SECTION 1: Our plan must honor your rights as a member of the plan
ᎤᏓᏡᎬ 1.1: ᏂᎦᏛᏉ ᎠᏎ ᎠᏓᏁᎳᏁᏗ ᎧᏃᎮᏢᎥᏍᎩ ᎾᎿᎢ ᏳᎵᏍᏙᏗ ᎾᏍᎩᎾᎢ ᏧᏂᎸᏫᏍᏓᏁᏗ ᎾᏍᎩᎾ ᏂᎯ (ᎾᎿᎢ ᏧᏂᏬᏂᎯᏍᏗ ᏐᎢ ᏏᏃ ᎩᎵᏏ, ᎠᏓᏁᏟᏴᏍᎩ ᏱᏗᎬᏁᏗᎢ, ᏐᎢ ᏧᏠᏯ.)
To get information from us in a way that works for you, please Contact Us.
ᎣᎦᏤᎵ ᎠᏍᏓᏩᏛᏍᏗ ᏄᏍᏓ ᎦᏬᏂᎯᏍᏗ ᎠᎾᏁᏢᏗᏍᎩ ᎢᏗᏓᏛᏁᏗ ᎠᏛᏅᎢᏍᏔᏅ, ᎤᎿᎢ Ꮭ ᏧᎬᏩᎶᏗ ᏱᎩ, ᎾᎢ ᎦᏬᎯᎵᏴᏍᎬ ᏗᏛᏛᎲᏍᎩ ᎾᏍᎩᎾ ᎥᏝ-ᎩᎵᏏ ᎠᏂᏬᏂᏍᎩ ᏂᎨᏒᎾ ᎠᏁᎳ. ᏂᎦᏛᏉ ᎾᏍᏊ ᎣᎩᎭ ᎠᏛᏅᎢᏍᏔᏅ ᎾᎿᎢ ᏗᎦᏬᏂᎯᏍᏗ ᏐᎢ ᏏᏃ ᎩᎵᏏ ᎾᏍᎩᎾᎢ ᎨᏒ ᎤᏂᎸᏫᏔᏅᎩ ᎾᎿᎢ ᎾᏍᎩ ᏗᏍᏓᏩᏛᏍᏗ ᎤᏂᎲ ᎢᏯᏓᏛᏁᏗ ᎢᎬᎾᏕᎾ. ᏂᎦᏛᏉ ᏰᎵᏊ ᎾᏍᏊ ᏱᏨᎥᏍᏏ ᎧᏃᎮᏢᎥᏍᎩ ᎾᎿᎢ ᎠᏓᏁᏟᏴᏍᎩ ᏱᏗᎬᏁᏗ ᎥᎿᎢ ᏂᎯ ᏣᏚᎵᏓ. ᎢᏳᏃ ᏂᎯ ᎨᏒᎢ ᏣᎦᏓᏂᎸᏨᎢ ᎾᏍᎩᎾ Medicare ᏅᏗᎦᎵᏍᏙᏗᏍᎬ ᎥᎿᎢ ᎾᏍᎩ ᎠᏓᏲᏍᏓᏁᎯ ᎠᏓᏅᏏᏓᏍᏗᎢ, ᏂᎦᏛᏉ ᎨᏒᎢ ᎠᏎᏯᏛᏁᏗ ᎾᎢ ᏣᏁᎰᎢ ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ ᎾᏍᎩ ᏗᏍᏓᏩᏛᏍᏗ ᎤᏂᎲ ᏧᎾᎵᏍᏕᎸᏙᏗ ᎾᏍᎩᎾᎢ ᏅᏛᏴᏍᏙᏗᎢ ᎠᎴ ᏚᏳᎪᏛᎢ ᎾᏍᎩᎾ ᏂᎯ.
If you have any trouble getting information from our plan because of problems related to language or disability, please call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week, and tell them that you want to file a complaint. TTY users call 1-877-486-2048.
ᎤᏓᏡᎬ 1.2: ᏂᎦᏛᏉ ᎠᏎᎢ ᎢᏨᏅᏬᏗ ᎬᏗ ᏙᏳ ᏚᏳᎪᏛᎢ, ᏗᏓᏂᎸᏍᏗ, ᎠᎴ ᎠᏢᏉᏙ ᎤᎿᎢ ᏂᎦᎥ ᎢᎸᎯᏳᎢ
ᎣᎦᏤᎵ ᎠᏍᏓᏩᏛᏍᏗ ᎠᏎ ᏦᎯᏳᏗ ᏗᎧᎿᏩᏛᏍᏗ ᎾᏍᎩᎾᎢ ᎠᎵᏍᏕᎸᏙᏗ ᏂᎯ ᎾᏍᎩᎾ ᎤᎾᏞᏴᏓ ᎠᎴᏃ ᏂᏚᏳᎪᏛᎾ ᎤᎾᏓᏅᏬᏗ.
ᏂᎦᏛᏉ ᎥᏝ ᎤᎾᏞᏴᏓ ᏓᎳᏏᏔᏅᎩ ᎤᎾᎢ ᎾᏍᎩ ᎠᏴᏫ ᏄᏍᏛ ᎾᏍᎩ ᎢᏳᏍᏗ ᏴᏫ, ᏴᏫ ᎠᏰᎵ ᏄᎾᏛᏅᎢ, ᎠᏰᎵ ᏂᏓᏳᎾᏓᎴᏅᎩ, ᏧᏁᎸᏗ, ᎠᎨᏯ ᎠᎴ ᎠᏍᎦᏯ, ᎢᏳᏕᏘᏴᏓ, ᎤᎾᏓᏅᏖᏗ ᎠᎴᏃ ᎠᏰᎸ ᏧᏓᏂᎳ, ᏅᏩᏙᎯᏯᏛ ᏄᏍᏗᏓᏅᎢ, ᎯᏔᏲᎯᎲ ᏣᏤᎵᎢ ᎤᎦᏙᎲᏒ, ᏅᏬᏘᏲᎢ ᏂᏧᎵᏍᏔᏅᏒ, ᏧᏓᎴᏅᎲ ᎤᏓᏰᎶᏒᎢ ᎧᏃᎮᏢᎥᏍᎩ, ᏗᎳᏏᏙᏗ ᎥᎿᎢ ᎦᏰᎫᏓᎸᏓ ᎨᏒᎢ, ᎠᎴ ᎡᎶᎯ ᏄᏍᏗᏓᏅᎢ ᎤᏙᏢᏒᎢ ᎠᏫᏂᏗᏢ ᎯᎠ ᎢᏯᏓᏛᏁᏗ ᎢᎬᎾᏕᎾ.
If you want more information or have concerns about discrimination or unfair treatment, please call the Department of Health and Human Services Office for Civil Rights 1-800-368-1019 (TTY 1-800-537-7697) or your local Office for Civil Rights.
If you have a disability and need help with access to care, please Contact Us. If you have a complaint, such as a problem with wheelchair access, Member Services can help.
ᎤᏓᏡᎬ 1.3: ᏂᎦᏛᏉ ᎠᏎ ᎪᎯᏳᏙᏓ ᎾᏍᎩᎾᎢ ᏂᎯ ᎠᎩᏍᏗ ᎩᎳᏈᏴ ᎠᏟᎢᎵᏒ ᎠᏴᏍᏗ ᎾᎢ ᏣᏤᎵ ᎠᏚᏓᎸᏙᏗ ᎢᏗᏓᏛᏁᏗ ᎠᎴ ᏗᎩᏍᏗ ᏧᏴᏍᏗ
As a member of our plan, you have the right to choose a Primary Care Provider (PCP) in the plan’s network to provide and arrange for your covered services (The EOC explains more about this). Contact Us to learn which doctors are accepting new patients. You also have the right to go to a women’s health specialist (such as a gynecologist) without a referral.
ᎾᏍᎩ ᎠᏍᏓᏩᏛᏍᏗ ᎨᎵ, ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᏗᏣᎩᏍᏗ ᏚᏂᏒᏍᏔᏅᎩ ᎠᎴ ᎠᏚᏓᎸᏙᏗ ᎢᏗᏓᏛᏁᏗ ᎾᏍᎩᎾ ᎠᏍᏓᏩᏛᏍᏗ ᏚᏂᎲ ᏧᎾᏚᏓᎵ ᎥᎿᎢ ᏗᎾᏓᏁᏢᏍᎩᎠᏫᏂᏗᏢ ᏄᎶᏒᏍᏛᎾ ᎢᎦᎢ ᎨᏒᎢ ᎥᎿᎢ ᎠᏟᎢᎵᏒ. ᎯᎠ ᏓᏠᏯᏍᏗ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᏣᎩᏍᏗ ᎩᎳᏈᏴ ᎠᏟᎢᎵᏒ ᎢᏗᏓᏛᏁᏗ ᎾᏍᎩᎾ ᏗᏏᎾᏍᏛ ᎾᏳᎢ ᎤᏚᎸᏛ ᎾᏍᎩᎾᎢ ᎠᎦᏎᏍᏙᏗ. ᏂᎯ ᎾᏍᏊ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᏣᎩᏍᏗ ᏣᏤᎵ ᏗᏓᏅᏍᏙᏗ ᏅᏬᏘᏱᏛᎧᎵᏣ ᎠᎴᏃ ᏱᏙᎯᎧᎵᏏᏌ ᏂᎦᎥᏉ ᎥᎿᎢ ᎣᎦᏤᎵ ᏧᎾᏚᏓᎵ ᏅᏬᏘ ᏧᏃᏢᏗᎢ ᏄᏠᏯᏍᏛᎾ ᎪᎯᏓ ᏗᏙᎯᏗᏍᏗ ᏂᎨᏒᎾ.
If you think that you are not getting your medical care or Part D drugs within a reasonable amount of time, your EOC tells what you can do. If we have denied coverage for your medical care or drugs and you don’t agree with our decision, your EOC tells what you can do.
