Medicare Medical + Part D Plans (2012)

Employer Group plans

Employer Group plans are also available for businesses to offer their Medicare-eligible employees and retirees. Learn more>

A Medicare Advantage organization with a Medicare contract

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Limitations, co-payments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1, 2013.

Availability of coverage beyond the end of the current contract year is not guaranteed. Members may enroll in these plans only during certain times of the year. Contact Health First Health Plans for more information. Individuals must have both Medicare Part A and Part B to enroll in the plan. You must continue to pay your Medicare Part B premium. Limitations, copayments, and restrictions may apply.

You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use a network pharmacy. Quantity limitations and restrictions may apply.

Health First Medicare Advantage Plans cover emergency services and unforeseen urgently needed medical care outside the United States, including when you are on a cruise ship. If you receive covered care from a provider outside the United States that does not participate with Medicare, you may be asked to pay up front for the services and be reimbursed from the plan later. We will pay up to 115% of the Medicare-allowed amount in our service area (Medicare’s limiting charge for non-participating providers), less any applicable cost-share. Please note that Medicare-allowed amounts can be much less than the provider charges you, and you will be responsible for paying the difference.

This information is available for free in other languages by contacting our Customer Service Department at the number listed below.

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). TTY users should call 1-877-486-2048, 24 hours a day/7days a week;
• The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or
• Your State Medicaid Office.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

You can also contact Social Security or Medicaid to find out your LIS status or level.

Unless your plan includes POS benefits, you must use plan providers except in emergency or urgent care situations, or for out-of-area renal dialysis. With the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers. Health First Health Plans cannot require out-of-network providers to see our members. If your plan does not include POS benefits and you obtain routine care from out-of-network providers, neither Medicare nor Health First Health Plans will be responsible for the cost.

Medicare beneficiaries may enroll in Health First Medicare Plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

More information

For more information on authorizations, eligibility, enrollment, pharmacies, prescriptions, or any other benefits, please contact Health First Health Plans Customer Service:

• Call weekdays from 8 am to 8 pm and Saturday from 8 am to noon: 321-434-5665, toll-free 1-800-716-7737, or through TDD/TTY relay 1-800-955-8771.
• Visit our office weekdays from 8 am to 5 pm or write to us at 6450 US Highway 1, Rockledge, FL 32955.

H1099_MP2760 CMS Approved 10212011
Last updated: 2/15/2012