Presentation Care Improvement Plus

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					               Care Improvement Plus-
        Making the Right Choice for You
                          2011 Plan Options



Y0072_OE11_6108 CMS Approved 10202010 TX




                                              1
  Making the Right Choice for You
• Medicare and You
• Care Improvement Plus- Who We Are
  – Chronic Conditions Special Needs Plans
  – Dual Special Needs Plan
  – Medicare Advantage Plans
• Plan Options for 2011
• How to Enroll



                                             2
        Medicare and You
• Who qualifies for Medicare?
  – You or your spouse worked for at least 10
    years (40 quarters)
  – Citizen or permanent resident of the U.S.
  – Age 65
  – Under age 65 and disabled
  – Living with ESRD (end stage renal disease)




                                                 3
           Medicare and You
• Original Medicare
  – Part A – If you have Part A, you have hospital
    insurance
  – Part B – If you are enrolled and continue to
    pay your Part B premium (may be covered if
    you have Medicaid), you have doctor and
    medical insurance
  – Part D – Prescription drug coverage for many
    outpatient medications


                                                4
What are Medicare Advantage Plans?




                                5
         Medicare Advantage Plans
• Health plan options that are part of the Medicare
  program
  – Also known as “Part C”
• Medicare pays the plan a set amount each
  month for your care
• Must offer all benefits of Original Medicare and
  most include Part D prescription drug coverage
• In most plans – including Care Improvement
  Plus– there are generally extra benefits and
  lower out-of-pocket costs than with Original
  Medicare
                                                 6
   Medicare Advantage Plans

• If you join a Medicare Advantage plan, you
  are still in the Medicare program
  – These plans are part of the Medicare program

• Medicare approves health plans such as
  Care Improvement Plus and pays them to
  provide your benefits



                                              7
   Medicare Advantage Plans
• Your Medicare coverage does not go
  away!
• Care Improvement Plus is focused on
  providing tailored benefits and care
  management services to improve your
  quality of care
  – Original Medicare does not provide additional
    services such as care management


                                               8
Care Improvement Plus has a
   plan that’s right for you




                               9
      Care Improvement Plus
• Provides a variety of plan options to fit the
  health and financial needs of Medicare
  beneficiaries
• Offers comprehensive medical and
  prescription drug benefits
  – All plans include Medicare Parts A, B, & D




                                                 10
      Care Improvement Plus
• Is dedicated to caring for the health and
  well-being of chronically ill and other
  underserved Medicare beneficiaries
• Has a contract with the Centers for
  Medicare and Medicaid Services (CMS) to
  serve Medicare beneficiaries in the plan’s
  service areas including:
  – Entire state of Texas


                                              11
                     Eligibility
• Eligibility requirements to enroll:
  – Must have Medicare Part A and Part B
  – Must continue to pay your monthly Medicare
    Part B premium
     • If you are a full benefit dual beneficiary and your
       Part B premium is paid for by the state, you will not
       be responsible for paying your Part B premium.
        – Limitations, copayments, and restrictions may apply.
  – Must live in the plan’s service area
     • Entire state of Texas


                                                                 12
                  Eligibility cont’d
• Chronic Conditions Special Needs Plan
  – Must have one or both of the qualifying chronic conditions
     • Diabetes
     • Heart failure (also known as congestive heart failure, chronic heart
       failure, left-sided heart failure, right-sided heart failure)
• Dual Special Needs Plan
  – To be eligible for this plan, you must:
     • Have both Medicare Part A and Part B,
     • Have your Medicare Parts A and B cost sharing covered by the
       state; and
     • Be a Medicare beneficiary living in Texas
• MAPD (Medicare Advantage Prescription Drug Plan)
  – Must complete the enrollment form during an applicable
    enrollment period
                                                                    13
                 “Best Fit” Plan Options
                              If You Are:                                  Then You Should Consider:


Diabetes &/or Heart Failure       + Full Dual (Medicare & Full Medicaid)   Silver Rx (CSNP)


Diabetes &/or Heart Failure       + Not Full Dual                          Gold Rx (CSNP)


No Chronic Condition Required     + Medicare & Full Medicaid               Dual Advantage (DSNP)


No Chronic Condition Required     + Medicare Only                          Medicare Advantage (RPPO)

                                      Medicare Only & reside in a
No Chronic Condition Required     +   select county                        Medicare Advantage (PPO)




                                                                                                14
   Complete Health Coverage
• With all Care Improvement Plus plans you
  get complete health coverage, including:
  – Hospital (Medicare Part A)
  – Medical (Medicare Part B)
  – Prescription drugs (Medicare Part D)
  – An open access provider network
    • No referral required for Medicare-covered services
    • Go to any Medicare-approved provider who
      accepts payment from our plans


                                                      15
If you have diabetes and/or heart failure
      and full Medicaid, consider the
              Silver Rx
     (Regional PPO SNP) plan



                                       16
        Silver Rx Overview
• Chronic Conditions Special Needs Plan
• $0 monthly plan premium and $0 cost
  sharing for Medicare-covered services for
  those with full Medicaid
• Transportation - $0 for up to 24 one-way
  trips to plan-approved locations
• Extra routine podiatry services up to six
  (6) visits annually at $0 copay


                                         17
         Silver Rx Overview
• Preventive dental services including oral
  exams, cleanings, dental x-rays, denture
  adjustments and dentures(6)
• Vision services – routine eye exams and
  $200 annually towards eyewear
• Over-The-Counter (OTC) benefit –
  monthly benefit for drug and other
  purchases via mail order
• Care management services – including
  24/7 nurse hotline

                                          18
                     Silver Rx Overview – TX
Basic and Additional Benefits              What You Pay if You Are                        What You Pay if You Are
                                              Medicare Only                               Medicare & Full Medicaid

Monthly Plan Premium                                $30.50(1)                                         $0(1)

Annual Out-of-Pocket Max                             $6,700                                         $6,700
Primary Care Physician Visit                    20% coinsurance                                  $0 copayment
Specialist Visit                                20% coinsurance                                  $0 copayment
Inpatient Hospital
                  Deductible:            $1,132 for each benefit period                              $0(2)(4)
              Days 1-60/ 61-90                $0(2) / $283per day(2)
                 Days 91-150
                                        $566 per lifetime reserve day(2)(4)

Retail Pharmacy                        $10 generic; $45 brand (preferred);               $0/$1.10/$2.50 - generic and
(30 day supply)                     $95 brand (non-preferred); 33% specialty          $0/$3.30/$6.30 for all other drugs(5)
Dental                           20% coinsurance for Medicare-covered benefits      $0 copay for Medicare-covered benefits
                                            $15 routine office visit                         $0 routine office visit
                                    $0 in-network/20% out-of network for             $0 in-network/20% out-of network for
                                          dentures(6) and adjustments                     dentures(6) and adjustments

Transportation                       $0 copayment for 24 one way trips (2)(3)       $0 copayment for 24 one way trips (2)(3)
Vision                           20% coinsurance for Medicare-covered benefits      $0 copay for Medicare-covered benefits
                                     $0 in-network/20% out-of network for            $0 in-network/20% out-of network for
                                           routine eye exam every year                     routine eye exam every year
                                   You’ll receive $200 yearly toward eyewear       You’ll receive $200 yearly toward eyewear
Over-The-Counter                 You’ll receive $19 monthly for health purchases     You’ll receive $19 monthly for health
                                                                                                   purchases
If you are a Medicare beneficiary with
   diabetes and/or heart failure and do
NOT receive full Medicaid, consider the
             Gold Rx
    (Regional PPO SNP) plan