ᎤᏓᏡᎬ 1.4: ᏂᎦᏛᏉ ᎠᏎ ᎠᎵᏍᏕᎸᏙᏗ ᎾᏍᎩ ᎤᏕᎵᏓ ᎥᎿᎢ ᏣᏤᎵ ᎠᏏᏴᏫ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ
ᏩᏥᏂ ᎠᎴ ᏍᎦᏚᎩ ᏗᎧᎿᏩᏛᏍᏗ ᎾᏍᎩ ᎤᏕᎵᏓ ᎾᎿᎢ ᏣᏤᎵ ᏅᏬᏘᏲᎢ ᏗᎪᏪᎳᏅᎯ ᎠᎴ ᎠᏏᏴᏫ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ. ᏂᎦᏛᏉ ᎠᎵᏍᏕᎸᏙᏗ ᏣᏤᎵ ᎠᏏᏴᏫ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ ᎾᏍᎩ as ᎠᏎᏯᏛᏁᏗ ᎬᏗ ᎯᎠᏃ ᏗᎧᎿᏩᏛᏍᏗ.
ᏣᏤᎵ ᎠᏏᏴᏫ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ (PHI) ᏗᏠᏯᏍᏗ ᎾᏍᎩ ᎠᏏᏴᏫ ᎧᏃᎮᏢᎥᏍᎩ ᏂᎯ ᏥᏍᎩᏁᎸᎩ ᎾᏳᎢ ᏂᎯ ᏥᏦᏪᎳᏅ ᏕᏣᏙᎥ ᎾᎿᎢ ᎯᎠ ᎠᏍᏓᏩᏛᏍᏗ, ᏣᏤᎵ ᏅᏬᏘᏲᎢ ᏗᎪᏪᎳᏅᎯ, ᎠᎴ ᏐᎢ ᏅᏬᏘᏲᎢ ᎠᎴ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ.
ᎾᏍᎩᏃ ᏗᎧᎿᏩᏛᏍᏗ ᎾᏍᎩᎾᎢ ᎠᎵᏍᏕᎸᏙᏗ ᏣᏤᎵ ᎤᏕᎵᏓ ᏣᏁᎰᎢ ᏄᏓᎴᏒ ᏗᏣᏤᎵᎦᏯ ᏧᏠᏱ ᎾᎢ ᎥᏍᎩᎬᎢ ᎧᏃᎮᏢᎥᏍᎩ ᎠᎴ ᏓᏓᏘᏂᏒ ᏰᎵᎢ ᏣᏤᎵ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ ᎾᏍᎩ ᎬᏔᏂᏓᏍᏗ. ᏂᎯ ᎢᏨᏅᏁ ᎪᏪᎳᏅᎯ ᎠᏓᏃᎯᏎᎯ, ᎾᏍᎩ ᏧᏙᎢᏛ “ᎠᏓᏃᎯᏎᎯ ᎥᎿᎢ ᎤᏕᎵᏓ ᎾᎾᏛᏁᎵᏙᎲᎢ,” ᎾᏍᎩᎾᎢ ᏕᎪᏏᏏ ᎯᎠᏃ ᏄᏓᎴᏒ ᎤᎾᏤᎵᎦᏯ ᎠᎴ ᏰᎵ ᎠᎵᏍᏕᎸᏙᏗ ᎾᏍᎩ ᎤᏕᎵᏓ ᎥᏄᎢ ᏣᏤᎵ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ.
ᏙᎡᎵ ᏱᏙᏥᏍᏕᎳ ᎾᏍᎩ ᎤᏕᎵᏓ ᎾᎿᎢ ᏣᏤᎵ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ?
ᏙᏳᎢ ᏚᏳᎪᏛ ᏳᎵᏍᏙᏗ ᏃᏨᏁᎰᎢ ᎾᏍᎩᎾᎢ ᎤᎾᎵᏍᎪᎸᏓᏁᎸ ᏂᎨᏒᎾ ᎠᏂᏴᏫ ᎥᏝ ᏯᎪᏩᏘᎭ ᎠᎴᏃ ᎦᏁᏟᏴᏓ ᏣᏤᎵ ᏗᎪᏪᎳᏅᎯ.
ᎾᎿᎢ ᏭᎪᏛᏃ ᏂᏚᏍᏗᏓᏅᎢ, ᎢᏳᏃ ᏱᏣᏁᎳ ᏣᏤᎵ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ ᎾᎢ ᏂᎦᎵᏍᏗᏊ ᎨᏒᎢ ᎾᏍᎩᎾᏃ ᏝᏰᏃ ᏱᎨᏣᏓᏁᎸᏓᏁᎭ ᏣᏤᎵ ᎾᏍᎩ ᎠᎦᏎᏍᏙᏗ ᎠᎴᏃ ᎠᏈᏰᏍᎩ ᎾᏍᎩᎾ ᏣᏤᎵ ᎠᎦᏎᏍᏙᏗ, ᏂᎦᏛᏉ ᎨᏒ ᎠᏎᏯᏛᏁᏗ ᎾᎢ ᎦᏁᏍᏗ ᎠᏓᎵᏍᎪᎸᏓᏁᎯ ᎪᏪᎳᏅᎯ ᏂᏓᏳᏓᎴᏅ ᏂᎯ ᎠᎬᏱ. ᎠᏓᎵᏍᎪᎸᏓᏁᎯ ᎪᏪᎳᏅᎯ ᏰᎵᏊ ᎨᏣᏓᏁᏗ ᎾᏃ ᎠᎴᏃ ᎾᏃ ᎩᎶᎢ ᏂᎯ ᎾᏍᎩ ᎯᏁᎸᎩ ᏚᏳᎪᏛ ᏓᎳᏏᏔᏅ ᏍᏕᎸᏗᎢ ᎾᏍᎩ ᏂᎯ ᏣᏓᏅᏖᏟᏓᏁᎯ ᎨᏒᎢ.
ᎾᏂᎠ ᏑᏓᎴᎩ ᎾᏍᎩ ᏧᏩᏌ ᎾᏍᎩᎾᎢ ᎥᏝ ᏲᎦᏛᏁᏗ ᏱᎩ ᎾᎢ ᏫᎦᏁᏍᏗ ᎠᏓᎵᏍᎪᎸᏓᏁᎯ ᎪᏪᎳᏅᎯ ᎠᎬᏱ. ᎯᎠᏃ ᎾᏍᎩ ᏧᏩᏌ ᎨᏒ ᎠᎵᏍᎪᎸᏔᏅ ᎠᎴᏃ ᎢᏯᏛᏁᏗ ᎬᏗ ᏗᎧᎾᏩᏛᏍᏗ. ᎾᏍᎩᎾ ᏗᏟᎶᏍᏔᏅᎢ, ᏂᎦᏛᏉ ᎨᏒᎢ ᎠᏎᏯᏛᏁᏗ ᎾᎢ ᏓᏲᎯᏍᏒ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ ᎾᎢ ᎠᏰᎵ ᎤᏙᏢᏒᎢ ᏗᏂᎦᏘᏲᎢ ᎾᏍᎩᎾᎢ ᎨᏒᎢ ᎠᎪᎵᏰᎠ ᎤᏍᎩ ᎢᏲᏍᏓ ᎥᎿᎢ ᎠᎦᏎᏍᏙᏗ.
ᏅᏗᎦᎵᏍᏙᏗᏍᎬ ᏂᎯ ᎨᏒᎢ ᎨᎵ ᎥᎿᎢ ᎣᎦᏤᎵ ᎠᏍᏓᏩᏛᏍᏗ ᏭᎵᏍᏗ Medicare, ᏂᎦᏛᏉ ᎨᏒᎢ ᎠᏎᏯᏛᏁᏗ ᎾᎢ ᎠᏓᏕᎮᏍᏗ Medicare ᏣᏤᎵ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ ᎤᏠᏯᏍᏗ ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ ᏣᏤᎵ ᎤᏓᏡᎬ D ᎠᏓᏅᏍᏙᏗ ᏗᎩᏍᏗ ᏧᏴᏍᏗ. ᎢᏳᏃ Medicare ᏗᏲᏍᏒ ᏣᏤᎵ ᎠᎧᎮᏢᎥᏍᎩ ᎾᏍᎩᎾ ᎤᏂᎦᏛᏂᏙᎸᎢ ᎠᎴᏃ ᏐᏒ ᏗᎬᏔᏂᏓᏍᏗ, ᎯᎠ ᎠᏍᏆᏛᎢ ᎨᏎᏍᏗ ᏚᎾᏙᎵᏤᎲ ᎾᎢ ᏩᏥᏂ ᏗᎧᎿᏩᏛᏍᏓ ᎠᎴ ᏧᎾᎳᏏᏙᏓ.
ᏂᎯ ᏰᎵᏊ ᎠᎪᏩᏛᏗ ᎾᏍᎩ ᎧᏃᎮᏢᎥᏍᎩ ᎾᎿᎢ ᏣᏤᎵ ᏗᎪᏪᎳᏅᎯ ᎠᎴ ᏣᏖᏍᏗ ᏰᎵ ᏄᎵᏍᏔᏅ ᎠᏯᏙᏢ ᎤᏠᏯᏍᏗ ᎠᏂᏐᎢ
ᏂᎯ ᏣᎭ ᏣᏤᎵᎦᏯ ᎾᎢ ᏗᎧᏃᎢ ᎤᎿᎢ ᏣᏤᎵ ᏅᏬᏘᏲᎢ ᏗᎪᏪᎳᏅᎯ ᏚᎾᏒᎦᏢᎢ ᎤᎿᎢ ᎠᏍᏓᏩᏛᏍᏗ, ᎠᎴ ᎾᎢ ᏣᏁᏍᏗ ᏗᏟᏩᏍᏔᏅᎯ ᎥᎿᎢ ᏣᏤᎵ ᏗᎪᏑᎳᏅᎯ. ᏂᎦᏛᏉ ᎨᏒᎢ ᎠᎵᏍᎪᎸᏔᏅ ᎾᎢ ᏗᏨᎪᏩᎳᏁᏗ ᎠᏈᏴᏗ ᎾᏍᎩᎾ ᏚᏣᏟᎶᏍᏗᏍᎬ ᏕᏦᏢᏍᎬᎢ. ᏂᎯ ᎾᏍᏊ ᏣᎭ ᏣᏤᎵᎦᏯ ᎾᎢ ᏱᏍᎩᏯᏛᏛᏂ ᎾᎢ ᎢᏗᎬᏁᏗ ᏗᎦᏟᏌᏅᎯ ᎠᎴᏃ ᏓᏃᏢᎯᏏᏍᎬ ᎾᎢ ᏣᏤᎵ ᏅᏬᏘᏲᎢ ᏗᎪᏪᎳᏅᎯ. ᎢᏳᏃ ᏂᎯ ᏱᏍᎩᏯᏛᏛᏂ ᎾᎢ ᎯᎠ ᏱᎬᏁᏗᎢ, ᏂᎦᏛᏉ ᎠᏎ ᏱᏙᎩᎸᏫᏍᏓᏏ ᎬᏗ ᏣᏤᎵ ᏅᏩᏙᎯᏯᏛ ᎠᎦᏎᏍᏙᏗ ᎠᏓᏁᏢᏍᎩ ᎾᎢ ᏗᎫᎪᏙᏗ ᎾᏍᏊᏃ ᎾᏍᎩ ᏗᎦᏁᏟᏴᏍᏗ ᎡᎵᏍᏗ ᎾᏍᎩ ᏱᎬᏁᏗ.
