H9572 002

Out-of-Network: Copayment for Urgent Care $0.00 to $40.00. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $40.00. Maximum Plan Benefit of $50,000. Emergency Room Visit. Copayment for Emergency Care $90.00. Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 3 days. Worldwide Coverage:

H9572 002. H9572-007-002. 2024 Overall Rating. 4.0 out of 5 stars. Blue Cross Blue Shield of Michigan ... H9572-003-006. 2024 Overall Rating. 4.0 out of 5 stars. Blue Cross Blue Shield of Michigan | Local PPO.

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Medicare Plus Blue PPO Essential H9572-004 (PPO) Michigan. Medicare. Health. Medicare Plus Blue PPO Essential (PPO) H9572-004. Blue Cross Blue Shield of Michigan | Local PPO. Why Trust U.S. News. 344. H9572-001 Medicare Plus Blue PPO Vitality (PPO) 2024 H9572-002 Medicare Plus Blue PPO Assure (PPO) 2024 H9572-003 Medicare Plus Blue PPO Essential (PPO) 2024 …DOI: 10.1016/j.resuscitation.2022.05.002 Abstract Background: Assessment of brain injury severity is critically important after survival from cardiac arrest (CA). Recent advances in low-field MRI technology have permitted the acquisition of clinically useful bedside brain imaging. Our objective was to deploy a novel approach for evaluating brain injury after …H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus Blue + Meijer (PPO) 2024: H9572-007: Cigna View payer . Plan Name Effective Year Benefit Package; Cigna True Choice Medicare (PPO) 2024:Medicare Plus Blue PPO Vitality (PPO) is a Medicare Advantage (Part C) Plan by Blue Cross Blue Shield of Michigan. Premium: $78.00. Enroll Now. This page features plan details for 2024 Medicare Plus Blue PPO Vitality (PPO) H9572 – 002 – 4 available in Region 4.

SKU: 9572-002. MPN: 9572-002. BRAND: Nelson. 10 PSI (0.7 Bar) $ 11.00. For an estimated shipping cost, click here. Please enter your zip/postal code. Calculate Quantity: Add to Cart Other Options (Size): 10 PSI FNPT x FNPT. $11.00. 10 PSI FNPT x ST. $11.00. 15 PSI FNPT x FNPT. $11.00. 15 PSI FNPT x ST. $11.00. 20 PSI FNPT x FNPT.H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus Blue + Meijer (PPO) 2024: H9572-007: Cigna View payer . Plan Name Effective Year Benefit Package; Cigna True Choice Medicare (PPO) 2024:H9572_24EOCEVSA_C NM 08282023 OMB Approval 0938-1051 (Expires: February 29, 2024) Medicare Advantage Plans Form Approved OMB# 0938-1421 Multi-language …Compute answers using Wolfram's breakthrough technology & knowledgebase, relied on by millions of students & professionals. For math, science, nutrition, history ...Average Cost of Medicare Advantage Plans in Saginaw County, Michigan. Average Monthly Premium. $93.98. Average in-network out-of-pocket spending limit. $6,123.78. Average drug deductible in 2024 (weighted) $349.17. Percentage of …Get 2021 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLCLearn More about Blue Cross Blue Shield of Michigan Medicare Plus Blue PPO Vitality (PPO) Plan Details, including how much you can expect to pay for coinsurance, deductibles, premiums and copays for various services covered by the plan.Learn More about Blue Cross Blue Shield of Michigan Medicare Plus Blue PPO Vitality (PPO) Plan Details, including how much you can expect to pay for coinsurance, deductibles, premiums and copays for various services covered by the plan.