                                    20
          Gold Rx Overview
• Chronic Conditions Special Needs Plan
• $0 monthly plan premium and low,
  predictable cost sharing
• Transportation – $0 for up to 12 one-way
  trips to plan approved locations
• Extra routine podiatry services up to six
  (6) visits annually at $0 copay

                                              21
          Gold Rx Overview
• Preventive dental services including oral
  exams, cleanings, dental x-rays, and
  denture adjustments
• Vision services—routine eye exams and
  $150 annually towards eyewear
• Care management services – including
  24/7 nurse hotline



                                              22
                  Gold Rx Overview- TX
Basic and Additional Benefits                     What You Pay with Gold Rx Plan
Monthly Plan Premium                                                  $0(1)
Annual Out-of-Pocket Maximum                                         $3,400
Physician Copayment                                                   $25
Specialist Copayment                                                  $50
Inpatient Hospital                                               No deductible
              Days 1-15/ 16-90 / 91-150:    $215(2) / $0 per day(2)/ $0 per lifetime reserve day(2)(4)
Retail Pharmacy                                      $8 generic; $45 brand (preferred);
(30-day supply)                                  $95 brand (non preferred); 33% specialty
                                              Lower cost-sharing may apply for those with LIS
Dental                                         $0 copayment for each Medicare-covered visit
                                           $10 routine preventive office visit that includes denture
                                                                adjustments
Transportation                                     $0 copayment for 12 one way trips(2)(3)
Vision                                                $50 for Medicare-covered visits
                                                      $10 for routine exam every year
                                                 You’ll receive $150 yearly toward eyewear
      Dual Advantage
(Regional PPO SNP) is a Special
Needs Plan designed specifically for
those who have both Medicare and
           full Medicaid



                                  24
      Dual Advantage Overview
• Dual Special Needs Plan designed for full
  duals whose A/B cost sharing is covered by
  their state Medicaid program.
• $0 monthly plan premium and $0 cost
  sharing for Medicare-covered services
• Transportation services—$0 for up to 26
  one-way trips to plan-approved locations.


                                          25
      Dual Advantage Overview

• Preventive dental services including oral
  exams, cleanings, dental x-rays, denture
  adjustments, and dentures6
• Vision services—routine eye exams and
  $200 annually towards eyewear
• Care management services – including
  24/7 nurse hotline


                                          26
            Dual Advantage Overview-TX
Basic and Additional Benefits                What You Pay if You Are
                                             Medicare & Full Medicaid
Monthly Plan Premium                                      $0(1)
Annual Out-of-Pocket Maximum                             $6,700
Physician Copayment                                        $0
Specialist Copayment                                       $0
Inpatient Hospital                                       $0(2)(4)

Retail Pharmacy                            $0/$1.10/$2.50 – for generic and
(30-day supply)                           $0/$3.30/$6.30 for all other drugs(5)
                                    Lower cost-sharing may apply for those with LIS
Dental                                      $0 for Medicare-covered benefits
                                            $0 routine preventive office visit
                                  $0 in-network/20% out-of-network for dentures(6), and
                                                   denture adjustments
Transportation                           $0 copayment for 26 one way trips(2)(3)
Vision                                       $0 for Medicare-covered benefits
                                $0 in-network/20% out-of-network for routine exam You’ll
                                           receive $200 yearly toward eyewear
   Medicare Advantage
  (Regional PPO) plan was
   specifically designed for
beneficiaries with Medicare only



                               28
    Medicare Advantage Overview
• Option for those who don’t qualify for the
  Special Needs Plans
  – Such as spouses and caregivers

• Convenience of one health plan for
  everyone in your household

• Affordable monthly plan premium and
  predictable cost sharing

                                           29
     Medicare Advantage Overview
• Transportation services—$0 for up to 12
  one-way trips to plan-approved locations
• Preventive dental services including oral
  exams, cleanings, dental x-rays, and
  denture adjustments
• Vision services—routine eye exams and
  $150 annually towards eyewear
• Care management services – including
  24/7 nurse hotline

