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Blue Cross and Blue Shield, CommunityCare announce plan to offer new Medicare Blue PPO

Two of the state’s leading private, locally owned insurers – Blue Cross and Blue Shield of Oklahoma and CommunityCare Managed Healthcare Plans of Oklahoma – are joining forces to offer a new health plan option for Oklahomans eligible for Medicare. Pending federal approval, Medicare beneficiaries in 21 counties throughout central and eastern Oklahoma may choose Medicare Blue PPO – an individual Medicare PPO health plan – instead of traditional Medicare coverage, beginning June 1, 2005.  The new plan will be provided and underwritten by Blue Cross and Blue Shield of Oklahoma and administered by CommunityCare Life and Health Insurance Company. 

Blue Cross and Blue Shield of Oklahoma has submitted an application to the Centers for Medicare and Medicaid Services (CMS) to offer Medicare Blue PPO under CMS’ new Medicare Advantage program.

Medicare Advantage plans like Medicare Blue PPO take the place of traditional Medicare Part A (hospital coverage), Part B (physician coverage) and Medicare supplemental insurance.

Medicare Blue PPO features a preferred provider organization (PPO) network including hospitals, doctors and other health care providers in the
21-county service area.  Medicare Blue PPO members will receive the highest level of benefits when they seek care within the Medicare Blue PPO network.

“Medicare Blue PPO brings together the resources of Blue Cross and Blue Shield of Oklahoma and CommunityCare to offer new, affordable choices to Medicare beneficiaries in the service area,” said Ron King, chairman, chief executive officer and president, Blue Cross and Blue Shield of Oklahoma.

“Medicare Blue PPO represents a unique and creative relationship formed between the area’s two largest insurers to better serve our community,” said Richard Todd, president and chief executive officer, CommunityCare Managed Healthcare Plans. “This will provide the cost effective, service-oriented approach to health care that CMS is seeking for our senior citizens.”

Congress created the Medicare Advantage program as part of the Medicare Modernization Act of 2003. 

“Because of rising health care costs, Medicare beneficiaries are looking for alternatives to traditional Medicare plans.  Medicare Advantage is a major step toward modernizing Medicare,” King said. “CMS recognizes and respects the private sector’s expertise in organizing health care provider networks and administering quality, cost effective plans.”

Medicare Blue PPO will be underwritten by Blue Cross and Blue Shield of Oklahoma.  Most of the plan’s administrative functions, including customer service, claims and medical management services will be performed by CommunityCare.

Counties in the Medicare Blue PPO service area are: Canadian, Cleveland, Creek, Delaware, Grady, Logan, Lincoln, Mayes, McClain, Muskogee, Oklahoma, Okmulgee, Osage, Pawnee, Payne, Pottawatomie, Rogers, Sequoyah, Tulsa, Wagoner and Washington counties.

Blue Cross and Blue Shield of Oklahoma is a member of the Blue Cross and Blue Shield Association, an association of 40 independent Blue Cross and Blue Shield Plans. The insurer and its subsidiaries provide benefits for more than 500,000 Oklahomans.

CommunityCare Life and Health Insurance Company is a wholly owned subsidiary of CommunityCare Managed Healthcare Plans of Oklahoma. CommunityCare Managed Healthcare Plans of Oklahoma is owned by St. John Health System and Saint Francis Health System, both of Tulsa. Through its wholly owned subsidiaries, CommunityCare provides a wide range of HMO and PPO health benefits plans, as well as third-party administrator (TPA) and utilization review (UR) services, to over 400,000 members.