Health New England Medicare Advantage Plan (HMO and HMO-POS) 2018 Pharmacy Directory

Size: px
Start display at page:

Download "Health New England Medicare Advantage Plan (HMO and HMO-POS) 2018 Pharmacy Directory"

Transcription

1 Health New England Medicare Advantage Plan (HMO and HMO-POS) 2018 Pharmacy Directory This pharmacy directory was updated on 03/2018. For more recent information or other questions, please contact Health New England Medicare Advantage Plan (HMO and HMO-POS) Member Services, at or, for TTY users, 711, 8:00 a.m. to 8:00 p.m., Monday through Friday, (October 1 through February 14: 8:00 a.m. to 8:00 p.m., 7 days a week), or visit Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory is located on our website at You may also call Member Services for updated provider.

2 Introduction This booklet provides a list of Health New England Medicare Advantage Plan (HMO and HMO-POS) network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Health New England Medicare Advantage Plan (HMO and HMO-POS) formulary. We call the pharmacies on this list our network pharmacies because we have made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under Health New England Medicare Advantage Plan (HMO and HMO-POS) only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any other of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this directory was printed. This means the pharmacies listed here may no longer be in our network, or there may be newer pharmacies in our network that are not listed. This list is current as of March 19, For the most current list, please contact us. Our contact information appears on the front and back cover pages. You can get prescription drugs shipped to your home through our network mail order delivery program. For more information, please contact us or see the mail order section of this pharmacy directory. If you have questions about any of the above, please see the first and last cover pages of this directory for information on how to contact Health New England Medicare Advantage Plan (HMO and HMO-POS). Health New England Medicare Advantage Plan (HMO and HMO-POS) pharmacy directory is organized by the type of pharmacy (retail, including chain pharmacies, mail order, home infusion, long-term care, and specialty pharmacies). Our pharmacies are then listed alphabetically by facility name. 2

3 Retail Pharmacies To contact your retail pharmacy via TTY/TDD Service, you may use the TRS Relay number 711. STATE: MA COUNTY: BERKSHIRE CITY: Adams ZIP: Big Y Pharmacy #25 1 Myrtle Street Adams, MA Rite Aid # Columbia Street Adams, MA CITY: Great Barrington ZIP: Big Y Pharmacy # Main St Ste 2 Great Barrington, MA CVS Pharmacy # Main St Great Barrington, MA Price Chopper Pharmacy 300 Stockbridge Rd Great Barrington, MA Rite Aid # Main St Great Barrington, MA CITY: Hyde Park ZIP: Rite Aid # Hyde Park Avenue Hyde Park, MA CITY: Lanesborough ZIP: CVS Pharmacy # 655 Cheshire Rd Lanesborough, MA CITY: Lee ZIP: Big Y Pharmacy #37 10 Pleasant St Lee, MA Rite Aid # Park Street Lee, MA

4 CITY: Lenox ZIP: CVS Pharmacy # Pittsfield Road Lenox, MA Lenox Village Pharmacy 5 Walker St Lenox, MA CITY: N Adams ZIP: Rite Aid # Lincoln St N Adams, MA CITY: North Adams ZIP: Berkshire Community Pharmacy Of North Adams 71 Hospital Ave North Adams, MA CVS Pharmacy #01131 Veterans Memorial Drive Big Y S C North Adams, MA Littles Hsc Pharmacy 109 Eagle St North Adams, MA State Road Rte 2 North Adams, MA Walmart Pharmacy Curran Hwy North Adams, MA CITY: Pittsfield ZIP: Berkshire Community Pharmacy 725 North St Pittsfield, MA Berkshire Medical Center 725 North St Pittsfield, MA

5 Big Y Pharmacy # West Street Pittsfield, MA CVS Pharmacy # West Street Pittsfield, MA Flynns Pharmacy 173 Elm St Pittsfield, MA Price Chopper Pharmacy 555 Hubbard Ave Pittsfield, MA Merrill Road Pittsfield, MA Walmart Pharmacy Hubbard Ave Suite 12 Pittsfield, MA Rite Aid # Cheshire Road Pittsfield, MA Rite Aid # South Street Pittsfield, MA Rite Aid # North Street Pittsfield, MA Dan Fox Dr Rte 7 Pittsfield, MA

6 Rite Aid # Elm Street Suite J Pittsfield, MA CITY: Williamstown ZIP: Rite Aid # Main St Williamstown, MA COUNTY: FRANKLIN CITY: Greenfield ZIP: Big Y Pharmacy # Mohawk Trl # 2 Greenfield, MA CVS Pharmacy # Federal Street Greenfield, MA Open 24 Hours: Yes Rite Aid Pharmacy Main Street Greenfield, MA French King Hwy Greenfield, MA Walgreens # Conway St Greenfield, MA Walgreens # Pierce St Greenfield, MA CITY: Orange ZIP: Walmart Pharmacy East Main St Orange, MA CITY: Shelburne Falls ZIP: Baker Pharmacy 52 Bridge St Shelburne Falls, MA

7 CITY: South Deerfield ZIP: Deerfield Pharmacy 45 Main St South Deerfield, MA CITY: Turners Falls ZIP: Rite Aid # Ave A Turners Falls, MA COUNTY: HAMPDEN CITY: Agawam ZIP: CVS Pharmacy # Springfield Avenue Agawam, MA CVS Pharmacy # Silver Street Agawam, MA Springfield Street Agawam, MA Walgreens # Springfield St Agawam, MA Rite Aid # Springfield St Agawam, MA CITY: Chicopee ZIP: Chicopee Health Center Pharmacy 505 Front Street Chicopee, MA CVS Pharmacy # Center Street Chicopee, MA Rite Aid # Meadow Street Chicopee, MA

8 ZIP: CVS Pharmacy # Memorial Drive Chicopee, MA Open 24 Hours: Yes CVS Pharmacy # Granby Road Chicopee, MA Walgreens # Granby Rd Chicopee, MA Walgreens # James St Chicopee, MA Open 24 Hours: Yes Walmart Pharmacy Memorial Drive Chicopee, MA ZIP: Memorial Drive Chicopee, MA CITY: E Longmeadow ZIP: North Main Street E Longmeadow, MA CITY: East Longmeadow ZIP: Big Y Pharmacy # North Main Street East Longmeadow, MA CVS Pharmacy # North Main Street East Longmeadow, MA Rite Aid # St James Avenue #5 Chicopee, MA

9 Walgreens # Center Square East Longmeadow, MA CITY: East Springfield ZIP: Liberty Street East Springfield, MA CITY: Holyoke ZIP: CVS Pharmacy # 50 Holyoke St Holyoke, MA CVS Pharmacy # Whiting Farms Road Holyoke, MA Genoa Healthcare 303 Beech Street, Ste L100 Holyoke, MA Holyoke Health Center Pharmacy 230 Maple Street Holyoke, MA Lincoln Street Holyoke, MA Northampton Street Holyoke, MA Walgreens # Northampton St Holyoke, MA CVS Pharmacy # Beech St Holyoke, MA

10 Rite Aid # North Hampton Street Holyoke, MA CITY: Longmeadow ZIP: Big Y Pharmacy # Williams Street Longmeadow, MA CVS Pharmacy # Bliss Rd Longmeadow Shops Longmeadow, MA CVS Pharmacy # Longmeadow Street Longmeadow, MA CITY: Ludlow ZIP: Big Y Pharmacy # Center Street Suite3 Ludlow, MA CVS Pharmacy # Center Street Ludlow, MA Walgreens # East Street Ludlow, MA CITY: Monson ZIP: Rite Aid # Main Street Monson, MA CITY: Palmer ZIP: Big Y Pharmacy # Thorndike Street Route 32 Palmer, MA CVS Pharmacy # Thorndike St Palmer, MA

