preferred select care (hmo-snp) offered by preferred care€¦ · annual notice of changes for 2013...

Preferred Select Care (HMO-SNP) offered by Preferred Care Partners

Annual Notice of Changes for 2013

You are currently enrolled as a member of Preferred Select Care (HMO-SNP) Next year there will be some changes to the planrsquos costs and benefits This booklet tells about the changes

bull You have from October 15 until December 7 to make changes to your Medicare coverage for next year

Additional Resources

bull This information is available for free in other languages Please contact our Member Services number toll free at 1-866-231-7201 for additional information TTY users should call 711 toll free (for the hearing impaired) Hours are October 1 2012 - February 14 2013 7 days a week from 800am - 800pm Eastern Beginning February 15 2013 Monday thru Friday 800am - 800pm Member Services also has free language interpreter services available for non-English speakers

bull Esta informacioacuten estaacute disponible en otros idiomas sin ninguacuten costo Por favor llame a nuestro departamento de Servicio al Miembro sin cargo al 1-866-231-7201 para obtener informacioacuten adicional los usuarios de TTY deben llamar sin cargo al 711 (para los que tengan dificultades de la audicioacuten) El horario es del 1ro de octubre del 2012 hasta el 14 de febrero del 2013 de 800 am a 800 pm hora del este 7 diacuteas a la semana Comenzando el 15 de febrero del 2013 de lunes a viernes de 800 am a 800 pm El departamento de Servicio al Miembro tiene disponible inteacuterpretes y traductores sin ninguacuten costo para quienes no hablen ingleacutes

bull This document may be available in an alternate format such as larger print or audio call our Member Services Department at the number listed above to request material in an alternate format

bull Este documento pudiera estar disponible en un formato alterno como en letra maacutes grande o en audio Llame al Departamento de Servicio al Miembro al nuacutemero que aparece anteriormente para solicitar el material en un formato alterno

About Preferred Select Care (HMO-SNP)

bull Preferred Care Partners is a Health Plan with a Medicare Contract bull When this booklet says ldquowerdquo ldquousrdquo or ldquoourrdquo it means Preferred Care Partners When it

says ldquoplanrdquo or ldquoour planrdquo it means Preferred Select Care (HMO-SNP)

1Preferred Select Care (HMO-SNP) Annual Notice of Changes for 2013

Think about Your Medicare Coverage for Next Year

Each fall Medicare allows you to change your Medicare health and drug coverage during the Annual Enrollment Period Itrsquos important to review your coverage now to make sure it will meet your needs next year

Important things to do

Check the changes to our benefits and costs to see if they affect you Do the changes affect the services you use It is important to review benefit and cost changes to make sure they will work for you next year Look in Sections 11 and 15 for information about benefit and cost changes for our plan

Check the changes to our prescription drug coverage to see if they affect you Will your drugs be covered Are they in a different tier Can you continue to use the same pharmacies It is important to review the changes to make sure our drug coverage will work for you next year Look in Section 16 for information about changes to our drug coverage

Check to see if your doctors and other providers will be in our network next year Are your doctors in our network What about the hospitals or other providers you use Look in Section 13 for information about our ProviderPharmacy Directory

Think about your overall costs in the plan How much will you spend out-of-pocket for the services and prescription drugs you use regularly How much will you spend on your premium How do the total costs compare to other Medicare coverage options

Think about whether you are happy with our plan

If you decide to stay with Preferred Select Care (HMO-SNP)

If you want to stay with us next year itrsquos easy - you donrsquot need to do anything If you donrsquot make a change by December 7 you will automatically stay enrolled in our plan

If you decide to change plans

If you decide other coverage will better meet your needs you can switch plans between October 15 and December 7 If you enroll in a new plan your new coverage will begin on January 1 2013 Look in Section 22 to learn more about your choices

