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Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits, all FreedomBlue PPO members have access to the Blue Cross Blue Shield Association Visitor and Travel Program beginning January 1, 2010. FreedomBlue PPO members may visit any participating Blue Cross and/or Blue Shield Medicare Advantage PPO provider in any geographic area where the Visitor and Travel Program is offered. Members will pay the same network cost-sharing level they pay if they receive covered services from network providers in the FreedomBlue PPO service area. FreedomBlue PPO network providers, as well as providers participating in the Visitor and Travel Program, are available in the following states and Puerto Rico: Alabama, California, Florida, Idaho, Indiana, Kentucky, Massachusetts, Michigan, Missouri, North Carolina, Nevada, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Wisconsin and West Virginia. For some of the states listed, Medicare Advantage PPO networks are only available in portions of the state. To find Blue Cross and/or Blue Shield Medicare Advantage PPO providers in the above states and Puerto Rico, you may do one or more of the following: Call 1-800-810-BLUE (1-800-810-2583), 24 hours a day, seven days a week, (hearing-impaired TTY users may call 711). Select “Find a Provider” on this Web site Visit the “Doctor Hospital Finder” at www.bcbs.com Select a state below to see where the Blue Cross Blue Shield Visitor and Travel Program and FreedomBlue PPO network is available. Alabama Michigan Pennsylvania California Missouri Puerto Rico Florida Nevada South Carolina Idaho New York Tennessee Indiana North Carolina Wisconsin Kentucky Ohio West Virginia Massachusetts

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Page 1: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program

In addition to standard network and out-of-network benefits, all FreedomBlue PPO members have access to the Blue Cross Blue Shield Association Visitor and Travel Program beginning January 1, 2010. FreedomBlue PPO members may visit any participating Blue Cross and/or Blue Shield Medicare Advantage PPO provider in any geographic area where the Visitor and Travel Program is offered. Members will pay the same network cost-sharing level they pay if they receive covered services from network providers in the FreedomBlue PPO service area. FreedomBlue PPO network providers, as well as providers participating in the Visitor and Travel Program, are available in the following states and Puerto Rico: Alabama, California, Florida, Idaho, Indiana, Kentucky, Massachusetts, Michigan, Missouri, North Carolina, Nevada, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Wisconsin and West Virginia. For some of the states listed, Medicare Advantage PPO networks are only available in portions of the state. To find Blue Cross and/or Blue Shield Medicare Advantage PPO providers in the above states and Puerto Rico, you may do one or more of the following:

Call 1-800-810-BLUE (1-800-810-2583), 24 hours a day, seven days a week, (hearing-impaired TTY users may call 711).

Select “Find a Provider” on this Web site Visit the “Doctor Hospital Finder” at www.bcbs.com

Select a state below to see where the Blue Cross Blue Shield Visitor and Travel Program and FreedomBlue PPO network is available.