11 Rite Aid # Thorndike Street Palmer, MA CITY: Southwick ZIP: Big Y Pharmacy # College Highway Southwick, MA CVS Pharmacy # College Hwy Southwick, MA Southwick Pharma, LLC 549 College Hwy Unit B Southwick, MA Rite Aid # College Highway Suite 1 Southwick, MA Caring Health Center Pharmacy 1049 Main St Springfield, MA CVS Pharmacy # Main Street Springfield, MA ZIP: CVS Pharmacy # St James Avenue Springfield, MA Louis And Clark Drug 572 LTC 490 Page Blvd Springfield, MA The Community Pharmacy At Mercy Medical Center 299 Carew Street Springfield, MA CITY: Springfield ZIP:

12 Walgreens # St James Blvd Springfield, MA ZIP: Baystate Pharmacy 140 High St Springfield, MA ZIP: Baystate Pharmacy 50 Wason Ave Springfield, MA Baystate Pharmacy 380 Plainfield St Springfield, MA Baystate Specialty Pharmacy 3300 Main St Springfield, MA Community A Walgreens Pharmacy # Chestnut St Springfield, MA ZIP: Caring Pharmacy 377 Belmont Ave Springfield, MA CVS Pharmacy # Belmont Avenue Springfield, MA Open 24 Hours: Yes Walgreens # Sumner Ave Springfield, MA Open 24 Hours: Yes ZIP: CVS Pharmacy # State St Springfield, MA Open 24 Hours: Yes 12

13 Walgreens # State St Springfield, MA ZIP: Rite Aid # Island Pond Road Springfield, MA ZIP: CVS Pharmacy # Boston Road Big Y S C Springfield, MA Walmart Pharmacy Boston Road Springfield, MA ZIP: Big Y Pharmacy # Cooley Street Springfield, MA Rite Aid # Cooley Street Springfield, MA ZIP: CVS Pharmacy # Parker Street Springfield, MA Boston Post Road Springfield, MA Walgreens # Wilbraham Rd Springfield, MA Walgreens # Boston Rd Springfield, MA

14 ZIP: Baystate Pharmacy 759 Chestnut St Springfield, MA CITY: W Springfield ZIP: CVS Pharmacy # b Memorial Avenue Century Plaza W Springfield, MA CVS Pharmacy # Elm Street W Springfield, MA Open 24 Hours: Yes 935 Riverdale Street W Springfield, MA CITY: West Springfield ZIP: Costco Pharmacy 119 Daggett Drive West Springfield, MA CVS Pharmacy # Riverdale Street West Springfield, MA Rite Aid # Westfield Street West Springfield, MA CITY: Westfield ZIP: Arrow Prescription Center 427 N Elm St Westfield, MA CVS Pharmacy # East Main Street Route 20 Westfield Shops Westfield, MA CVS Pharmacy # Elm St Westfield, MA

15 57 Main Street Westfield, MA Walgreens # Main Street Westfield, MA Walmart Pharmacy Springfield Road Westfield, MA Rite Aid # East Silver Street Westfield, MA CITY: Wilbraham ZIP: Big Y Pharmacy # Boston Rd Wilbraham, MA CVS Pharmacy # Boston Road Wilbraham, MA COUNTY: HAMPSHIRE CITY: Amherst ZIP: Amherst Pharmacy 381 College Street Amherst, MA CVS Pharmacy # North Pleasant Street Amherst, MA CVS Pharmacy # University Drive Amherst, MA North Amherst Pharmacy 19 Montague Rd Amherst, MA

16 CITY: Belchertown ZIP: CVS Pharmacy # North Main Street Crystal Springs Plaza Belchertown, MA Federal St Belchertown, MA CITY: Easthampton ZIP: CVS Pharmacy # Northampton St Route 10 Easthampton, MA Rite Aid # Union St Easthampton, MA CITY: Florence ZIP: Walgreens # Main Street Florence, MA CITY: Granby ZIP: Center Pharmacy 242 State St Granby, MA CVS Pharmacy # West State Street Granby, MA CITY: Hadley ZIP: CVS Pharmacy # 367 Russell St Hadley, MA Russell St Hadley, MA Walmart Pharmacy Russell Street Hadley, MA

17 CITY: Northampton ZIP: Big Y Pharmacy # N King Street Northampton, MA CVS Pharmacy # King Street Northampton, MA CVS Pharmacy # Main Street Northampton, MA Serios Pharmacy 63 State St Northampton, MA King Street Northampton, MA Walgreens # r King St Northampton, MA Walmart Pharmacy North King Street Northampton, MA CITY: South Hadley ZIP: Big Y Pharmacy #50 44 Willimansett Street South Hadley, MA CITY: Southampton ZIP: Rite Aid # College Highway Southampton, MA CITY: Springfield ZIP: Walgreens # Carew St Springfield, MA

18 CITY: Ware ZIP: CVS Pharmacy # West St Ware, MA Walgreens # West St Ware, MA Walmart Pharmacy Palmer Road Ware, MA Rite Aid # West St Ware, MA CITY: Williamsburg ZIP: Williamsburg Pharmacy 49 Main St Williamsburg, MA

19 Mail Order Pharmacies To contact your mail order pharmacy via TTY/TDD Service, you may use the TRS Relay number 711. Optumrx You can get prescriptions shipped to your home through our network mail order delivery program. For refills to your mail order prescriptions, please contact us 14 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time. Typically, you should expect to receive your prescription drugs from 14 to 21 days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact us at (TTY: 711). Welldynerx-Fl You can get prescriptions shipped to your home through our network mail order delivery program. For refills to your mail order prescriptions, please contact us 14 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time. Typically, you should expect to receive your prescription drugs from 14 to 21 days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact us at (TTY: 711). 19

20 Briovarx You can get prescriptions shipped to your home through our network mail order delivery program. For refills to your mail order prescriptions, please contact us 14 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time. Typically, you should expect to receive your prescription drugs from 14 to 21 days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact us at (TTY: 711). Optumrx You can get prescriptions shipped to your home through our network mail order delivery program. For refills to your mail order prescriptions, please contact us 14 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time. Typically, you should expect to receive your prescription drugs from 14 to 21 days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact us at (TTY: 711). Briovarx You can get prescriptions shipped to your home through our network mail order delivery program. For refills to your mail order prescriptions, please contact us 14 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time. Typically, you should expect to receive your prescription drugs from 14 to 21 days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact us at (TTY: 711). 20

21 Home Infusion Pharmacies To contact your home infusion pharmacy via TTY/TDD Service, you may use the TRS Relay number 711. Health New England Medicare Advantage Plan (HMO and HMO-POS) will cover home infusion therapy if: Your prescription drug is on the Health New England Medicare Advantage Plan (HMO and HMO-POS) formulary or you have a formulary exception Health New England Medicare Advantage Plan (HMO and HMO-POS) has approved your prescription drug for home infusion therapy; and Your prescription is written by an authorized prescriber If you have any questions, please call Health New England Medicare Advantage at (413) or toll-free at (TTY 711). A representative will be available to speak with you from 8:00 a.m. to 8:00 p.m., Monday through Friday, (October 1 through February 14: 8:00 a.m. to 8:00 p.m., 7 days a week) (October 1 through February 14: 8:00 a.m. to 8:00 p.m., seven days a week). STATE: MA COUNTY: MIDDLESEX CITY: Woburn ZIP: Diplomat Specialty Infusion Group 20 Commerce Way Ste 2 Woburn, MA COUNTY: NORFOLK CITY: Canton ZIP: Soleo Health Inc. 5 Shawmut Road Suite 103 Canton, MA CITY: Norwood ZIP: Coram CVS/Specialty Infusion Services 575 University Ave Ste 2 Norwood, MA CITY: Stoughton ZIP: Boston Home Infusion 30 Buckley Rd Stoughton, MA COUNTY: WORCESTER CITY: Southborough ZIP: Bioscrip Infusion Services 337 Turnpike Road Southborough, MA Option Care 257 Turnpike Rd Southborough, MA