ᏂᎯ ᏣᎭ ᏣᏤᎵᎦᏯ ᎾᎢ ᏣᏖᏍᏗ ᏰᎵ ᏣᏤᎵ ᏅᏩᏙᎯᏯᏛ ᎧᏃᎮᏢᎥᏍᎩ ᏄᎵᏍᏔᏅ ᎠᏯᏙᏢ ᎤᏠᏯᏍᏗ ᎠᏂᏐᎢ ᎾᏍᎩᎾ ᏂᎦᎥ ᏧᎬᏩᎵ ᎾᏍᎩᎾᎢ ᎨᏒᎢ Ꮭ ᎤᏩᎪᏘᎶᏛ ᏱᎩ.
If you have questions or concerns about the privacy of your personal health information, please Contact Us.
ᎤᏓᏡᎬ 1.5: ᏂᎦᏛᏉ ᎠᏎ ᎢᏨᏁᏗ ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ ᎾᏍᎩ ᎠᏍᏓᏩᏛᏍᏗ, ᎾᏍᎩ its ᏧᎦᏚᏓᎵ ᎥᎿᎢ ᏗᎾᏓᏁᏢᏍᎩ, ᎠᎴ ᏣᏤᎵ ᎠᏚᏓᎸᏙᏗ ᎢᏗᏓᏛᏁᏗ ᎠᎴ ᏣᏤᎵ ᏄᏓᎴᏒ ᎤᎾᏤᎵᎦᏯ ᎠᎴ ᏕᎭᏚᏓᎸᎲᏍᎬᎢ
ᎾᏍᎩ ᎨᎵ ᎥᎿᎢ ᎣᎦᏤᎵ ᎠᏍᏓᏩᏛᏍᏗ, ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᏗᏣᏕᏍᏗ ᎢᎸᏍᎩ ᏧᏓᎴᏅᏓ ᎥᎿᎢ ᎧᏃᎮᏢᎥᏍᎩ ᎣᎩᎪᏓ ᏂᏓᏳᏓᎴᏅᎲᎢ. ᎾᏍᎩ ᏚᏬᏏᏌᏅ ᎾᎿᎢ ᎤᏓᏡᎬ 1.1, ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᏣᎩᏍᏗ ᎧᏃᎮᏢᎥᏍᎩ ᎣᎩᎪᏓ ᏂᏓᏳᏓᎴᏅᎲᎢ ᎾᎿᎢ ᏳᎵᏍᏙᏗ ᎾᏍᎩᎾᎢ ᏧᎸᏫᏍᏓᏁᏗ ᏂᎯ ᏍᏕᎵᏍᎩ. ᎯᎠ ᏗᏠᏯᏍᏗ ᏛᎩᏍᎬᎩ ᎾᏍᎩ ᎧᏃᎮᏢᏍᎩ ᎾᎿᎢ ᏗᎦᏬᏂᎯᏍᏗ ᏐᎢ ᏏᏃ ᎩᎵᏏ ᎠᎴ ᎾᎿᎢ ᎠᏓᏁᏟᏴᎩ ᏱᏗᎬᏁᏗᎢ.
If you want any of the following kinds of information, please Contact Us:
- ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛᎢ ᎣᎦᏤᎵ ᎠᏍᏓᏩᏛᏍᏗ. ᎯᎠ ᏓᏠᏯᏍᏗ, ᎾᏍᎩᎾ ᏱᏓᏟᎶᏍᏔᎾ, ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ ᎾᏗᎩ ᏗᏍᏓᏩᏛᏍᏗ ᏚᏂᎲ ᎠᏕᎸ ᏄᎾᏍᏛ ᏄᏍᏗᏓᏅᎢ. ᎾᏍᎩ ᎾᏍᏊ ᎤᏠᏯᏍᏗ ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ ᎾᏍᎩ ᎠᏎᏍᏗ ᎥᎿᎢ ᏧᏂᏔᎲᏍᏗ ᎪᏢᏅᎢ ᎬᏗ ᎠᏁᎳ ᎠᎴ ᎾᏍᎩ ᎠᏍᏓᏩᏛᏍᏗ ᏄᏍᏛ ᏚᎸᏫᏍᏓᏁᎲᎢ ᎢᎦᎢ ᏧᏂᏅᏅᎢ, ᎤᏠᏯᏍᏗ ᎾᏍᎩ ᏄᎵᏍᏔᏅ ᎠᏟᎶᏓ ᎬᏗ ᎠᏍᏓᏯᏛᏍᏗ ᎠᏁᎳ ᎠᎴ ᏰᎵᎢ ᎾᏍᎩ ᏧᏠᏱᎭᎢ ᎾᎢ ᏐᎢ Medicare ᏅᏩᏙᎯᏯᏛ ᏗᏍᏓᏩᏛᏍᏗ.
- ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ ᎣᎦᏤᎵ ᏧᎾᏚᏓᎵ ᏓᎾᏓᏁᏢᏍᎬᎢ ᏓᏠᏯᏍᏛᎢ ᎣᎦᏤᎵ ᏧᎾᏚᏓᎵ ᏅᏬᏘ ᏧᏂᏍᏆᏂᎪᏙᏗᎢ.
- ᎾᏍᎩᎾ ᏱᏓᏟᎶᏍᏔᎾ, ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᎠᎩᏍᏗ ᎧᏃᎮᏢᎥᏍᎩ ᎠᏯᏃᎬᏅ ᏂᏓᏳᏓᎴᏅᎢ ᏄᏰᎵᏛ ᎾᏍᎩ ᏧᏂᎸᏫᏍᏓᏁᏗ ᎨᏒ ᎾᎢ ᎾᏍᎩ ᏗᎾᏓᏁᏢᏍᎩ ᎠᎴ ᏅᏬᏘ ᏧᏃᏢᏗᎢ ᎾᎿᎢ ᎣᎦᏤᎵ ᏧᎾᏚᏓᎵ ᎠᎴ ᏰᎵ ᏂᎦᏛᏉ ᎠᏈᏗ ᎾᏍᎩ ᏗᎾᏓᏁᏢᏍᎩ ᎾᎿᎢ ᎣᎦᏤᎵ ᏧᎾᏚᏓᎵ.
- ᎾᏍᎩᎾ ᏕᎦᏅᏛᎢ ᎾᏍᎩ ᏓᎾᏓᏁᏢᏍᎬᎢ ᎠᎴ ᏅᏬᏘ ᏧᏂᏍᏆᏂᎪᏙᏗᎢ ᎾᎿᎢ ᎾᏍᎩ ᏗᏍᏓᏩᏛᏍᏗ ᏚᏂᎲ ᏧᎾᏚᏓᎵ, ᎠᎪᏩᏛᏗ ᎾᏍᎩ ᎠᏓᏁᏢᏍᎩ & ᏅᏬᏘ ᎤᏂᏍᏆᏂᎪᏙᏗ ᎠᏓᏎᎮᎯ.
- For more detailed information about our providers or pharmacies, you can Contact Us.
- ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ ᏣᏤᎵ ᏣᏚᏓᎸᏛᎢ ᎠᎴ ᎾᏍᎩ ᏣᏂᎧᎾᏩᏛᏍᏗ ᏂᎯ ᎠᏎ ᎠᏍᏓᏩᏛᏍᏗ ᎾᏳᎢ ᎬᏗᏍᎬᎢ ᏣᏤᎵ.
- In your EOC, we explain what medical services are covered for you, any restrictions to your coverage, and what rules you must follow to get your covered medical services.
- Refer to your EOC to get the details on your Part D prescription drug coverage plus the plan's List of Covered Drugs (Formulary). The EOC, together with the List of Covered Drugs (Formulary), tell you what drugs are covered and explain the rules you must follow and the restrictions to your coverage for certain drugs.
- ᏂᎦᏛᏉ ᏫᏙᎦᎦᎾᏅᎩ ᎤᎿᎢ ᎢᏤ ᎠᎦᏙᎲᏒᎩ ᎾᎯᏳ ᏗᏔᏲᏢᎩ ᎬᏗ ᎨᎵ. ᎾᏍᎩᏃ ᏗᏩᏛᏗ ᎨᏒᎢ ᏗᎪᎵᏰᏓ ᏂᏓᏕᏘᏴᎯᏒᎢ ᎾᎢ ᏗᎫᎪᏙᏗ ᏰᎵ ᎢᏤ ᏗᏌᎳᏙᏗ ᏰᎵᏊ ᎨᏒ ᎠᏠᏯᏍᏔᏅ ᎾᎿᎢ ᎾᏍᎩ ᏧᎾᎵᏍᏕᎸᏙᏗ ᎾᏍᎩᎾᎢ ᎠᏁᎳ ᎠᎩᏍᏗ, ᎾᎢ ᏙᏳᎢ ᏚᏳᎪᏛ ᎨᏎᏍᏗ ᎾᏍᎩᎾᎢ ᎠᏁᎳ ᎤᏂᎮᏍᏗ ᏚᏳᎪᏛ ᎠᏴᏍᏗ ᎾᎢ ᏂᎦᎾᏰᎬᎾ ᎠᎴ ᎢᏳᎵᏍᏙᏗᏱ ᎠᎦᏎᏍᏙᏗ, ᎠᎴ ᎾᎢ ᏙᏳᎢ ᏚᏳᎪᏛ ᎨᏎᏍᏗ ᎾᏍᎩᎾᎢ ᏂᎦᏛᏉ ᎨᏒᎢ ᎯᎦᏔᎲᎢ ᎥᎿᎢ ᏗᎦᏁᏟᏴᏓ ᎾᎿᎢ ᎾᏍᎩ ᏗᎦᎸᏫᏍᏓᏁᏗ. ᎢᏤ ᎠᎦᏙᎲᏒᎩ ᏰᎵᏉ ᎠᏠᏯᏍᏓ ᎠᏓᏅᏖᏗ ᏯᏛᏁᏗ ᏅᏩᏙᎯᏯᏛ ᏧᎾᏓᎯᎸᏍᏗ, ᏅᏬᏘᏲᎢ ᏥᏂᏕᎬᏅᏗᏓᎾ, ᏅᏬᏘᏲᎢ ᏧᎾᏓᎯᎸᏍᏗ, ᎠᎴ ᎠᎩᏍᏗ ᎤᏴᏍᏗ ᏗᎬᏙᏗ, ᎾᏍᎩᎾ ᏱᏓᏟᎶᏍᏔᎾ.
