Currentblue cross blue shield - michiganPolicy MAPPO 1019

SilverSneakers Fitness benefit

Defines the SilverSneakers basic fitness benefit offered to Medicare Plus Blue PPO members (individual and select group plans), including program features, enrollment, vendor requirements, member cost responsibilities, and contact info.

Policy Summary

Payerblue cross blue shield - michigan

PolicySilverSneakers Fitness benefit

Policy CodePolicy MAPPO 1019

Change TypeNo material change

Effective Date

Next Review DateNov 18, 2024

Key ActionVerify member benefits via the provider portal or by calling 1-866-309-1719 before arranging services and do not have members sign ABNs to transfer financial responsibility without prior coverage determination.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

nationwide networknetwork

LIVE, On-Demand, GOdigital

membership cardmembership

1-866-309-1719provider contact

1-866-584-7389member contact

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SilverSneakers Coverage Criteria

SilverSneakers coverage criteria

Covered when the following membership, vendor, and cost-responsibility conditions are met:

Coverage available to members under all individual Medicare Plus Blue PPO and select Medicare Plus Blue Group PPO plans.

Members must enroll at participating SilverSneakers facilities and show their Medicare Plus Blue ID when enrolling.

Eligible members receive a SilverSneakers membership card; members not near a contracted center may request an at‑home SilverSneakers Steps kit.

Benefit includes use of exercise equipment, classes, amenities at participating locations, SilverSneakers LIVE, On‑Demand library, GO mobile app, community activities, and GetSetUp virtual enrichment.

Members must use plan‑authorized vendors; gym or health club memberships are only covered for participating facilities.

Non‑participating gyms/health clubs are not included.

Members are fully liable for additional‑cost services (e.g., court sports, massage) and for any noncovered services they elect.

Providers may not have members sign an Advance Beneficiary Notice (ABN) to shift financial responsibility for noncovered items or services; if coverage is uncertain, obtain a coverage determination from Blue Cross before providing the item or service.

If a provider furnishes a noncovered item/service without a prior coverage determination, the member must be held harmless except for any applicable cost share.

Providers may verify member benefits and cost sharing via the provider portal or by calling 1-866-309-1719; members can contact Tivity servicing or visit www.silversneakers.com for program information.

Provider verification contact is required before relying on coverage status for questionable services.

Provider Verification and Vendor Requirements

Documentation Required

Provider Verification and Vendor Requirements

Providers must verify member benefits, eligibility, and cost sharing before providing services. Use the Blue Cross Blue Shield of Michigan provider portal or call 1-866-309-1719 to confirm coverage for SilverSneakers services and any associated member liabilities. Members must use plan-authorized SilverSneakers vendors; the benefit applies only at participating facilities.

Members must use plan-authorized SilverSneakers vendors; the benefit does not cover non-participating gyms or health clubs.
Providers must verify benefits and cost sharing via the provider portal or by calling 1-866-309-1719 before delivering services.
Providers may NOT have members sign an Advance Beneficiary Notice (ABN) to accept financial responsibility for noncovered items or services.
If coverage is uncertain, providers should seek a coverage determination from Blue Cross before providing the item or service.
If a provider furnishes a noncovered item/service without first obtaining a coverage determination, the member must be held harmless for all charges except any applicable cost share.
Services with additional fees (e.g., court sports, massage therapy) may be available at some centers; members are fully liable for those extra charges.
If a member elects to receive a noncovered service, the member is responsible for the entire charge for that service.

Key Terms

SilverSneakers — definition and program features

Program definitionSilverSneakers is a basic fitness benefit for older adults that provides programs to improve strength, endurance, flexibility, agility and balance and to encourage physical activity and social participation.

Participating facilitiesMembership payments cover access only at participating SilverSneakers facilities; gym or health club memberships at nonparticipating facilities are not included.

Online and digital offeringsIncludes SilverSneakers LIVE online classes, an On‑Demand library, and GO mobile app (program access and digital classes).

Community activitiesOffers community activities beyond the gym to promote social interaction and overall well‑being.

Eligibility scopeProvided to members under all individual Medicare Plus Blue PPO and select Medicare Plus Blue Group PPO plans; benefit scope and cost sharing are determined by Blue Cross for individual plans and by the group for group plans.