22 Long-Term Care Pharmacies To contact your long-term care pharmacy via TTY/TDD Service, you may use the TRS Relay number 711. Residents of a long-term care facility may access their prescription drugs covered under Health New England Medicare Advantage Plan (HMO and HMO-POS) through the facility's long-term care pharmacy or another network long-term care pharmacy. If you have any questions, please call Health New England Medicare Advantage at (413) or toll-free at (TTY 711). A representative will be available to speak with you from 8:00 a.m. to 8:00 p.m., Monday through Friday, (October 1 through February 14: 8:00 a.m. to 8:00 p.m., 7 days a week) (October 1 through February 14: 8:00 a.m. to 8:00 p.m., seven days a week). STATE: MA COUNTY: BARNSTABLE CITY: Hyannis ZIP: Apothecare Of Cape Cod 145 Barnstable Rd Hyannis, MA CITY: North Falmouth ZIP: North Falmouth Pharmacy 111 County Rd. North Falmouth, MA COUNTY: ESSEX CITY: Haverhill ZIP: Preferred Pharmacy Solutions Inc 35 Avco Rd Haverhill, MA CITY: Lynn ZIP: Richmond Pharmacy 499 Eastern Ave Lynn, MA CITY: Methuen ZIP: Resident Care Pharmacy 380 Merrimack Street Unit 1b Methuen, MA CITY: Peabody ZIP: Omnicare Of Northern Massachusetts 2 Technology Dr Peabody, MA COUNTY: FRANKLIN CITY: Greenfield ZIP: Genoa Healthcare 55 Federal St Ste 105 Greenfield, MA COUNTY: HAMPDEN CITY: Holyoke ZIP: Genoa Healthcare 303 Beech Street, Ste L100 Holyoke, MA CITY: Springfield ZIP:

23 Louis And Clark Drug 572 LTC 490 Page Blvd Springfield, MA CITY: West Springfield ZIP: Integriscript, Inc. 95 Ashley Ave Ste B West Springfield, MA COUNTY: MIDDLESEX CITY: Acton ZIP: Genoa Healthcare 289 Great Rd Ste G1 Acton, MA CITY: Marlborough ZIP: Bouvier Pharmacy Inc 515 Lincoln St Marlborough, MA CITY: North Billerica ZIP: Medical Center Pharmacy 221 Boston Rd North Billerica, MA CITY: Tewksbury ZIP: Tewksbury Hospital 369 East St Tewksbury, MA CITY: Waltham ZIP: Pelham Community Pharmacy 196 Bear Hill Road Waltham, MA Woodmark Pharmacy Of Massachusetts, LLC 69 Hickory Dr Waltham, MA Genoa Healthcare 340 Maple St Ste 450 Marlborough, MA Partners Of Massachusetts 181 Cedar Hill Street Marlborough, MA

24 COUNTY: NORFOLK CITY: Needham ZIP: Medminder Pharmacy 30 Wexford St Needham, MA COUNTY: PLYMOUTH CITY: Brockton ZIP: Pharmerica 1123 Pearl Street Brockton, MA ZIP: Apothecare South Shore 720 Centre St Brockton, MA CITY: Pembroke ZIP: Arxcare,LLC 42 Winter Street Unit 1 Pembroke, MA COUNTY: SUFFOLK CITY: Boston ZIP: Tai Tung Pharmacy Inc 256 Harrison Ave Boston, MA CITY: Roslindale ZIP: Sullivan's Health Care Inc 30 Belgrade Ave Roslindale, MA CITY: West Roxbury ZIP: Greater Boston Long Term Care 1864 Centre St West Roxbury, MA COUNTY: WORCESTER CITY: Shrewsbury ZIP: Omnicare Of Central Massachusetts 574 Hartford Tpke Shrewsbury, MA CITY: Southborough ZIP: Procare LTC Of Ma, LLC 155 N. Borough Rd Ste 4 Southborough, MA CITY: Worcester ZIP: Prescott Pharmacy LTC, Inc. 100 Grove St Ste B12 Worcester, MA

25 Network Pharmacies outside the geographic area We have network pharmacies outside of the service area where you can get your drugs covered as a member of our plan. If you have any questions, please call Health New England Medicare Advantage at (413) or toll-free at , (TTY 711). A representative will be available to speak with you from 8:00 a.m. to 8:00 p.m., Monday through Friday, (October 1 through February 14: 8:00 a.m. to 8:00 p.m., 7 days a week) (October 1 through February 14: 8:00 a.m. to 8:00 p.m., seven days a week). 25

26 This pharmacy directory was updated on 03/2018. For more recent information or other questions, please contact Health New England Medicare Advantage Plan (HMO and HMO-POS) Member Services, at or, for TTY users, 711, 8:00 a.m. to 8:00 p.m., Monday through Friday, (October 1 through February 14: 8:00 a.m. to 8:00 p.m., 7 days a week), or visit Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory is located on our website at The pharmacy network may change at any time. You will receive notice when necessary. Health New England Medicare Advantage is an HMO plan with a Medicare contract. Enrollment in Health New England Medicare Advantage depends on contract renewal. H8578_2018_003NM 26

27 Nondiscrimination Statement: Discrimination Is Against the Law National Pharmaceutical Services complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. National Pharmaceutical Services does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. National Pharmaceutical Services: Provides free aids and services to people with disabilities to communicate effectively with us, such as: 1) Qualified sign language interpreters and 2) Written information in other formats (large print, audio, accessible electronic formats, other formats). Provides free language services to people whose primary language is not English, such as: 1) Qualified interpreters and 2) Information written in other languages. If you need these services, you can call our contact center at (TTY: ) 24 hours a day. If you believe that National Pharmaceutical Services has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with the NPS Compliance Officer; PO Box 407, Boys Town, NE 68010; (TTY: ); fax ; compliance@pti-nps.com. You can file a grievance in person or by mail, fax, or . If you need help filing a grievance, our Compliance Officer is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C , (TDD) Complaint forms are available at 27

28 If you speak one of the following languages, or need assistance in another language, free assistance services are available - call (TTY: ). SPANISH: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: ). CHINESE: 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 (TTY : ) FRENCH: ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le (ATS : ). FRENCH CREOLE (HAITIAN CREOLE): ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele (TTY: ). KOREAN: 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (TTY: ) 번으로전화해주십시오. VIETNAMESE: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (TTY: ) ملحوظة: إذا كنت تتحدث اذكر اللغة فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم ARABIC:.( )رقم هاتف الصم والبكم: RUSSIAN: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: ). TAGALOG: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (TTY: ). GERMAN: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (TTY: ). JAPANESE: 注意事項 : 日本語を話される場合 無料の言語支援をご利用いただけます (TTY: ) まで お電話にてご連絡ください SERBO-CROATIAN*: OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: ). ITALIAN: ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero (TTY: ). ALBANIA: KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në (TTY ). توجه : اگر به زبان فارسی گفتگو می کنید تسهیالت زبانی بصورت رايگان برای شما فراهم می باشد. با (FARSI): PERSIAN.تماس بگیريد ) (TTY: PORTUGUESE: : OاأATEN Se fala português, encontram-se disponيveis serviços linguيsticos, grلtis. Ligue para (TTY: ). GUJARATI: સ ચન : જ તમ ગ જર ત બ લત હ, ત નન:શ લ ક ભ ષ સહ ય સ વ ઓ તમ ર મ ટ ઉપલબ ધ છ. ફ ન કર (TTY: ). 28

