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  Public Health Emergency Declaration

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Important Benefit Change Reminder!    Effective January 1st, 2018 your pharmacy benefit manager is changing from MagellanRx to National Pharmaceutical Services. For any questions please contact Customer Service at the number listed in the back of your card.

How We Provide Benefits During a Disaster

Ultimate Health Plans follows all CMS guidelines for providing benefits during disaster or public health emergency declarations.


For Medical Benefits

In the event of a Presidential emergency declaration, a Presidential (major) disaster declaration, a declaration of emergency or disaster by the Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, we:

  • Allow Part A/B plan benefits and supplemental Part C plan benefits to be furnished at specified non-contracted facilities (so long as any Part A and B benefits are furnished at Medicare certified facilities);
  • Waive the requirements for gatekeeper referrals for those services that require it;
  • Temporarily reduce plan-approved out-of-network cost sharing to in-network cost-sharing amounts; and
  • Waive the 30-day notification requirement to Members as long as all the changes (such as reduction of cost sharing and waiving authorization) benefit you, our Member.

For Drug Benefits

If the President has declared a major disaster or the Secretary of Health and Human Services has declared a public health emergency, we:

  • Ensure you can use out-of-network pharmacies when you cannot reasonably be expected to obtain covered Part D drugs at a network pharmacy, and when such access is not routine;
  • Lift the “refill too soon” restriction so that you can get another supply of your medication earlier than you usually could get it; and
  • Ensure that you can get the maximum extended day supply of your medication if you request it and its available at the time of refill.

Depending on the situation, we may take the above steps before the impending emergency to help you prepare and ensure you have access to your medications even if the President or Secretary have not yet made a declaration.

If you need help accessing your medical benefit, please call 1-888-657-4170 (TTY 711). Our hours are Monday through Sunday from 8am to 8pm.

If you need help getting your medications, please call 1-800-311-7517 (TTY 711), 24 hours a day seven days a week.


This page was last modified: 9/6/2017 1:26:44 PM
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Ultimate Health Plans is an HMO plan with a Medicare contract. Enrollment in Ultimate Health Plans depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Medicare beneficiaries may also enroll in Ultimate Health Plans through the CMS Medicare Online Enrollment Center located at www.medicare.gov. Ultimate Health Plans does not collect any member information through this website.

 

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