Alabama Michigan Pennsylvania California Missouri Puerto Rico

Florida Nevada South Carolina Idaho New York Tennessee

Indiana North Carolina WisconsinKentucky Ohio West Virginia

Massachusetts

Page 2: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

BIRMINGHAM

MONTGOMERY

MOBILE

HUNTSVILLE

TUSCALOOSA

HOOVER

DOTHAN

DECATUR

AUBURN

GADSDEN

FLORENCE

ENTERPRISE

SELMA

ALEXANDER CITY

TROYEUFAULA

ATMORE

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

ALABAMA

Page 3: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

DENVER

LONG BEACH

FRESNO

SACRAMENTO

COLORADO SPRINGS

BAKERSFIELD

ORANGE

DOWNEY WEST COVINA

PUEBLO

BURBANK

CARSON

SAN LEANDROMOUNTAIN VIEW

NEWPORT BEACH

UPLANDTUSTIN

UNION CITY

REDONDO BEACH

MILPITAS

SOUTH SAN FRANCISCO

PALO ALTO

ENCINITAS SAN MARCOSLA MESA

CHEYENN

SANTEESan Diego

San Jose

San FranciscoAURORA

GLENDALE

CHULA VISTA

OXNARD

OCEANSIDE

SANTA CLARITA

SALINAS

SANTA ROSA

MORENO VALLEY

LANCASTER

VALLEJO

PALMDALE

BERKELEY FAIRFIELD

ARDEN-ARCADE

SANTA BARBARA

VISALIA

VISTA

REDDING

ROSEVILLE

SANTA MARIA

GREELEY

CLOVIS

VICTORVILLE

MERCED

HESPERIA

ELK GROVE

CHICO

HEMET

RANCHO CORDOVA

SANTA CRUZ

PETALUMA

NATIONAL CITY

ROSWELL

SAN LUIS OBISPO

TULARE

PALM SPRINGS

PORTERVILLE

EUREKA

PASO ROBLES

SOUTH LAKE TAHOE

BARSTOW

DAN

SUSANVILLE

BLYTHE

TRINIDADRATON

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

CALIFORNIA

Page 4: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

MIAMI

TAMPA

ORLANDO

FORT LAUDERDALE

TALLAHASSEE

CAPE CORAL

SUNRISEPLANTATION

POMPANO BEACH

DAVIEMIRAMAR

DEERFIELD BEACH

NORTH MIAMI

FOUNTAINBLEAU

CAROL CITY

KENDALE LAKES

Jacksonville

ST. PETERSBURG

HIALEAH

CLEARWATER

GAINESVILLE

PORT ST. LUCIE

WEST PALM BEACH

PALM BAYLAKELAND

KENDALL

BOCA RATON

MELBOURNE

DELTONA

LARGO

SPRING HILL

DAYTONA BEACH

BOYNTON BEACHDELRAY BEACH

PALM HARBOR

PENSACOLA

SARASOTA

PORT CHARLOTTE

OCALA

PANAMA CITY

KEY WEST

NAPLES

CRESTVIEW

KEY LARGO

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

FLORIDA

Page 5: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

BOISENAMPA

POCATELLO

IDAHO FALLS

TWIN FALLS

LEWISTON

MOSCOW

REXBURGHAILEY

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

IDAHO

Page 6: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

INDIANAPOLIS

FORT WAYNE

EVANSVILLE

SOUTH BENDGARY

BLOOMINGTON

MUNCIEANDERSON

TERRE HAUTE

LAFAYETTE

ELKHART

KOKOMO

LOGANSPORT

VINCENNES

BEDFORD

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

INDIANA

Page 7: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

LEXINGTON-FAYETTE

LOUISVILLE

OWENSBORO

BOWLING GREEN

RICHMOND

PADUCAH

ELIZABETHTOWN

RADCLIFF

DANVILLE

SOMERSET

CAMPBELLSVILLE

MIDDLESBOROUGH

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

KENTUCKY

Page 8: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

BOSTONWORCESTER

SOMERVILLEWALTHAM

BROOKLINE

MALDENMEDFORD

SPRINGFIELD

LOWELL

BROCKTON

NEW BEDFORDFALL RIVER

LYNN

QUINCY

LAWRENCE

FRAMINGHAM

HAVERHILL

TAUNTON

CHICOPEE WEYMOUTH

PITTSFIELD

GARDNER

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

MASSACHUSETTS

Page 9: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

GRAND RAPIDS

FLINT

LANSING

WESTLANDFARMINGTON HILLS

TROYSOUTHFIELD

CANTON

WATERFORD ROCHESTER HILLS

TAYLOR

SHELBY

DEARBORN HEIGHTSWARREN

ANN ARBOR

LIVONIA

KALAMAZOO

WYOMING

SAGINAW

BATTLE CREEK

MIDLAND

MUSKEGON

HOLLAND

PORT HURON

MARQUETTESAULT STE. MARIE

TRAVERSE CITY

ESCANABA

ALPENA

BIG RAPIDS

CADILLAC

PETOSKEY

CHEBOYGAN

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