Professional irrigation products; Stock products ordered before 3pm, shipped the same day; Personal advice from our experts; See our reviews on Trustpilot H9572-806: BCN Advantage (HMO-POS) 2024: H5883-801: Medicare Plus Blue PPO Signature (PPO) 2024: H9572-001: Medicare Plus Blue PPO Vitality (PPO) 2024: H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus ... Plan ID: H9572-002-002 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $68.00 Monthly PremiumCopayment for Worldwide Urgent Coverage $55.00. Maximum Plan Benefit of $50,000. Out-of-Network: Copayment for Urgent Care $0.00 to $55.00. Emergency room visit. Emergency Care: Copayment for Emergency Care $100.00. Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 3 days.Шпули (втулки) изготавливаемые по ТУ 5481-002-57389331-2002. 4. Технические требования. Упаковка и маркировка 4.1. Каждый рулон этикетки упаковываются в один или два слоя пленки полиэтиленовой ГОСТ 10354 и H9572:007-2 Medicare Plus Blue + Meijer (PPO) H9572:007-3 Medicare Plus Blue + Meijer (PPO) H9572:007-4 Medicare Plus Blue + Meijer (PPO) H9572:007-6 Medicare Plus Blue + Meijer (PPO) Compare the 30 Medicare Advantage plans available from Blue Cross Blue Shield of Michigan through Alight Retiree Health Solutions.

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Medicare Plus Blue is a PPO plan with a Medicare contract. Enrollment in Medicare Plus Blue depends on contract renewal. H9572_SOM20MABAAG_M FVNR 1120. Physician Office services. Office visits. $20 Copay. Telehealth (online visit) – via the Blue Cross online tool powered by American Well®.TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the Medicare Plus Blue PPO Essential (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $9.00 (see Plan Premium Details below) Annual Deductible: $200 (Tier 1 and 6 excluded from the Deductible.) Annual Initial Coverage Limit (ICL): The Medicare Plus Blue PPO Essential (PPO) (H9572 - 004) currently has 47,608 members. There are 105 members enrolled in this plan in Barry, Michigan. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars. The detail CMS plan carrier ratings are as follows: We would like to show you a description here but the site won’t allow us.

4 out of 5 stars* for plan year 2024. Medicare Plus Blue PPO Vitality (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Blue Cross Blue Shield of Michigan. Plan ID: H9572-002-002. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $68.00 Monthly Premium. H9572_24EOCEVSA_C NM 08282023 . OMB Approval 0938-1051 (Expires: February 29, 2024) Medicare Advantage Plans . Form Approved OMB# 0938-1421 . Multi-language ... Get help from a licensed insurance agent. Call 1-877-354-4611 TTY 711. 8am – 11pm EST. 7 days a week TTY 711. 8am – 11pm EST. 7 days a week4 out of 5 stars* for plan year 2024. Medicare Plus Blue PPO Essential (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Blue Cross Blue Shield of Michigan. Plan ID: H9572-004-002. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium.Medicare Plus Blue PPO Signature (PPO) is a Medicare Advantage (Part C) Plan by Blue Cross Blue Shield of Michigan. Premium: $150.00. Enroll Now. This page features plan details for 2024 Medicare Plus Blue PPO Signature (PPO) H9572 – 001 – 3 available in Region 3. IMPORTANT: This page has been updated with plan and premium data for 2024.View the coverage and benefits provided in the Medicare Plus Blue PPO Vitality (PPO) plan from Blue Cross Blue Shield of Michigan. Alight Retiree Health Solutions represents Medicare plans from 59 insurers nationwide.H9572_24EOCEVSA_C NM 08282023 . OMB Approval 0938-1051 (Expires: February 29, 2024) Medicare Advantage Plans . Form Approved OMB# 0938-1421 . Multi-language ...Medicare Plus Blue PPO Vitality H9572-002 (PPO) Michigan. Medicare. Health. Medicare Plus Blue PPO Vitality (PPO) H9572-002. Blue Cross Blue Shield of Michigan | Local PPO. Why Trust U.S. News. 344.