                                          30
         Medicare Advantage RPPO Overview- TX
Basic and Additional Benefits     What You Pay With the Medicare Advantage Plan

Monthly Plan Premium                          $47(1) or as low as $27.50
                                   (premium depends on your LIS level, if available)
Annual Out-of-Pocket Maximum                             $3,400

Physician Copayment                                        $35
Specialist Copayment                                       $50
Inpatient Hospital                                    No deductible
              Days 1-15 /16-90:                  $220(2) / $0 per day(2)
                   Days 91-150:              $0 per lifetime reserve day(2)(4)
Retail Pharmacy                          $9 generic; $45 brand (preferred);
(30-day supply)                      $95 brand (non- preferred); 33% specialty
                                   Lower cost-sharing may apply for those with LIS
Dental                               $0 copayment for Medicare-covered benefits
                                   $10 for routine preventive office visit that includes
                                                   denture adjustments
Transportation                           $0 copayment for 12 one way trips (2)(3)

Vision                               $50 copayment for Medicare-covered benefits
                                              $10 routine exam every year
                                      You’ll receive $150 yearly toward eyewear
 Medicare Advantage PPO Overview
• Available to Medicare beneficiaries living
  in select counties in Texas
• Premium as low as $0.20 if you have LIS
  assistance
• Transportation services—$0 for up to 12
  one-way trips to plan-approved locations



                                           32
Medicare Advantage PPO Overview

• Preventive dental services including oral
  exams, cleanings, dental x-rays, and
  denture adjustments
• Vision services—routine eye exams and
  $150 annually towards eyewear
• Care management services – including
  24/7 nurse hotline


                                         33
         Medicare Advantage PPO Overview-TX
      Basic and Additional Benefits         What You Pay With the Medicare Advantage PPO Plan

Monthly Plan Premium                                       $9(1) or as low as $0.20
                                               (premium depends on your LIS level, if available)
Annual out-of-pocket maximum                                         $3,400

Physician Copayment                                                    $35
Specialist Copayment                                                   $50
Inpatient Hospital                                                No deductible
                       Days 1-15 / 16-90:                    $220(2) / $0 per day(2)
                           Days 91-150:                  $0 per lifetime reserve day(2)(4)
Retail Pharmacy                                       $10 generic; $43 brand (preferred);
(30-day supply)                                   $95 brand (non- preferred); 33% specialty
                                                Lower cost-sharing may apply for those with LIS
Dental                                           $0 copayment for Medicare-covered benefits
                                               $10 for routine preventive office visit that includes
                                                               denture adjustments
Transportation                                       $0 copayment for 12 one way trips(2)(3)

Vision                                           $50 copayment for Medicare-covered benefits
                                                         $10 routine exam every year
                                                  You’ll receive $150 yearly toward eyewear
                    Benefit Notes
  Cost sharing is the same in or out-of-network except for the
  DME, home health, dentures (Silver Rx/Dual Advantage plan
  only) and vision (routine eye exam) benefits.
  In 2011 Silver Rx and Dual Advantage have an annual $162
  Part B deductible which is generally paid for by those who
  have full Medicaid.
(1)You   must continue to pay your Medicare Part B premium if not
     otherwise paid for under Medicaid and/or another third party.
(2) Prior authorization required. Contact plan for details.
(3) A reimbursable out-of-network benefit amount applies for non-
     network providers. Contact plan for details.
(4) Plan covers 60 lifetime reserve days. Lifetime reserve days
     can only be used once.
(5) If you are in a long term care facility, you pay $0 for your
     prescription drugs.
(6) Dentures require referrals (Silver Rx /Dual Advantage plan
     only).