2 Preferred Select Care (HMO-SNP) Annual Notice of Changes for 2013

Summary of Important Costs for 2013

The table below compares the 2012 costs and 2013 costs for Preferred Select Care (HMOshySNP) in several important areas Please note this is only a summary of changes It is important to read the rest of this Annual Notice of Changes and review the enclosed Evidence of Coverage to see if other benefit or cost changes affect you

2012 (this year) 2013 (next year)

Monthly plan premium Your premium may be higher or lower than this amount See Section 11 for details

$0 $0

Maximum out-of-pocket amount This is the most you will pay out-of-pocket for your covered Part A and Part B services (See Section 12 for details)

$3400 $5400

Doctor office visits Primary care visits $0 copay per visit Specialist visits $0 copay per visit

Primary care visits $0 copay per visit Specialist visits $25 copay per visit

In-patient hospital stays $0 copay For Medicare-covered hospital stays Days 1 ndash 7 $225 copay per day Days 8 ndash 90 $0 copay per day $0 copay for additional hospital days


Part D prescription drug coverage (See Section 16 for details)

Deductible $0 Deductible $0

Copays during the Initial Coverage Stage Retail Pharmacy Drug Tier 1 Generic Drugs bull $0 copay for a one-

month (30-day) supply of drugs in this tier

bull $0 copay for a two-month (60-day) supply of drugs in this tier

bull $0 copay for a three-month (90-day) supply of drugs in this tier

Drug Tier 2 Preferred Drugs bull $0 copay for a one-




Drug Tier 3 Non-Preferred Brand Drugs bull $50 copay for a one-

















Drug Tier 4 Specialty Tier Drugs bull 33 coinsurance for

a one-month (30-day) supply of drugs in this tier

bull 33 coinsurance for a two-month (60-day) of drugs in this tier

bull 33 coinsurance for a three-month (90shyday) supply of drugs in this tier

Long Term Care Pharmacy Drug Tier 1 Generic Drugs bull $0 copay for a one-


Drug Tier 2 Preferred Brand Drugs bull $0 copay for a one-




Drug Tier 4 Specialty Tier Drugs bull 33 coinsurance for a

one-month (34-day) supply of drugs in this tier



bull 33 coinsurance for a two-month (60-day) supply of drugs in this tier

bull 33 coinsurance for a three-month (90-day) supply of drugs in this tier





Drug Tier 3 Non-Preferred Brand Drugs $60 copay for a one-month (34-day) supply of drugs in this tier Drug Tier 4 Specialty Tier Drugs bull 33 coinsurance for a


Please note that brand drugs must be dispensed incrementally in long-term care facilities Generic drugs may be dispensed incrementally


Mail Order Drug Tier 1 Generic Drugs bull $0 copay for a one-












Contact our plan about cost-sharing billingcollection when less than a one-month supply is dispensed Mail Order Drug Tier 1 Generic Drugs bull $0 copay for a one-















bull 33 coinsurance for two-month (60-day) supply of drugs in this tier







Annual Notice of Changes for 2013 Table of Contents

Think about Your Medicare Coverage for Next Year 1

Summary of Important Costs for 2013 2

SECTION 1 Changes to Benefits and Costs for Next Year 8

Section 11 ndash Changes to the Monthly Premium 8

Section 12 ndash Changes to Your Maximum Out-of-Pocket Amount 8

Section 13 ndash Changes to the Provider Network 9

Section 14 ndash Changes to the Pharmacy Network 9

Section 15 ndash Changes to Benefits and Costs for Medical Services 9

Section 16 ndash Changes to Part D Prescription Drug Coverage 12

SECTION 2 Deciding Which Plan to Choose 16

Section 21 ndash If you want to stay in Preferred Select Care (HMO-SNP) 16

Section 22 ndash If you want to change plans 16

SECTION 3 Deadline for Changing Plans 17

SECTION 4 Programs That Offer Free Counseling about Medicare 17

SECTION 5 Programs That Help Pay for Prescription Drugs 17

SECTION 6 Questions 18

Section 61 ndash Getting Help from Preferred Select Care (HMO-SNP) 18

Section 62 ndash Getting Help from Medicare 18


SECTION 1 Changes to Benefits and Costs for Next Year

Section 11 ndash Changes to the Monthly Premium


Monthly premium (You must continue to pay your Medicare Part B premium)