WF 11717 JAN 19 H9572_IGMemReimburseForm_C FVNR 0119. To speed up processing of your request, please complete the form, printing clearly, sign and date it. •If submitting claims for more than one family member, complete a new form for each person. •Mail only original clear itemized bill(s) on your provider's letterhead for each medical expense.

9491-002 . Nelson Pressure Regulator 15 PSI 9491-003 . Nelson Pressure Regulator 20 PSI 9491-004 . Nelson Pressure Regulator 25 PSI 9491-005 . Accessories. Hose Barb Fitting- Barb x 3/4" FNPT 10057 . 10148 . Hose Barb Fitting- 3/4" Barb x Sq Thrd 9901 . 10130 . Nozzles #9 3TN Nozzle for Pivot SprayOrder Belden Electronic Wire/Cable, Multi-Cond Cable, 9572 002-1 at Zoro.com. Great prices & free shipping on orders over $50 when you sign in or sign up for an account.We would like to show you a description here but the site won’t allow us. BELDEN | 9572 002U1000 Multi-Conductor Cable, 2 Conductors, 16 AWG, Solid, Bare Copper, PVC Insulation, PVC Jacket Professional irrigation products; Stock products ordered before 3pm, shipped the same day; Personal advice from our experts; See our reviews on TrustpilotPlan ID: H9572-002-006 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $75.00 Monthly Premium9572-002-U1000 Cable and Wire from BELDEN In Stock, Order Now! Same Day Shipping, 2-Year Warranty - . MULTICORE CABLE, 2 CONDUCTOR, 304.8M, 300V; JKT COLOR:RED; NO.

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4 out of 5 stars* for plan year 2024. Medicare Plus Blue PPO Signature (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Blue Cross Blue Shield of Michigan. Plan ID: H9572-001-003. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $150.00 Monthly Premium.Medicare Plus Blue PPO Essential H9572-004 (PPO) Michigan. Medicare. Health. Medicare Plus Blue PPO Essential (PPO) H9572-004. Blue Cross Blue Shield of Michigan | Local PPO. Why Trust U.S. News. 344.Electronic Component Mall, offers the cheapest 9572-002-U1000 price, guarantee original authentic 9572-002-U1000, rich 9572-002-U1000 spot inventory, is a domestic professional electronic components procurement website, 9572-002-U1000 Buy Wholesale Global Semiconductor Alliance Technology Co., Ltd.!The big boom in the wearables sector will continue to expand over the next decade beyond fitness and into sectors....AAPL The big boom in the wearables sector will continue to expa...4 out of 5 stars* for plan year 2024. Medicare Plus Blue PPO Vitality (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Blue Cross Blue Shield of Michigan. Plan ID: H9572-002-006. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $75.00 Monthly Premium. Medicare Plus Blue PPO Essential H9572-004 (PPO) Michigan. Medicare. Health. Medicare Plus Blue PPO Essential (PPO) H9572-004. Blue Cross Blue Shield of Michigan | Local PPO. Why Trust U.S. News. 344. Medicare Plan Name: Medicare Plus Blue PPO Essential (PPO) Location: Dickinson, Michigan Click to see other locations. Plan ID: H9572 - 004 - 4 Click to see other plans. …Learn More about Blue Cross Blue Shield of Michigan Medicare Plus Blue PPO Vitality (PPO) Plan Details, including how much you can expect to pay for coinsurance, deductibles, premiums and copays for various services covered by the plan.H9572-007-002. 2024 Overall Rating. 4.0 out of 5 stars. Blue Cross Blue Shield of Michigan ... H9572-003-006. 2024 Overall Rating. 4.0 out of 5 stars. Blue Cross Blue Shield of Michigan | Local PPO. ….

