The Health Plan has established a Disaster and Emergency Declaration policy in accordance with state and federal laws and related regulations.

In the event of a Presidential emergency declaration, a Presidential (major) disaster declaration, a declaration of emergency or disaster by a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, but or prior to the issuance of, an 1135 waiver by the Secretary, the Health Plan will:

During this period:

• For any medical emergency please contact 911
• The plan will allow Part A/B benefits to be furnished at non-contracted (out of network) facilities
• Plan will waive requirements for obtaining gatekeeper (PCP) referrals.
• The Plan will temporarily reduce plan-approved out-of-network cost sharing to in-network cost-sharing amounts;
• Enrollees will have adequate access to covered Part D drugs dispensed at out-of-network pharmacies when those enrollees cannot reasonably be expected to obtain covered Part D drugs at a network pharmacy, and when such access is not routine;
• The Plan will lift "refill-too-soon" edits. You can get your refills at your pharmacy with no problem. Talk to your pharmacist. They can help you fill a prescription.
• Affected enrollee can obtain the maximum extended day supply, if requested and available at the time of refill.
• Waive prior authorization requirements for covered and critical life-sustaining services such as oxygen, nebulizer, ventilator, feeding pump, dialysis, insulin/insulin administration, DME, skilled nursing facility services, and chemotherapy.
• Will not deny a continued inpatient facility stay for late submission of clinical information and will accept verbal concurrent reviews.
• Access to Part C Provider Network: Typically, the source that declared the disaster will clarify when the disaster or emergency is over. If, however, the disaster or emergency time frame has not been closed 30 days from the initial declaration, and if CMS has not indicated an end date to the disaster or emergency, the Health Plan will resume normal operations 30 days from the initial declaration.
• Waive prior authorization requirements for covered and critical life-sustaining services such as oxygen, nebulizer, ventilator, feeding pump, dialysis, insulin/insulin administration, DME, skilled nursing facility services, and chemotherapy.

These measures will remain in place for the duration of the emergency declaration. Disasters or emergencies may be declared by the U.S. Government, the Federal Emergency Management Agency (FEMA), or a state Governor.