29 LAOTIAN: ໂປດຊາບ: ຖ າວ າ ທ ານເວ າພາສາ ລາວ, ການບ ລການຊ ວຍເຫອດ ານພາສາ, ໂດຍບ ເສ ຽຄ າ, ແມ ນມ ພ ອມໃຫ ທ ານ. ໂທຣ (TTY: ). THAI: เร ยน: ถ าค ณพ ดภาษาไทยค ณสามารถใช บร กา รช วยเหล อทางภาษาได ฟร โทร (TTY: ). POLISH: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer (TTY: ). CUSHITE: XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa (TTY: ). MON-KHMER, CAMBODIAN: ប រយ ត ន បរ ស នជ អ នកន យ យ ភ ស ខ ម រ, បសវ ជ ន យខ នកភ ស ប យម នគ ត ឈ ន ល គ អ ចម នស រ រ រ បរ អ នក ច រ ទ រស ព ទ (TTY: ) HINDI: ध य न द : यदद आप द द ब लत त आपक दलए म फ त म भ ष स यत स व ए उपलब ध (TTY: ) पर क ल कर NEPALI: ध य न ददन स : तप र इ ल न प ल ब ल न न छ भन तप र इ क दनदतत भ ष स यत स व र दन श ल क र पम उपलब ध छ फ न गन स (द द व र इ: ) خبردار: اگر آپ اردو بولتے ہیں تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں کال کريں URDU: (TTY: ). HMONG: LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau (TTY: ). GREEK: ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε (TTY ). 29

Notice of Denial of Medical Coverage

Notice of Denial of Medical Coverage Important: This notice explains your right to appeal our decision. Read this notice carefully. If you need help, you can call one of the numbers listed on the last page under Get help & more information.

More information

2019 Formulary Monthly Notice of Change

2019 Formulary Monthly Notice of Change Updated: 03/01/2019 2019 Formulary Monthly Notice of Change Medicare Advantage Employer Group Plans (EGWP) This is a listing of the changes that have occurred to the 2019 MAPD formulary. For a complete

More information

Community Care Family Care Partnership Program (HMO SNP) (Community Care) 2019 Pharmacy Directory

Community Care Family Care Partnership Program (HMO SNP) (Community Care) 2019 Pharmacy Directory Community Care Family Care Partnership Program (HMO SNP) (Community Care) 2019 Pharmacy Directory This pharmacy directory is updated monthly For more recent information or other questions, please contact

More information

COMPOUNDED PRESCRIPTION DRUG PRODUCTS

COMPOUNDED PRESCRIPTION DRUG PRODUCTS COMPOUNDED PRESCRIPTION DRUG PRODUCTS UTILIZATION MANAGEMENT CRITERIA COVERAGE AUTHORIZATION CRITERIA Compounded drug products whose total prescription ingredient cost is $200 or more are covered only

More information

APPOINTMENT OF REPRESENTATIVE

APPOINTMENT OF REPRESENTATIVE PO Box 31368 Tampa, FL 33631-3368 APPOINTMENT OF REPRESENTATIVE Name: Member number: Reference/Case number: PART 1 --- APPOINTMENT OF REPRESENTATIVE (to be filled out by member) I allow (Name of person

More information

Appendix A to Part 92 Notice Informing Individuals About Nondiscrimination and

Appendix A to Part 92 Notice Informing Individuals About Nondiscrimination and Appendix A to Part 92 Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement: Discrimination is Against the Law Radiologic Associates, PC complies

More information

Health New England Medicare Advantage Plan Pharmacy Directory

Health New England Medicare Advantage Plan Pharmacy Directory Health New England Medicare Advantage Plan Pharmacy Directory This booklet provides a list of Health New England (HNE) Medicare Advantage Plan network pharmacies. All network pharmacies may not be listed

More information

2018 PDP Summary of Benefits

2018 PDP Summary of Benefits 2018 PDP Summary of Benefits Contracts S5540-002, S5540-004 January 1, 2018 December 31, 2018, SM Marks of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of North Carolina is an

More information

Our dental plan for individuals age 65 and over

Our dental plan for individuals age 65 and over 2017 Dental plan information Our dental plan for individuals age 65 and over bcbsnc.com/dentalblueseniors What you get 1 + Affordable premiums with easy ways to pay + No wait for preventive services (which

More information

SENSIPAR 1 (CINACALCET) UTILIZATION MANAGEMENT CRITERIA

SENSIPAR 1 (CINACALCET) UTILIZATION MANAGEMENT CRITERIA SENSIPAR 1 (CINACALCET) UTILIZATION MANAGEMENT CRITERIA DRUG CLASS: Calcium-Sensing Receptor Agonist BRAND (generic) NAMES: Sensipar (cinacalcet) 30 mg, 60 mg, 90 mg strength tablets FDA-APPROVED INDICATIONS

More information

Health New England Medicare Premium (HMO) 2018 Pharmacy Directory

Health New England Medicare Premium (HMO) 2018 Pharmacy Directory Health New England Medicare Premium (HMO) 2018 Pharmacy Directory This pharmacy directory was updated on 07/2018. For more recent information or other questions, please contact Health New England Medicare

More information

UTILIZATION MANAGEMENT CRITERIA

UTILIZATION MANAGEMENT CRITERIA Proprotein Convertase Subtilisin Kexin Type 9 (PCSK9) Inhibitors UTILIZATION MANAGEMENT CRITERIA DRUG CLASS: PCSK9 Inhibitor BR (generic) NAMES: Praluent 1 (alirocumab) 75 mg/ml; 150 mg/ml Repatha 1 (evolocumab)

More information

Health New England Medicare Advantage Plan (HMO and HMO-POS) 2018 Pharmacy Directory

Health New England Medicare Advantage Plan (HMO and HMO-POS) 2018 Pharmacy Directory Health New England Medicare Advantage Plan (HMO and HMO-POS) 2018 Pharmacy Directory This pharmacy directory was updated on 10/2018. For more recent information or other questions, please contact Health

More information

Preventive Health Care Guide Adults. Save and share with your doctor! Primary Care Office Visits. Screening Schedule. Immunization Schedule

Preventive Health Care Guide Adults. Save and share with your doctor! Primary Care Office Visits. Screening Schedule. Immunization Schedule Preventive Health Care Guide 2016 2017 At any stage of life, it s important to make your health a priority. That means making healthy lifestyle choices and seeing your doctor regularly. The charts on the

More information

BUPROPION/NALTREXONE (Contrave 1 ) LORCASERIN (Belviq 1, Belviq XR 1 ) PHENTERMINE/TOPIRAMATE ER (Qsymia 1 )

BUPROPION/NALTREXONE (Contrave 1 ) LORCASERIN (Belviq 1, Belviq XR 1 ) PHENTERMINE/TOPIRAMATE ER (Qsymia 1 ) BUPROPION/NALTREXONE (Contrave 1 ) LORCASERIN (Belviq 1, Belviq XR 1 ) PHENTERMINE/TOPIRAMATE ER (Qsymia 1 ) UTILIZATION MANAGEMENT CRITERIA DRUG CLASS: Obesity BRAND (generic) NAMES: Belviq (lorcaserin)

More information

Summary of Benefits. Humana Walmart Rx Plan (PDP) State of North Carolina. Our service area includes the following state(s): North Carolina.

