Bright Advantage Plus (HMO) Annual Notice of Changes for 2021

Introduction

This document outlines the changes to your Bright Advantage Plus (HMO) Medicare health plan for the upcoming year. Medicare requires us to inform you annually of any modifications to benefits, costs, and provider networks.

Bright Advantage Plus is dedicated to providing quality healthcare coverage while maintaining affordability. We have carefully evaluated our plan offerings for 2021 to ensure they continue to meet your healthcare needs.

Important Dates

• Annual Enrollment Period: October 15 - December 7, 2020
• Changes Effective Date: January 1, 2021

Benefit Changes for 2021

Medical Services

The following changes will take effect for medical services in 2021:

• Primary Care Physician: Copayment increasing from $0 to $10 per visit
• Specialist Visits: Copayment increasing from $25 to $35 per visit
• Urgent Care: New copayment of $40 per visit
• Emergency Services: $75 copayment per visit (previously $50)
• Telehealth Services: No copayment for virtual visits with in-network providers (new benefit)

Prescription Drug Coverage (Part D)

Your prescription drug coverage will include the following changes:

• Annual Deductible: Increasing from $310 to $435
• Tier 1: Generic drugs increasing from $5 to $7 copayment
• Tier 2: Preferred brand drugs increasing from $25 to $30 copayment
• Tier 3: Non-preferred brand drugs increasing from $45 to $50 copayment
• Coverage Gap: Continuing coverage with 25% coinsurance for brand-name and generic drugs
• Formulary Updates: Several medications have moved to different tiers; please review updated formulary

Preventive Care

We continue to prioritize your wellness with comprehensive preventive care benefits:

• Annual Wellness Visit: Covered at 100% when performed by in-network providers
• Screening Services: All Medicare-covered preventive screenings remain covered in full
• New Benefit: $200 quarterly allowance for approved over-the-counter health items
• New Benefit: $500 annual allowance for hearing aids

Vision and Dental Benefits

Your vision and dental benefits will include these changes:

• Routine Eye Exams: Once per year with $10 copayment (previously no cost)
• Eyeglass Frames: Up to $150 allowance (increased from $100)
• Contact Lenses: Up to $150 allowance annually (new benefit)
• Comprehensive Dental Exam: Once per year, covered at 100%
• Routine Cleanings: Twice per year, covered at 100%
• Basic Dental Services: 50% coinsurance (changed from 80% coverage)
• Major Dental Services: 50% coinsurance (changed from 80% coverage)

Additional Benefits

We have enhanced several additional benefits for 2021:

• Fitness Program: SilverSneakers membership now includes virtual fitness classes
• Transportation Benefit: Increased to 24 one-way trips per year for medical appointments
• Home Meal Delivery: Up to 32 meals after a hospital stay (increased from 16)
• Healthy Food Allowance: New $150 quarterly benefit for healthy food purchases
• Podiatry Coverage: New annual foot exam and nail care coverage for members with specific conditions

Cost Information

Your monthly premium and annual deductible for 2021 will be:

Cost Category	2020 Amount	2021 Amount
Monthly Premium	$35.00	$42.00
Annual Deductible (Medical)	$0	$0
Maximum Out-of-Pocket	$3,400	$4,900

Network Changes

Bright Advantage Plus maintains an extensive network of healthcare providers. For 2021, please note the following changes:

• New Hospitals: St. Joseph's Medical Center and Westside Community Hospital have joined our network
• New Providers: Over 50 new primary care physicians and specialists across our service area
• Network Termination: Dr. Emily Smith Cardiology Group and Memorial Pharmacy will no longer be in our network as of January 1, 2021
• Service Area Expansion: Our network now includes 3 additional counties: Cedar, Pine, and Lakeview

Appeals and Grievances

If you disagree with a decision about coverage services, you have the right to appeal. The process includes:

1. Level 1 (Redetermination): Request within 60 calendar days of the initial decision
2. Level 2 (Reconsideration): Request within 60 calendar days of Level 1 decision
3. Level 3 (Administrative Law Judge Hearing): Request within 60 calendar days of Level 2 decision
4. Level 4 (Medicare Appeals Council Review): Request within 60 calendar days of Level 3 decision
5. Level 5 (Judicial Review): Request within 60 calendar days of Level 4 decision

Plan Performance

Bright Advantage Plus received a 4.5-star rating from CMS for 2019, placing us among the top-rated Medicare Advantage plans. This rating reflects our commitment to:

• Member satisfaction
• Preventive health services
• Chronic disease management
• Customer service
• Pharmacy and medication safety

Contact Information

If you have questions about these changes or need additional information:

• Call Member Services: 1-800-BRIGHT-2 (1-800-274-4482) 8 a.m. to 8 p.m., 7 days a week
• TTY users: 1-800-795-2476
• Visit our website: www.brightadvantageplus.com
• Request a copy of the Evidence of Coverage document for detailed information

Member Rights and Responsibilities

As a Bright Advantage Plus member, you have important rights:

• The right to receive information about your plan in a clear, understandable format
• The right to file a grievance about the quality of care or service
• The right to appeal decisions to deny or limit payment for services
• The right to receive emergency care regardless of network status
• The right to receive care coordination for complex health conditions

Your responsibilities include:

• Following treatment plans prescribed by your provider
• Showing your member ID card when receiving services
• Paying your premiums and cost-sharing amounts on time
• Using in-network providers when possible
• informing us of changes to your address or other personal information

Summary

This Annual Notice of Changes serves as a guide to the modifications in your Bright Advantage Plus plan for 2021. We've made adjustments to copayments, allowances, and provider networks while maintaining comprehensive coverage.

We appreciate your membership in Bright Advantage Plus and are committed to providing high-quality healthcare coverage. If you have questions about these changes, please contact our Member Services team.