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BlueExtraSM

Overview

Everyoneís insurance needs are different. Independence Blue Cross developed BlueExtra Basic and BlueExtra Plus for residents in Philadelphia and the surrounding counties of Bucks, Chester, Delaware and Montgomery. With BlueExtra, you receive affordable dental and vision benefits, and a hearing aid reimbursement allowance not covered by Original Medicare or other commercial health care plans.

  • You choose between a Basic or Plus plan — both at affordable premiums.
  • You receive dental and vision benefits and a reimbursement allowance for hearing aids.
  • You may be enrolled in any insurance company’s health care plan or have traditional Medicare for your medical coverage.

In order to qualify for BlueExtra, you must live in Bucks, Chester, Delaware, Montgomery, or Philadelphia counties in Pennsylvania.

With BlueExtra, you get access to the following:

BlueExtra Basic

BlueExtra Plus

Monthly Plan Premium $19 $29
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Vision Benefits
Annual eye exam Covered in full Covered in full
Eyeglass lenses or contact lenses Every 12 months Every 12 months
Eyeglass frame benefit Every 24 months Every 12 months
Non-collection frame allowance* Up to $100 Up to $150
Scratch-resistant coating, polarized lenses, and other options Specific copays apply Specific copays apply
Contact lens allowance** (in lieu of glasses) towards evaluation, fitting, follow up, and materials Up to $100 Up to $150
Dental Benefits
Routine exam and cleaning every 6 months $20 copay $15 copay
Clinical oral evaluations and diagnostic imaging Copays vary for covered procedures. Please see Outline of Coverage for details. Copays vary for covered procedures. Please see Outline of Coverage for details.
Certain maintenance and surgical procedures Copays vary for covered procedures. Please see Outline of Coverage for details. Copays vary for covered procedures. Please see Outline of Coverage for details.
Restoration procedures (such as amalgam and resin-based composite) Copays vary for covered procedures. Please see Outline of Coverage for details. Copays vary for covered procedures. Please see Outline of Coverage for details.
Hearing Benefits
Hearing aids $500 reimbursement, every 3 years, for up to 2 hearing aids $1,000 reimbursement, every 3 years, for up to 2 hearing aids
Health & Wellness Programs***
Fitness reimbursement   Up to $150 reimbursed after 120 workouts in 365 days at an approved gym
Tobacco cessation   Up to $200 reimbursement for completing an approved tobacco cessation program
“Healthy Weight, Healthy You”   Up to $200 reimbursement towards an approved weight-loss program
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Even better news! BlueExtra has partnered with HearPO®, one of the nation’s leading hearing health care providers to make your reimbursement go even further with deeply discounted prices on hearing aids from the top manufacturers.

Learn more about HearPO.

To request a reimbursement for a hearing aid purchase, please complete the Hearing Aid Reimbursement Form and submit to the Independence Blue Cross Claims Department at the address listed on the form.

Please note: HearPO is a discount program only for hearing services/benefits. Actual costs and savings vary by provider and geographic region. Members are responsible for payment upon receiving hearing services/benefits but receive a discount from contracted HearPO providers. To receive reimbursement for the purchase of hearing aids Members must submit proof of payment to the Independence Blue Cross Claims Department.

Additional Information

For more information about Vision and Dental providers in our network, view the BlueExtra 2014 Vision and Dental Directory.

* Frames other than Davis Vision's Designer or Premier Collections will be paid up to a maximum of $100 (Basic) and $150 (Plus). The balance, if any, is the covered person's responsibility.

** Contact lenses will be paid up to a maximum of $100 (Basic) and $150 (Plus). The balance, if any, is the covered person's responsibility.

Benefits are underwritten by QCC Insurance Company, a subsidiary of Independence Blue Cross — independent licensees of the Blue Cross and Blue Shield Association.

*** Only available to BlueExtra Plus members.

Please note: Some restrictions may apply. Please refer to the Outline of Coverage for details.


You can enroll in BlueExtra by completing an online enrollment form.

You can also enroll in BlueExtra by downloading an PDF icon enrollment application and mail in the completed form to: PO Box 37576, Philadelphia, PA 19101-7576.


Contact Us

  • If you are interested in learning more about BlueExtra, please call 1-877-393-6733 (for the speech- and hearing-impaired: 711), seven days a week, from 8 a.m. to 8 p.m. Or mail any inquiries to PO Box 37576, Philadelphia, PA 19101-7576.
  • If you are already enrolled in BlueExtra and have questions call 1-800-ASK-BLUE (for the speech- and hearing-impaired: 711), Monday through Friday, 8 a.m. to 8 p.m. Or mail any inquiries to 1901 Market Street, Philadelphia, PA 19103.
  • Send us an email.

Here are some of the most frequently asked questions concerning BlueExtra.

What are BlueExtra plans?
BlueExtra provides affordable vision and dental plans that include a hearing aid reimbursement allowance. When you enroll in BlueExtra, you will pay a monthly premium and any copays as defined in the Outline of Coverage.

How much does BlueExtra cost?
The BlueExtra Basic planís monthly premium is $19, and the BlueExtra Plus planís monthly premium is $29.

