Thank you for joining [PLAN_FULL]. We are looking forward to starting a new journey with you. Your plan coverage will start on January 1. As a new member you will receive materials from us, such as:

• A new Membership ID Card
  
• Evidence of Coverage
  
• Summary of Benefits
  
• List of Drugs (Formulary) 

You can ask questions and get support from our Member Services team 7 days a week. Here are some ways you can contact us.

Call:
[PHONE_COMBO]

Write:
[ADDRESS]

Email:
Create or log into your online member account to send secure messages.

Creating an account is easy! Just follow the below steps:

1. Go to the Member Login
2. Search for your member information by entering your Medicare Advantage ID number. This number can be found on your NAME ID card.  
3. Register your account by entering your email address and choose a password. A confirmation message will appear on the screen. You will also receive an email to verify your account and to complete your account registration.
4. Once you've verified your account, you can then choose your preferred language and add answers to the secret questions you pick. These questions will help you access your account if you forget your password. When you are done, click "Next" to finish your account registration.

Once your account has been created, you can use your member account to:

• View your plan benefits and claims information.
• Get a replacement ID card.
• Search or select a primary care provider (PCP).
• Send or receive secure messages about your plan coverage.

If you have questions setting up or logging into your account, please contact Member Services. We are here to help!

For certain kinds of drugs, you can use our mail-order services. Generally, the drugs provided through mail-order (MO) are drugs that you take on a regular basis for a chronic or long-term medical condition such as high blood pressure or diabetes. The drugs available through our plan’s mail-order service are marked as “mail-order or MO” in our List of Drugs (Formulary).

Our plan’s mail-order service allows you to order up to a 90-day supply. To get order forms and information about filling your prescriptions by mail, contact Member Services.

You can authorize anyone (like a relative, friend, advocate, an attorney, or a doctor) to act as your representative and file an appeal or ask for a coverage decision on your behalf. Just complete an Appointment of Representative form (PDF) and follow the instructions on where to send it.

Visit our Appeals and Grievances web page for more information about this form and how to authorize a representative.

Network providers are doctors, pharmacies, hospitals, and other health care professionals or facilities that have an agreement with us to deliver covered services to members in our plan. You can use our Find a Provider tool to see if your doctor, pharmacy, or other healthcare professional or facility is in our network.

Your doctor or pharmacy should be an in-network provider, so your health services are covered. If you use an out-of-network provider, you will likely pay more for your healthcare services.

If you need care and an in-network provider is unable to provide this care, you may be able to get care from an out-of-network provider. Your PCP must confirm there is not a network provider available and contact the plan to request authorization for you to obtain services from an out-of-network provider. If approved, the out-of-network provider will be issued an authorization to provide the service(s).

You are entitled to receive services from out-of-network providers for emergency or out-of-area urgently needed services. In addition, our plan must cover dialysis services for members with End-Stage Renal Disease (ESRD) who have traveled outside the plan’s service area and are not able to access network providers.

Your PCP is your main doctor. Your PCP should know your complete medical history to evaluate changes in your health. You can visit your PCP for sick and well visits. Your PCP will also help with coordinating other services, such as seeing a specialist or having a procedure in a hospital or an outpatient facility.

If you don't have a PCP, here are ways to choose one:

1. Use our Find a Provider tool to find an in-network provider and contact Member Services with your selection.
2. Or, you can just call us! Member Services will help you find a PCP.

If you already have a PCP:

That’s great! You may want to contact Member Services or use our Find a Provider tool to make sure your PCP is in our network. If your PCP is not in our network, don’t worry, we will work with you to make sure you are assigned a PCP that is in our network.

Deciding where to go for care can sometimes be confusing. For non-emergency illness or injury, call your PCP, contact the 24/7 nurse advice line or visit an in-network urgent care facility. If you feel you are experiencing a life-threatening condition, go to the emergency room (ER).

See below to help you decide where to go for the care you need.

DO YOU HAVE A PHYSICAL INJURY OR ILLNESS LIKE THE FLU? IF YES... 

• Call Our 24/7 Nurse Advice Line at [PHONE_NURSE] (TTY: 711)
  Get quick, reliable answers to your health questions.
  
  
• Call Your Primary Care Provider (PCP)
  Set up an appointment to see your main doctor.
  
  
• Go to In-Network Urgent Care
  Get quickly diagnosed and treated for less serious illnesses or injuries.

CALL 9-1-1 IMMEDIATELY OR GO TO AN EMERGENCY ROOM IF:

You feel you have a life-threatening injury or illness like:

• Chest pains
• Bleeding that won’t stop
• Shortness of breath
• Broken bones
• Poisoning
• Severe cuts or burns

Always follow up with your PCP if you have gone to an emergency room, visited an urgent care facility or had a hospital stay.

Yes. If you have limited income and resources, Medicare will provide "Extra Help" to pay for your plan's monthly premium, yearly deductible, prescription co-payments and coinsurance. Resources include your savings and stocks, but not your home or car. This Extra Help also counts toward your out-of-pocket costs.

Some people automatically qualify for Extra Help and don't need to apply. Medicare will mail a letter to people who automatically qualify for Extra Help.

To see if you qualify for getting Extra Help call:

• 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. Get information 24 hours a day, 7 days a week. You can also visit www.medicare.gov to view a copy of the 'Medicare and You' handbook - see section 'Programs for People with Limited Income and Resources'; or
  
• The Social Security Administration at 1-800-772-1213 between 7:00 a.m. and 7:00 p.m., Monday through Friday. TTY users call 1-800-325-0778; or
  
• Your State Medicaid Office

After you apply, you will get a letter letting you know if you qualify for Extra Help and what you need to do next.

Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Your Medicare plan will renew automatically each year unless you make changes to your coverage. You may choose to change your coverage during the Annual Enrollment Period: October 15 – December 7.

If you are a member of a Dual Eligible Special Needs Plan (DSNP), your renewal is contingent upon your Medicaid eligibility.

If you qualify for a Special Enrollment Period, you can change plans according to the situation that is allowing you a Special Enrollment Period.