Medicare Must Approve Our Plan Each Year

Medicare (the Centers for Medicare and Medicaid Services) must approve our Medicare Advantage Plan each year. All Medicare Advantage Plans agree to stay in the program for a full year at a time. The contract is in effect for the months in which you are enrolled in the Plan between January 1 and December 31 each calendar year. You can continue to get Medicare coverage as a member of our plan only as long as we choose to continue to offer the plan for the year in question and the Centers for Medicare & Medicaid Services renews its approval of the plan. Even if a Medicare Advantage Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.

Until Your Membership Ends, You Are Still A Member Of Our Plan

Ending your membership in our Plan may be voluntary (your own choice) or involuntary (not your own choice). See Chapter 10 of the Evidence of Coverage to find out more information about ending your membership in our Plan. The Evidence of Coverage can be found under the Benefits Overview section of the website.

If you leave our Plan, it may take time before your membership ends and your new Medicare coverage goes into effect. During this time, you must continue to get your medical care and prescription drugs through our plan.

• You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends. Usually, your prescription drugs are only covered if they are filled at a network pharmacy including through our mail-order pharmacy services.
• If you are hospitalized on the day that your membership ends, your hospital stay will usually be covered by our plan until you are discharged (even if you are discharged after your new health coverage begins).

Information About Our Plan

As a member of our plan, you have the right to get a summary of information about the appeals, grievances and exceptions that other members have filed against our plan in the past. Call Member Services at 1-800-399-7226 for additional information (TTY users: 711). Hours are 8 a.m. to 8 p.m., seven days a week from October 1 to March 31. From April 1 to September 30, hours are 8 a.m. to 8 p.m. Monday through Friday. Messages received on holidays and outside of our business hours will be returned within one business day.

Federal and state laws protect the privacy of your medical records and personal health information. Our plan protects your personal health information as required by these laws. For detailed information regarding your privacy rights, please refer to the Evidence of Coverage booklet under Chapter 8, Your Rights and Responsibilities, Section 1.4 We Must Protect the Privacy of Your Personal Health Information.