blue Medicare to provide Medicare Advantage member rewards programs. Y0083_MA Website.

GO PAPERLESS

How to go paperless: Sign in to My Blueprint. Go to the Settings link in the top right to add or verify your email address. Check the "Email Me" box in the Claims documents section. Select the Save button. You're all set! You'll now receive claims notifications by email. PHARMACY INFORMATION Fax signed forms to CVS/Caremark at 1-855-245-2134 for prior approval and quantity limit requests. Contact CVS/Caremark at 1-855-582-2022 with questions regarding the prior approval and quantity limit review process. For Step Therapy and Non-Formulary Exception requests, fax the form to 501-378-6980. For Step Therapy and Non-Formulary Exception MY BLUEPRINT MEMBER PORTAL: ARKANSAS BLUE CROSS AND BLUE Access your member portal to review claims, see your ID card, find care and estimate costs, review personal health records, pay premiums

and more.

2021 OTC BENEFITS

2021 OTC Benefits. Over-the-counter benefits catalog

H9699_21HA_MOTCC_C

REQUEST TO CANCEL POLICY Request to cancel policy Please cancel my individual policy through Arkansas Blue Cross and Blue Shield or Health Advantage. Current ID number Current group number PRIOR AUTHORIZATION REQUEST FORM 9. Previous services/therapy (Including medication, dose, duration) a. Date (mm/dd/yyyy) b. Date (mm/dd/yyyy) c. Date (mm/dd/yyyy) d. Reason for discontinuing previous therapy (e.g. contraindications, allergies, therapeutic failure) Additional Information: Please attach and submit any progress notes, lab data, discharge summaries, or other relevant documentation to support discontinuation of HOME - ARKANSAS BLUE CROSS AND BLUE SHIELDSIGN INSHOPMEMBERSMEDICAREPROVIDERSSUPPORT Download the My Blueprint Mobile app to sign into your account and pay from your mobile phone. Eligible 1 members can make payments using a check, credit or debit card by calling 800-354-9904. Visit an Arkansas Blue Cross location to pay your bill in person. Send a check or money order to us. Remember to include your member ID or account number.

PAYMENT OPTIONS

For all other members (including dental and non-Metallic medical plans): Arkansas Blue Cross and Blue Shield. P.O. Box 954722. St. Louis, MO 63195-4772. 1 Medicare Advantage and Prescription Drug plan product members can mail their monthly payment or set up an automatic monthly bank draft. If there are questions, please call customer

service to

MEDICARE - ARKANSAS BLUE CROSS AND BLUE SHIELD The 2021 Plans That Give You More. Call now 888-754-0751. Shop plans Free plan information kit. Shop Find care COVID-19 Find forms Sign in. HEALTHY BLUE REWARDS If you have other questions, please call Healthy Blue Rewards Customer Service at 800-960-6360 from Monday through Friday 8:00 a.m. to 8:00 p.m. Central Time. HealthMine, Inc., is an independent company that contracts with Arkansas Blue Medicare to provide Medicare Advantage member rewards programs. Y0083_MA Website.

GO PAPERLESS

How to go paperless: Sign in to My Blueprint. Go to the Settings link in the top right to add or verify your email address. Check the "Email Me" box in the Claims documents section. Select the Save button. You're all set! You'll now receive claims notifications by email. PHARMACY INFORMATION Fax signed forms to CVS/Caremark at 1-855-245-2134 for prior approval and quantity limit requests. Contact CVS/Caremark at 1-855-582-2022 with questions regarding the prior approval and quantity limit review process. For Step Therapy and Non-Formulary Exception requests, fax the form to 501-378-6980. For Step Therapy and Non-Formulary Exception MY BLUEPRINT MEMBER PORTAL: ARKANSAS BLUE CROSS AND BLUE Access your member portal to review claims, see your ID card, find care and estimate costs, review personal health records, pay premiums

and more.