$0 $0

Monthly Medicare Part B premium refund of up to (You must continue to pay your Medicare Part B premium)

Benefit Not Offered $4000

bull Your monthly plan premium will be more if you are required to pay a late enrollment penalty

bull If you have a higher income you may have to pay an additional amount each month directly to the government for your Medicare prescription drug coverage

bull Your monthly premium will be less if you are receiving ldquoExtra Helprdquo with your prescription drug costs

Section 12 ndash Changes to Your Maximum Out-of-Pocket Amount

To protect you Medicare requires all health plans to limit how much you pay ldquoout-of-pocketrdquo during the year This limit is called the ldquomaximum out-of-pocket amountrdquo Once you reach the maximum out-of-pocket amount you generally pay nothing for covered Part A and Part B services for the rest of the year



Maximum out-of-pocket amount Your costs for covered medical services (such as copays) count toward your maximum out-of-pocket amount Your costs for prescription drugs do not count toward your maximum out-of-pocket amount

$3400 $5400 Once you have paid $5400 out-of-pocket for covered Part A and Part B services you will pay nothing for your covered Part A and Part B services for the rest of the calendar year

Section 13 ndash Changes to the Provider Network

There are changes to our network of doctors and other providers for next year

An updated ProviderPharmacy Directory is located on our Web site at wwwmypreferredcarecommydoctors You may also call Member Services for updated provider information or to ask us to mail you a ProviderPharmacy Directory Please review the 2013 ProviderPharmacy Directory to see if your providers are in our network

Section 14 ndash Changes to the Pharmacy Network

Amounts you pay for your prescription drugs may depend on which pharmacy you use Medicare drug plans have a network of pharmacies In most cases your prescriptions are covered only if they are filled at one of our network pharmacies

There are changes to our network of pharmacies for next year

An updated ProviderPharmacy Directory is located on our Web site at wwwmypreferredcarecommypharmacy You may also call Member Services for updated provider information or to ask us to mail you a ProviderPharmacy Directory Please review the 2013 ProviderPharmacy Directory to see which pharmacies are in our network

Section 15 ndash Changes to Benefits and Costs for Medical Services

We are changing our coverage for certain medical services next year The information below describes these changes For details about the coverage and costs for these services see Chapter 4 Medical Benefits Chart (what is covered and what you pay) in your 2013 Evidence of Coverage



Inpatient Hospital Care $0 copay For Medicare-covered hospital stays bull Days 1 ndash 7 $225

copay per day bull Days 8 ndash 90 $0 copay

per day

Inpatient Mental Health Care $0 copay For Medicare-covered hospital stays bull Days 1 ndash 7 $200


per day

Skilled Nursing Facility (SNF) For SNF Stays bull Days 1-10 $0 copay

per day bull Days 11-20 $50

copay per day bull Days 21-100 $75

copay per day Plan covers up to 100 days each benefit period

For SNF Stays bull Days 1-10 $0 copay

per day bull Days 11-20 $50 copay



Chiropractic Services $0 copay for Medicare-covered chiropractic visits

$20 copay for each Medicare-covered chiropractic visit

Podiatry Services $0 copay for Medicare-covered podiatry visits bull 1 supplemental routine

visit every three months

$25 copay for each Medicare-covered podiatry visit $25 copay for up to 1 supplemental routine podiatry visit every three months


Outpatient Mental Health Care $0 copay for Medicare-covered Mental Health visits $0 copay for Medicare-covered partial hospitalization program services

$25 copay for each Medicare-covered individual therapy visit $25 copay for each Medicare-covered group therapy visit $25 copay for each Medicare-covered individual therapy visit with a psychiatrist $25 copay for each Medicare-covered group therapy visit with a psychiatrist $0 copay for Medicare-covered partial hospitalization program services