                                                                35
           Part D Overview
• Comprehensive, low-cost Part D coverage
• $0 annual deductible
• Covers most generics that are not
  excluded by Medicare
• Accepted at nearly 60,000 network
  pharmacies nationwide, including many
  national and local chains
  – Mail order service for home-delivery available


                                                36
             Part D Overview
• A formulary (list of covered drugs) chosen
  by our pharmacy experts to meet our
  member’s healthcare needs
  – Mailed to all members and available through
    the website (www.careimprovementplus.com)
  – Use the formulary to:
     • See if your medications are covered
     • Determine the copayment for your medications
  – Mail-order pharmacy service is available for
    added convenience and savings
     • Up to 10% off the prescription drug costs

                                                      37
                  “Extra Help”
• People with limited incomes may qualify for Extra
  Help to pay for their prescription drug costs.
• If eligible, Medicare could pay for up to 100% of
  drug costs including monthly prescription drug
  premiums, annual deductibles, and coinsurance.
• Additionally, those who qualify will not be subject to
  the coverage gap or a late enrollment penalty.
• Premiums, co-payments, coinsurance, and
  deductibles may vary based on the level of help
  that beneficiaries may receive. Contact the plan for
  further details.
                                                      38
               “Extra Help”
• Many people are eligible for these savings
  and don’t even know it. To see if you
  qualify for Extra Help, contact:
  – Medicare: 1-800-MEDICARE (1-800-633-
    4227), 24 hours per day, 7 days per week.
    (TTY: 1-877-486-2048)
  – Social Security: 1-800-772-1213, 7 a.m. – 7
    p.m., Monday-Friday. (TTY: 1-800-325-0778)
  – Your state’s Medicaid program office

                                                39
Medicare Coverage Gap Discount Program
• Effective January 1, 2011, as a result of
  health care reform, Medicare beneficiaries
  who are not already receiving “Extra Help”
  will experience lower cost-sharing on their
  medications while in Medicare’s coverage
  gap, “donut hole”. They will receive:
  – 50% discounts on brand-name drugs from
    participating manufacturers
  – 7% reductions on the cost of all generic
    drugs.
                                               40
Additional Care Improvement Plus Services

• Care Management
• Care Coordination
• 24/7 Nurse Hotline
• Social Service Coordinators
• HouseCalls
• PharmAssist

                                       41
  What is Care Management?
• Supports, helps, and assists people
  living with long-term chronic illnesses
• Provides personalized care to meet
  individual needs of members
  – Nursing support
  – Medication monitoring/counseling
  – Health education
  – Tools to help manage your health
     • in-home monitoring equipment (if needed)


                                                  42
 What is Care Coordination?

The management of healthcare between
doctor visits coordinated among multiple
providers.

Making sure you are getting the right care
at the right time.



                                        43
          24/7 Nurse Hotline
• Information and support when you need it
  – Nurses are available 24 hours a day to
    answer health-related questions
• Communicate better with your provider
  – Call before or after you see your doctor to
    make the most of your appointment.
• Guidance for difficult decisions
  – The more you know, the better decision you
    can make.

                                                  44
   Social Service Coordinators
• Available to help determine your eligibility
  for state, local and federal programs that
  can assist with expenses such as
  – Medical costs
  – Prescription drugs
  – Heating and electric bills
  – Housing/rent
  – Meals
  – Legal

                                             45
                   HouseCalls
• Offers members in-person visit with a physician or
  nurse practitioner who performs a health
  assessment to:
   – Gather information to help Care Improvement Plus
     provide additional health education and care
     coordination
   – Identify urgent health problems or health risks
   – Provide advice on health-related topics to discuss at
     the next appointment with provider
• No additional cost to members
• All members are eligible for this program

                                                        46
              PharmAssist
• Specialist Pharmacists are available 24/7
  for personalized, private counseling
  – Review of medications to avoid duplication
  – Educate members about their medications
  – Ensure medications are being taken as
    prescribed
  – Assess needs for any new drugs
  – Discuss any issues with physician


