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Policies & Procedures


Conditions & Limitations
Beginning January 1, 2006, there are limits to when and how often you can change your Medicare plan options.

To take advantage of Medicare Prescription Drug coverage (Part D), you must be eligible for Medicare Part A and Part B. You must also maintain your Medicare Part A and Part B coverage by paying Part B premiums, and if applicable, Part A premiums, if not otherwise paid for under Medicaid or another third party.

To receive benefits, you must see contracted providers and pharmacies, except for emergency care, or post-stabilization services, urgent care, out-of-area renal dialysis, or emergency ambulatory services within the U.S. and certain hospitals in Mexico and Canada.

For more information about policies and procedures, please review the items below:

Potential for Contract Termination

Complaints, Grievances and Appeals

Quality Assurance Policies and Procedures

How to obtain aggregate number of the Planís grievances, appeals and exceptions



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