What is the difference between the Basic and Plus plans?
While both plans include vision and dental benefits and a reimbursement allowance for hearing aids, they offer different levels of benefits and monthly premiums. For example, BlueExtra Plus vision and dental benefits are generally richer; the hearing aid reimbursement is $1,000; and health and wellness value-added programs through Healthy Lifestyles SolutionsSM are included. BlueExtra Basic has a $500 reimbursement for hearing aids; however, health and wellness value added programs through Healthy Lifestyles Solutions are not included.

For details of covered services and copays for Basic, see the:

For details of covered services and copays for Plus, see the:

Can I add dependents to my plan?
No, you cannot add dependents to your BlueExtra plan. However, spouses and children may enroll in their own individual BlueExtra policy.

What is Healthy Lifestyles Solutions?
Healthy Lifestyles Solutions provides wellness programs designed to educate and encourage healthy behavior through active participation. Healthy Lifestyles Solutions programs are only available with the BlueExtra Plus plan. Please follow the Healthy Lifestyles Solutions link for more details.

How is BlueExtra different from my current plan?
Unlike other plans which may provide hospital, medical, behavioral health and/or prescription drug coverage, BlueExtra only provides vision and dental plans that include hearing aid reimbursement allowances. It does not cover any medical services, behavioral health services, or prescription drug coverage.

How do I enroll in BlueExtra?
You can enroll online or download an PDF icon enrollment application and mail it in to:
P.O. Box 37576, Philadelphia, PA 19101-7576.

Will BlueExtra disrupt my current health care plan?
No. BlueExtra is a supplemental plan, so it is offered in addition to your current health care plan.

What if I already have vision, dental, or hearing aid benefits with another Independence Blue Cross plan?
BlueExtra works independently of your other vision, dental, or hearing aid reimbursement benefits. In some cases, you can coordinate those benefits with BlueExtra. In other cases, you will only have access to one of the benefits. Call us to discuss how BlueExtra may affect access to your current vision, dental, or hearing aid benefits to be sure BlueExtra is right for you.

Can I choose my own dentist?
As a member of BlueExtra, you must choose a Primary Dental Office (PDO) from the list of dentists in the BlueExtra network and list that dentist on your application. If you do not select a dentist when you enroll, we will select one for you based on availability and proximity to the address on file with your enrollment information. You will be notified of the selection and will have the opportunity to change this assignment at any time by calling the Customer Service number listed on the back of your ID card.

PDF icon BlueExtra 2014 Dental Directory

Does your benefit cover dentures?
The Plan covers facets of denture care. Please refer to the fee schedule within your BlueExtra Basic or BlueExtra Plus Outline of Coverage for specific fees associated with denture care. It may be helpful to present the fee schedule to your dentist prior to surgery to make sure you understand the fees associated with the care you will be receiving.

Does your benefit cover orthodontics/braces?
While both plans provide dental coverage, orthodontics/braces are not covered.

Can I go to any vision provider?
You can only go to a BlueExtra vision network provider.

PDF icon BlueExtra 2014 Vision Directory

How will I be billed for BlueExtra?
You will be billed each month for the next month’s premium. If you already receive an invoice from IBC for another type of coverage, you will receive this invoice. Your BlueExtra invoice will arrive separately and will be due by the date listed on the invoice. Your BlueExtra invoice cannot be combined with other IBC invoices and must be paid on a monthly basis.

How does the hearing aid reimbursement work?
Submit your reimbursement form along with your receipt of purchase to the Independence Blue Cross Claims Department.

How does the HearPO program work?
1. Call 1-888-610-1850 and a HearPO Patient Care Advocate will assist you in finding a hearing care provider near you.
2. The Advocate will explain the HearPO process, obtain your mailing information and assist you in making the appointment with the hearing care provider.
3. HearPO will send information to you and the provider prior to your appointment. This will ensure your HearPO benefit is activated.

Do I still have to submit a form for reimbursement of hearing aid if I purchase my hearing aids through HearPO?
Yes, you still must submit the form to IBC. You will still receive a valid receipt of purchase through HearPO.

Can I downgrade or upgrade my plans whenever I want?
You may change plans on your enrollment anniversary date. This is the date on which your contract will automatically renew. You may disenroll at any time during the contract year; however if you disenroll prior to the anniversary date, you will not be able to apply for BlueExtra policy for one year from the effective date of disenrollment.

Can I get an information packet sent to me in the mail?
Yes. You can request an information packet through the mail, or call 1-877-393-6733 (for the speech- and hearing impaired: 711), seven days a week, from 8 a.m. to 8 p.m. to have information sent to you. However, please be aware that on weekends and holidays from February 15 through September 30, your call may be sent to voice mail. If requesting an information packet through the mail please send request to:
P.O. Box 37576, Philadelphia, PA 19101-7576.

What if I have a question or problem?
We offer one-on-one, personal service. Once you become a member, you can call our Customer Service representatives at 1-800-ASK-BLUE, 8 a.m. to 6 p.m., Monday through Friday, or discuss your concerns with a representative, face-to-face, in our Walk-In Services area located on Market Street, at the corner of Market Street and 20th Street. To better meet customer needs, Walk-In Services hours will be expanded to 8 a.m. to 5 p.m., Monday through Friday. Feel free to stop by — no appointment is necessary.


Website last updated: 9/30/2014
Y0041_HM_15_20730 Approved 10/06/2014