CALIFORNIA - Pacificare Health Systems

The University of California establishes
its own medical plan eligibility criteria for
Retirees based on the University of California
Group Insurance Regulations. Portions of
these regulations are summarized below. If
you reside in the Secure Horizons Medicare
Advantage (MA) Plan Service Area, and meet
the University’s and the Plan’s eligibility
criteria, you may enroll in the Plan.
To Enroll in the Secure Horizons Group
Retiree Medicare Advantage (MA) Plan:
1. You must be entitled to Medicare Part A
and enrolled in Medicare Part B.
2. You must not currently have end stage
renal disease or receive routine kidney
dialysis. However, if either of these
conditions should apply to you, in some
instances you may still enroll if you are
a current Member of PacifiCare either
through an Employer Group Sponsored
Health Plan or as an Individual. If you
develop end stage renal disease while a
Member of the Secure Horizons Group
Retiree MA Plan, you can continue your
membership under these circumstances.
Additionally:
n If you have received a transplant that
has restored your kidney function and
you no longer require a regular course
of dialysis, you are not considered
to have ESRD and you are eligible to
enroll in the Secure Horizons Group
Retiree MA Plan.
n Individuals with ESRD who are
affected by the non-renewal of another
Medicare Advantage Organization
may make one election to enroll
in a different Medicare Advantage
Organization.
We accept enrollees with ESRD who
are enrolling in an MA plan through
an employer or union group under the
following circumstances:
a. If an employer or union group offers
an MA plan as a new option to its
employees and retirees, regardless of
Section 2 – Eligibility, Enrollment
Periods and Effective Date
whether it has been an option in the
past, ESRD retirees may select this new
MA plan option as the employer or
union’s open enrollment rules allow.
b. If an employer or union group that
has been offering a variety of coverage
options consolidates its employee/
retiree offerings (i.e., it drops one
or more plans), current enrollees of
the dropped plans may be accepted
into an MA plan that is offered by the
group.
c. If an employer or union group
has contracted locally with an MA
organization in more than one
geographic area (for example, in
two or more states), an ESRD retiree
who relocates permanently from one
geographic location to another may
remain with the MA organization in
the local employer or union MA plan.
3. You must permanently reside in the
Service Area as defined in Section 13.
4. You must complete and sign an Election
Form. If another person assists you in
completing the Election Form, that person
must also sign the form and state his or
her relationship to you.
5. You must agree to abide by Secure
Horizons Medicare Advantage Plan rules.
If you meet the above eligibility
requirements, you cannot be denied
membership in the Secure Horizons
Group Retiree MA Plan on the basis of
your health status, excluding end stage
renal disease as described above.
When You May Enroll in the Secure
Horizons Group Retiree Medicare
Advantage Plan
Eligible individuals can enroll in the Secure
Horizons Group Retiree Medicare Advantage
Plan at the following times:
n Open Enrollment – You may enroll in the
University of California’s group plan when
that plan is in open enrollment. For more
Questions? Call the Customer Service Department at 1-800-228-2144,
(TDHI) 1-800-685-9355, Monday through Friday, 7:00 a.m. to 9:00 p.m.
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PART B