Important Information on Obtaining HMO Services:
HMO plans have a network of doctors and hospitals. Except for emergency care, out-of-area urgent care, and out-of-area kidney dialysis, neither the HMO nor Medicare will cover the costs/services of out-of-network providers. PPO plans offer out-of-network coverage, but at a higher coinsurance or copayment and with higher premiums.

Medicare Advantage Exclusions:
Exclusions that apply to Original Medicare also apply to UPMC for Life Medicare Advantage Plans.

Prescription Drug Information:
Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances when they cannot reasonably use network pharmacies.

Medicare beneficiaries may be enrolled in only one Part D plan at a time. If enrolled in an HMO, a PPO, or a PFFS plan with Medicare prescription drug coverage, the enrollee may not enroll in a Prescription Drug Plan (PDP) unless he or she disenrolls from the HMO, PPO, or PFFS plan. Enrollees in a PFFS plan that does not provide Medicare prescription drug coverage or a Medicare Advantage Medical Savings Account plan may enroll in a PDP.

If a beneficiary is already enrolled in a Medicare Advantage Prescription Drug (MAPD) plan, the enrollee must receive his or her Medicare prescription drug benefit through that plan.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day, seven days a week;
• The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
• Your state Medicaid office.

Medicare Advantage Eligibility and Contracting Statements:
UPMC Health Plan is a health plan with a Medicare contract. Our Medicare plans are available to persons entitled to Medicare Part A and enrolled in Part B. You must continue to pay Medicare premiums, reside in the service area, and not have end-stage renal disease (ESRD).

UPMC Health Plan’s contract with CMS is renewed annually and availability of coverage beyond the end of the current contract year is not guaranteed.

UPMC for Life is a product of and operated by UPMC Health Plan, Inc., UPMC Health Network, Inc., and UPMC Health Benefits, Inc.

Enrollment Limitations:
Members may enroll in a plan only at specific times during the year. The following is an overview of the dates for electing a new plan:

Annual Election Period from November 15, 2008, to December 31, 2008:

• You can make one election during this time.
• If you enroll during this time period, your coverage will be effective January 1, 2009.

Open Enrollment Period from January 1, 2009, to March 31, 2009:

• If you enroll during this time period, your coverage will become effective the first of the month after your completed election is received (subject to Medicare approval).
• You may make one election to the same type of plan you had previously.

After March 31, 2009, you cannot make a plan change unless you qualify for a special election period (e.g., you move out of the plan’s service area) or have Medical Assistance coverage.

Alternative Formats:
You have the right to get your questions answered. Our plan has individuals and translation services available to answer questions from non-English speaking beneficiaries, and must provide information about our benefits that is accessible and appropriate for persons eligible for Medicare because of disability. If you need plan documents in other formats, please contact UPMC for Life at the number below.

UPMC for Life Contact Information:
For full information on UPMC Health Plan benefits, call our Medicare Sales Hotline at 1-877-381-3765, seven days a week, from 8 a.m. to 8 p.m. TTY/TDD users should call 1-800-361-2629. From March 2 through November 14, you may receive a messaging service on weekends and holidays. Please leave a message and your call will be returned the next business day.