2021 OTC BENEFITS

2021 OTC Benefits. Over-the-counter benefits catalog

H9699_21HA_MOTCC_C

REQUEST TO CANCEL POLICY Request to cancel policy Please cancel my individual policy through Arkansas Blue Cross and Blue Shield or Health Advantage. Current ID number Current group number PRIOR AUTHORIZATION REQUEST FORM 9. Previous services/therapy (Including medication, dose, duration) a. Date (mm/dd/yyyy) b. Date (mm/dd/yyyy) c. Date (mm/dd/yyyy) d. Reason for discontinuing previous therapy (e.g. contraindications, allergies, therapeutic failure) Additional Information: Please attach and submit any progress notes, lab data, discharge summaries, or other relevant documentation to support discontinuation of CONTACT US - ARKANSAS BLUE CROSS AND BLUE SHIELD Call us. Main numbers 800-238-8379. Metallic plan members (Gold, Silver, Bronze and Catastrophic) 800-800-4298 (TDD 501-502-1458) . Or

a complete list

HEALTH AND WELLNESS

A wellness visit is a meeting between you and your doctor, also called your primary care provider, once a year, to talk about your health concerns, go over your health history and consider other services to help keep you well. Learn about wellness visits.

MEMBER REWARDS CARD

Member Rewards Card Claim your $50 annual wellness exam reward. Arkansas Works members can earn a $50 rewards card by visiting their doctor for an annual wellness exam as part of the Arkansas Blue Cross Member Rewards Visa® Prepaid Card program.* BLUEMEDICARE SAVER CHOICE (PPO) FORMULARY A formulary is a list of covered drugs selected by BlueMedicare Saver Choice (PPO) in consultation with a team of health care providers, which represents the prescription therapies believed

DRUG PRICING

Drug pricing. Pharmacy benefits are administered through the Arkansas Blue Cross and Blue Shield Pharmacy Program, which eliminates paper claim forms and employs the latest technology for electronic pharmacy

claims processing.

BLUEMEDICARE PREMIER (HMO) FORMULARY A formulary is a list of covered drugs selected by BlueMedicare Premier (HMO) in consultation with a team of health care providers, which represents the prescription therapies believed 2021 MEDI-PAK MEDICARE SUPPLEMENT MEDI-PAK ® MEDICARE SUPPLEMENT 2021 INSURANCE POLICIES For individuals newly eligible for Medicare on or after January 1, 2020.

MPI 8546.2 11/20

MEDI-PAK SUPPLEMENT GI RULES QUICK-REFERENCE CHART *No commissions for individuals under age 65 effective 1/1/2021. Scenario Details Time Period Eligible Plans MA plan “drops ball”*

Medigap plan

COVERAGE POLICY

The medical director of Arkansas Blue Cross and Blue Shield has established specific coverage policies addressing certain medical procedures or technologies. The purpose of a Coverage Policy is to inform members and their physicians why certain medical procedures may or may not be covered under Arkansas Blue Cross and Blue Shield health

plans.

BLUE & YOU FITNESS CHALLENGE WINNERS FINISH STRONG The 2021 Blue & You Fitness Challenge finished strong! This year, 4,176 participants in 77 groups joined the competition. Groups from across the United States participated in the Challenge and ranged in size from 2 to 1,200 participants. HOME - ARKANSAS BLUE CROSS AND BLUE SHIELDSIGN INSHOPMEMBERSMEDICAREPROVIDERSSUPPORT Download the My Blueprint Mobile app to sign into your account and pay from your mobile phone. Eligible 1 members can make payments using a check, credit or debit card by calling 800-354-9904. Visit an Arkansas Blue Cross location to pay your bill in person. Send a check or money order to us. Remember to include your member ID or account number.

PAYMENT OPTIONS

For all other members (including dental and non-Metallic medical plans): Arkansas Blue Cross and Blue Shield. P.O. Box 954722. St. Louis, MO 63195-4772. 1 Medicare Advantage and Prescription Drug plan product members can mail their monthly payment or set up an automatic monthly bank draft. If there are questions, please call customer

service to

MEDICARE - ARKANSAS BLUE CROSS AND BLUE SHIELD The 2021 Plans That Give You More. Call now 888-754-0751. Shop plans Free plan information kit. Shop Find care COVID-19 Find forms Sign in. HEALTHY BLUE REWARDS If you have other questions, please call Healthy Blue Rewards Customer Service at 800-960-6360 from Monday through Friday 8:00 a.m. to 8:00 p.m. Central Time. HealthMine, Inc., is an independent company that contracts with Arkansas Blue Medicare to provide Medicare Advantage member rewards programs. Y0083_MA Website. PHARMACY INFORMATION Fax signed forms to CVS/Caremark at 1-855-245-2134 for prior approval and quantity limit requests. Contact CVS/Caremark at 1-855-582-2022 with questions regarding the prior approval and quantity limit review process. For Step Therapy and Non-Formulary Exception requests, fax the form to 501-378-6980. For Step Therapy and Non-Formulary Exception

GO PAPERLESS

How to go paperless: Sign in to My Blueprint. Go to the Settings link in the top right to add or verify your email address. Check the "Email Me" box in the Claims documents section. Select the Save button. You're all set! You'll now receive claims notifications by email. MY BLUEPRINT MEMBER PORTAL: ARKANSAS BLUE CROSS AND BLUE Access your member portal to review claims, see your ID card, find care and estimate costs, review personal health records, pay premiums

and more.