MICHIGAN

Page 10: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

KANSAS CITY

ST. LOUIS

SPRINGFIELD

INDEPENDENCE

COLUMBIA

ST. JOSEPH

LEE'S SUMMIT

ST. CHARLESST. PETERS

FLORISSANT

CAPE GIRARDEAU

OAKVILLE

SEDALIA

HANNIBAL

SIKESTON

KIRKSVILLE

POPLAR BLUFF

ROLLA

FARMINGTON

WEST PLAINS

MARYVILLE

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

MISSOURI

Page 11: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

LAS VEGAS

RENO

SUNRISE MANOR

SPRING VALLEYNORTH LAS VEGAS

CARSON CITY

PARADISEHENDERSON

SPARKS

ELKOSPRING CREEK

WINNEMUCCA

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

NEVADA

Page 12: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

BUFFALO

ROCHESTER

ALBANY

CHEEKTOWAGA

IRONDEQUOIT

New York

YONKERS

SYRACUSE

NEW ROCHELLEMOUNT VERNON

SCHENECTADY

TONAWANDAUTICANIAGARA FALLS

BRENTWOOD

WHITE PLAINS

LEVITTOWN

BINGHAMTON

ROME

JAMESTOWN ELMIRA

POUGHKEEPSIE

ITHACA

WATERTOWN

SARATOGA SPRINGS

MIDDLETOWN

PLATTSBURGH

CORTLAND

OSWEGO

ONEONTA

POTSDAM

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

NEW YORK

Page 13: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

RALEIGH

GREENSBORO

Charlotte

DURHAMWINSTON-SALEM

FAYETTEVILLE

CARY

HIGH POINT

WILMINGTON

ASHEVILLE

JACKSONVILLE

GASTONIA

GREENVILLE

CONCORD

ROCKY MOUNT

HICKORYASHEBORO

SHELBY

ELIZABETH CITY

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

NORTH CAROLINA

Page 14: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

COLUMBUS

CLEVELAND

CINCINNATI

TOLEDO

AKRON

DAYTON

PARMA

YOUNGSTOWN

CANTON

LORAIN

SPRINGFIELD

HAMILTON

KETTERING

ELYRIA

EUCLID

MIDDLETOWN

MENTOR

LIMA

FINDLAY

MARION

BOWLING GREEN

WOOSTER

CHILLICOTHE ATHENS

ASHLAND

PORTSMOUTH

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

OHIO

Page 15: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

PITTSBURGH

ERIE

Philadelphia

ALLENTOWN

READING

SCRANTON

BETHLEHEM

LANCASTER

LEVITTOWN

ALTOONA

WILKES-BARRE

YORK

STATE COLLEGE

WILLIAMSPORT

BUTLER

ST. MARYS

MEADVILLE

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

PENNSYLVANIA

Page 16: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

SAN JUAN

BAYAMÓNCAROLINA

PONCE

CAGUAS

GUAYNABO

MAYAGÜEZ

TRUJILLO ALTO

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

Puerto Rico

Page 17: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

COLUMBIA

CHARLESTONNORTH CHARLESTON

GREENVILLE

ROCK HILL

MOUNT PLEASANT

HILTON HEAD ISLAND

FLORENCE

ANDERSON

MYRTLE BEACH

GREENWOOD

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

SOUTH CAROLINA

Page 18: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

NASHVILLE-DAVIDSON

KNOXVILLE

CHATTANOOGA

CLARKSVILLE

Memphis

MURFREESBORO

JACKSON

JOHNSON CITY

KINGSPORT

COLUMBIA

MORRISTOWN

MARYVILLE

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

TENNESSEE

Page 19: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

MADISON

GREEN BAY

WEST ALLIS Milwaukee

KENOSHA

RACINE

APPLETON

WAUKESHA

OSHKOSH

EAU CLAIRE

JANESVILLE

LA CROSSESHEBOYGANFOND DU LAC

WAUSAU

MANITOWOC

STEVENS POINT

NEENAH

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

WISCONSIN

Page 20: Blue Cross Blue Shield Medicare Advantage Visitor and ...Blue Cross Blue Shield Medicare Advantage Visitor and Travel Program In addition to standard network and out-of-network benefits,

CHARLESTONHUNTINGTON

PARKERSBURG

WHEELING

MORGANTOWN

FAIRMONT

BECKLEY

CLARKSBURG

BLUEFIELD

Medicare Advantage PPO Network Access In-Network Benefits Available Out-of-Network Benefits

WEST VIRGINIA


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