Outpatient Services $0 copay for each Medicare-covered ambulatory surgical center visit

$50 copay for each Medicare-covered ambulatory surgical center visit

Outpatient Substance Abuse $0 copay for Medicare-covered visits

$0 copay for bull each Medicare-covered

individual substance abuse outpatient treatment visit

bull each Medicare-covered group substance abuse outpatient treatment visit

Emergency Care $50 copay for Medicare-covered emergency room visits

$65 copay for Medicare-covered emergency room visits

Diagnostic Tests X-Rays Lab Services and Radiology Services

$0 to $200 copay for Medicare-covered diagnostic procedures and tests



$0 to $200 copay for $50 to $150 copay for Medicare-covered Medicare-covered diagnostic radiology diagnostic radiology services (not including x- services (not including x-rays) rays)

Section 16 ndash Changes to Part D Prescription Drug Coverage

Changes to Our Drug List

Our list of covered drugs is called a Formulary or ldquoDrug Listrdquo We sent you a copy of our Drug List in this envelope

We made changes to our Drug List including changes to the drugs we cover and changes to the restrictions that apply to our coverage for certain drugs Review the Drug List to make sure your drugs will be covered next year and to see if there will be any restrictions

If you are affected by a change in drug coverage you can

bull Work with your doctor (or other prescriber) and ask the plan to make an exception to cover the drug You can ask for an exception before next year and we will give you an answer before the change takes effect To learn what you must do to ask for an exception see Chapter 9 of your Evidence of Coverage (What to do if you have a problem or complaint (coverage decisions appeals complaints)) or call Member Services

bull Find a different drug that we cover You can call Member Services to ask for a list of covered drugs that treat the same medical condition

If you or your doctor has requested a formulary exception this year and the plan has approved it you will need to request a new formulary exception for the next year if the drug continues to not be covered on the formulary

Changes to Prescription Drug Costs

There are four drug payment stages Which ldquoDrug Payment Stagerdquo you are in affects how much you pay for a Part D drug

The information below shows the four drug payment stages You can also look in Chapter 6 of your Evidence of Coverage for more information about the stages

Note If you are in a program that helps pay for your drugs (ldquoExtra Helprdquo) the information about costs for Part D prescription drugs may not apply to you We sent you a separate insert called the ldquoEvidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugsrdquo (also called the ldquoLow Income Subsidy Riderrdquo or the ldquoLIS Riderrdquo) which


tells you about your drug coverage If you donrsquot have this insert please call Member Services and ask for the ldquoLIS Riderrdquo Phone numbers for Member Services are in Section 61 of this booklet

Stage 1 Yearly Deductible

Stage

Stage 2 Initial Coverage

Stage

Stage 3 Coverage Gap Stage

Stage 4 Catastrophic

Coverage Stage

Because we have no deductible this payment stage does not apply to you

You begin in this payment stage During this stage the plan pays its share of the cost of your drugs and you pay your share of the cost You stay in this stage until your total drug costs reach the limit for the Initial Coverage Stage

Most people do not reach the Coverage Gap Stage If you do reach this stage your share of the costs for your drugs will change You stay in this stage until your total ldquooutshyof-pocket costsrdquo (your payments) reach the limit for the Coverage Gap Stage

Most people do not reach the Catastrophic Coverage Stage If you do reach this stage we will pay most of the cost of your drugs for the rest of the calendar year (through December 31 2013)

Stage 1 ldquoYearly Deductible Stagerdquo

Because our plan has no deductible this stage does not apply to you

Stage 2 ldquoInitial Coverage Stagerdquo

In this stage how much you pay for a drug depends on which ldquotierrdquo the drug is in

We moved some of the drugs on the Drug List to a lower or higher drug tier To see if your drugs will be in a different tier look them up on the Drug List

The table in the next page shows your costs for drugs in each of our 4 drug tiers These amounts apply only during the time when you are in the Initial Coverage Stage



