2018 Medicare Advantage HMO plans Ally Rx (HMO SNP) Dual-eligible Special Needs Plan Affordable health coverage that looks out for you Y0117_MC-778-2824-C-09-17 approved
Security Health Plan has you covered Ally Rx (HMO SNP) from Security Health Plan is a dual-eligible special needs plan or D-SNP. This means it offers exceptional health care, prescription drug coverage and financial advantages to people who receive both Medicare and full-benefit Medicaid. Ally Rx D-SNP is available to qualified Wisconsin residents who live in Chippewa, Clark, Eau Claire, Lincoln, Marathon, Portage, Price, Rusk, Taylor and Wood counties. Enrolling in Ally Rx means Security Health Plan will provide your Medicare coverage plus added benefits described in this brochure. Why choose Ally Rx from Security Health Plan? For more than 45 years, Security Health Plan has worked with health care professionals and hospitals in Wisconsin communities to deliver high quality coverage and customer experiences. You can count on our commitment to excellence and the security of a health plan that works for you. Our members generally receive more personalized care, pay fewer unnecessary health care costs, have fewer frustrations with claims and are more satisfied with their plan. 1 Ally Rx has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) at least until 2019 based on a review of the Ally Rx Model of Care. Learn what a plan from Security Health Plan can offer you. $0 $0 Costs You pay no plan premium for Ally Rx. You must continue to pay your Medicare Part B premium unless it is paid for you by Medicaid or another third party. You pay nothing for Medicare-covered medical services. Your Wisconsin Medicaid benefits (ForwardHealth card) pay the Medicare cost sharing on your behalf for Medicare-covered services you receive as long as plan coverage rules are followed. Your only costs may be small copayments on your Medicaid coverage or a few dollars on prescription drugs through Medicare s Low Income Subsidy program. 1. Based on Healthcare Effectiveness Data and Information Set and Consumer Assessment of Health Providers and Systems results. 2 Compare plans and apply online at www.securityhealth.org/medicare18
Services You get high quality health care close to home from our network of more than 5,000 doctors, health care professionals, hospitals and clinics. Choose from hundreds of doctors who participate in Ally Rx at Marshfield Clinic Health System, Aspirus, Allied Chiropractic, Mayo Clinic Health System, Ministry Health Care, most OakLeaf Medical Network providers, Sacred Heart Hospital Eau Claire, St. Joseph s Hospital Chippewa Falls and other convenient locations. To find out if your provider is part of the Ally Rx network, visit www.securityhealth.org/allyproviders. You enjoy enhanced medical benefits. You get care above what Medicare and Medicaid cover alone, such as: A $175 allowance for eyeglasses for members with routine correction needs. Worldwide emergency and urgent care. A 3-day hospital stay is not required to be covered for skilled nursing home care to recover from an illness or injury. Member care Your care is personal with us. As a member of Ally Rx from Security Health Plan you have a personal care team focused on you and your health. This team consists of registered nurses, social workers and a Community Support Specialist who assist you with: Managing your health conditions Reviewing your medications and treatments Your Community Support Specialist is your go-to resource for questions about your health care and services. The specialist works closely with you to: Address your concerns Communicating with your doctors and other health care providers Locating community resources when needed Create a care plan tailored to your specific needs Coordinate your benefits with Medicare and Medicaid Whenever you have health care questions or you re not sure if you need to seek care, you can call our 24-hour Nurse Line. To talk with a registered nurse, 7 days a week including holidays, simply call 1-800-549-3174 (TTY: 711). Your calls are answered by your neighbors right here in Wisconsin. Our friendly customer service professionals and benefits specialists share your Midwestern values and do what it takes to get your questions answered to your satisfaction. 3
Besides Medicare health plans, Security Health Plan offers health coverage for all stages in life. If you know someone looking for individual and family coverage or small or large business health insurance, please tell them to call us at 1-800-622-7790. Ally Rx prescription coverage Because you are eligible for Medicaid, you qualify for and are getting Extra Help from Medicare to pay for your prescription drug plan costs. This means you will pay little or nothing for drugs. You must get your drugs from a network pharmacy, and your drugs must be on the Ally Rx list of covered drugs. CHECK US OUT Ally Rx complete drug list www.securityhealth.org/allyformulary Ally Rx pharmacy network Includes nationwide chain pharmacies and local pharmacies www.securityhealth.org/allypharmacies 4 Compare plans and apply online at www.securityhealth.org/medicare18
