PPO II - EmblemHealth

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2013 Evidence of Coverage for PPO II) II Chapter 1: Getting started as a member Chapter 1. Getting started as a member SECTION 1 Introduction ............................................................................................. 3 Section 1.1 You are enrolled in PPO II, which is a Medicare PPO ..................................................3 Section 1.2 What is the Evidence of Coverage booklet about? ...........................................................3 Section 1.3 What does this Chapter tell you? ..................................................................................3 Section 1.4 What if you are new to our plan? .................................................................................3 Section 1.5 Legal information about the Evidence of Coverage .........................................................4 SECTION 2 What makes you eligible to be a plan member? ............................... 4 Section 2.1 Your eligibility requirements ........................................................................................4 Section 2.2 What are Medicare Part A and Medicare Part B? ..........................................................4 Section 2.3 Here is the plan service area for our plan ......................................................................4 SECTION 3 What other materials will you get from us? ....................................... 5 Section 3.1 Your plan membership card – Use it to get all covered care and prescription drugs .......5 Section 3.2 Th e Provider/Pharmacy Directory: Your guide to all providers and pharmacies in the plan’s network ...........................................................................................................5 Section 3.3 Th e plan’s List of Covered Drugs (Formulary) .................................................................6 Section 3.4 Th e Explanation of Benefi ts (the “EOB”): Reports with a summary of payments made for your Part D prescription drugs ............................................................................6 SECTION 4 Your monthly premium for our plan .................................................... 7 Section 4.1 How much is your plan premium? ...............................................................................7 Section 4.2 Th ere are several ways you can pay your plan premium ................................................9 Section 4.3 Can we change your monthly plan premium during the year? ....................................10 SECTION 5 Please keep your plan membership record up to date ....................10 Section 5.1 How to help make sure that we have accurate information about you ........................10 SECTION 6 We protect the privacy of your personal health information ..........11 Section 6.1 We make sure that your health information is protected.............................................11 1
2 2013 Evidence Evidence of Coverage Coverage for PPO II Chapter 1: Getting started as a member SECTION 7 How other insurance works with our plan ..........................................11 Section 7.1 Which plan pays fi rst when you have other insurance? ...............................................11
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104 • Chapter 5 of this booklet.
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55 Water Street, New York, New York
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PPO II - EmblemHealth

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