Drugs in Tier 1 (Generic Drugs) Cost for a one-month (30-day) supply of a drug in tier 1 that is filled at a network pharmacy

You pay $0 per prescription


Drugs in Tier 2 (Preferred Brand Drugs) Cost for a one-month (30-day) supply of a drug in tier 2 that is filled at a network pharmacy



Drugs in Tier 3 (Non-Preferred Brand Drugs) Cost for a one-month (30-day) supply of a drug in tier 3 that is filled at a network pharmacy



Drugs in Tier 4 (Specialty Drugs) Cost for a one-month (30-day) supply of a drug in tier 4 that is filled at a network pharmacy

You pay 33 of the total cost


You will stay in this stage until you reach the limit for the Initial Coverage Stage

bull In 2013 the limit for the Initial Coverage Stage is $2970 (this year the limit is $3500) You stay in the Initial Coverage Stage until your ldquototal drug costsrdquo reach $2970

bull Once you reach this limit you move on to the ldquoCoverage Gap Stagerdquo

Stage 3 ldquoCoverage Gap Stagerdquo

Once you reach the Coverage Gap Stage for Part D drugs your cost will change


In 2013 you receive limited coverage by the plan on certain drugs Your costs for drugs in the Coverage Gap Stage will be

bull For Tier 1 Generics drugs You pay $0 copay

o The plan covers 611 formulary generics (76 of formulary generic drugs) through the coverage gap out of 810 generics that are covered on the formulary

bull Brand name drugs You pay 475 of the total cost (plus a portion of the dispensing fee) (this year you pay 50 of the total cost for brand name drugs)

bull Generic drugs You pay 79 of the total cost (this year you pay 86 of the total cost for generic drugs)

Please note that brand drugs must be dispensed incrementally in long-term care facilities Generic drugs may be dispensed incrementally Contact our plan about cost-sharing billingcollection when less than a one-month supply is dispensed

You will stay in the Coverage Gap Stage until you pay $4750 out-of-pocket for Part D drugs (this year it is $4700)

bull Once you reach this total amount you move on to the ldquoCatastrophic Coverage Stagerdquo

Stage 4 ldquoCatastrophic Coverage Stagerdquo

The Catastrophic Coverage Stage is the last of the Drug Payment Stages Once you are in this stage you stay in it until the end of the calendar year

Medicare requires all plans to have the same coverage in the Catastrophic Coverage Stage So in this stage all people with Medicare pay the same amount no matter which plan they are in In the Catastrophic Coverage Stage we pay most of the cost for your Part D drugs You pay the greater of

bull 5 of the total cost bull --or-- $265 copay for generic (including brand drugs treated as generic) and a $660

copay for all other drugs (this year you pay a $260 copay for generic drugs and a $650 copay for other drugs)


SECTION 2 Deciding Which Plan to Choose

Section 21 ndash If you want to stay in Preferred Select Care (HMO-SNP)

To stay in our plan you donrsquot need to do anything If you do not sign up for a different plan or change to Original Medicare by December 7 you will automatically stay enrolled as a member of our plan for 2013

Section 22 ndash If you want to change plans

We hope to keep you as a member next year but if you want to change for 2013 follow these steps

Step 1 Learn about and compare your choices

bull You can join a different Medicare health plan bull --OR-- You can change to Original Medicare If you change to Original Medicare you

will need to decide whether to join a Medicare drug plan and whether to buy a Medicare supplement (Medigap) policy

To learn more about Original Medicare and the different types of Medicare plans read Medicare amp You 2013 call your State Health Insurance Assistance Program (see Section 4) or call Medicare (see Section 62)

You can also find information about plans in your area by using the Medicare Plan Finder on the Medicare Web site Go to httpwwwmedicaregov and click ldquoCompare Drug and Health Plansrdquo Here you can find information about costs coverage and quality ratings for Medicare plans