- If you have questions about the rules or restrictions, please Contact Us.
- ᎧᏃᎮᏢᎥᏍᎩ ᎦᏙᏃ ᏄᏰᎵᏛ ᎪᎱᏍᏗ ᎾᏍᎩ Ꮭ ᏅᏚᏓᎸᎾ ᎠᎴ ᎦᏙᎤᏍᏗ ᏂᎯ ᏰᎵᏊ ᎪᎱᏍᏗ ᏱᎨᏣᏛᏗ ᏄᏰᎵᏛᎢ.
- ᎢᏳᏃ ᎾᏍᎩ ᏅᏬᏘᏲᎢ ᎢᏯᏓᏛᏁᏗ ᎠᎴᏃ ᎤᏓᏡᎬ D ᎠᎩᏍᏗ ᎤᏴᏍᏗ Ꮭ ᏅᏚᏓᎸᎾ ᏍᎾᎩᎾ ᏂᎯ , ᎠᎴᏃ ᎢᏳᏃ ᏣᏤᎵ ᏣᏚᏓᎸᏛᎢ ᎾᏍᎩ ᎠᏓᎨᏗᏍᎩ ᎾᎿᎢ ᎢᎦᏓ ᏳᎵᏍᏙᏗ, ᏂᎯ ᏰᎵᏊ ᏱᏍᎩᏯᏛᏛᎯ ᎾᏍᎩᎾ ᎪᏪᎳᏅᎯ ᏗᎪᏏᏌᏅ. ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᎯᎠ ᏗᎪᏏᏌᏅ ᎥᏍᏊ ᎢᏳᏃ ᏂᎯ ᏱᏣᏁᏏ ᎾᏍᎩ ᏅᏬᏘᏲᎢ ᎢᏯᏓᏛᏁᏗ ᎠᎴ ᎠᎩᏍᏗ ᎤᏴᏍᏗ ᏂᏓᏳᏓᎴᏅᏓ ᎾᏍᎩ ᏙᏯᏗᏢ-ᎥᎿᎢ-ᏧᎾᏚᏓᎵ ᎠᏓᏁᏢᏍᎩ ᎠᎴᏃ ᏅᏬᏘ ᎤᏂᏍᏆᏂᎪᏙᏗ.
- If you are not happy or if you disagree with a decision we make about what medical care or Part D drug is covered for you, you have the right to ask us to change the decision. You can ask us to change the decision by making an appeal. For details on what to do if something is not covered for you in the way you think it should be covered, refer to your EOC. It gives you the details about how to make an appeal if you want us to change our decision. (it also tells about how to make a complaint about quality of care, waiting times, and other concerns.)
- If you want to ask our plan to pay a bill you have received for medical care or a Part D prescription drug, see refer to your EOC.
ᎤᏓᏡᎬ 1.6: ᏂᎦᏛᏉ ᎠᏎ ᎦᎫᏍᏛᏓ ᏣᏤᎵ ᏣᏤᎵᎦᏯ ᎾᎢ ᏕᏧᎪᏔᏅᎢ ᏄᏰᎵᏛ ᏣᏤᎵ ᎠᎦᏎᏍᏙᏗ
ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᏣᏅᏖᏍᏗ ᏣᏤᎵ ᎤᎾᏓᏅᏬᏗ ᏗᏲᏰᏍᏗ ᎠᎴ ᎨᎳᏗᏓᏍᏗ ᎾᎿᎢ ᏕᏧᎪᏔᏅᎩ ᏕᏧᎪᏔᏅᎢ ᏄᏰᎵᏛ ᏣᏤᎵ ᏅᏩᏙᎯᏯᏛ ᎠᎦᏎᏍᏙᏗ
ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᎧᎵᎢ ᏣᎩᏍᏗ ᎧᏃᎮᏢᎥᏍᎩ ᎾᏍᎩᎾ ᏣᏤᎵ ᎠᏂᎦᎾᎦᏘ ᎠᎴ ᏐᏱ ᏅᏩᏙᎯᏯᏛ ᎠᎦᏎᏍᏙᏗ ᏗᎾᏓᏁᏢᏍᎩ ᎾᎯᏳ ᏂᎯ ᎮᏒᎢ ᎾᏍᎩᎾ ᏅᏬᏘᏲᎢ ᎠᎦᏎᏍᏙᏗ. ᏣᏤᎵ ᏗᎾᏓᏪᏢᏍᎩ ᎠᏎ ᏗᎪᏏᏐᏗ ᏣᏤᎵ ᏅᏬᏘᏲᎢ ᏄᏍᏗᏓᏅᎢ ᎠᎴ ᏣᏤᎵ ᎤᎾᏓᏅᏬᏗ ᏗᏑᏰᏛ ᎾᎿᎢ ᎾᏍᎩ ᏳᎵᏍᏙᏗ ᎾᏍᎩᎾᎢ ᏣᏤᎵ ᎨᏦᎵᏍᏗ.
ᏂᎯ ᎾᏍᏊ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᎧᎵᎢ ᏤᎳᏗᏓᏍᏗ ᎾᎿᎢ ᏕᏧᎪᏔᏅᎢ ᏄᏰᎵᏛ ᏣᏤᎵ ᎤᏩᏙᎯᏯᏛ ᎠᎦᏎᏍᏙᏗ. ᎾᎢ ᏥᏕᎵᏍᎩ ᏕᎱᎪᏗᏍᎬᎢ ᎤᏠᏯᏍᏗ ᏣᏤᎵ ᎠᏂᎦᎾᎦᏘ ᏄᏰᎵᏛ ᎢᏳᏍᏗ ᏫᏓᏤᏢ ᎤᎾᏓᏅᏬᏗ ᏂᎯ ᎤᎬᏩᎵ, ᏣᏤᎵ ᏄᏓᎴᏒ ᏗᏣᏤᎵᎦᏯ ᎤᏠᏯᏍᏗ ᎾᏍᎩ ᎠᏍᏓᏩᏛᏍᏗ:
- To know about all of your choices. This means that you have the right to be told about all of the treatment options that are recommended for your condition, no matter what they cost or whether they are covered by our plan. It also includes being told about programs our plan offers to help manage medications and use drugs safely.
- ᎾᏍᎩ ᏄᏰᎵᏛᎢ ᏂᏕᎦᎾᏰᎬ ᏣᏅᏔᏍᏗ. ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᎡᏣᏃᎯᏎᏗ ᏄᏰᎵᏛ ᏂᎦᎥ ᏂᏕᎦᎾᏰᎬ ᎤᏠᏯᏍᏔᏅ ᎾᎿᎢ ᏣᏤᎵ ᎠᎦᏎᏍᏙᏗ. ᏂᎯ ᎠᏎ ᎡᏣᏃᏎᏗ ᎠᎬᏱᏗᏢ ᎾᏍᎩ ᏂᎦᎥ ᏚᏄᎪᏛᎢ ᏅᏬᏘᏲᎢ ᎠᎦᏎᏍᏙᏗ ᎠᎴᏃ ᎤᎾᏓᏅᏬᏗ ᎾᏍᎩ ᎤᏓᏡᎬ ᎾᎿᎢ ᎤᏂᎦᏙᎲᏒᎩ ᎤᏂᎦᏛᏂᏙᎸᎢ ᎠᎦᏛᏂᏓᏍᏗ. ᏂᎯ ᏂᎪᎯᎸᎢ ᏣᎭ ᎾᏍᎩ ᎠᏑᏰᏍᏗ ᎾᎢ ᎠᏓᏱᏍᏗ ᏂᎦᎥ ᎠᎦᏛᏗ ᏂᎦᎵᏍᏗᏍᎬ ᏗᏓᏅᏬᏙᏗ.
- ᎾᏍᎩᏃ ᏣᏤᎵᎦᏯ ᎾᎢ ᏱᏣᏪᏍᏗ “Ꮭ.” ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᎠᏓᏱᏍᏗ ᏂᎦᎥ ᎦᎸᏉᏔᏅ ᏗᏓᏅᏬᏙᏗ. ᎯᎠ ᏓᏠᏯᏍᏛ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᎠᏂᎩᏍᏗ ᎾᏍᎩ ᏧᏂᏢᎩ ᎨᏥᏍᏆᏂᎪᏙᏗᎢ ᎠᎴᏃ ᏐᎢ ᏅᏬᏘᏲᎢ ᎠᏓᏁᎸᎢ, ᎾᏍᏉᏃ ᎢᏳᏃ ᏣᏤᎵ ᎦᎾᎦᏘ ᏱᏣᏬᏘᎭ ᏣᏂᎩᏍᏗᎢ ᏂᎨᏒᎾ. ᏂᎯ ᎾᏍᏊ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᏧᎳᎪᎢᏍᏗ ᎤᏗᏍᎬ ᏅᏬᏗᏃ. ᎢᏳᏃ ᏂᎯ ᏱᏣᏓᏱᎸ ᎤᎾᏓᏅᏬᏗ ᎠᎴᏃ ᏯᎴᏫᏍᏔᎾ ᎤᎬᏗᏍᎬ ᏅᏬᏘ, ᏂᎯ ᏕᎭᏓᏂᎸᎨᏍᏗ ᎧᎵᎢ ᎠᏚᏓᎸᎥᏍᎬᎢ ᎾᏍᎩᎾ ᎢᏳᏍᏗ ᏂᎬᏩᎵᏍᏙᏗ ᎨᏒᎢ ᎾᎢ ᎯᏰᎸᎩ ᎾᏍᎩ ᏱᎬᏩᎵᏍᏙᏗ.