Answers to often asked questions about Ally Rx Who is eligible to enroll in Ally Rx? Anyone can join Ally Rx who lives in the service area (see map on front cover), is entitled to Medicare Part A, is enrolled in Medicare Part B, and has full-benefit Medicaid. Full-benefit Medicaid benefits can be received through several Medicaid plans as well as FamilyCare or a Supplemental Security Income (SSI) managed care plan. Enrollment in Ally Rx does not affect your SSI or FamilyCare program or benefits. If you lose your Medicaid eligibility, we are required to disenroll you if you don t become eligible for Medicaid again during the 2-month Ally Rx grace period. How do I enroll? We have several ways you can get started. Go to www.securityhealth.org/medicare18 to complete an online application. If you have a kit, complete the attached application and mail it to us. Call us at 1-888-456-2188 to request an application. For assistance in completing an application, call us any weekday between 8 a.m. and 5 p.m. at 1-888-456-2188 and one of our credentialed sales agents will be happy to help you. After we receive your application and verify your information with Medicare, we will send you confirmation of your enrollment and your plan ID card. If for any reason you are denied coverage, we will send you a letter explaining why. What if I have significant medical concerns? No medical underwriting is required. Your plan premium will not increase because of your medical condition or your age. One exception: You are not eligible if you have end-stage renal disease (ESRD) except under certain conditions. Call us for more information on ESRD. How do I make sure I am covered correctly for health care visits? You will use your Security Health Plan ID card, not your red, white and blue Medicare card, to obtain health care services. You will also need to continue using your ForwardHealth Medicaid card as both programs will cover your health care costs. What if I change my mind after I enroll? Because you have both Medicare and Medicaid, you can join or switch your Medicare plan at any time. Our network providers are focused on you, helping you understand and manage your health care for your best health. 5
Discrimination is against the law Security Health Plan of Wisconsin, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Security Health Plan of Wisconsin, Inc. does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. Security Health Plan of Wisconsin, Inc.: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters 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: Qualified interpreters Information written in other languages If you need these services, contact Customer Service. If you believe that Security Health Plan of Wisconsin, Inc. 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 Security Health Plan, Attn: Grievances, 1515 North Saint Joseph Avenue, Marshfield, WI 54449-8000. Phone: 715-221-9596 (TTY: 711). Fax: 715-221-9424. Email: shp.appeals.grievance@securityhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Security Health Plan can 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 https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201. Phone: 1 800 368 1019 or 800 537 7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html Language assistance services ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-877-998-0998 (TTY: 711). 6 Compare plans and apply online at www.securityhealth.org/medicare18
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Security Health Plan of Wisconsin, Inc., is an HMO-POS, MSA and D-SNP plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in Security Health Plan depends on contract renewal. This plan is available to anyone who has both Medical Assistance from the state and Medicare. Premium and copayments may vary based on the level of Extra Help you receive. Please contact the plan for further details. This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums and copayments may change on January 1 of each year. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary. Generally, you must use plan providers except in emergency or urgent care situations. This document may be available in alternate formats. Call Customer Service for more information at 1-877-998-0998 or 715-221-9897, 7 days a week from 8 a.m. to 8 p.m. If you are hearing or speech impaired, please call TTY 711. About Security Health Plan Security Health Plan of Wisconsin, Inc., part of the Marshfield Clinic Health System, is helping its 220,000 members in Wisconsin and beyond reach their best health. Accredited by the National Committee for Quality Assurance (NCQA), Security Health Plan offers health insurance coverage for employees of large and small businesses, individuals and families. Security Administrative Services, a wholly-owned subsidiary of Security Health Plan, provides full service third party administration for self-funded employers in Wisconsin, Indiana and Michigan. 1515 North Saint Joseph Avenue PO Box 8000 Marshfield, WI 54449-8000 Sales Department 1-888-456-2188 (TTY: 711) Monday-Friday, 8 a.m. to 5 p.m. www.securityhealth.org/medicare18 HP-00154-119 (09/17) 2017 Security Health Plan of Wisconsin, Inc. 18741-000