As a reminder Preferred Care Partners offers other Medicare Advantage prescription drug plans These other plans may differ in coverage and cost-sharing amounts

Step 2 Change your coverage

To change to a different Medicare health plan enroll in the new plan You will automatically be disenrolled from our plan

To change to Original Medicare with a prescription drug plan enroll in the new drug plan You will automatically be disenrolled from our plan

To change to Original Medicare without a prescription drug plan you can either o Send us a written request to disenroll Contact Member Services if you need more

information on how to do this (phone numbers are in Section 61 of this booklet)


o --or-- Contact Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day 7 days a week and ask to be disenrolled TTY users should call 1-877-486shy2048

SECTION 3 Deadline for Changing Plans

If you want to change to a different plan or to Original Medicare for next year you can do it from October 15 until December 7 The change will take effect on January 1 2013

Are there other times of the year to make a change

In certain situations changes are also allowed at other times of the year For example people with Medicaid those who get Extra Help paying for their drugs and those who move out of the service area are allowed to make a change at other times of the year For more information see Chapter 10 Section 23 of the Evidence of Coverage

If you donrsquot like your plan choice for 2013 you can switch to Original Medicare between January 1 and February 14 2013 For more information see Chapter 10 Section 22 of the Evidence of Coverage

SECTION 4 Programs That Offer Free Counseling about Medicare

The State Health Insurance Assistance Program (SHIP) is a government program with trained counselors in every state In Florida the SHIP is called SHINE (Serving Health Insurance Needs of Elders)

SHINE is independent (not connected with any insurance company or health plan) It is a state program that gets money from the Federal government to give free local health insurance counseling to people with Medicare SHINE counselors can help you with your Medicare questions or problems They can help you understand your Medicare plan choices and answer questions about switching plans You can call SHINE at 1-800-963-5337 You can learn more about SHINE by visiting their Web site wwwfloridashineorg

SECTION 5 Programs That Help Pay for Prescription Drugs

You may qualify for help paying for prescription drugs

bull ldquoExtra Helprdquo from Medicare People with limited incomes may qualify for Extra Help to pay for their prescription drug costs If you qualify Medicare could pay up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums annual deductibles and coinsurance Additionally those who qualify will not


have a coverage gap or late enrollment penalty Many people are eligible and donrsquot even know it To see if you qualify call

o 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048 24 hours a day7 days a week

o The Social Security Office at 1-800-772-1213 between 7 am and 7 pm Monday through Friday TTY users should call 1-800-325-0778 or

o Your State Medicaid Office

SECTION 6 Questions

Section 61 ndash Getting Help from Preferred Select Care (HMO-SNP)

Questions Wersquore here to help Please call Member Services toll free at 1-866-231-7201 (TTY only call 711 toll free) We are available for phone calls October 1 2012-February 14 2013 7 days a week from 800 am-800 pm Eastern Beginning February 15 2013 Monday thru Friday 800 am-800pm Calls to these numbers are free

Read your 2013 Evidence of Coverage (it has details about next years benefits and costs)

This Annual Notice of Changes gives you a summary of changes in your benefits and costs for 2013 For details look in the 2013 Evidence of Coverage for our plan The Evidence of Coverage is the legal detailed description of your plan benefits It explains your rights and the rules you need to follow to get covered services and prescription drugs A copy of the Evidence of Coverage was included in this envelope

Visit our Web site

You can also visit our Web site at wwwmypreferredcarecom As a reminder our Web site has the most up-to-date information about our provider network (ProviderPharmacy Directory) and our list of covered drugs (FormularyDrug List)

Section 62 ndash Getting Help from Medicare

To get information directly from Medicare

Call 1-800-MEDICARE (1-800-633-4227)

You can call 1-800-MEDICARE (1-800-633-4227) 24 hours a day 7 days a week TTY users should call 1-877-486-2048