H9572-001: Medicare Plus Blue PPO Vitality (PPO) 2024: H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus Blue + Meijer (PPO) 2024: H9572-007Get 2018 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC9572-RED-U1000 : 5 available at OnlineComponents.com. Datasheets, competitive pricing, flat rate shipping & secure online ordering.Medicare Plus Blue PPO Vitality (PPO) is a Medicare Advantage (Part C) Plan by Blue Cross Blue Shield of Michigan. Premium: $78.00. Enroll Now. This page features plan …H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus Blue + Meijer (PPO) 2024: H9572-007: Cigna View payer . Plan Name Effective Year Benefit Package; Cigna True Choice Medicare (PPO) 2024: H7787 …H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus Blue + Meijer (PPO) 2024: H9572-007: Cigna View payer . Plan Name Effective Year Benefit Package; Cigna True Choice Medicare (PPO) 2024: The table below outlines some of the specific plan details for Blue Cross Blue Shield of Michigan Medicare Advantage plans available in Michigan in 2024. Plan Name. Plan Code. Monthly Premium. Deductible. Out of. Pocket Max. Prescription Drug Coverage. Medicare. Plan ID: H9572-006-002 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. Michigan Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part …Millennials aren't investing enough in their financial education, according to famed finance author Robert Kiyosaki. He is author of the new book "Why the Rich Are Get... H9572 002, Medicare Plus Blue PPO Vitality H9572-002 (PPO) Michigan. Medicare. Health. Medicare Plus Blue PPO Vitality (PPO) H9572-002. Blue Cross Blue Shield of Michigan | Local PPO. Why Trust U.S. News. 344., Browse the Medicare Plus Blue PPO Signature (PPO) Formulary. This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers . Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less. Formulary Drug Details: , H9572-806: BCN Advantage (HMO-POS) 2024: H5883-801: Medicare Plus Blue PPO Signature (PPO) 2024: H9572-001: Medicare Plus Blue PPO Vitality (PPO) 2024: H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus ... , H9572-001: Medicare Plus Blue PPO Vitality (PPO) 2024: H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus Blue + Meijer (PPO) 2024: H9572-007, The Medicare Plus Blue PPO Essential (PPO) (H9572 - 004) currently has 47,608 members. There are 105 members enrolled in this plan in Barry, Michigan. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars. The detail CMS plan carrier ratings are as follows:, H9572-007-002. 2024 Overall Rating. 4.0 out of 5 stars. Blue Cross Blue Shield of Michigan ... H9572-003-006. 2024 Overall Rating. 4.0 out of 5 stars. Blue Cross Blue Shield of Michigan | Local PPO. , Create Account. View the coverage and benefits provided in the Medicare Plus Blue PPO Vitality (PPO) plan from Blue Cross Blue Shield of Michigan. Alight Retiree Health Solutions represents Medicare plans from 59 insurers nationwide. , 9572-002-U1000 : 5 available at OnlineComponents.com. Datasheets, competitive pricing, flat rate shipping & secure online ordering., 4 out of 5 stars* for plan year 2024. Medicare Plus Blue PPO Signature (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Blue Cross Blue Shield of Michigan. Plan ID: H9572-001-002. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $117.00 Monthly Premium., H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus Blue + Meijer (PPO) 2024: H9572-007: Cigna View payer . Plan Name Effective Year Benefit Package; Cigna True Choice Medicare (PPO) 2024:, H9572-001. Medicare Plus Blue PPO UT. 2024. H9572-806. Medicare Plus Blue PPO Vitality (PPO) 2024. H9572-002. Discover Blue Cross Blue Shield Medicare Insurance Plans accepted at Oak Street Health centers and find primary care doctors accepting Blue Cross Blue Shield near you., H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus Blue + Meijer (PPO) 2024: H9572-007: Cigna View payer . Plan Name Effective Year Benefit Package; Cigna True Choice Medicare (PPO) 2024:, Regulators / Nelson NEL 9572-002 10PSI 3000 REG SQ THRD x3/4 FNPT PIVOT PRESSURE REGULATOR