- To receive an explanation if you are denied coverage for care. You have the right to receive an explanation from us if a provider has denied care that you believe you should receive. To receive this explanation, you will need to ask us for a coverage decision.
ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᏘᏁᏗᎢ ᏗᏓᏕᏲᎲᏍᎩ ᏄᏰᎵᏛ ᎢᏳᏍᏗ ᎾᏍᎩ ᎢᏯᏛᏁᏗ ᎢᏳᏃ ᏂᎯ ᎥᏝ ᏰᎵᎢ ᏗᎨᏧᎪᏙᏗ ᏂᎨᏒᎾ ᏱᎩ ᎾᏍᎩ ᏅᏬᏘᏲᎢ ᏗᏧᎪᏙᏗᎢ ᎾᏍᎩᎾ ᏨᏌ ᎨᏒᎢ
ᎢᏳᏓᎭᏉ ᎠᏂᏴᏫ ᎤᏂᏄᎸᎲᏍᎦ ᎾᎾᎵᏍᏗᏍᎪ ᎾᎢ ᏅᏩᏙᎯᏯᏛ ᎠᎦᏎᏍᏙᏗ ᏧᏄᎪᏔᏂᏗᏍᏗᎢ ᎾᏍᎩᎾ ᎤᏅᏌ ᎨᏒᎢ ᏂᏗᎦᎵᏍᏙᏗᏍᎬ ᎾᎢ ᎪᎱᏍᏗ ᏚᏂᏎᎦᏤᎸ ᎠᎴᏃ ᎤᏢᏲᎵᏍᏗ ᎤᏓᏂᎶᏒᎢ. ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᎢᏳᏍᏗ ᏣᏚᎵᏍᎬᎢ ᎾᎢ ᏳᎵᏍᏙᏗ ᎢᏳᏃ ᏂᎯ ᎨᏒᎢ ᎾᎿᎢ ᏌᏊ ᎥᎿᎢ ᎯᎠᏃ ᏂᏚᏍᏗᏓᏅ. ᎯᎠᏃ ᎦᏛᎦ ᎾᏍᎩᎾᎢ, ᎢᏳᏃ ᏂᎯ ᏱᏣᏚᎵ, ᏂᎯ ᏰᎵᏊ:
- ᎯᎧᎵᏣ ᎾᏍᎩ ᎪᏪᎳᏅᎯ ᎠᎧᎵᏏᏐᏗ ᎾᎢ ᎠᏓᏅᏁᏗ ᎩᎶᎢ ᎾᏍᎩ ᏓᎳᏏᏛᎢ ᎠᎵᏍᎪᎸᏗᏍᎩ ᎾᎢ ᎪᏢᏗ ᏅᏬᏘᏲᎢ ᏧᏚᎪᏔᏅᎢ ᎾᏍᎩᎾ ᏂᎯ ᎢᏳᏃ ᏂᎯ ᎢᎸᎯᏳ ᎡᎵᎢ ᏂᎨᏣᏛᏗ ᏂᎨᏒᎾ ᏱᎩ ᎾᎢ ᏨᏌᏊ ᏗᏧᎪᏙᏗ ᎨᏎᏍᏗ.
- ᏂᎦᏮᎵ ᎠᏂᎦᎾᎦᏘ ᏗᎨᎯᏅᏌ ᎪᏪᎳᏅᎯ ᏗᏓᏕᏲᎲᏍᎩ ᏄᏰᎵᏛ ᏰᎵ ᏂᎯ ᏱᏗᏣᎸᎵᎢ ᎾᎢ ᏧᏂᎸᏫᏍᏓᏁᏗ ᏣᏤᎵ ᏅᏬᏘᏲᎢ ᎠᎦᏎᏍᏙᏗ ᎢᏳᏃ ᏂᎯ ᎡᎵᎢ ᏂᎨᏣᏛᏗ ᏂᎨᏒᎾ ᏱᎩ ᎾᎢ ᏨᏌᏊ ᏗᏧᎪᏙᏗ ᎨᏎᏍᏗ.
ᎾᏍᎩᏃ ᏓᎳᏏᏛᎢ ᏗᎪᏪᎳᏅᎢ ᎾᏍᎩᎾᎢ ᏂᎯ ᏰᎵᏊ ᏣᏙᏗ ᎾᎢ ᏗᏣᏓᏁᏗ ᏣᏤᎵ ᏫᏚᏳᎪᏛᎢ ᎾᎿᎢ ᎠᏱᎸᏛ ᎾᎿᎢ ᎯᎠᏃ ᏂᏚᏍᏗᏓᏅᎢ ᎨᏒᎢ ᏧᏙᎢᏛ “advance directives.” ᎾᏂᎠ ᏧᏓᎴᎿᎢ ᎢᏧᏍᏗ ᎥᎿᎢ ᎠᏱᎸᏛ ᏗᏓᏕᏲᎲᏍᎩ ᎠᎴ ᏧᏓᎴᎿᎢ ᎢᏧᎾᏙᎢᏛ ᎾᏍᎩᎾ ᎢᏯᏂᎢ. ᏗᎪᏪᎳᏅᎢ ᏧᏙᎢᏛ “ᎠᎴᏂᏓᏍᏗ ᎠᎯᏩᏍᏗ ᎪᏪᎵ” ᎠᎴ “ᎠᏓᎵᏍᎪᎸᏗᏍᎩ ᎠᏍᏕᎵᏍᎩ ᎾᏍᎩᎾ ᏅᏩᏙᎯᏯᏛ ᎠᎦᏎᏍᏙᏗ” ᎨᏒᎢ ᏱᏓᏟᎶᏍᏔᎾ ᎥᎿᎢ ᎠᎵᏱᎸᏛ ᏗᏓᏑᏲᎯᏍᎩ.
ᎢᏳᏃ ᏱᏣᏚᎵᎢ ᎾᎢ ᏨᏙᏗ ᎾᏍᎩ ᎠᏱᎸᏛ ᏗᏓᏕᏲᎲᏍᎩ ᎾᎢ ᏂᎯ ᏣᏁᎰᎢ ᏗᏓᏕᏲᎲᏍᎩ, ᎠᏂ ᎾᏍᎩ ᎢᏯᏚᏁᏗᎢ:
- ᎾᏍᎩᏃ ᎠᎧᎵᎢᏍᏗ ᏣᏁᏍᏗ. ᎢᏳᏃ ᏂᎯ ᏱᏣᏚᎵᎢ ᎾᎢ ᏣᎲᎢ ᎾᏍᎩ ᎠᏱᎸᏛ ᎠᏓᏕᏲᎲᏍᎩ, ᏂᎯ ᏰᎵᏊ ᎠᎩᏍᏗ ᎾᏍᎩ ᎠᎧᎵᏏᏐᏗ ᏂᏓᏳᏓᎴᏅ ᏣᏤᎵ ᏗᏘᏲᎯᎯ, ᏂᏓᏳᏓᎴᏅ ᎾᏍᎩ ᎠᏰᎵ ᏧᏂᎸᏫᏍᏓᏁᎯ, ᎠᎴᏃ ᏂᏓᏳᏓᎴᏅ ᎢᎦᏓ ᏗᎦᎸᏫᏍᏓᏁᏗ ᎬᏔᏂᏓᏍᏗ ᏓᏓᎾᏅᎢ. ᏂᎯ ᏰᎵᏊ ᎢᏴᏓᎭᏉ ᎠᎩᏍᏗ ᎠᏱᎸᏛ ᎠᏓᏕᏲᎲᏍᎩ ᎠᎧᎵᏏᏐᏗ ᏂᏓᏳᏓᎴᏅ ᏧᎾᏙᏢᎯ ᎾᏍᎩᎾ ᏓᏂᎰᎢ ᎠᏂᏴᏫ ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ Medicare.
- ᎯᎧᎵᏏᏌ ᎠᎴ ᏕᏣᏙᎥ ᎰᏪᎸᎦ. ᎤᏍᎩ ᎠᏂᏰᎸᏍᎬ ᎥᎿᎢ ᎤᎿᎢ ᏂᎯ ᎯᏁᏍᎬ ᎯᎠ ᎠᎧᎵᏏᏐᏗ, ᎯᏍᏆᏂᎪᏓ ᎾᏍᎩ ᏣᏓᏅᏛᎢ ᎾᏍᎩᎾᎢ ᏓᎳᏏᏛᎢ ᎪᏪᎳᏅᎢ. ᏂᎯ ᎡᎵᏍᏗ ᎭᏓᏅᏖᏗᎢ ᏗᏘᏲᎯᎯ ᎯᏯᏗᎢ ᎾᏍᎩ ᏍᏕᎸᏗᎢ ᎾᏍᎩ ᎠᏓᏅᎢᏍᏙᏗᎢ.
- ᏗᏟᎵᎶᏍᏔᏅ ᏗᎨᎯᏅᏏ ᎾᎢ ᏚᏳᎪᏛ ᎠᏂᏴᏫ. ᏂᎯ ᎡᎵᏍᏗ ᏱᏅᏏ ᏗᏟᎶᏍᏔᏅᎯ ᎥᎿᎢ ᎾᏍᎩ ᎠᎧᎵᎢᏍᏗ ᎾᎢ ᏣᏤᎵ ᎦᎾᎦᏘ ᎠᎴ ᎾᎢ ᎾᏍᎩ ᎠᏴᏫ ᏂᎯ ᏚᏙᎥᎢ ᎤᎾᎢ ᎾᏍᎩ ᎠᎧᎵᏏᏐᏗ ᎾᏍᎩ ᏌᏊ ᎾᎢ ᎪᏢᏗ ᏗᏧᎪᏔᏅᎢ ᎾᏍᎩᎾ ᎢᏳᏃ ᏂᎯ Ꮭ ᏰᎵ. ᏂᎯ ᏰᎵᏉ ᏱᏣᏚᎵ ᎾᎢ ᏗᏟᎶᏍᏔᏅᎢ ᏘᏅᏁᏗᎢ ᏗᏣᎵᎢ ᎠᎴ ᏏᏓᏁᎸᎢ ᎠᏁᎳ ᎾᏍᏊᎢ. ᎤᏙᎯᏳᏃ ᏂᎯ ᏗᏟᎶᏍᏔᏅᎢ ᎯᏍᏆᏂᎪᏔᏅᎢ ᏗᏣᏅᏒᎢ.