2021 OTC BENEFITS

2021 OTC Benefits. Over-the-counter benefits catalog

H9699_21HA_MOTCC_C

REQUEST TO CANCEL POLICY Request to cancel policy Please cancel my individual policy through Arkansas Blue Cross and Blue Shield or Health Advantage. Current ID number Current group number NEW SPRINGDALE CONSTRUCTION PROJECT MOVING FORWARD Next month, Arkansas Blue Cross and Blue Shield will break ground for the construction of a new 81,000-square-foot building in Springdale that will expand the company’s presence in Northwest Arkansas. Curtis Barnett President and CEO of Arkansas Blue Cross and Blue Shield “Arkansas Blue Cross has grown and changed with our state for more than seven decades now,” said Curtis Barnett HOME - ARKANSAS BLUE CROSS AND BLUE SHIELDSIGN INSHOPMEMBERSMEDICAREPROVIDERSSUPPORT If you choose to access other websites from this website, you agree, as a condition of choosing any such link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to others in any way for your decision to link to such other websites.

PAYMENT OPTIONS

If you choose to access other websites from this website, you agree, as a condition of choosing any such link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to others in any way for your decision to link to such other websites. MEDICARE - ARKANSAS BLUE CROSS AND BLUE SHIELD Blue Medicare Reimagined The 2021 Plans That Give You More Call now

888-754-0751

HEALTHY BLUE REWARDS Registration is required to participate. Visit ArkansasHealthyBlue.HealthMine.com to register and see what healthy behaviors earn rewards. If you do not have internet access, call Healthy Blue Rewards Customer Service at 800-960-6360.

GO PAPERLESS

If you choose to access other websites from this website, you agree, as a condition of choosing any such link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to others in any way for your decision to link to such other websites. PHARMACY INFORMATION Pharmacy information Pharmacy forms. Prescription Claim Form ; Prescription Mail Service Order Form If your policy has a mail-order drug benefit, use this form to MY BLUEPRINT MEMBER PORTAL: ARKANSAS BLUE CROSS AND BLUE Access your member portal to review claims, see your ID card, find care and estimate costs, review personal health records, pay premiums

and more.

2021 OTC BENEFITS

2021 OTC Benefits. Over-the-counter benefits catalog

H9699_21HA_MOTCC_C

REQUEST TO CANCEL POLICY Request to cancel policy Please cancel my individual policy through Arkansas Blue Cross and Blue Shield or Health Advantage. Current ID number Current group number NEW SPRINGDALE CONSTRUCTION PROJECT MOVING FORWARD Next month, Arkansas Blue Cross and Blue Shield will break ground for the construction of a new 81,000-square-foot building in Springdale that will expand the company’s presence in Northwest Arkansas. Curtis Barnett President and CEO of Arkansas Blue Cross and Blue Shield “Arkansas Blue Cross has grown and changed with our state for more than seven decades now,” said Curtis Barnett CONTACT US - ARKANSAS BLUE CROSS AND BLUE SHIELD Call us. Main numbers 800-238-8379. Metallic plan members (Gold, Silver, Bronze and Catastrophic) 800-800-4298 (TDD 501-502-1458) . Or

a complete list

BLUEMEDICARE SAVER CHOICE (PPO) FORMULARY A formulary is a list of covered drugs selected by BlueMedicare Saver Choice (PPO) in consultation with a team of health care providers, which represents the prescription therapies believed

MEMBER REWARDS CARD

Member Rewards Card Claim your $50 annual wellness exam reward. Arkansas Works members can earn a $50 rewards card by visiting their doctor for an annual wellness exam as part of the Arkansas Blue Cross Member Rewards Visa® Prepaid Card program.*

HEALTH AND WELLNESS

A wellness visit is a meeting between you and your doctor, also called your primary care provider, once a year, to talk about your health concerns, go over your health history and consider other services to help keep you well. Learn about wellness visits. BLUEMEDICARE PREMIER (HMO) FORMULARY A formulary is a list of covered drugs selected by BlueMedicare Premier (HMO) in consultation with a team of health care providers, which represents the prescription therapies believed

DRUG PRICING

Drug pricing. Pharmacy benefits are administered through the Arkansas Blue Cross and Blue Shield Pharmacy Program, which eliminates paper claim forms and employs the latest technology for electronic pharmacy

claims processing.