Summary of Benefits. Humana Walmart Rx Plan (PDP) State of North Carolina. Our service area includes the following state(s): North Carolina. SBOSB026 2018 Summary of Benefits Humana Walmart Rx Plan (PDP) State of North Carolina Our service area includes the following state(s): North Carolina. Other pharmacies are available in our network. GNHH4HIEN_18

More information

Page 1. Utilization Management Policy Name: Topical Tretinoin Products Restricted Product(s): Unrestricted/Suggested Alternative(s):

Page 1. Utilization Management Policy Name: Topical Tretinoin Products Restricted Product(s): Unrestricted/Suggested Alternative(s): Utilization Management Policy Name: Topical Tretinoin Products Restricted Product(s): All topical tretinoin containing products require medical necessity review Atralin (tretinoin) Altreno (tretinoin)

More information

Health New England Medicare Advantage Plan HMO and HMO-POS Pharmacy Directory

Health New England Medicare Advantage Plan HMO and HMO-POS Pharmacy Directory Health New England Medicare Advantage Plan HMO and HMO-POS Pharmacy Directory This booklet provides a list of Health New England (HNE) Medicare Advantage Plan network pharmacies. All network pharmacies

More information

CONTACT PERSON PRESCRIBER PHONE PRESCRIBER FAX. PRESCRIBER ADDRESS CITY STATE ZIP Formulary Drug? Yes No

CONTACT PERSON PRESCRIBER PHONE PRESCRIBER FAX. PRESCRIBER ADDRESS CITY STATE ZIP Formulary Drug? Yes No ORAL DRUGS FOR PULMONARY ARTERIAL HYPERTENSION (PAH) BOSENTAN (Tracleer ), AMBRISENTAN (Letairis ), SILDENAFIL (Revatio ), TADALAFIL (Adcirca ), RIOCIGUAT (Adempas ), MACITENTAN (Opsumit ), TREPROSTINIL

More information

2019 Summary of Benefits Medicare Prescription Drug Plans. BlueMedicare Value Rx (PDP) S

2019 Summary of Benefits Medicare Prescription Drug Plans. BlueMedicare Value Rx (PDP) S 2019 Summary of Benefits Medicare Prescription Drug Plans BlueMedicare Value Rx (PDP) S5904-006 January 1, 2019 December 31, 2019 The plan s service area includes: State of Florida 1 Y0011_92839_M 0818

More information

Doxazosin Dutasteride Finasteride Tamsulosin Viagra (sildenafil) benefit limitations apply

Doxazosin Dutasteride Finasteride Tamsulosin Viagra (sildenafil) benefit limitations apply Utilization Management Policy Name: Cialis Restricted Product(s): Cialis (tadalafil) Tadalafil (Cialis) (for BPH) Unrestricted Suggested Alternative(s): Doxazosin Dutasteride Finasteride Tamsulosin Viagra

More information

Kadlec Regional Medical Center 0118 KMC-002B

Kadlec Regional Medical Center 0118 KMC-002B Kadlec Regional Medical Center 0118 KMC-002B Washington ASO KMC-002B Kadlec HSA 10/25/50/3000 1500d Kadlec Regional Medical Center 0118 KMC-002B Washington ASO KMC-002B Kadlec HSA 10/25/50/3000 1500d n

More information

TRIPTAN RESTRICTED ACCESS; QUANTITY LIMIT EXCEPTION CERTIFICATION FAX REQUEST FORM

TRIPTAN RESTRICTED ACCESS; QUANTITY LIMIT EXCEPTION CERTIFICATION FAX REQUEST FORM TRIPTAN RESTRICTED ACCESS; QUANTITY LIMIT EXCEPTION CERTIFICATION FAX REQUEST FORM INCOMPLETE FORMS MAY DELAY PROCESSING ALL NC PROVIDERS MUST PROVIDE THEIR 5 DIGIT Blue Cross NC PROVIDER ID# BELOW PRESCRIBER

More information

2019 Over-the-Counter Drugs and Vitamins - Puerto Rico*

2019 Over-the-Counter Drugs and Vitamins - Puerto Rico* 209 Over-the-Counter Drugs and Vitamins - Puerto Rico* Federal Employees Health Benefits Program Effective January, 209 OVER-THE COUNTER COVERAGE FOR PUERTO RICO CATEGORY PRODUCT LIMIT Allegra-D 2 Hour

More information

Notice of Appeal Resolution

Notice of Appeal Resolution Behavioral Health Services Department Quality Assurance Program PO Box 28504 San Jose, California 95159-8504 Tel. (408) 793-5894 Fax. (408) 288-6113 Notice of Appeal Resolution DATE Beneficiary s Name

More information

Ready. Set. CAPTURE LIFE REWARDS. Earn plenty of Points. GET ACTIVE ENJOY LIVE HEALTHY REWARDS GCHJMJXEN 0916

Ready. Set. CAPTURE LIFE REWARDS. Earn plenty of Points. GET ACTIVE ENJOY LIVE HEALTHY REWARDS GCHJMJXEN 0916 Ready. Set. CAPTURE LIFE REWARDS Earn plenty of Points. GET ACTIVE LIVE HEALTHY ENJOY REWARDS GCHJMJXEN 0916 Say hello to Go365. It s your personalized wellness and rewards program. Getting healthier is

More information

ATTENTION- DEFICIT HYPERACTIVITY DISORDER (ADHD) PRIOR REVIEW/CERTIFICATION FAXBACK FORM

ATTENTION- DEFICIT HYPERACTIVITY DISORDER (ADHD) PRIOR REVIEW/CERTIFICATION FAXBACK FORM ATTENTION- DEFICIT HYPERACTIVITY DISORDER (ADHD) PRIOR REVIEW/CERTIFICATION FAXBACK FORM INCOMPLETE FORMS MAY DELAY PROCESSING ALL NC PROVIDERS MUST PROVIDE THEIR 5-DIGIT Blue Cross NC PROVIDER ID# BELOW

More information

There are 2 kinds of appeals with Blue Cross of Idaho Care Plus

There are 2 kinds of appeals with Blue Cross of Idaho Care Plus You have the right to appeal our decision You have the right to ask Blue Cross of Idaho Care Plus to review our decision by asking us for an appeal. If you lose the Medicaid services appeal with Blue Cross

More information

ATYPICAL ANTIPSYCHOTICS

ATYPICAL ANTIPSYCHOTICS ATYPICAL ANTIPSYCHOTICS UTILIZATION MANAGEMENT CRITERIA DRUG CLASSES: Second Generation (Atypical) Antipsychotics BRAND (generic) NAMES: Restricted Access Agents: Abilify Discmelt (aripiprazole), Fanapt

More information

Ready. Set. CAPTURE LIFE REWARDS. Earn plenty of Points. GET ACTIVE ENJOY LIVE HEALTHY REWARDS GCHJMJXEN 0916

Ready. Set. CAPTURE LIFE REWARDS. Earn plenty of Points. GET ACTIVE ENJOY LIVE HEALTHY REWARDS GCHJMJXEN 0916 Ready. Set. CAPTURE LIFE REWARDS Earn plenty of Points. GET ACTIVE LIVE HEALTHY ENJOY REWARDS GCHJMJXEN 0916 Say hello to Go365. It s your personalized wellness and rewards program. Getting healthier is

More information

MARIPOSA COUNTY HUMAN SERVICES PROVIDER LIST

MARIPOSA COUNTY HUMAN SERVICES PROVIDER LIST Behavioral Health and Recovery Services 5362 Lemee Lane (209) 966-2000 www.mariposacounty.org MARIPOSA COUNTY HUMAN SERVICES PROVIDER LIST Services Provided: Adult and Children ADA Compliant Facility:

More information

Dental Blue 65. Outline of Coverage. Dental Blue 65 Preventive Dental Blue 65 Basic Dental Blue 65 Premier Effective January 1, 2017

Dental Blue 65. Outline of Coverage. Dental Blue 65 Preventive Dental Blue 65 Basic Dental Blue 65 Premier Effective January 1, 2017 Dental Blue 65 Outline of Coverage Policy Number: DENT SR (1 1 2012) Read your subscriber certificate carefully. This disclosure statement is a very brief summary of your dental plan. The plan itself sets

More information

2019 Pharmacy Directory

2019 Pharmacy Directory FLORIDA 2019 Pharmacy Directory This directory is for Duval County, Florida. This pharmacy directory was updated on January 16, 2019. For more recent information or other questions, please contact PHP

More information

Growth Hormones (GH) UTILIZATION MANAGEMENT CRITERIA

Growth Hormones (GH) UTILIZATION MANAGEMENT CRITERIA Growth Hormones (GH) UTILIZATION MANAGEMENT CRITERIA DRUG CLASS Synthetic recombinant Growth Hormone (Somatropin) BRAND NAMES: Genotropin Humatrope, HumatroPen Norditropin Nordiflex, Norditropin Flexpro

More information

FRM016178CO00 (10/17)

FRM016178CO00 (10/17) Y0020_18_2827FORM_3836_CHI Accepted 07302017 FRM016178CO00 (10/17) Health Net complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin,

More information

Page 1. Unrestricted/Suggested Alternative(s): generic formulations of ADHD medications unless otherwise noted. Quantity limits apply.

Page 1. Unrestricted/Suggested Alternative(s): generic formulations of ADHD medications unless otherwise noted. Quantity limits apply. Utilization Management Policy Name: Attention Deficit Hyperactive Disorder (ADHD) Restricted Product(s): restriction is on branded products unless otherwise noted. Quantity restrictions apply to brand

More information

SELECTIONS. Welcome to the UPMC MyHealth Selections program

SELECTIONS. Welcome to the UPMC MyHealth Selections program SELECTIONS Welcome to the UPMC MyHealth Selections program Congratulations on taking this step toward a healthier lifestyle! By taking part in the UPMC MyHealth Selections program you are showing that

More information

Ready. Set. CAPTURE LIFE REWARDS. Earn plenty of Points. GET ACTIVE ENJOY LIVE HEALTHY REWARDS GCHJMJXEN 0916

Ready. Set. CAPTURE LIFE REWARDS. Earn plenty of Points. GET ACTIVE ENJOY LIVE HEALTHY REWARDS GCHJMJXEN 0916 Ready. Set. CAPTURE LIFE REWARDS Earn plenty of Points. GET ACTIVE GCHJMJXEN 0916 LIVE HEALTHY ENJOY REWARDS Say hello to Go365. It s your personalized wellness and rewards program. Getting healthier is

More information

Warfarin. (Coumadin, Jantoven ) Taking your medication safely

Warfarin. (Coumadin, Jantoven ) Taking your medication safely Warfarin (Coumadin, Jantoven ) Taking your medication safely Welcome This booklet is designed to provide you with important information about warfarin to help you take this medication safely and effectively.

More information

Personal Dental Coverage with Optional VisionBlueSM. Affordable Dental Plans for Individuals of All Ages

Personal Dental Coverage with Optional VisionBlueSM. Affordable Dental Plans for Individuals of All Ages Personal Dental Coverage with Optional VisionBlueSM Affordable Dental Plans for Individuals of All Ages When it comes to maintaining a healthy body, a good place to start is a healthy mouth. BlueCross

More information

A healthy smile just got easier with our dental benefit!

A healthy smile just got easier with our dental benefit! A healthy smile just got easier with our dental benefit! 2018 TX MMP ACCESS How do I access the benefit? A ENEFIT As a member of the Molina Dual Options STAR+PLUS MMP, you get the added benefit of supplemental

More information

Health Net Transition of Care Form. Welcome to Health Net! To be completed by agent: New member medical care checklist. Agent name M M D D Y Y Y Y

Health Net Transition of Care Form. Welcome to Health Net! To be completed by agent: New member medical care checklist. Agent name M M D D Y Y Y Y Health Net Transition of Care Form To be completed by agent: Agent name Health plan name Health plan start date New member medical care checklist Welcome to Health Net! As a new Health Net member, we want

More information

2018 Formulary Annual Notice of Change

2018 Formulary Annual Notice of Change Updated: October 1, 2017 2018 Formulary Annual Notice of Change Medicare Advantage Plans (MAPD) This is a listing of the changes that have occurred to the 2018 MAPD formulary. For a complete list, please

More information

Notice of Appeal Resolution

Notice of Appeal Resolution Notice of Appeal Resolution DATE Beneficiary s Name Address City, State Zip Treating Provider s Name Address City, State Zip RE: Service Requested You or Name of requesting provider or authorized representative,

More information

NOTICE OF ADVERSE BENEFIT DETERMINATION About Your Treatment Request

NOTICE OF ADVERSE BENEFIT DETERMINATION About Your Treatment Request NOTICE OF ADVERSE BENEFIT DETERMINATION About Your Treatment Request DATE Beneficiary s Name Address City, State Zip Treating Provider s Name Address City, State Zip RE: Service Requested You are currently

More information

Healthy Moves. A better flu season for you

Healthy Moves. A better flu season for you Fall/Winter 2017 Healthy Moves A better flu season for you Adults 65 years of age and older are a higher risk for getting and developing serious risks from the flu. Some of the risks are bronchitis, sinus

More information

TRANSITION OF CARE APPLICATION

TRANSITION OF CARE APPLICATION Dear Member: Thank you for enrolling in MedStar Medicare Choice. You may currently be receiving services from healthcare providers that are not part of the MedStar Medicare Choice Provider Network. An

More information

CONTACT PERSON PRESCRIBER PHONE PRESCRIBER FAX. PRESCRIBER ADDRESS CITY STATE ZIP Formulary Drug? Yes No

CONTACT PERSON PRESCRIBER PHONE PRESCRIBER FAX. PRESCRIBER ADDRESS CITY STATE ZIP Formulary Drug? Yes No IMMEDIATE RELEASE OPIOID 7 DAY FIRST FILL AND QUANTITY LIMIT EXCEPTION PRIOR REVIEW/CERTIFICATION FAXBACK FORM INCOMPLETE FORMS MAY DELAY PROCESSING ALL NC PROVIDERS MUST PROVIDE THEIR -DIGIT Blue Cross

More information

Federal DentalBlue. Standard and Basic Options

Federal DentalBlue. Standard and Basic Options Federal DentalBlue Standard and Basic Options Effective January 1, 2018 Federal DentalBlue Standard Option 2018 Deductible Maximum Benefit Diagnostic and Preventive Basic Restorative Services Endodontics,

More information

PRESCRIBER ADDRESS CITY STATE ZIP. PATIENT NAME Blue Cross NC ID DATE OF BIRTH GENDER

PRESCRIBER ADDRESS CITY STATE ZIP. PATIENT NAME Blue Cross NC ID DATE OF BIRTH GENDER GENERAL AUTHORIZATION/QUANTITY LIMIT EXCEPTION CERTIFICATION FAXBACK FORM INCOMPLETE FORMS MAY DELAY PROCESSING ALL NC PROVIDERS MUST PROVIDE THEIR 5-DIGIT Blue Cross NC PROVIDER ID# BELOW PRESCRIBER NAME

More information

Provides free aids and services to people with disabilities to communicate effectively with us, such as:

Provides free aids and services to people with disabilities to communicate effectively with us, such as: Non-Discrimination Statement As a recipient of Federal financial assistance, Aegis Therapies complies with applicable Federal Civil Rights laws and does not exclude, deny benefits to, or otherwise discriminate

More information

GCHJUV2EN Member Registration Guide

GCHJUV2EN Member Registration Guide GCHJUV2EN 0417 Member Registration Guide Go365 Trilogy Member Registration Instructions Two Ways to Register for Go365 1. Go365.com 2. Go365 App (available in the Apple and Google Play Stores) Select the

More information

IN THIS ISSUE MEMBER NEWSLETTER AUGUST Dear Amida Care Members,

IN THIS ISSUE MEMBER NEWSLETTER AUGUST Dear Amida Care Members, MEMBER NEWSLETTER AUGUST 2017 Dear Amida Care Members, With this new, shortened member newsletter format, we are reaching out to you with clear, simple messages that cut right to the chase. Whether we

More information

Granite Alliance Insurance Company (PDP) 2019 Step Therapy Criteria

Granite Alliance Insurance Company (PDP) 2019 Step Therapy Criteria Granite Alliance Insurance Company (PDP) 2019 Step Therapy Criteria Last Approved: 02/20/2019 Granite Alliance requires step therapy for certain drugs. This means prior to receiving a drug with a step

More information

2017 Pharmacy Directory

2017 Pharmacy Directory 2017 Pharmacy Directory This directory is for Duval County, Florida. This pharmacy directory was updated on June 16, 2017. For more recent information or other questions, please contact PHP (HMO SNP) Pharmacy

More information

CheckUp. Today. Free Diabetes Education Class. Sign Up. Fall More Diabetes Tips

CheckUp. Today. Free Diabetes Education Class. Sign Up. Fall More Diabetes Tips CheckUp Fall 2018 Sign Up Today Protect your good health by attending the free Healthy Living with Diabetes class. Here are the upcoming class dates in Madison: September 26 November 1, 2018 5 7:30 pm

More information

Affordable Care Act Section 1557 Nondiscrimination Policy for Kentucky

Affordable Care Act Section 1557 Nondiscrimination Policy for Kentucky 1. Nondiscrimination Notice and Accessibility Requirements. ENT & Allergy Specialists will take reasonable steps to ensure that persons with Limited English Proficiency (LEP) have meaningful access and

More information

Healthy Moves. Top Five Tips for Aging Better. Summer 2017

Healthy Moves. Top Five Tips for Aging Better. Summer 2017 Summer 2017 Healthy Moves Top Five Tips for Aging Better Aging is a natural process. Although, you cannot stop the clock, you can make the process smoother. Here are five tips to help you age better: 1.

More information

Optional Supplemental Benefits Gold Benefits Enrollment Form

Optional Supplemental Benefits Gold Benefits Enrollment Form Optional Supplemental Benefits Gold Benefits Enrollment Form Health Net Medicare Advantage Plans Health Net offers optional supplemental benefits Gold Benefits for an additional monthly premium to our

More information

Kaiser Permanente 2018 Pharmacy Directory

Kaiser Permanente 2018 Pharmacy Directory Kaiser Permanente 2018 Pharmacy Directory This pharmacy directory was updated on 08/2017. For more recent information or other questions, please contact Kaiser Permanente Member Services at 1-800-232-4404

More information

Appeals & Grievances Department REQUEST FOR RECONSIDERATION (APPEAL) Part C MEMBER NAME: HNET Member ID Number:

Appeals & Grievances Department REQUEST FOR RECONSIDERATION (APPEAL) Part C MEMBER NAME: HNET Member ID Number: Health Net Medicare Programs P.O. Box 10344 Van Nuys, CA 91410-0344 Phone: 1-800-431-9007 TTY: 711 Fax: 1-877-713-6189 Health Net Medicare Programs Appeals & Grievances Department REQUEST FOR RECONSIDERATION

More information

February is National Heart Month

February is National Heart Month Health Partners Talk WINTER 2018 February is National Heart Month H eart disease is the leading cause of death for men and women in the U.S. Every year, 1 in 4 deaths are caused by heart disease. A healthy

More information

ENHANCED FORMULARY for Medicare Plus Group Members

ENHANCED FORMULARY for Medicare Plus Group Members ENHANCED FORMULARY for Medicare Plus Group Members H2150_EG_17_38 Kaiser Permanente 2018 Medicare Plus enhanced formulary for group members DRUG NAME DRUG TIER REQUIRE MENTS/ LIMITS ANTICHOLINERGICS ANTIMUSCARINICS/ANTISPASMODICS

More information

The FitnessCoach Program

The FitnessCoach Program The FitnessCoach Program Learn how to improve your health and use our tools to do it. THE RIGHT FIT FOR YOU This program gives you: No-cost memberships* at local participating fitness centers or YMCAs

More information

Complete. Pennsylvania. How your plan works. Calendar year deductible This is the amount you will pay out-of-pocket for services in a calendar year

Complete. Pennsylvania. How your plan works. Calendar year deductible This is the amount you will pay out-of-pocket for services in a calendar year Complete Individual Dental Pennsylvania About your plan Good health starts with a healthy mouth. Regular dental exams and cleanings can lower the risk of gum disease, which is linked to heart disease,

More information

Member Matters Newsletter

Member Matters Newsletter Member Matters Newsletter 2017 Winter Issue IN THIS ISSUE 2 A New Year with Premier HealthOne 2 Is it Time to See Your Doctor? 3 Chicken & White Bean Soup 4-5 Preventive Health Checklist 6-7 Recognizing

More information

Get $150 back! WELL-BEING. Start your well-being journey today! Complete 120 workouts at an approved fitness center ACHIEVE

Get $150 back! WELL-BEING. Start your well-being journey today! Complete 120 workouts at an approved fitness center ACHIEVE ACHIEVE WELL-BEING Get $150 back! Complete 120 workouts at an approved fitness center Looking for motivation to exercise? The Healthy LifestylesSM fitness program will reimburse you $150 for working out

More information

Indemnity PPO Medical Plan Preventive Care Guidelines

Indemnity PPO Medical Plan Preventive Care Guidelines Southern California Drug Benefit Fund Indemnity PPO Medical Plan Preventive Care Guidelines - 2018 The Indemnity PPO Medical Plan pays 100% of the cost of coverage for many routine preventive care services

More information

Request for Redetermination of Medicare Prescription Drug Denial

Request for Redetermination of Medicare Prescription Drug Denial Request for Redetermination of Medicare Prescription Drug Denial Because we, Health Net Medicare Programs, denied your request for coverage of (or payment for) a prescription drug, you have the right to

More information

QUANTITY LIMIT EXCEPTION PRIOR REVIEW/CERTIFICATION FAXBACK FORM

QUANTITY LIMIT EXCEPTION PRIOR REVIEW/CERTIFICATION FAXBACK FORM QUANTITY LIMIT EXCEPTION PRIOR REVIEW/CERTIFICATION FAXBACK FORM INCOMPLETE FORMS MAY DELAY PROCESSING ALL NC PROVIDERS MUST PROVIDE THEIR 5-DIGIT Blue Cross NC PROVIDER ID# BELOW PRESCRIBER NAME PRESCRIBER

More information

Kaiser Permanente 2018 Sample Fee List *

Kaiser Permanente 2018 Sample Fee List * Kaiser Permanente 2018 Sample Fee List * COLORADO What s a Sample Fee List? Knowing how much you can expect to pay for care and services can help give you peace of mind. As a deductible plan member, you

More information

Healthy. Now. vaccines? Is your child up to date on. page 4. Keep blood pressure in check with this healthy low-sodium recipe.