ᎢᏳᏃ ᏂᎯ ᏣᏅᏔ ᎢᎬᏱᏗᏢ ᎠᏟᏱᎵᏒ ᎾᏍᎩᎾᎢ ᏂᎯ ᎨᏒᎢ ᎾᎢᏃ ᏧᏂᏢᎩ ᎨᏥᏍᎬᏂᎪᏙᏗᎢ ᏫᏓᏴᎩᏔᏂ, ᎠᎴ ᏂᎯ ᎦᏳᎳ ᏕᏣᏩᏙᎥ ᏦᏪᎳᏅᎢ ᎾᏍᎩ ᎠᏱᎸᏛ ᎠᏓᏕᏲᎲᏍᎩ, ᎯᎾᏫᏓ ᎾᏍᎩ ᏗᏟᎶᏍᏔᏅ ᎾᎾᎢ ᏧᏂᏢᎩ ᎨᏥᏍᎬᏂᎪᏙᏗᎢ.
- ᎢᏳᏃ ᏂᎯ ᎨᏒᎢ ᎡᏣᏴᏔᏅᎩ ᎾᏍᎩ ᏧᏂᏢᎩ ᎨᏥᏍᏆᏂᎪᏙᏗᏱ, ᎾᏍᎩᏛ ᎠᏎᎢ ᏓᎨᏍᏛᏛᏂ ᎢᏳᏃ ᏕᏣᏙᎥ ᏱᏦᏪᎳᎾ ᎾᏍᎩ ᎠᏱᎸᏛ ᎠᏓᏕᏲᎲᏍᎩ ᎠᎧᎵᏏᏐᏗ ᎠᎴ ᎢᏳᏃ ᏂᎯ ᏱᏣᏃᏟ.
- ᎢᏳᏃ ᏂᎯ ᏕᏟᏙᎥ ᏦᏪᎳᏅ ᏱᎩ ᎾᏍᎩ ᎠᏱᎸᏛ ᎠᏓᏕᏲᎲᏍᎩ ᎠᎧᎵᏏᏐᏗ, ᎾᏍᎩ ᏧᏂᏢᎩ ᎨᏥᏍᏆᏂᎪᏙᏗᏱ ᎾᏍᎩ ᏗᎧᎵᏏᏐᏗ ᎤᎾᏛᏅᎢᏍᏔᏅ ᏱᎩ ᎠᎴ ᎠᏎᎢ ᏓᏰᏍᏛᏛᏂ ᎾᏍᎩ ᏦᏪᎶᏗ ᏱᏣᏚᎵᎢ.
ᎠᏅᏓᏗᏍᎬ, ᎾᏍᎩ ᏣᏤᎵ ᎠᏑᏰᏍᏗ ᎢᏳᏃ ᏂᎯ ᏱᏣᏚᎵ ᎾᎢ ᏣᎧᎵᎢᏍᏗ ᎾᏍᎩ ᎠᏱᎸᏛ ᎠᏓᏕᏲᎲᏍᎩ (ᎤᏠᏯᏍᏗ ᎢᏳᏃ ᏂᎯ ᏱᏣᏚᎵ ᎾᎢ ᏦᏪᎶᏗ ᏌᏊ ᎢᏳᏃ ᏂᎯ ᎨᏒᎢ ᎾᎿᎢ ᎾᏍᎩ ᏧᏂᏢᎩ ᎨᏥᏍᎬᏂᎪᏙᏗᎢ). ᏚᎾᏙᎵᏤᎲ ᎾᎢ ᏗᎧᎿᏩᏛᏍᏗ, Ꮭ ᏌᏊ ᏰᎵᏊ ᏱᎨᏣᏓᏱᏏ ᎠᎦᏎᏍᏙᏗ ᎠᎴᏃ ᎤᎾᏞᏴᏓ ᏂᎯ ᏗᏣᎦᏘᎴᎩ ᏓᎳᏏᏔᏅᎩ ᎤᎾᎢ ᎢᏳᏃ ᎠᎴᏃ Ꮭ ᏂᎯ ᎦᏳᎳ ᏕᏣᏩᏙᎥ ᏦᏪᎳᏅᎢ ᎾᏍᎩ ᎠᏱᎸᏛ ᎠᏓᏕᏲᎲᏍᎩ.
ᎾᏍᎩᎾᏃ ᏣᏤᎵ ᏗᏓᏕᏲᎲᏍᎩ ᎨᏒᎢ Ꮭ ᎠᏍᏓᏩᏛᏍᏗ ᏱᎩ?
ᎢᏳᏃ ᏂᎯ ᎦᏳᎳ ᏕᏣᏩᏙᎥ ᏦᏪᎳᏅᎢ ᎾᏍᎩ ᎠᏱᎸᏛ ᎠᏓᏕᏲᎲᏍᎩ, ᎠᎴ ᏂᎯ ᏦᎯᏳᎭ ᎾᏍᎩᎾᎢ ᎾᏍᎩ ᎦᎾᎦᏘ ᎠᎴ ᏧᏂᏢᎩ ᎨᏥᏍᏆᏂᎪᏙᏗᎢ Ꮭ ᏱᏚᏂᏍᏓᏩᏛᏎᎢ ᎾᏍᎩ ᏗᏓᏕᏲᎲᏍᎦ ᎾᎿᎢ, ᏂᎯ ᏰᎵᏉ ᏱᏫᏢᎲᎦ ᎾᏍᎩ ᎠᎵᏍᎦᏃᏍᏗ ᎬᏗ ᏣᏤᎵ ᏍᎦᏚᎩ ᏄᏅᎾ ᎤᎾᏓᏡᎬ ᎥᎿᎢ ᏅᏩᏙᎯᏯᏛ.
ᎤᏓᏡᎬ 1.7: ᏂᎯ ᏣᏤᎵ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᎾᎢ ᏗᎵᏍᎦᏃᏍᏗ ᏦᏢᏗᎢ ᎠᎴ ᎾᎢ ᎢᏍᎩᏯᏛᏛᎲᎦ ᎾᎢ ᎤᎾᏓᏅᏖᎯᏐᏗ ᏙᎫᎪᏔᏅᎩ ᏙᎪᏢᏅᎢ.
If you have any problems or concerns about your covered services or care, refer to your EOC. It gives the details about how to deal with all types of problems and complaints.
As explained in your EOC, what you need to do to follow up on a problem or concern depends on the situation. You might need to ask our plan to make a coverage decision for you, make an appeal to us to change a coverage decision, or make a complaint. Whatever you do, we are required to treat you fairly.
You have the right to get a summary of information about the appeals and complaints that other members have filed against our plan in the past. To get this information, please Contact Us.
ᎤᏓᏡᎬ 1.8: ᎦᏙ ᎡᎵ ᏂᎯ ᏯᏛᎩ ᎢᏳᏃ ᏱᏁᎵ ᏂᎯ ᏂᏚᏳᎪᏛᏊᏃ ᎡᏣᏅᏫᏍᎬᎢ ᎠᎴᏃ ᏣᏤᎵ ᏄᏓᎴᏒ ᎤᎾᏤᎵᎦᏯ ᎨᏒᎢ Ꮭ ᏱᏕᏣᏓᏁᎸᏍᏗᎢ?
ᎢᏳᏃ ᎾᏍᎩ ᏄᏰᎵᏛ ᎤᎾᏞᏴᏓ, ᏫᎨᎯᏴᏓᏏ ᎾᏍᎩ ᏗᎦᎸᏫᏍᏓᏁᏗ ᎾᏍᎩᎾ ᎤᏓᏅᏘ ᏄᏓᎴᏒ ᎤᎾᏤᎵᎦᏯ
If you believe you have been treated unfairly or your rights have not been respected due to your race, disability, religion, sex, health, ethnicity, creed (beliefs), age, or national origin, you should call the Department of Health and Human Services Office for Civil Rights at 1-800-368-1019 or TTY 1-800-537-7697, or call your local Office for Civil Rights.
ᎾᏍᎩᎾᎢ ᏄᏰᎵᏛᎢ ᎪᎱᏍᏗ ᏓᎴᎢ?
ᎢᏳᏃ ᏂᎯ ᏱᏦᎯᏳ ᎤᎵᏍᎦᏘ ᏂᏳᏁᎸᎩ ᎠᎴᏃ ᏣᏤᎵ ᏄᏓᎴᏒ ᎤᎾᏤᎵᎦᏯ ᎥᏝ ᏂᏕᏣᏓᏂᎸᏨᎾ ᎠᎴᏃ ᏣᏤᎵ ᎠᎴᏃ ᏣᏤᎵ ᏄᏓᎴᏒ ᎤᎾᏤᎵᎦᏯ ᎨᏒᎢ Ꮭ ᏱᏕᏣᏓᏁᎸᏍᏗᎢ, ᎠᎴ Ꮭ ᏄᏰᎵᏛ ᎤᎾᏞᏴᏓ, ᏂᎯ ᏰᎵᏊ ᎠᎩᏍᏗ ᎠᏓᏍᏕᎵᏍᎩ ᎠᏂᎾᏕᎬ ᎬᏗ ᎾᏍᎩ ᏓᏓᎴᎬ ᏂᎯ ᏂᏣᎵᏍᏓᏁᎲᎢ:
- You can Contact Us.
- You can call the State Health Insurance Assistance Program. For details about this organization and how to contact it, refer to your EOC.
- Or, you can call Medicare 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.
ᎤᏓᏡᎬ 1.9: ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᏣᎲᎩ ᎾᎢ ᏗᎦᎸᏉᏔᏅᎯ ᏱᏗᏨᏁᏗ ᎾᏍᎩᏯᏊᏃ ᎠᎩᏍᏗ ᎤᏟ ᎢᎦᎢ ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ ᏣᏤᎵ ᏄᏓᎴᏒ ᏗᏣᏤᎵᎦᏯ ᎠᎴ ᏓᎾᏚᏓᎸᎲᏍᎬᎢ
ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᏣᎲᎩ ᎾᎢ ᏗᎦᎸᏉᏔᏅᎯ ᏱᏗᏨᏁᏗ ᎤᎬᏩᏢᎢ ᎾᏍᎩ ᏗᏍᏓᏩᏛᏍᏗ ᎠᏁᎳ ᏄᏓᎴᏒ ᏗᏣᏤᎵᎦᏯ ᎠᎴ ᏓᎾᏚᏓᎸᎲᏍᎬᎢ ᏗᎳᏏᏙᏗ.