UNI-FLO BLUE TOP .5-10 GPM NELSON. Manufacturer: NELSON. Mfg Part #: 9572 ..., Learn More about Blue Cross Blue Shield of Michigan Medicare Plus Blue PPO Vitality (PPO) Plan Details, including how much you can expect to pay for coinsurance, deductibles, premiums and copays for various services covered by the plan., Plan ID: H9572-002-003 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $83.00 Monthly Premium. Michigan Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. ..., Home. Medicare Plans. Medicare Plus Blue PPO Part B Credit (PPO) 4 out of 5 stars* for plan year 2024. Medicare Plus Blue PPO Part B Credit (PPO) is a PPO Medicare …, Plan ID: H9572-002-003 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $83.00 Monthly Premium, Plan ID: H9572-002-002 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $68.00 Monthly Premium. Michigan Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. ..., 1. Premium/Cost-sharing Table for Medicare Plus Blue PPO. Premiums vary by county in which you permanently reside (rates are based on the use and cost of health care services in each regional, The table below outlines some of the specific plan details for Blue Cross Blue Shield of Michigan Medicare Advantage plans available in Michigan in 2024. Plan Name. Plan Code. Monthly Premium. Deductible. Out of. Pocket Max. Prescription Drug Coverage. Medicare., Get 2021 Medicare Advantage Part C/Part D Health and Prescription plan benefit details for any plan in any state, including premiums, deductibles, Rx cost-sharing and health benefits/cost-sharing. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC, Plan ID: H9572-002-006 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $75.00 Monthly Premium, TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the Medicare Plus Blue PPO Essential (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $9.00 (see Plan Premium Details below) Annual Deductible: $200 (Tier 1 and 6 excluded from the Deductible.) Annual Initial Coverage Limit (ICL):, Product Compliance Certificate Download Product Compliance Certificate. Authorized Distributor: Buy 9572 002U1000 - Belden - Multiconductor Cable, Unshielded, 2 Conductor, 16 AWG, 1000 ft, 304.8 m. Newark offers fast quotes, same day shipping, fast delivery, wide inventory, datasheets & technical support., H9572-001: Medicare Plus Blue PPO Vitality (PPO) 2024: H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus Blue + Meijer (PPO) 2024: H9572-007 , H Contract Wyatt Sofa. View all of the items in the Wyatt collection. Spec Sheet. The clean lines and simple silhouette of the Wyatt three-cushion sofa make it the ideal addition to any common seating area. SKU: HC9572-002., @Pierre48,. Thanks for stopping by the HP community. A very good day to you. I reviewed the post regarding information to remove google drive plugin from your notebook., Medicare Plus Blue is a PPO plan with a Medicare contract. Enrollment in Medicare Plus Blue depends on contract renewal. H9572_SOM20MABAAG_M FVNR …, H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus Blue + Meijer (PPO) 2024: H9572-007: Cigna View payer . Plan Name Effective Year Benefit Package; Cigna True Choice Medicare (PPO) 2024: H7787 …, Medicare Plan Name: Medicare Plus Blue PPO Signature (PPO) Location: Crawford, Michigan Click to see other locations. Plan ID: H9572 - 001 - 0 Click to see other plans. …, H9572-001: Medicare Plus Blue PPO Vitality (PPO) 2024: H9572-002: Medicare Plus Blue PPO Assure (PPO) 2024: H9572-003: Medicare Plus Blue PPO Essential (PPO) 2024: H9572-004: Medicare Plus Blue PPO Part B Credit (PPO) 2024: H9572-006: Medicare Plus Blue + Meijer (PPO) 2024: H9572-007, WF 11717 JAN 19 H9572_IGMemReimburseForm_C FVNR 0119. To speed up processing of your request, please complete the form, printing clearly, sign and date it. •If submitting claims for more than one family member, complete a new form for each person. •Mail only original clear itemized bill(s) on your provider's letterhead for each medical expense., Plan ID: H9572-002-006 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $75.00 Monthly Premium