ARKANSAS ~ ~ BLUECROSS BLUESHIELD PROVIDERS• NEWS .ffl..'01 Arkansas ~ ~ BlueCross BlueShield PROVIDERS• NEWS June 2021 Published for providers and their office staffs by Arkansas Blue Cross and Blue Shield • Editor: Sarah Ricard • 501-378-2150 • Fax: 501-378-2465 • ProvidersNews@arkbluecross.com TABLE OF CONTENTS MEDI-PAK SUPPLEMENT GI RULES QUICK-REFERENCE CHART *No commissions for individuals under age 65 effective 1/1/2021. Scenario Details Time Period Eligible Plans MA plan “drops ball”*

Medigap plan

2021 MEDI-PAK MEDICARE SUPPLEMENT MEDI-PAK ® MEDICARE SUPPLEMENT 2021 INSURANCE POLICIES For individuals newly eligible for Medicare on or after January 1, 2020.

MPI 8546.2 11/20

COVERAGE POLICY

The medical director of Arkansas Blue Cross and Blue Shield has established specific coverage policies addressing certain medical procedures or technologies. The purpose of a Coverage Policy is to inform members and their physicians why certain medical procedures may or may not be covered under Arkansas Blue Cross and Blue Shield health

plans.

HOME - ARKANSAS BLUE CROSS AND BLUE SHIELDSIGN INSHOPMEMBERSMEDICAREPROVIDERSSUPPORT If you choose to access other websites from this website, you agree, as a condition of choosing any such link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to others in any way for your decision to link to such other websites.

PAYMENT OPTIONS

If you choose to access other websites from this website, you agree, as a condition of choosing any such link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to others in any way for your decision to link to such other websites. MEDICARE - ARKANSAS BLUE CROSS AND BLUE SHIELD Blue Medicare Reimagined The 2021 Plans That Give You More Call now

888-754-0751

HEALTHY BLUE REWARDS Registration is required to participate. Visit ArkansasHealthyBlue.HealthMine.com to register and see what healthy behaviors earn rewards. If you do not have internet access, call Healthy Blue Rewards Customer Service at 800-960-6360.

GO PAPERLESS

If you choose to access other websites from this website, you agree, as a condition of choosing any such link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to others in any way for your decision to link to such other websites. PHARMACY INFORMATION Pharmacy information Pharmacy forms. Prescription Claim Form ; Prescription Mail Service Order Form If your policy has a mail-order drug benefit, use this form to MY BLUEPRINT MEMBER PORTAL: ARKANSAS BLUE CROSS AND BLUE Access your member portal to review claims, see your ID card, find care and estimate costs, review personal health records, pay premiums

and more.

2021 OTC BENEFITS

2021 OTC Benefits. Over-the-counter benefits catalog

H9699_21HA_MOTCC_C

REQUEST TO CANCEL POLICY Request to cancel policy Please cancel my individual policy through Arkansas Blue Cross and Blue Shield or Health Advantage. Current ID number Current group number NEW SPRINGDALE CONSTRUCTION PROJECT MOVING FORWARD Next month, Arkansas Blue Cross and Blue Shield will break ground for the construction of a new 81,000-square-foot building in Springdale that will expand the company’s presence in Northwest Arkansas. Curtis Barnett President and CEO of Arkansas Blue Cross and Blue Shield “Arkansas Blue Cross has grown and changed with our state for more than seven decades now,” said Curtis Barnett HOME - ARKANSAS BLUE CROSS AND BLUE SHIELDSIGN INSHOPMEMBERSMEDICAREPROVIDERSSUPPORT If you choose to access other websites from this website, you agree, as a condition of choosing any such link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to others in any way for your decision to link to such other websites.

PAYMENT OPTIONS

If you choose to access other websites from this website, you agree, as a condition of choosing any such link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to others in any way for your decision to link to such other websites. MEDICARE - ARKANSAS BLUE CROSS AND BLUE SHIELD Blue Medicare Reimagined The 2021 Plans That Give You More Call now

888-754-0751

HEALTHY BLUE REWARDS Registration is required to participate. Visit ArkansasHealthyBlue.HealthMine.com to register and see what healthy behaviors earn rewards. If you do not have internet access, call Healthy Blue Rewards Customer Service at 800-960-6360.