- You can Contact Us.
ᏂᎯ ᏣᎭ ᎾᏍᎩ ᏣᏤᎵᎦᏯ ᏣᎲᎩ ᎾᎢ ᏣᎩᏍᏗ ᎤᏟ ᎢᎦᎢ ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ ᏣᏤᎵ ᏣᏤᎵᎨᏯᎢ.
ᎾᏂᎠ ᎯᎸᏍᎩ ᏚᏙᏢᏒᎢ ᎭᏢᏃ ᏂᎯ ᏰᎵᏊ ᏣᎩᏍᏗ ᎤᏟ ᎢᎦᎢ ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ ᏂᎯ ᏣᏤᎵ ᏗᏣᏤᎵᎨᏯᎢ:
- You can Contact Us.
- You can call the State Health Insurance Assistance Program. For details about this organization and how to contact it, refer to your EOC.
- ᏂᎯ ᏰᎵᏊ ᎠᏟᏃᎮᏙᏗMedicare.
- ᏂᎯ ᏰᎵᏊ ᎠᏩᏛᎯᏓᏍᏗ ᎾᏍᎩ Medicare ᎠᏏᎳᏕᏫᏒᎢ ᎤᏙᏢᏒᎢ ᎾᎢ ᎠᎪᎵᏰᏗ ᎠᎴᏃ ᎡᎳᏗᏟ ᎦᏢᏍᎬᎢ ᎾᏍᎩ ᏗᎦᎴᏴᏔᏅᎢ “ᏣᏤᎵ Medicare ᏄᏓᎴᏒ ᎤᎾᏤᎵᎦᏯ & ᏧᎾᏓᎵᏍᎦᏍᏙᏗ.” (ᎾᏍᎩᏃ ᏗᎦᎴᏴᏔᏅᎢ ᎠᏛᏅᎢᏍᏔᏅ ᎾᎿᎢ: Medicare.gov ᎣᏤᎵ ᏱᎬᏁᏗᎢ ᎠᎴ ᏧᏂᏔᏲᏍᏗᎢ.)
- ᎠᎴᏃ, ᏂᎯ ᏰᎵ ᏱᎨᎯᏴᏓᏏ 1-800-MEDICARE (1-800-633-4227), 24 ᎢᏧᏟᎶᏛ ᎾᏍᎩᎾ ᎢᎦ, ᎦᎵᏉᎩ ᏧᏒᎯᏓ ᎾᏍᎩ ᏑᎾᏙᏓᏆᏍᏗ. TTY ᏗᏅᏗᏍᎩ ᎡᎵᏍᏓ ᏱᏩᏅᏓ1-877-486-2048.
SECTION 2: You have responsibilities as a member of the plan
ᎤᏓᏡᎬ 2.1: ᎦᏙᎤᏍᏗ ᎨᏒ ᏣᏤᎵ ᎭᏚᏓᎸᎲᏍᎬᎢ?
Things you need to do as a member of the plan are listed below. If you have any questions, please Contact Us. We’re here to help.
ᎠᏓᏙᎳᎩ ᏅᎦ ᎬᏗ ᏣᏤᎵ ᎠᏚᏓᎸᏙᏗ ᎢᏗᏓᏛᏁᏗ ᎠᎴ ᎾᏍᎩ ᏧᏂᎧᎾᏩᏛᏍᏗ ᏂᎯ ᎠᏎ ᎤᏍᏓᏩᏛᏍᏗ ᎾᎢ ᎠᎩᏍᏗ ᎾᏍᎩ ᎯᎠ ᎠᏚᏓᎸᏙᏗ ᎢᏗᏓᏛᏁᏗᎢ. ᎬᏙᏗ ᏣᏤᎵ ᏗᎳᏏᏙᏗ ᎥᎿᎢ ᏣᏚᏓᎸᏛᎢ (EOC) ᎤᏍᏗ ᎪᏪᎵ ᎾᎢ ᎠᏕᎶᏆᏍᏗ ᎦᏙᎤᏍᏗ is ᎠᏚᏓᎸᏙᏗ ᎾᏍᎩᎾ ᏂᎯ ᎠᎴ ᎾᏍᎩ ᏧᏂᎧᎾᏩᏛᏍᏗ ᏂᎯ ᎤᏚᎸᏓ ᎾᎢ ᎠᏍᏓᏩᏛᏍᏗ ᎾᎢ ᎠᏱᏍᏗ ᏣᏤᎵ ᎠᏚᏓᎸᏙᏗ ᎢᏗᏓᏛᏁᏗ.
If you have any other health insurance coverage or prescription drug coverage in addition to our plan, you are required to tell us. Please Contact Us to let us know.
- We are required to follow rules set by Medicare and Medicaid to make sure that you are using all of your coverage in combination when you get your covered services from our plan. This is called “coordination of benefits” because it involves coordinating the health and drug benefits you get from our plan with any other health and drug benefits available to you. We’ll help you coordinate your benefits. For more information about coordination of benefits, refer to your EOC.
Tell your doctor and other health care providers that you are enrolled in our plan. Show your member ID card whenever you get your medical care or Part D prescription drugs.
ᎯᏍᏕᎳ ᏣᏤᎵ ᏗᏂᎦᎾᎦᏘ ᎠᎴ ᏐᎢ ᏗᎾᏓᏁᏢᏍᎩ ᏫᎨᏍᏕᎵ ᏕᎯᏕᎲᎩ ᎬᏗ ᎧᏃᎮᏢᎥᏍᎩ, ᎠᏓᏛᏛᎲᏍᎬ ᏗᏛᏛᎲᏍᎩ, ᎠᎴ ᎠᏍᏓᏩᏛᏍᏗ ᏬᎶᎯᏍᏗ ᎤᎾᎢ ᏣᏤᎵ ᎠᎦᏎᏍᏙᏗ.
- ᎾᎢ ᎠᏍᏕᎸᏗ ᏣᏤᎵ ᎠᏂᎦᎾᎦᏘ ᎠᎴ ᏐᎢ ᏅᏩᏙᎯᏯᏛ ᏗᎾᏓᏁᏢᏍᎩ ᎨᏣᏁᎰᎢ ᎾᏍᎩ ᏫᏓᏤᏢ ᎠᏍᏎᏍᏙᏗ, ᎠᏕᎶᏆᏍᏗ ᎢᎦᎢᏉ ᏱᏂᎦᎵᏍᏗ ᏂᎯ ᎨᏒᎢ ᏰᎵᏉ ᏄᏰᎵᏛ ᏣᏤᎵ ᏅᏩᏙᎯᏯᏛ ᏓᏓᎴᏍᏗᏍᎬ ᎠᎴ ᏗᏁᏗ ᎾᏍᎩ ᎧᏃᎮᏢᎥᏍᎩ ᎢᏳᏍᏗ ᎤᎾᏚᎸᏛᎢ ᏄᏰᎵᏛ ᏂᎯ ᎠᎴ ᏣᏤᎵ ᏅᏩᏙᎯᏯᏛ. ᎠᏍᏓᏩᏛᏍᏗ ᎾᏍᎩ ᎤᎾᏓᏅᏬᏗ ᏗᏍᏓᏩᏛᏍᏗ ᎠᎴ ᏗᏓᏕᏲᎲᏍᎩ ᎾᏍᎩᎾᎢ ᏂᎯ ᎠᎴ ᏗᏣᏤᎵ ᏗᏂᎦᎾᎦᏘ ᎣᏏ ᏕᏍᏓᏙᎵᎬᎢ.
- ᏂᎯ ᏣᎭ ᎾᏍᎩ ᎭᏚᏓᎸᎥᏍᎬᎩ ᎾᎢ ᎪᏢᏍᏗ ᏣᏤᎵ ᏅᏩᏙᎯᏯᏛ ᏓᏓᎴᏍᏗᏍᎬ ᎠᎴ ᎠᏍᏕᎸᏗ ᎦᎧᎲᎢ ᎠᏚᏓᎸᎥᏍᎬᎩ ᏗᎵᏐᏍᏔᏅᎢ ᎾᏍᎩᎾᎢ ᏂᎯ ᎠᎴ ᏣᏤᎵ ᎠᎦᎾᎦᏘ ᎾᎢ ᎣᏏ ᏍᏗᏰᎸᏅᎢ.
- ᏂᎯ ᏣᎭ ᎾᏍᎩ ᎭᏚᏓᎸᎥᏍᎬᎩ ᎾᎢ ᏍᏓᏩᏛᏍᏗᎢ ᎾᏍᎩ ᏧᎾᏓᏅᏬᏗ ᏗᏍᏓᏩᏛᏍᏗ ᎠᎴ ᏗᏓᏕᏲᎲᏍᎩ ᎾᏍᎩᎾᎢ ᏂᎯ ᎠᎴ ᏗᏣᏤᎵ ᏗᏂᎦᎾᎦᏘ ᎣᏏ ᎢᏥᏰᎸᏍᎬᎢ.
- ᏙᏳᎢ ᏚᏳᎪᏛ ᎨᏎᏍᏗ ᎾᏍᎩ ᏣᏤᎵ ᏗᏂᎦᎾᎦᏘ ᎤᎾᏅᏘᏍᏗ ᏂᎦᎥ ᎾᏍᎩ ᏗᎩᏍᏗ ᏧᏴᏍᏗ ᏂᎯ ᏕᎯᎩᏍᎬᎩ, ᎤᏠᏯᏍᏗ ᎢᏴᏛ-ᎾᏍᎩ-ᎦᏍᎩᎸᎢ ᏗᎩᏍᏗ ᏧᏴᏍᏗ, ᏗᎵᏍᏓᏴᏗ ᏧᎵᏑᏱ ᏗᎩᏍᏗ, ᎠᎴ ᏗᏑᏯᎾᎢ ᏧᎾᎵᏍᏕᎸᏙᏗ.