                                                 47
Care Improvement Plus is
available where you live.




                            48
                  Texas
The Care Improvement Plus service area includes
  the entire state of Texas




                                             49
                 Texas MAPD PPO
    Medicare Advantage PPO is offered in the following
    41 counties in Texas:
•    Bexar         •   Jim Hogg
•    Bowie         •   Johnson
•    Brazoria      •   Kaufman
•    Brooks        •   Kenedy
•    Cass          •   Kleberg
•    Chambers      •   Liberty
•    Collin        •   Montgomery
•    Culberson     •   Navarro
•    Dallas        •   Nueces
•    Denton        •   Orange
•    Dimmit        •   Polk
•    Duval         •   Presidio
•    El Paso       •   Red River
•    Ellis         •   Tarrant
•    Fort Bend     •   Taylor
•    Guadalupe     •   Titus
•    Harris        •   Van Zandt
•    Hood          •   Wilson
•    Hudspeth      •   Wood
•    Hunt          •   Zavala
•    Jefferson



                                                         50
   So…How Do You Choose?
Factors to consider when choosing your plan:
– Health needs- How often and for what services will
  you use the plan most often?
– Cost- Compare your current out of pocket costs
  including monthly premium, copayment and
  coinsurance amounts.
– Providers- Are your providers (doctors and hospitals)
  Medicare-approved? And are they willing to accept
  payment from the plan?
– Benefits- Does the plan offer you the coverage and
  benefits you need including valuable extras at no
  additional cost?

                                                    51
Keep in Mind…




                52
• No matter which Care Improvement Plus
  plan you choose to join, you are still part
  of the Medicare program and you must
  continue to pay your applicable Medicare
  premiums.
• Care Improvement Plus is not a “stand-
  alone” Part D plan (PDP)
• Care Improvement Plus is not a Medicare
  Supplement plan (Medigap)

                                           53
• If you currently have a Medicare Supplement or
  Medigap plan, you should not cancel or stop
  paying your premiums until your enrollment in
  Care Improvement Plus has been confirmed by
  Medicare.
• If you currently have Medicare Advantage (MA),
  Medicare Advantage Part D (MAPD) or Part D
  coverage you will be AUTOMATICALLY
  disenrolled from your plan by Medicare upon
  your effective date with Care Improvement Plus.

                                               54
                      Important Dates
  Members may enroll in the plan only during specific times
  of the year.
       In 2010                       Description                            In 2011
 October 1 – November 14    Plans can begin to share new benefits
                            for the coming year

November 15 – December 31   Annual Enrollment Period (AEP)
                            begins. You can enroll or dis-enroll in a
                            Medicare Advantage health plan.

                            Special Election Period (SEP) begins        January 1– October 14




                                                                                        55
       Special Election Period
• If you have diabetes, heart failure or
  Medicaid/Low Income Subsidy (LIS), you
  may enroll in a Care Improvement Plus
  Special Needs Plan ANYTIME during the
  year by exercising a “Special Election
  Period”.
• There are other times you are eligible for a
  special election period; for example:
  – If you permanently move to another service area
  – Other Medicare-approved circumstances


                                               56
           How Do I Enroll?
  Here are four easy steps to follow:
1. Decide which plan is best for you.
2. Complete the enrollment application and
   other applicable paperwork.
3. Receive an education call.
4. Become a Care Improvement Plus member!




                                        57
What Happens Next?




                     58
    Temporary Proof of Coverage
• Once you complete the enrollment
  application, you will be given a Temporary
  Proof of Coverage Envelope.
  – This provides you with proof of your
    application for enrollment and important
    contact information until your Care
    Improvement Plus ID card and Welcome
    Kit arrives.
  – You should keep your copy of the
    completed application in this envelope.
                                               59
Sample Temporary Proof of Coverage




                                60
   Enrollment and Verification Call
• To confirm that enrolled beneficiaries
  understand the rules applicable under the plan,
  an enrollment and verification call will be made
  by Care Improvement Plus.
• Calls will be made within 10 days of receipt of
  the application.
  – 3 attempts in 10 days
  – Sales agent will not be present at the time of the
    education call.
  – Calls are followed up with a letter if the beneficiary
    could not be contacted.

