Optima Medicare (PPO)
Disclaimers for Optima Medicare Plans
Disclaimer A:
Except for emergencies and urgent care, the use of non-plan or non-participating pharmacies may cost more.
Disclaimer B:
Please follow this link for a list of doctors, and this link for a list of network pharmacies, or call 1-800-927-6048 (TTY users: 1-800-225-7784) seven days a week, 8 a.m. – 8 p.m. On weekends and holidays during these times, you may have access to an interactive voice response (IVR) system. If you leave a message, a Member Services Representative will call you back the next business day.
Disclaimer C:
If you have questions about Medicare benefits, including general information regarding health or benefits, you can call 1-800-MEDICARE (1-800-633-4227); TTY/TDD users should call 1-877-486-2048, 24 hours a day, seven days a week. You can also visit www.medicare.gov/.*
Disclaimer D:
Optima Health Insurance Company has a contract with the federal government to provide Medicare Part C or D benefits to people with Medicare in Virginia. Benefits, formulary, pharmacy network, premium and/or co-payments or coinsurance may change January 1, 2011. Please contact Optima Health for details.
Disclaimer E:
Optima Medicare Preferred, Optima Medicare Preferred Plus, Optima Medicare Preferred Value and Optima Medicare Preferred Value Plus are Medicare Advantage Preferred Provider Organizations (PPO) plans with a Medicare contract.
Disclaimer F:
By law, Optima Health can refuse to renew its contract with CMS, and CMS also may refuse to renew the contract. Termination or non-renewal may result in termination of the beneficiary’s enrollment in the plans. In addition, the plan may reduce its service area and no longer offer services in the area where the beneficiary resides.
Disclaimer G:
Optima Medicare Preferred, Optima Medicare Preferred Plus, Optima Medicare Preferred Value and Optima Medicare Preferred Value Plus are underwritten by Optima Health Insurance Company.
Disclaimer H:
Optima Medicare is open to everyone who’s eligible for Medicare in the plan service area. Specifically, a person eligible for this plan: 1) is entitled to Medicare benefits under Part A or enrolled in Medicare Part B; and 2) resides in the service area of the Optima Medicare plans. You may be enrolled in only one Medicare prescription drug plan at a time.
Disclaimer I:
You may enroll in a Medicare plan only during specific times of the year. To learn more about all of the possible enrollment periods, call Optima Medicare Member Services toll-free: 1-800-927-6048, 8 AM-8 PM, 7 days a week. TTY/TDD users call: 1-800-225-7784. Or visit www.optimahealth.com. For more information, call Medicare toll-free: 1-800-MEDICARE (1-800-633-4227), 24 hours a day. 7 days a week. TTY/TDD users call: 1-877-486-2048. Or visit the website at www.medicare.gov.
Disclaimer J:
Details regarding Exceptions, Appeals & Grievance Processes, including timeframes for filing, can be found on our website (www.optimahealth.com) or in the Evidence of Coverage.
Disclaimer K:
You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.
Disclaimer L:
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help call:
- 1-800-MEDICARE (1-800-633-4227) or TTY/TDD users call 1-877-486-2048, 24 hours a day/7 days a week;
- Your State Medicaid Office; or
- The Social Security Administration at 1-800-772-1213. TTY/TDD users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
Disclaimer M:
All network pharmacies may not be listed in the pharmacy directory. Inclusion of a pharmacy does not guarantee that the pharmacy is open, at the same location as listed in the online directory, or is included in the network. Pharmacy network information may change on January 1st of each year.
Disclaimer N:
Optima Health Medicare contracts with CMS are renewed annually, and the availability of coverage beyond the end of the current contract year is not guaranteed. Termination or non-renewal of the contract by CMS or Optima Health, as authorized by law, may end your enrollment in the plan. If this occurs, you will be able to choose another plan without incurring a late enrollment penalty, as long as you do it within the time period required. Even if a Medicare 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 ninety (90) days before your coverage will end. The letter will explain your options for coverage in your area.
Disclaimer O:
You cannot be denied coverage for health reasons. Participation is voluntary. You get to decide if you want to enroll or not. If you have Medicare and Medicaid and you did not enroll in a plan by December 31, 2005, you were assigned to a plan automatically. The first enrollment period ended May 15, 2006. In subsequent years, there is an annual election period from November 15th to December 31st. If you decide to join later, you monthly premiums may be higher because there’s a late enrollment penalty.
Disclaimer P:
For more information on Optima Health Medicare benefits, please call Member Services at: 1-800-927-6048, 8 AM-8 PM, 7 days a week. TTY/TDD users call: 1-800-225-7784.
Disclaimer Q:
The sponsor and publisher of this continuing education activity has made all reasonable efforts to ensure that the information contained herein is accurate in accordance with the latest available knowledge. Information regarding the implementation of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (P.L. 108-173) is subject to change, and the reader is advised to check the Centers for Medicare & Medicaid Services website at www.medicare.gov* for updates.
Disclaimer R:
Medicare beneficiaries may enroll in Optima Medicare (PPO) through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at http://www.medicare.gov. For more information contact Optima Medicare Member Services at 1-800-927-6048, (TTY users call 1-800-225-7784) seven days a week, 8 a.m. – 8 p.m.
Disclaimer S:
Documents are available in alternative formats and languages. For more information contact Optima Medicare Member Services at 1-800-927-6048, (TTY users call 1-800-225-7784) seven days a week, 8 a.m. – 8 p.m.
Disclaimer T:
Optima Medicare (PPO) provides reimbursement for all covered benefits as long as they are medically necessary.
Disclaimer U:
Extra value-added services and products are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Optima Medicare (PPO) grievance process.
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