Visit the Medicare Web site

You can visit the Medicare Web site httpwwwmedicaregov It has information about cost coverage and quality ratings to help you compare Medicare health plans You can find information about plans available in your area by using the Medicare Plan Finder on the Medicare Web site (To view the information about plans go to httpwwwmedicaregov and click on ldquoCompare Drug and Health Plansrdquo)

Read Medicare amp You 2013

You can read Medicare amp You 2013 Handbook Every year in the fall this booklet is mailed to people with Medicare It has a summary of Medicare benefits rights and protections and answers to the most frequently asked questions about Medicare If you donrsquot have a copy of this booklet you can get it at the Medicare Web site httpwwwmedicaregov or by calling 1-800-MEDICARE (1-800-633-4227) 24 hours a day 7 days a week TTY users should call 1-877-486-2048


Multi-language Interpreter Services

English We have free interpreter services to answer any questions you may have about our health or drug plan To get an interpreter just call us at 1-866-231-7201 Someone who speaks English can help you This is a free service

Spanish Tenemos servicios de inteacuterprete sin costo alguno para responder cualquier pregunta

ᛘሽᡁفⲴڕᓧᡆ㰕䳚ਟ㜭ᆈᴹˈharrᡁفᨀݽ䋫Ⲵ㘫䆟

que pueda tener sobre nuestro plan de salud o medicamentos Para hablar con un inteacuterprete por favor llame al 1-866-231-7201 Alguien que hable espantildeol le podraacute ayudar Este es un servicio gratuito

ఱ䲙≀ಖ㦟னᗣᡈޣゎ⟅ᛘຓᑞ㸪䈁⩻䍩ᥦ౪චԜᡃChinese Mandarin 䰞ࠋዴᯝᛘ㟂せṈ⩻䈁㸪䈧 1-866-231-7201ࠋᡃԜᕤసேઈᚇҀពᑞຓ ᛘࠋ䘉亩ච䍩ࠋ

Chinese Cantonese ᴽउǄ䴰㘫䆟ᴽउˈ䃻㠤䴫 1-866-231-7201Ǆᡁف䅋ѝ᮷ⲴӪሷprimeᛘᨀᒛǄ䙉ᱟа丵ݽ䋫ᴽउǄ

Tagalog Mayroon kaming libreng serbisyo sa pagsasaling-wika upang masagot ang anumang mga katanungan ninyo hinggil sa aming planong pangkalusugan o panggamot Upang makakuha ng tagasaling-wika tawagan lamang kami sa 1-866-231-7201 Maaari kayong tulungan ng isang nakakapagsalita ng Tagalog Ito ay libreng serbisyo

French Nous proposons des services gratuits dinterpreacutetation pour reacutepondre agrave toutes vos questions relatives agrave notre reacutegime de santeacute ou dassurance-meacutedicaments Pour acceacuteder au service dinterpreacutetation il vous suffit de nous appeler au 1-866-231-7201Un interlocuteur parlant Franccedilais pourra vous aider Ce service est gratuit

Vietnamese Chuacuteng tocirci coacute dich v thocircng dich mieuron phiacute deuro tra lei caacutec cacircu h6i veuro chuang suc kh6e vagrave chuang trigravenh thu6c men Neurou quiacute vi cdn thocircng dich viecircn xin g9i 1-866-231-7201 se coacute nhacircn viecircn noacutei tieurong Vit giuacutep dO quiacute vi Dacircy lagrave dich v mieuron phiacute

German Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu unserem Gesundheits- und Arzneimittelplan Unsere Dolmetscher erreichen Sie unter 1-866-231-7201 Man wird Ihnen dort auf Deutsch weiterhelfen Dieser Service ist kostenlos

Korean 㢌⨀⸨䜌㚱䖼⸨䜌㜄Ḵ䚐㫼ⱬ㜄䚨⫠Ḕ㣄 ⱨ⨀䋩㜡⪰㥐ḩ䚌Ḕ㢼䋩㜡⪰㢨㟝䚌⥘㤸䞈 1-866-231-7201ⶼ㡰⦐ⱬ㢌䚨㨰㐡㐐㝘䚐ạ㛨⪰䚌㣄ᴴ⓸㝴 ⫨ᶷ㢹㢨 ⱨ⨀⦐㟨㜵