                                                             61
         Welcome Kit & ID Card
• A Welcome Kit is mailed to you 10 days after
  the completed enrollment application is
  received.
  – Your kit includes
     •   Confirmation of enrollment letter
     •   Mail-order pharmacy forms
     •   Pharmacy and provider directories
     •   Drug formulary
     •   Other important plan information….
• Your Member ID card will be mailed
  separately along with your acknowledgement
  letter
                                              62
Sample Member ID Card




                        63
                 Disclaimers
• Care Improvement Plus is a Medicare Advantage
  organization with a Medicare contract. The Care
  Improvement Plus contract with CMS is renewed
  annually and coverage availability beyond the end of
  the current contract year is not guaranteed.
• The benefit information provided herein is a brief
  summary, but not a comprehensive description of
  available benefits. For more information, contact the
  plan.
• Benefits, formulary, pharmacy network, premium
  and/or co-payments/coinsurance may change on
  January 1, 2012.

                                                     64
                         Disclaimers
• You may be able to get Extra Help to pay for your prescription drug
  premiums and costs. To see if you qualify for extra help, call:
    – 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-
      2048, 24 hours a day/7 days a week;
    – The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m.,
      Monday through Friday. TTY users should call, 1-800-325-0778
    – Your State Medicaid Office.
• People with limited incomes may qualify for Extra Help to pay for their
  prescription drug costs. If eligible, Medicare could pay for up to one
  hundred (100) percent of drug costs including monthly prescription
  drug premiums, annual deductibles, and coinsurance. 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



                                                                         65
                 Disclaimers
• Eligible beneficiaries must use network
  pharmacies to access their prescription drug
  benefit, except under non-routine circumstances,
  and quantity and restrictions may apply.
• It may cost more to get care from out-of-network
  providers, except in an emergency. Because our
  plan is a Regional Preferred Provider
  Organization, if there isn’t a network provider
  available to see, you can go to an out-of-network
  provider but still pay the in-network amounts.
• This document is available in alternative formats.
  Contact the plan for details

                                                   66
   Plan Eligibility Status Change
• We work hard to verify members’ plan eligibility.
  However, there are circumstances beyond our control
  where we are forced by Medicare to dis-enroll certain
  members from our plan.
• Care Improvement Plus may end your membership in
  the plan if you do not meet the plan’s eligibility
  requirements:
      • C-SNP: If we are unable to confirm with your doctor that
        you have diabetes or heart failure, you will have 60 days
        to confirm your eligibility before we end your membership.
      • D-SNP: If you no longer have full Medicaid (your A/B cost
        sharing is no longer covered by the State), you will have 6
        months to regain eligibility before we end your
        membership.

                                                              67
                            Thank You
                                                Prospective Members:
For more information:                           1-800-711-1656, TTY 1-800-713-1603

                                                Member Services:
•   “Medicare and You 2011” handbook            1-800-204-1002, TTY 1-800-713-1603
                                                8:00 am – 8:00 pm, 7 days a week
•   www.medicare.gov

•   Your local State Health Insurance Program
    (SHIP)                                      Send completed applications to:
                                                Care Improvement Plus
                                                P.O. Box 691350
•   Visit us at:                                San Antonio, TX 78269-1350
          www.careimprovementplus.com           Attn: Enrollment Department


•   Contact us at:
         info@careimprovementplus.com
                                                For overnight applications:
                                                Care Improvement Plus
                                                4350 Lockhill-Selma Road
                                                San Antonio, TX 78249
                                                Attn: Enrollment Department
                                                (210) 587-2111

                                                                                     68
      Care Improvement Plus

“Specialized Care for Medicare Beneficiaries”




                                                             69
                     Y0072_OE11_6108 CMS Approved 10202010

				
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