- ᎢᏳᏃ ᏂᎯ ᏱᏣᎯ ᏂᎦᎥ ᎪᎱᏍᏗ ᏗᏣᏓᏛᏗᎢ, ᎤᏙᎯᏳᎯᏯᏃ ᎭᏓᏛᏛᏅᎢ. ᏗᏣᏤᎵ ᏗᏂᎦᎾᎦᏘ ᎠᎴ ᏐᎢ ᏅᏩᏙᎯᏯᏛ ᎠᎦᏎᏍᏙᏗ ᏓᏂᏱᎵᏒᎢ ᎨᏒᎢ ᎡᎵᏍᏗᏉ ᎾᎢ ᏗᎪᏏᏐᏗ ᎢᏳᏍᏗ ᎾᏍᎩ ᏳᎵᏍᏙᏗ ᏂᎯ ᏰᎵᏊ ᎨᏦᎵᏍᏗ. ᎢᏳᏃ ᏂᎯ ᏱᏣᏓᏛᏛᎾ ᎠᎴ ᏂᎯ ᎥᏝ ᏃᎵᎬᎾ ᏱᎩ ᎾᏍᎩ ᎦᏬᎯᎵᏴᏍᎬ ᏂᎯ ᏁᏣᏪᏎᎸᎩ, ᏏᏊ ᏥᎭᏓᏛᏛᎾᎦ.
ᏣᏓᏅᏘ ᎨᏎᏍᏗ. ᏂᎦᏓᏉ ᎤᏚᎩ ᎬᏗ ᏂᎦᎥ ᏂᏙᎬᏅ ᎠᏁᎳ ᏓᎾᏓᏂᎸᏍᏗ ᎾᏍᎩ ᏄᏓᎴᏒ ᎤᎾᏤᎵᎦᏯ ᎥᎿᎢ ᏐᎢ ᏧᏂᏢᎩ. ᏂᎦᏓᏉ ᎾᏍᏊ ᎤᏚᎩ ᎬᏗ ᏂᎯ ᏗᏣᏓᎧᎾᏩᏛᏍᏗ ᎾᏍᎩ ᎾᏛᏁᏙᎲᎢ ᎾᏍᎩᎾᎢ ᏕᎯᏍᏕᎵᏍᎬ ᎠᏂᎩᏍᎬᎢ ᎤᏓᏫᏍᎦᎨᏊ ᏣᏤᎵ ᎠᏂᎦᎾᎦᏘ ᏧᏂᎸᏫᏍᏓᏁᏗᎢ, ᏧᏂᏢᎩ ᏗᎨᏥᏍᏆᏂᎪᏙᏗᏱ, ᎠᎴ ᏐᎢ ᏧᏂᎸᏫᏍᏓᏁᏗᎢ.
ᎠᏈᏗ ᎢᏳᏍᏗ ᏂᎯ ᎡᏍᏚᎬᎢ. ᎾᏍᎩ ᎠᏍᏓᏩᏛᏍᏗ ᎨᎵ, ᏂᎯ ᎨᏒ ᏣᏚᏓᎴᏍᏗ ᎾᏍᎩᎾ ᎯᎠᎾᎢ ᏗᏣᏈᏴᏗᎢ:
- In order to be eligible for our plan, you must have Medicare Part A and Medicare Part B. For most HMO SNP members, Medicaid pays for your Part A premium (if you don’t qualify for it automatically) and for your Part B premium. If Medicaid is not paying your Medicare premiums for you, you must continue to pay your Medicare premiums to remain a member of the plan.
- ᎾᏍᎩᎾ ᎤᎪᏗ ᎥᎿᎢ ᏣᏤᎵ ᏗᎩᏍᏗ ᏧᏴᏍᏗ ᎠᏚᏓᎸᏙᏗ ᎬᏗ ᎾᏍᎩ ᎠᏍᏓᏩᏛᏍᏗ, ᏂᎯ ᎠᏎ ᎠᏈᏗ ᏣᏤᎵ ᏣᏚᏓᎸ ᎾᏍᎩ ᏧᎬᏩᎶᏗ ᎾᏳᎢ ᏂᎯ ᎾᏍᎩ ᎯᎩᏒᎢ ᎠᎩᏍᏗ ᎤᏴᏍᏗ. ᎯᎠ ᎨᏎᏍᏗ ᎾᏍᎩ ᏔᎵ ᎠᎦᏓᏗᏍᏗ-ᎠᏈᏴᏗ (ᎾᏍᎩ ᎣᏍᏓ ᏱᎬᏁᎸ ᎢᎦᎢ ᎨᏒᎢ) ᎠᎴᏃ ᎢᎦᏛ ᎠᏈᏴᏓ ᎠᏚᏓᎸᏙᏗ (ᎢᎦᏘᎭ ᎾᎿᎢ ᎾᏍᎩ ᏂᎦᏛ ᎦᏟᏌᏅ ᏧᎬᏩᎶᏗ). ᎠᏯᏙᎸᎢ 6 ᎾᎿᎢ ᏣᏤᎵ EOC ᏣᏃᏎᎯ ᎠᏎ ᏣᏈᏴᏗ ᎾᏍᎩᎾ ᏣᏤᎵ ᎤᏓᏡᎬ D ᏗᏓᏅᏍᏙᏗ ᏅᏬᏘ ᏗᎩᏍᏗ ᏧᏴᏍᏗ.
- ᎢᏳᏃ ᏂᎯ ᎠᎩᏍᏗ ᏂᎦᎥ ᎠᏬᏘᏲᎢ ᎢᏗᏓᏛᏁᏗ ᎠᎴᏃ ᏗᎩᏍᏗ ᏧᏴᏍᏗ ᎾᏍᎩᎾᎢ ᎨᏒᎢ Ꮭ ᏱᏣᏚᏓᎸᏓ ᎬᏗ ᎣᎦᏤᎵ ᎠᏍᏓᏩᏛᏍᏗ ᎠᎴᏃ ᎬᏗ ᏐᎢ ᎫᏓᎸᏓ ᏂᎯ ᏰᎵᏉ ᏱᏂᏣᎿ, ᏂᎯ ᎠᏎ ᏣᏈᏗ ᎾᏍᎩ ᎧᎵᎢ ᏧᎬᏩᎶᏗ.
- ᎢᏳᏃ ᏂᎯ ᏯᏓᏱᎭ ᎬᏗ ᎤᎩᎲ ᏥᏙᎫᎪᏔᏅᎩ ᎾᎢ ᎣᎦᏓᏱᎸ ᏣᏚᏓᎸᏛᎢ ᎾᏍᎩᎾ ᎢᏯᏓᏛᏁᏗ ᎠᎴᏃ ᎠᎩᏍᏗ ᎤᏰᏍᏗ, ᏂᎯ ᏰᎵᏊ ᎾᏍᎩ ᎠᏔᏲᏍᏗ ᏱᎾᏛᎦ. ᎰᏩᏊ ᎯᎪᏩᏔ ᎠᏯᏙᎸᎢ 9 ᎾᎿᎢ ᏣᏤᎵ EOC ᎾᏍᎩᎾ ᎧᏃᎮᏢᎥᏍᎩ ᏄᏰᎵᏛ ᏰᎵ ᎾᎢ ᎪᏢᏗ ᎾᏍᎩ ᎠᏔᏲᏍᏗ.
- ᎢᏳᏃ ᏂᎯ ᎨᏒᎢ ᎠᏎᏱᏣᏛᏁᏗ ᎾᎢ ᎠᏈᏗ ᎾᏍᎩ ᎤᎪᏂᏲᏨ ᎰᏪᎵᏍᎬ ᏍᏛᏗᏍᏗ, ᏂᎯ ᎠᏎ ᎠᏈᏗ ᎾᏍᎩ ᏍᏛᏗᏍᏗᏍᎩ ᎾᏍᎩ ᏂᎬᏯᎢᏒ ᏣᎮᏍᏗ ᏣᏤᎵ ᎠᏓᏅᏍᏙᏗ ᎠᎩᏍᏗ ᎤᏴᏍᏗ ᏣᏚᏓᎸᏛᎢ .
- ᎢᏳᏃ ᏂᎯ ᎠᏎᏱᏣᏛᏗ ᏱᎩ ᎥᎢ ᎠᏈᏗ ᎾᏍᎩ ᎧᏁᏉᏗ ᎢᎦᎢ ᎾᏍᎩᎾ ᎤᏓᏡᎬ D ᏅᏗᎦᎵᏍᏙᏗᏍᎬ ᎥᎿᎢ ᏣᏤᎵ ᎾᏕᏘᏴᎯᏒᎢ ᎠᏕᎳ ᎤᎷᏤᎯ, ᏂᎯ ᎠᏎᎢ ᎠᏈᏗ ᎾᏍᎩᎾ ᎧᏁᏉᏗ ᎢᎦᎢ ᏂᎦᏯᎢᏒᏊ ᎾᎢ ᎾᏍᎩ ᎠᏰᎵ ᎤᏙᏢᏒᎢ ᎾᎢ ᏅᏩᏍᏕᏍᏗ ᎾᏍᎩ ᎨᎵ ᎾᏍᎩ ᎠᏍᏓᏩᏛᏍᏗ.
Tell us if you move. If you are going to move, it’s important to tell us right away. Contact Us.
- If you move outside of our plan service area, you cannot remain a member of our plan. We can help you figure out whether you are moving outside our service area. If you are leaving our service area, you will have a Special Enrollment Period when you can join any Medicare plan available in your new area. We can let you know if we have a plan in your new area.
- ᎢᏳᏃ ᏂᎯ ᏣᏓᏅᏍᏗ ᎭᏫᏂᏗᏢ ᎣᎦᏤᎵ ᎢᏯᏓᏛᏁᏗ ᎢᎬᎾᏕᎾ, ᏂᎦᏛᏉ ᏏᏃ ᎾᎢ ᎤᏚᎸᏓ ᏣᏔᏳᎵᏍᏙᏗᎢ ᎾᏍᎩ ᏂᎦᏛᏉ ᏰᎵᏊ ᎯᏍᏆᏂᎪᏓ ᏣᏤᎵ ᎠᏁᎳ ᎤᎾᏓᏡᎬ ᎪᏪᏫᏅ ᎾᎢ ᎢᏴ ᎢᎪᎯ ᎠᎴ ᏣᏅᏘᏍᏗ ᎾᎢ ᎡᏣᎳᏃᎮᏙᏓ.
- If you move, it is also important to tell Social Security (or the Railroad Retirement Board). You can find phone numbers and contact information for these organizations in your EOC.
Contact Us for help if you have questions or concerns. We also welcome any suggestions you may have for improving our plan.