Russian EcJI y Bac Bo3HIKHyT BoIpoch oTHocITeJhHo cTpaxoBoro IJI MeIKaMeHTHoro IJaHa Bh Mo)eTe BocIoJh3oBaThc5 HalIMI 6ecIJaTHhMI ycJyraMI IepeBoqIKoB lTo6h


BocIoJh3oBaThc5 ycJyraMI IepeBoqIKa Io3BoHITe HaM Io TeJeltoHy 1-866-231-7201 BaM oKa)eT IoMoIh coTpyHIK KoTophH roBopIT Io-pyccKI aHHa5 ycJyra 6ecIJaTHa5

Arabic 1027-132-668-1

Italian Egrave disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sul nostro piano sanitario e farmaceutico Per un interprete contattare il numero 1-866-231shy7201 Un nostro incaricato che parla Italianovi forniragrave lassistenza necessaria Egrave un servizio gratuito

Portugueacutes Dispomos de serviccedilos de interpretaccedilatildeo gratuitos para responder a qualquer questatildeo que tenha acerca do nosso plano de sauacutede ou de medicaccedilatildeo Para obter um inteacuterprete contacteshynos atraveacutes do nuacutemero 1-866-231-7201 Iraacute encontrar algueacutem que fale o idioma Portuguecircs para o ajudar Este serviccedilo eacute gratuito

French Creole Nou genyen segravevis entegravepregravet gratis pou reponn tout kesyon ou ta genyen konsegravenan plan medikal oswa dwograveg nou an Pou jwenn yon entegravepregravet jis rele nou nan 1-866-231shy7201 Yon moun ki pale Kreyogravel kapab ede w Sa a se yon segravevis ki gratis

Polish Umozliwiamy bezplatne skorzystanie z uslug tlumacza ustnego ktoacutery pomoze w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania lekoacutew Aby skorzysta6 z pomocy tlumacza znajltcego jyzyk polski nalezy zadzwoni6 pod numer 1-866-231-7201 Ta usluga jest bezplatna

Hindi u 0 q 0 (

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1Preferred Select Care (HMO-SNP) Annual Notice of Changes for 2013

Think about Your Medicare Coverage for Next Year

Each fall Medicare allows you to change your Medicare health and drug coverage during the Annual Enrollment Period Itrsquos important to review your coverage now to make sure it will meet your needs next year

Important things to do

Check the changes to our benefits and costs to see if they affect you Do the changes affect the services you use It is important to review benefit and cost changes to make sure they will work for you next year Look in Sections 11 and 15 for information about benefit and cost changes for our plan

Check the changes to our prescription drug coverage to see if they affect you Will your drugs be covered Are they in a different tier Can you continue to use the same pharmacies It is important to review the changes to make sure our drug coverage will work for you next year Look in Section 16 for information about changes to our drug coverage

Check to see if your doctors and other providers will be in our network next year Are your doctors in our network What about the hospitals or other providers you use Look in Section 13 for information about our ProviderPharmacy Directory

Think about your overall costs in the plan How much will you spend out-of-pocket for the services and prescription drugs you use regularly How much will you spend on your premium How do the total costs compare to other Medicare coverage options

Think about whether you are happy with our plan

If you decide to stay with Preferred Select Care (HMO-SNP)

If you want to stay with us next year itrsquos easy - you donrsquot need to do anything If you donrsquot make a change by December 7 you will automatically stay enrolled in our plan

If you decide to change plans

If you decide other coverage will better meet your needs you can switch plans between October 15 and December 7 If you enroll in a new plan your new coverage will begin on January 1 2013 Look in Section 22 to learn more about your choices






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preferred select care (hmo-snp) offered by preferred care€¦ · annual notice of changes for 2013...

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