UPMC for Life Additional Information 2008

• UPMC for Life Pharmacy Directory
• Pennsylvania and West Virginia
• Ohio
• Searchable Pharmacy Directory
• UPMC for Life Drug Formulary
  • Pennsylvania and West Virginia
  • Ohio
• UPMC for Life searchable Drug Formulary
• Provider Directory - Select one of the following counties to locate a provider.
  • Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Washington, and Westmoreland counties
  • Clarion, Crawford, Erie, Forest, Lawrence, Mercer, and Venango counties
  • Bedford, Blair, Cambria, Cameron, Clearfield, Elk, Jefferson, McKean, and Somerset counties
  • Searchable Pharmacy Directory
• How to file a complaint, appeal, or grievance, or request an exception
  
• Disenrollment Rights and Responsibilities
• What happens if UPMC for Life leaves the Medicare program or UPMC for Life leaves the area where you live?
• Privacy Statement
• List of Exclusions and Limitations

Useful Forms:

• Personal Representative Designation Form
• Member Authorization to Use/Disclose PHI

Helpful Links:

• Your Medicare Rights and Protections
• Medicare website

Disenrollment rights and responsibilities

• To become familiar with your coverage and the rules you must follow to get care as a member. You can use the Evidence of Coverage and other information we give you to learn about your coverage, what you have to pay, and the rules you need to follow.
  
  
• To give your doctor and other providers the information they need to care for you, and to follow the treatment plans and instructions that you and your doctors agree upon. Be sure to ask your doctors and other providers if you have any questions.
  
  
• To act in a way that supports the care given to other patients and helps the smooth running of your doctor's office, hospitals, and other offices.
  
  
• To pay any plan copayments you may owe for the covered services you get. You must also meet your other financial responsibilities related to your health care, as applicable.
  
  
• To let us know if you have any questions, concerns, problems, or suggestions. If you do, please call Member Services.
  
  

1. From November 15 through March 31, anyone with Medicare will have two chances to switch from one way of getting Medicare to another.
   
   
2. From January 1 until March 31, anyone with Medicare has another chance to make one change in the way they get Medicare.
   
   With this chance, you are limited in the type of plan you may join. If you have Medicare prescription drug coverage when making your change, you will only be able to join a Medicare Advantage plan or a Medicare private fee-for-service plan that offers Medicare Part D (Prescription Drug), or you will have to go to Original Medicare and join a Prescription Drug Plan. If you do not have Medicare prescription drug coverage when making this change, you will only be able to join a Medicare Advantage plan or a private fee-for-service plan that does not offer the Medicare Part D (Prescription Drug), or go to Original Medicare.
   
   
3. Generally, you can't make any other changes during the year unless you meet special exceptions, such as if you move or if you have Medical Assistance coverage. Later in the year, from November 15 through December 31, anyone with Medicare can switch their way of getting Medicare to another way for the following year.
   
   In most cases, your disenrollment date will be the first day of the month that comes after the month we receive your request to leave. For example, if we receive your request to leave during the month of February, your disenrollment date will be March 1.
   
   If you leave UPMC for Life, one choice for continuing with Medicare is to join a Medicare Advantage plan or other Medicare health plan if any of these types of plans are available in your area, and if they are accepting new members. You can also choose the Original Medicare plan. If you choose Original Medicare, you must choose a Prescription Drug Plan if you wish to have Medicare prescription drug coverage.
   
   

• If you move out of our geographic service area or live outside the plan's service area for more than six months at a time.
  
  
• If you do not stay continuously enrolled in both Medicare Part A and Medicare Part B.
  
  
• If you give us information on your enrollment form that you know is false or deliberately misleading, and it affects whether or not you can enroll in UPMC for Life.
  
  
• If you behave in a way that is disruptive to the extent that your continued enrollment seriously impairs our ability to arrange or provide medical care for you or for others who are members of UPMC for Life. We cannot make you leave UPMC for Life for this reason unless we get permission first from the Centers for Medicare & Medicaid Services, the government agency that runs Medicare.
  
  
• If you let someone else use your plan membership card to get medical care. If you are disenrolled for this reason, CMS may refer your case to the Inspector General for additional investigation.
  
  
• If you do not pay the plan premiums, as applicable, we will tell you in writing that you have a 90-day grace period during which you can pay the plan premiums before you are required to leave UPMC for Life.
  
  

  UPMC_06_296 (03/2006)

Last Updated 12_20_2007