GO PAPERLESS

If you choose to access other websites from this website, you agree, as a condition of choosing any such link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to others in any way for your decision to link to such other websites. PHARMACY INFORMATION Pharmacy information Pharmacy forms. Prescription Claim Form ; Prescription Mail Service Order Form If your policy has a mail-order drug benefit, use this form to MY BLUEPRINT MEMBER PORTAL: ARKANSAS BLUE CROSS AND BLUE Access your member portal to review claims, see your ID card, find care and estimate costs, review personal health records, pay premiums

and more.

2021 OTC BENEFITS

2021 OTC Benefits. Over-the-counter benefits catalog

H9699_21HA_MOTCC_C

REQUEST TO CANCEL POLICY Request to cancel policy Please cancel my individual policy through Arkansas Blue Cross and Blue Shield or Health Advantage. Current ID number Current group number NEW SPRINGDALE CONSTRUCTION PROJECT MOVING FORWARD Next month, Arkansas Blue Cross and Blue Shield will break ground for the construction of a new 81,000-square-foot building in Springdale that will expand the company’s presence in Northwest Arkansas. Curtis Barnett President and CEO of Arkansas Blue Cross and Blue Shield “Arkansas Blue Cross has grown and changed with our state for more than seven decades now,” said Curtis Barnett CONTACT US - ARKANSAS BLUE CROSS AND BLUE SHIELD Call us. Main numbers 800-238-8379. Metallic plan members (Gold, Silver, Bronze and Catastrophic) 800-800-4298 (TDD 501-502-1458) . Or

a complete list

BLUEMEDICARE SAVER CHOICE (PPO) FORMULARY A formulary is a list of covered drugs selected by BlueMedicare Saver Choice (PPO) in consultation with a team of health care providers, which represents the prescription therapies believed

HEALTH AND WELLNESS

Wellness visits. A wellness visit is a meeting between you and your doctor, also called your primary care provider, once a year, to talk about your health concerns, go over your health history and consider other services to help keep you well.

MEMBER REWARDS CARD

Member Rewards Card Claim your $50 annual wellness exam reward. Arkansas Works members can earn a $50 rewards card by visiting their doctor for an annual wellness exam as part of the Arkansas Blue Cross Member Rewards Visa® Prepaid Card program.* BLUEMEDICARE PREMIER (HMO) FORMULARY A formulary is a list of covered drugs selected by BlueMedicare Premier (HMO) in consultation with a team of health care providers, which represents the prescription therapies believed

DRUG PRICING

Drug pricing. Pharmacy benefits are administered through the Arkansas Blue Cross and Blue Shield Pharmacy Program, which eliminates paper claim forms and employs the latest technology for electronic pharmacy

claims processing.

ARKANSAS ~ ~ BLUECROSS BLUESHIELD PROVIDERS• NEWS .ffl..'01 Arkansas ~ ~ BlueCross BlueShield PROVIDERS• NEWS June 2021 Published for providers and their office staffs by Arkansas Blue Cross and Blue Shield • Editor: Sarah Ricard • 501-378-2150 • Fax: 501-378-2465 • ProvidersNews@arkbluecross.com TABLE OF CONTENTS MEDI-PAK SUPPLEMENT GI RULES QUICK-REFERENCE CHART *No commissions for individuals under age 65 effective 1/1/2021. Scenario Details Time Period Eligible Plans MA plan “drops ball”*

Medigap plan

2021 MEDI-PAK MEDICARE SUPPLEMENT MEDI-PAK ® MEDICARE SUPPLEMENT 2021 INSURANCE POLICIES For individuals newly eligible for Medicare on or after January 1, 2020.

MPI 8546.2 11/20

COVERAGE POLICY

If you choose to access other websites from this website, you agree, as a condition of choosing any such link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to others in any way for your decision to link to such other websites. Skip to Content (Press Enter)

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ARKANSAS BLUE CROSS AND BLUE SHIELD

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1 Medicare Advantage and Prescription Drug plan product members can mail their monthly payment or set up an automatic monthly bank draft. If there are questions, please call customer service at 877-233-7022 to discuss payment options. Health Advantage conversion plans are not eligible for online, mobile, AutoPay or pay-by-phone payment options. Arkansas State Icon Find care X to plus Member portal X to plus SIGN IN TO MY BLUEPRINT Username Please enter a username Exclamation Mark Password Please enter a password (8-12 characters) Exclamation Mark Sign inRegister

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