Healthy. Now. vaccines? Is your child up to date on. page 4. Keep blood pressure in check with this healthy low-sodium recipe. Healthy SPRING 2017 Now www.amerihealthcaritasia.com Is your child up to date on vaccines? page 4 Keep blood pressure in check with this healthy low-sodium recipe. See page 6 Tips for caregivers 2 Kids

More information

Getting to the BOTTOM OF BACK PAIN

Getting to the BOTTOM OF BACK PAIN Getting to the BOTTOM OF BACK PAIN What You Should Know About Low Back Pain Do I Need an X-ray? According to the American College of Physicians, most people with low back pain feel better after a month

More information

Member Grievance Form

Member Grievance Form Member Grievance Form Member Name: Last First Middle Initial Member Address: Phone: City: State: Zip Code: Member ID#: Birthdate: Sex: Primary Care Provider Name: Complaint Where did the problem happen?

More information

HealthyFocus Spring 2017

HealthyFocus Spring 2017 HealthyFocus Spring 2017 Thanks for Your Feedback. We re Listening! Every year, the Oregon Health Authority (OHA) puts out a survey called the Consumer Assessment of Healthcare Providers and System, or

More information

Sore Throat or Strep? ALWAYS GET A STREP TEST BEFORE TAKING AN ANTIBIOTIC

Sore Throat or Strep? ALWAYS GET A STREP TEST BEFORE TAKING AN ANTIBIOTIC Sore Throat or Strep? ALWAYS GET A STREP TEST BEFORE TAKING AN ANTIBIOTIC What is Strep? Strep or strep throat is also known as Streptococcal Pharyngitis. Pharyngitis is a type of sore throat and is a

More information

Your Feelings Matter WITH TYPE 2 DIABETES

Your Feelings Matter WITH TYPE 2 DIABETES Your Feelings Matter WITH TYPE 2 DIABETES A new diagnosis of type 2 diabetes may trigger a range of emotions from minor stress to major depression. Recognizing and addressing emotional reactions can play

More information

2018 Preventive Drug List

2018 Preventive Drug List 2018 Preventive Drug List Introduction In addition to a healthy lifestyle, preventive prescription drugs are important in helping people avoid many types of illnesses and complications from illnesses.

More information

Josette E. Spotts, MD, FACS W. Warm Springs Road, Suite 105 Henderson, NV Tel: Fax:

Josette E. Spotts, MD, FACS W. Warm Springs Road, Suite 105 Henderson, NV Tel: Fax: Josette E. Spotts, MD, FACS 1485 W. Warm Springs Road, Suite 105 Henderson, NV 89014 Tel: 702.990.6360 Fax: 702.990.6363 Patient Name: Date: Age: Referred by: Reason for visit: Patient Name: Medical History

More information

Solutions Fitness Program

Solutions Fitness Program Healthy LifestylesSM Solutions Fitness Program With Independence Blue Cross Fitness Program you can get up to $150 back You don t have to enroll in the Healthy Lifestyles Solutions Fitness Program to become

More information

Coverage for: Individual and Eligible Family

Coverage for: Individual and Eligible Family Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 07/01/2018 06/30/2019 Regence BlueCross BlueShield of Oregon: Expressions SM Coverage for: Individual

More information

2018 Annual Notice of Changes

2018 Annual Notice of Changes 2018 Annual Notice of Changes AETNA BETTER HEALTH OF OHIO a MyCare Ohio plan (Medicare-Medicaid Plan) Aetna Better Health of Ohio, a MyCare Ohio plan (Medicare-Medicaid Plan), is a health plan that contracts

More information

Life After a Heart Attack WHAT ARE MY CHANCES OF HAVING ANOTHER HEART ATTACK?

Life After a Heart Attack WHAT ARE MY CHANCES OF HAVING ANOTHER HEART ATTACK? Life After a Heart Attack WHAT ARE MY CHANCES OF HAVING ANOTHER HEART ATTACK? A previous heart attack increases your risk of having a second one. However, you can make changes to prevent a second heart

More information

Preventive Drug List

Preventive Drug List 2019 Preventive Drug List Introduction In addition to a healthy lifestyle, preventive prescription drugs are important in helping people avoid many types of illnesses and complications from illnesses.

More information

Small group quote request

Small group quote request Small Business Group Small group quote request (for groups with 1 50 employees) Requested effective date: First of (month) Send quote to: Producer Company contact person via: Email Fax Mail 1. PLEASE TELL

More information

Kaiser Permanente 2018 Sample Fee List *

Kaiser Permanente 2018 Sample Fee List * Kaiser Permanente 2018 Sample Fee List * What s a Sample Fee List? NORTHWEST Knowing how much you can expect to pay for care and services can help give you peace of mind. As a deductible plan member, you

More information

Take Charge of YOUR COPD

Take Charge of YOUR COPD Take Charge of YOUR COPD You are the Key Did you know that Chronic Obstructive Pulmonary Disease (COPD) Flare-Ups cause your COPD to progress faster and shorten your life? The key is managing your COPD

More information

Total Health Plus supplemental benefits designed for members in need of extra care. We re giving you more to smile about.

Total Health Plus supplemental benefits designed for members in need of extra care. We re giving you more to smile about. HDS BASIC DENTAL PLAN Summary of Dental Benefits Effective January 1, 2019 ADULTS (& CHILDREN AGE 19 THROUGH 25) PLAN MAXIMUM $1,000 per person, per calendar year. The most HDS will pay for each person

More information

REGISTRATION FORM (Please Print)

REGISTRATION FORM (Please Print) REGISTRATION FORM (Please Print) Today s date: Primary Care Physician: Referring Physician: PATIENT INFORMATION Patient s last name: First: Middle: Dr. Mr. Mrs. Miss Ms. Widowed Is this your legal name?

More information

Member Registration Guide GCHJUV2EN 0117

Member Registration Guide GCHJUV2EN 0117 Member Registration Guide GCHJUV2EN 0117 This guide covers Go365 registration based on two member types. Reference the applicable slides based on member type: 1. Humana Medical Members (members who have

More information

2018 Preventive Medication List

2018 Preventive Medication List 2018 Preventive Medication List Introduction In addition to a healthy lifestyle, preventive medications are important in helping people avoid many types of illnesses and complications from illnesses. This

More information

YOUR DENTAL HEALTH IS OUR CAUSE DENTAL CHOICE (PPO) kp.org/dental/nw

YOUR DENTAL HEALTH IS OUR CAUSE DENTAL CHOICE (PPO) kp.org/dental/nw YOUR DENTAL HEALTH IS OUR CAUSE DENTAL CHOICE (PPO) kp.org/dental/nw 258275553_DENT_08-18 All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite

More information

Pediatric Benefits. Affordable Care Act Plans. Dental Coverage Vision Coverage

Pediatric Benefits. Affordable Care Act Plans. Dental Coverage Vision Coverage Pediatric Benefits Affordable Care Act Plans Dental Coverage Vision Coverage Pediatric Coverage The Affordable Care Act requires vision and dental coverage for children (dependents) 18 years and younger.

More information

Delta Dental Individual and Family - PPO SM Value for Seniors

Delta Dental Individual and Family - PPO SM Value for Seniors Delta Dental Individual and Family - PPO SM Value for Seniors The Delta Dental Individual and Family - PPO Value for Seniors plan is designed to help you maintain good oral health providing you with national

More information

Preventive Drug List

Preventive Drug List 2018 Preventive Drug List Introduction In addition to a healthy lifestyle, preventive prescription drugs are important in helping people avoid many types of illnesses and complications from illnesses.

More information